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.
Chaya, ASN, RN
932 Posts
Interesting take on the situation. As for family dissatisfaction, as an eve shift RN I do find that it is usually between 1600 and 2000 that families are actually in visiting, each expecting you to spend 20 min going over EVERY med Grandpa has taken since he was admitted 10 days ago and voicing indignation that the only MD around to talk to at 6 PM Fri nite is the resident covering the whole service. I'm just sayin...