Are You A Type "a" Nurse Or Type "b"

[kellbell1]

Many years ago, when I was director of nursing at a hospital in east San Gabriel Valley, I was confronted by patients and patient's families expressing grievances during the 1500-1900 shift. This shift had a disproportionate number of complaints. Yet, I knew that the nursing staff on this shift was both competent and efficient, so I wondered what was the problem could be. I set about observing the nurses as they worked. It didn't take long to realize that the problem wasn't so much the nurses's skills, but how they executed their work. For some reason, this shift had a disproportionate number of nurses who were task-oriented and it was this behavior that was at the heart of the problem.

Individuals exhibit both a variety and a continuum of behaviors, but many of us have certain traits that mark us as either a task-oriented or a nurture-oriented person. It is one of these two modes that defines how we organize and execute our work. Being aware of your predilection can help you work more smoothly with your fellow nurses, customize your interaction with patients and their families, and even be more effective as a nurse.

The task-oriented (Type A) nurse will usually have a To Do list, with an idea of how much time each task will take. This nurse will plan breaks and meal times around a schedule of work responsibilities. She is usually praised for her organizational skills.

The nurture-oriented (Type B) nurse is more focused on the interpersonal aspects of her work. Her focus is on meet ing the emotional/spiritual needs of her patients. The task itself is secondary. Problems generally arise when the ratio of Type A and Type B nurses are out of sync, as this can lead to subtle and not so subtle conflicts among the nursing team, as well as complaints from patients and their families.

A "Type A" nurse may:

* Fight to get one of the limited number of scales available to weight her baby, rather than wait until later, when there is less demand;

* Get that patient out of bed and sitting up in the chair at the designated time, even if the patient is engaged in some other activity;

* Change the dressing of the patient's open wound, even though housekeeping is in the room vacuuming and doing other cleaning tasks;

* Arrive 15 minutes or more before the shift is set to begin;

* Collect all the necessary equipment for the lab tests ordered, even if the labs don't need to be sent in until end of shift--twelve hours later; or,

* Stick a patient to get that IV started even if it means trying 13 times.

A "Type B" nurse may:

* Arrive late for the start of your shift because she is busy talking to everyone in the nursing office, cafeteria, hallway, and parking lot;

* Know the entire life story of each and every one of her patients;

* Leave the bay supplies more depleted, or in more chaos, than when she arrived;

* Be looking for the supplies needed to draw the labs that were due in the lab 20 minutes ago;

* Know that it just isn't her day to start a patient's IV if by the third attempt she has still been unsuccessful;

* Be overhead saying, "but it's an organized mess."

So, which "type" makes the perfect nurse? If your answer is both and neither then you'd be right. A strictly "Type A" nurse is the nurse caricature that we all dread and hate--this is the Nurse Ratched stereotype that dogs our profession to this day. Meanwhile, the "Type B" nurse is the one we all dread to work with because she is so busy with the "touchy-feely" side that no tasks get done. Nursing teammates are often left to do her work in addition to their own.

The best nursing model is a blend of the two types. Most of us shift between the two types, adjusting our style as needed. Problems arise when we become stuck in one style of behavior. We may not always be aware of our proclivities, but our fellow coworkers generally are.

Any NICU nurse, especially those who work the night shift, knows of the mad dash to get all babies weighed at the start of shift. When Type A nurses make up the majority on the shift, there is an almost comic, and sometimes stressful, ballet as each nurse tries to secure one of the few scales that are available for this function. A Type B nurse would generally choose to wait a little later in the shift to do the weigh-in (especially if it is not a time-sensitive task) and let the Type A's "duke it out" over the limited number of scales.

When Type B nurses make up a large percentage of your nursing team, things like restocking the bay or calling in all the labs, etc., might not get done in a timely manner, since they may focus most of their work time interacting with other nurses, the patient, or the patient's family.

Neither scenario is an example of "bad" nursing. The solution lies in a strong manager who can identify the traits of her nurses and try the following solutions:

* Redistribute the "mix" of personality types, ensuring that one type does not dominate.

* Hold in-services for the nursing teams so they can learn to identify and integrate their styles into their work.

* Help an over-strong Type A or Type B personality learn how to moderate the behavior so that it does not continue to overwhelm the other nurses, patients, and themselves.

Good and competent nursing leadership, from both the nursing management and from the nurses themselves, is a critical element in a nursing team that excels in its work and provides the best of patient care.

Knowing what personality trait you are likely to exhibit, especially in moments of stress, can help you to be a better nurse. No one style is always superior to the other. However, knowing when and how to shift from one style of behavior to the other can help you perform in an even more effective manner, and interact better with the other members of the nursing team.

[AMARTIN1]

Thanks forthe post!!! I've learned "in the real world of nursing," it's either patient care or charting!! I'm totally Type B and I spend most of my overtime charting in the end :chuckle. I'm not sure if there is a balance between the two? I've been a nurse now for eight months on a busy step-down unit and I truly love making my patients feel as comfortable as I can, but you can't please everyone. I've lost 10 pounds just from working there and I'm one step away from a kidney infection :roll !! Thanks again for my mystery diagnosis:eek: God Bless, Amartin1 in Texas

[GI Jackie]

By your standards, I would consider myself type AB positive. When I first came out of nursing school I was totally type A. I had something to prove and a chip on my shoulder like everyone was second guessing me. Looking back, I am glad they were. I had alot a great nurses looking out for me in the beginning. I thought I knew the right way to do everything and they were just going to have to accept the changes in them that were necessary to maintain my rightness. Luckily for me, they were patient and taught me about real world nursing and are still my very good friends today, seven years later. I am a better person and nurse for it. So today I know when it's important to pick the battle and when it is not.

[greatshakes]

Years ago I was rostered on with a type A preceptor and things came adrift. I could never keep up with her. I was voicing my concerns to another nurse who'd been on the ward for ages also to discover most of the others, all capable competent nurses, couldn't either. It's nice to know that sometimes you aren't fighting the battle alone. I found the type A type B posting very helpful and wish I'd known that much earlier. Sometimes you just need to know and hear from someone who has been through it before, it's amazing how much better it makes you feel.

[tlhubbard]

In my past job experience (pre-op) You find you need to be both. You have to keep on task (you have incision times to meet), however you have a very anxious patient that needs the nurturing piece.

I find it easy to stay on task, yet interact with my patient at the same time. Tried to meet all the needs (which is another personality trait of most nurses--keeping everyone happy). We all seemed to strike a good balance, we had 98.5% patient satisifaction in our facility.

[Fairemaid]

What a great thread!!

I don't consider myself a type A person. I was raised by a father who had no concept of time. I have become more type A in general, as far as being on time for things.

I was a 'C' student in school last year, and my clinical instructor told me not to worry about it because some people learn in different ways. But I passed and after I got my license, my first preceptor was a type B. I didn't really notice it at first, I thought she was just having a bad day, because everything was done on the run, or meds given late. It took me several weeks to realize that she was like that every day. She always showed up several minutes late, takes too long for lunch and breaks, but she is so friendly to everyone and she loves to talk. She is a wonderful person and she does her job well, but she does spend a lot of time talking.

I have tried to be more type A at work. I have only been an RN for 6 months, and I wanted to develop good organizational habits right at the start. I was a librarian many years ago and I have a great fondness for organization, although I fall short in my personal life. I use a preprinted pt info form and add everything I need to know, including what meds are scheduled, vitals, previous shift report highlights, labs, ivf, code status. etc. It has become my lifesaver. A mistake I made right off the bat was to only start giving the 8 o'clock meds at 8. Now I start giving the meds at 730. :chuckle

It has taken me 40 years of type B to even see the need to be more type A. I bet the type A high school grads are the ones who go straight into nursing school. I never would have even thought it was an option back then. I agree with previous poster that you can't change you personality type, but we can adapt if needed to fit into a type A job.

Rebecca:nurse:

[geekgolightly, BSN, RN]

im task oriented. so i guess im type A. but i schedule in the time to talk with patients; its part of the bare bones of my nursing care. it takes longer to get to the next "task" by visiting with patients at med time, assessment time and popping in to see how they are doing time (i do this before i do meals or breaks) but its essential to my idea of nursing.

[dorimar, BSN, RN]

This was a great post! I am a total Tye A. I DO spend a great deal of time with my paitients and families, but I do become extremely STRESSED when my timelines aren't being met, & i always have a running list in my head (in fact, i talk to myself often at work, but i never answer... lol). That being said, I have recognized this about myself, and have never given the next shift grief for not getting tasks done, unless it is consistent and detrimental. I think the nursing schools come across as teaching type A behavior, because they are supposed to teach you these tasks and organizational skills. The first year of nursing is all task orientied. I think we need to remeber Maslow's heiarchy. Airway, breathing & circulation come before your patient's feeling of well being. After you become more comfortable with the tasks, the other aspects of your personality can come through more readily. I think nursing is truyly an ART of mastering both aspects. Kudos to the poster for recognizing the strengths of both as a manager.

[racks]

nice one. makes me think what type i'll be when i graduate and start to work. maybe a combination of the two would be nice

[jcmoore07]

I realize this is an old thread, but it really interested me. I definitely think the Type A and Type B is an easier way of summarizing one's personality than, say the Myers-Briggs personality types, which have so much spill-over into other types that it's hard to pinpoint one's self. I am a type B person, who is considering nursing school. I have the very empathic, selfless type of desire to help others. I realize this is a great asset for a nurse. I am, however, concerned about the organizational and detail-oriented aspect of nursing. I have always been more of a big picture thinker and the sort of person who always just wanted everyone to feel good, regardless of the situation. I have been trying to decide if nursing would be a good fit for me due to some of these qualities. From what I've read, I feel like I could learn many of the type A skills necessary to become a good nurse, in spite of not being the kind of person for whom they come naturally. It's nice to know that there are nurses out there with a type B personality who are still able to be good nurses with a little extra effort.

[RNforLongTime]

we've got several type b's in my icu now. one of them is always late finishing up her work no matter what is going on in the unit. last night, she texted me at 2:30am to say she was just now getting out of work when her shift ended at 11:15pm. she is always behind. i worked with her the other night and i had to do some of her work for her. she claimed her assignment was too heavy when i had 2 of her 3 pt's the night before and i handled the assingment just fine..must be because im a mix of a and b but lean towards a.

then there is another type b who had an order to transfuse two units of blood on a pt that was ordered at 0630 and by 3pm she still hadn't hung the first unit. her excuse? she was "too busy" um blood is a priority!! it can't wait until your not busy!! she's one that no matter what is going on in the unit..if she's got more than 1 pt she's running around like a chicken with her head cut off running around in circles. is it a time management issue? could be.

we don't have the ancillary staff that most hospitals have. no unit clerk or nursing assistant to help on most shifts. no transporter to take pt's to ct scan or to the or..we have to deliver them ourselves. on night shift, there is no respiratory therapist or ekg technician so we have to do all our own breathing treatments, vent checks and ekg's. no iv team either and this 2nd b nurse doesn't know how to start iv's although she hasn't admitted it to anyone. she finds someone else to do it because she is "too busy". i hate following her because she's been know to leave admission assessments undone because she was too busy when the pt has been in the unit for 6 or more hours. um it is your responsibility to complete the admission assessment on a pt that was admitted on your shift unless the pt just got admitted in the last hour, which with her most of the time is not the case. she just leaves it for someone else to do.

[morte, LPN, LVN]

we've got several type b's in my icu now. one of them is always late finishing up her work no matter what is going on in the unit. last night, she texted me at 2:30am to say she was just now getting out of work when her shift ended at 11:15pm. she is always behind. i worked with her the other night and i had to do some of her work for her. she claimed her assignment was too heavy when i had 2 of her 3 pt's the night before and i handled the assingment just fine..must be because im a mix of a and b but lean towards a.

then there is another type b who had an order to transfuse two units of blood on a pt that was ordered at 0630 and by 3pm she still hadn't hung the first unit. her excuse? she was "too busy" um blood is a priority!! it can't wait until your not busy!! she's one that no matter what is going on in the unit..if she's got more than 1 pt she's running around like a chicken with her head cut off running around in circles. is it a time management issue? could be.

we don't have the ancillary staff that most hospitals have. no unit clerk or nursing assistant to help on most shifts. no transporter to take pt's to ct scan or to the or..we have to deliver them ourselves. on night shift, there is no respiratory therapist or ekg technician so we have to do all our own breathing treatments, vent checks and ekg's. no iv team either and this 2nd b nurse doesn't know how to start iv's although she hasn't admitted it to anyone. she finds someone else to do it because she is "too busy". i hate following her because she's been know to leave admission assessments undone because she was too busy when the pt has been in the unit for 6 or more hours. um it is your responsibility to complete the admission assessment on a pt that was admitted on your shift unless the pt just got admitted in the last hour, which with her most of the time is not the case. she just leaves it for someone else to do.

hey! as a self acknowledged type b, i take exception, lol. these arent type b's they disorganized, underperforming and potentially lazy employees.....or just new nurses?

[CFitzRN, ADN]

Hahaha - I am SO a type-B. When I was working in the hospital, my preceptor used to tell me that I didn't need the patient's life story to give her an IV or foley, etc. ... I prefer the human-connection type of nursing. I wouldn't be good in a lot of units in a hospital but I'm great in others. I hear EVERYTHING. I notice everything they say. And it has been a life-saver at times.