The Three Types of Nurses (and why it's important you know which one you are)

[rnk123]

The 3 types of nurses (and why you need know if you're #3)

There are 3 types of nurses. Two are more like each other, and one is much different, and it's not what you think. I am first going to classify the types of nurses as the thinkers, the carers, and the runners. There is nothing saying you can't be two of the three, and although you may have some traits from each, you cannot work as all three.

The thinkers – these are the nurses that are always learning, with a true need to know why they do what they do. They need to know everything, not only to succeed at their job, but so they themselves feel accomplished and educated. They are always inquisitive, and they have (or strive to have) a complete understanding of the pathophysiology of the diseases and disorders they see on a daily basis, because if they don't, they risk patients' lives. They have a high level of focus, and limit their focus to fewer patients so they can truly accomplish the patient care goals they set. They are often seen in the ICUs. These people may also be carers but they cannot be runners.

The carers – these are the nurses whose major focus is ensuring patient comfort, safety, and overall well-being. These everyday nurses are the ones who make the patients better. Without them, the hospital would come to a screeching halt. They help manage patient care overall, and though they have more patients per nurse than in the ICUs, their patients tend to be either on some sort of road to recovery or in need of comfort as they struggle with a terminal illness. These nurses can be found in most hospital units, from mother-baby to med-surg to post-op, and these nurses are vital to the survival of hospitals and the healthcare system overall. These people can be thinkers but they cannot be runners.

Then there are the runners – these nurses are a little different. Though they do care, and though they do try to learn what they can to help their patients, they thrive in learning in a trial-by-fire environment. They learn by reviewing the chart of their patient who died in front of them when they didn't really understand why. They learn by doing something for the first time on someone who thinks they've done it a thousand times before. And they're smart just like any other nurse, but they don't think the same way. These people can be thinkers but they cannot be carers. They simply don't have time to be carers. They typically have some form of an attention disorder, and they couldn't function properly as a floor or even as an ICU nurse. These nurses are appropriately over-trained for things that have a low chance of happening (like a major outbreak/epidemic, hazardous material spill, plane crash, etc.), and because of this they feel like they're something special. They have each participated in dozens upon dozens of codes per year, and have run a few all by themselves. These nurses often feel as though they are underpaid for what they do, as their patient:nurse ratio is WAY over what it should be, and because on a daily basis their decisions and actions affect people in an often life-or-death kind of way. But honestly, where else would they work? These people couldn't function at a desk job. Hell, many wouldn't even be able to function on a floor or in an ICU as a nurse. They should be grateful that they have found a job that caters to their need to have a hundred different things on their mind, their need to be in complete control of a patient care assignment, their inability to focus on one situation at a time, and their fear of getting too attached to their patients. There is a special bond between these nurses, a war-buddy mentality, where no matter what you think of a coworker they will fight in the trenches with you to get through a shift. The retention rate of these nurses is close to 1-2 years, because many people who think they can handle it can not. The ones that stay often have to apologize for their seemingly insensitive sense of humor (coming from the daily realization that we as humans are in fact temporary), and their thick skin (coming from the verbal abuse from patients and families when you know you are doing your best and no matter how good of a nurse you are, you are human and cannot stay ahead of your assignment). They aren't usually coddlers and often have a ‘get up and walk it off' mentality, making them seem a little rough around the edges. But they care. They really do. If they didn't have thick skin or a tough outside, they wouldn't be able to watch so many people suffer, so many people die. And when bad things happen, they wouldn't be able to take a deep breath, splash water on their face, and go back to work (often walking into the room right next door with optimism and a smile). These nurses work in the emergency room.

I know this because I left. I went to an environment where I could focus more on the caring side of nursing. Because I care. I do. And I wish I had that in the ER. But I was trained in war-zone medicine. And if you can live with the demons of what you see every day, if you thrive in the ER, if you learn the ER-way, and if have the ability to hyper-focus on multiple things at once as well as the intensity to do so calmly, you belong in the ER. While I have learned so much in the ICU (including improved assessments, plans of care, bonding with patients and their families, etc), the most important thing I have learned is that once you are a long-term ER nurse, damnit, they take away your ability to successfully work as any other type of nurse.

[Nalon1 RN/EMT-P, BSN, RN]

And then there are the rest that you can't categorize.

You say runners can't work in the ICU, well, I fit the "runner" category most from those you listed, yet really enjoyed ICU. I am no way a "thinker". I got into the medical field to help people, so I guess that makes me a "carer".

Interesting descriptions but not one that fits everyone.

[Dragonnurse1, ASN, RN]

9 yrs and 4 months and I never would have left the ER if it had not been for a latex allergy. Yes I was a runner (no attention disorder), I was a thinker - my first overdose was a pyridium OD - but I was a carer. I worked in a smaller ER (30 beds) on nights and saw the same patients many times over the 9+ years. They knew me by name and some families asked for me. I knew them on sight without seeing the chart and I knew what they were in for that night. So depending on your ER you can be all three.

[tachybradyRN]

I'm a little confused... you say in the "thinkers" section that these people can be "carers" but not "runners", but then in the "runners" section you say these people can be "thinkers" but not "carers."

I think it's hard to fit every nurse into a tiny, compartmentalized box that way. I guess I'd characterize myself primarily as a "runner", but I did work in ICU before ED and I did function well in that environment, as well as on a med-surg floor, an observation unit, and a telemetry floor. I am a "thinker" as well in the sense that I'm always curious to learn more and constantly working to advance my knowledge by studying patho and attaining specialty certifications, going back to school for my BSN and MSN, and asking the providers I work with to teach me about the procedures they do. I also feel I function well as a "carer"; probably not as obviously in ED as I'm a lot busier here, but I've spent many hours holding the hands of the dying, or listening to patients' life stories, seeking out warm blankets and sources of comfort and overall trying to make people's stays in the hospital as comfortable as possible.

So I just don't know about all this. I think many nurses have some of each of these categories within them, and the characteristics that shine most obviously are probably determined more by the environment and the particular goings-on of the shift rather than some innate character asset/flaw that makes them fall into one category. I just can't see it as that black and white.

Thanks for your article. It's an interesting thinking and talking point.