Personality traits of Australian nurses and doctors - Wiley Online Library

International Journal of Nursing Practice 2011; 17: 380–387

RESEARCH PAPER

Personality traits of Australian nurses and doctors: Challenging stereotypes? ijn_1952

380..387

Diann S Eley MSc PhD Associate Professor, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia

Robert M Eley MSc PhD Senior Research Fellow, Centre for Rural and Remote Area Health, The University of Southern Queensland, Toowoomba, Queensland, Australia

Accepted for publication May 2011 Eley DS, Eley RM. International Journal of Nursing Practice 2011; 17: 380–387 Personality traits of Australian nurses and doctors: Challenging stereotypes? This study compared temperament and character traits of Australian registered nurses and general practitioners. A cross-sectional quantitative design used the Temperament and Character Inventory. Total sample size was 426. Only main effects were detected. Nurses were higher in the temperament traits of Novelty Seeking and Reward Dependence, lower in the character traits of Self-Directedness and Cooperativeness but higher in Self-Transcendence compared with the sample of doctors. Differences in personality profiles between registered nurses and general practitioners might challenge existing stereotypes between these professions. Further exploration of traits exclusive to and shared among health professions would supplement a broad conceptualization of specialities and support the enhancement of appropriate training and career counselling. Awareness of one’s temperament and character can lead to a clearer understanding of how they function in the workplace and might encourage reflection on and insight into the implications of their personality and career plans. Key words: character, doctors, nurses, personality, temperament, traits.

INTRODUCTION A current topic of interest and debate in nursing and medical education involves the recognition that noncognitive features that are personality traits can enhance our understanding of, and possibly predict characteristics associated with, the ‘ideal’ health professional. There is varied opinion on the use of personality measures because much of behaviour is context-specific and not related to stable traits. Nevertheless, specialists in the area of

Correspondence: Diann S. Eley, School of Medicine, The University of Queensland, 288 Herston Road, Brisbane, QLD 4006, Australia. Email: [email protected] © 2011 Blackwell Publishing Asia Pty Ltd

personality research recommend the identification of personality patterns as a means to better understand the profiles of traits that cause people to be attracted to and thrive in certain professions. This knowledge might have the potential to enhance training strategies and career counselling by helping students choose a career path to which they are most suited.1 The extent to which one’s personality is shaped by environment and conversely how personality allows adaptation to one’s environment is well documented.2–4 For the health sciences this is a significant fact because we recognize the vital characteristics that are crucial to being a competent, safe and ethical clinician.5 Yet, despite this knowledge discussions on the importance of measuring and monitoring behaviours of professionalism, communication, ethics doi:10.1111/j.1440-172X.2011.01952.x

Personality traits of nurses and doctors

and teamwork go on without due consideration of personality as a predictor of the traits that comprise them. Earlier studies have identified personality profiles for many medical specialities6–8 but much of this is dated and there is little in the current health science literature on the personal trait profiles of the ‘ideal clinician’ in nursing, medicine and the allied health sciences. The issue of personality is also integral to the current debate on selection procedures for entry into the health sciences, in particular the professional careers such as nursing and medicine.3,4,9 The relationship between personality and performance is well recognized in other high-performance professions such as aviation and the police where selection procedures attempt to identify the ideal applicant or trainee using standardized personality testing. However, apart from anaesthesiology health disciplines do not appear to have explored this process.10,11 A valid and up-to-date foundation of personality profiles established on all professions would be of immense value for counselling both students before and during their university training and early career professionals towards their most appropriate career intentions by providing the maximum information (professional and personal) about various disciplines. This study is part of a large programme addressing these issues within the health professions. Its specific aim was to compare the temperament and character trait profiles of registered nurses (RNs) with those of general practitioners (GPs). Our objective was to contribute to the establishment of a psychobiological profile of the two professions to better understand the personal traits associated with each. We chose nursing and general practice because both are commonly noted for their varied nature of practice, which combines expertise in personal communication and procedural skills. Traditionally, nursing is thought of as the ‘caring profession’.9 Likewise GPs have been portrayed as caring and person-oriented.6 The main research tool was The Temperament and Character Inventory (TCI-R 140),12 which has been validated worldwide11,13,14 and used previously by the authors to show trait profiles of nurses, nursing students, urban and rural doctors, and medical students.15–18 The TCI is based on a theory of personality development that identifies the two primary aspects of personality: temperament and character. Temperament refers to automatic emotional responses to experience that are moderately heritable and developmentally stable (i.e. not influenced by sociocultural learning). The four dimensions of temperament are Novelty Seeking, Harm Avoidance, Reward

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Dependence and Persistence. Character traits reflect personal goals and values that tend to develop in response to life experience. They are influenced by sociocultural learning and develop in progressive steps throughout life. These three dimensions are Self-Directedness, Cooperativeness and Self-Transcendence. Each trait is multifaceted. High and low descriptors of each trait are summarized in Table 1. Our research question asked: do registered nurses and general practitioners differ in their temperament and character profiles? We hypothesized that their profiles would be different.

METHODS Ethical approval was obtained from the Behavioural and Social Science Ethical Review Committee of the University ‘Name Hidden’ and the Human Research Ethics Committee of the University of ‘Name Hidden’.

Design A cross-sectional design using quantitative methods (self-report questionnaire).

Participant sample The health service district assisted in the distribution of the research materials to the RNs, whereas the Australian College of Rural and Remote Medicine and the Royal Australian College of General Practitioners assisted similarly for GPs. Research materials included the questionnaire (TCI-R 140 and demographic), information sheet and consent form and were distributed either as postal hard copy or online as preferred by the participant. A criterion for inclusion was at least 5 years of active work as an RN or a GP.

Materials The demographic survey (2–3 min) included age, sex, urban/non-urban background; location lived longest and current practice location (urban/non-urban). The TCI-R 140 (20–30 min) is the 140-question Likert scale version (1 = definitely false to 5 = definitely true) designed to assess four temperament (Harm Avoidance, Novelty Seeking, Reward Dependence, Persistence) and three character (Self-Directedness, Cooperativeness, SelfTranscendence) dimensions of personality. The internal consistency (Cronbach alpha) of the dimensions in our sample ranged from 0.86 to 0.89 for character and from 0.71 to 0.91 for temperament scales. © 2011 Blackwell Publishing Asia Pty Ltd

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Table 1 Temperament and character descriptors Temperament is defined as those components of personality that are heritable, developmentally stable, emotion-based and not influenced by sociocultural learning. The four dimensions of Temperament all reflect a heritable bias. Temperament dimensions

High scorers

Low scorers

Novelty Seeking

Exploratory and curious Impulsive, disorderly Extravagant and enthusiastic Seeks challenge Worrying and pessimistic Fearful and doubtful Shy, fatigable Indecisive Sentimental and warm Dedicated and attached Dependent Needs to please Seeks approval from others Industrious and diligent Hard-working Ambitious and overachiever Perseverant and perfectionist Determined

Indifferent, reflective Frugal and detached Orderly and regimented

Harm Avoidance

Reward Dependence

Persistence

Relaxed and optimistic Bold and confident Outgoing, vigorous Opinionated, decisive Practical and cold Withdrawn and detached Independent Not influenced by others Socially insensitive Inactive and indolent Gives up easily Un-ambitious underachiever Quitting and pragmatist

Character traits reflect personal goals and values and are subject to sociocultural learning. Each trait quantifies the extent to which an individual displays certain related qualities. Character dimensions

High scorers

Low scorers

Self-Directness

Responsible and reliable Purposeful, self-accepted Resourceful and effective Habits congruent with long-term goals Socially tolerant Empathic, helpful Compassionate, constructive Ethical and principled Wise and patient Creative, imaginative Self-effacing United with universe Modest, humble, spiritual

Blaming and unreliable Purposeless, self-striving Inert and ineffective Habits congruent with short-term goals Socially intolerant Critical, unhelpful Revengeful and destructive Opportunistic Impatient Unimaginative Proud and lack of humility Materialistic Practical

Cooperativeness

Self-Transcendence

Adapted from Cloninger et al.12

© 2011 Blackwell Publishing Asia Pty Ltd


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Table 2 Demographics of respondents Variable

Doctors

Nurses

Total N Sex Men Women Age (years) 20–29 30–39 40–49 50–59 ⱖ 60

214

212

132 (62.0)† 82 (38.0)

25 (12.0) 187 (88.0)

2 43 74 52 27

(0.1) (20.0) (34.0) (24.0) (13.0)

13 36 85 65 13

(6.0) (17.0) (40.0) (31.0) (6.0)

†

Numbers in parentheses are percentage of the total number in each group for sex or age.

Statistical analysis The total TCI dimensions scores and demographic data were entered into spss 14 for analysis (SPSS, Chicago, IL USA). All analyses used a = 0.05 with an accompanying 95% confidence level for measuring significant differences between variables. Chi-squared analysis analysed categorical variables. T-tests and subsequent two-way analysis of variance determined differences in TCI levels between RNs and GPs while covarying for age, sex, background, location lived longest and current practice location (urban vs. non-urban).

RESULTS Research materials were distributed to 451 RNs and 524 GPs with responses of 212 (47%) and 214 (41%), respectively.

Demographics Table 2 provides the basic demographics of our sample. The age distribution of respondents was similar between groups. Twice as many GPs were male as female, whereas all but 12% of the RNs were female. More RNs reported a rural background and similarly lived longest in a nonurban location although their current place of practice was not different from the GPs. The mean number of years in practice for GPs was 23 and for RNs 25 with the range for both groups between 7 and 40 years.

normally distributed. Comparison of combined (all RNs and GPs) TCI scores with Cloninger’s population norms19 showed scores for Harm Avoidance and Novelty Seeking in the average percentile, Reward Dependence, Persistence, Self-Directedness and Cooperativeness in the very high percentile and Self-Transcendence in the low percentile range. There were main effect differences between nurses and doctors for five of the seven traits and sex or age effects in three of the seven traits. However, there were no significant main effects with respect to location lived longest, current practice location or background. Nor were significant interactions detected on any TCI dimension for combination of variables. A summary of the significant findings follow.

Novelty Seeking

A main effect for group (F(1, 422) = 8.70, P < 0.003, Partial Eta2 = 0.020) showed that RNs were higher than GPs in Novelty Seeking.

Harm Avoidance No main effects were detected for Harm Avoidance although generally men were lower in this temperament trait.

Reward Dependence

A main effect for group (F(1, 422) = 4.82, P < 0.029, Partial Eta2 = 0.011) showed that RNs were higher in Reward Dependence than GPs. A main effect for sex was also detected showing all women (both RNs and GPs) higher in RD (F(1, 422) = 13.43, P < 0.001, Partial Eta2 = 0.031) compared with men.

Persistence

A main effect for age group (F(4, 400) 2.91, P < 0.021; Partial Eta2 = 0.028) showed that Persistence increased across both groups with age.

Self-Directedness

A main effect for group (F(1, 422) = 21.58, P < 0.001, Partial Eta2 = 0.049) showed GPs were higher than RNs in Self-Directedness.

Cooperativeness

Differences in TCI Tests of normality (Kolmogorov–Smirnov statistic, Normal Q–Q Plots) showed the TCI scores to be

A main effect for group (F(1, 422) = 15.35, P < 0.001, Partial Eta2 = 0.033) showed RNs to be lower than GPs in Cooperativeness. A main effect for sex © 2011 Blackwell Publishing Asia Pty Ltd

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(F(1, 422) = 20.08, P < 0.001, Partial Eta2 = 0.045) showed women to be higher in Cooperativeness than men. However, the mostly female RNs were still lower in levels of Cooperativeness than GPs.

Self-Transcendence A main effect for group showed the RNs are higher in Self-Transcendence than GPs (F(1, 422) = 28.55, P < 0.001, Partial Eta2 = 0.063) (see Table 3).

Table 3 Means and standard deviations of TCI dimensions for nurses (n = 212) and general practitioners (GPs) (n = 214) and combined sample (n = 416) Variable Harm Avoidance GPs Nurses Combined Novelty Seeking GPs Nurses Combined Reward Dependence GPs Nurses Combined Persistence GPs Nurses Combined Self-Directedness GPs Nurses Combined Cooperativeness GPs Nurses Combined Self-Transcendence GPs Nurses Combined

Mean

Standard deviation

53.93** 54.09 54.01—average†

11.822 10.086 10.980

51.51 54.34 52.92—average

7.381 7.231 7.435

65.18 69.50* 67.33—very high

9.737 8.725 9.486

71.00 70.87 70.94—very high

8.518 8.186 8.345

78.61** 74.73 76.68—very high

9.232 9.887 9.748

80.89 79.75** 80.32—very high

7.332 7.241 7.300

40.12 47.05** 43.57—low

10.826 10.052 10.996

Asterisk (*) denotes significant difference between groups: ** P < 0.001, * P < 0.05. † Combined sample mean scores ranked against published population norms.19


DISCUSSION This study compared the temperament and character traits of a sample of RNs and GPs and found different trait profiles. Although the differences were small and only showed weak affect sizes, they do provide interesting insights into the two professions. Compared with GPs, the RNs were higher in the temperament traits of Novelty Seeking and Reward Dependence, and among the character traits, lower in Self-Directedness and Cooperativeness but higher in Self-Transcendence. To our knowledge, these are the first data that compare personality traits between the nursing and medical professions. Overall, both groups showed a temperament and character trait profile that would be expected of practising professionals in nursing and medicine. Compared with the population norms, they are highly self-directed, cooperative, compassionate, responsible, modest risk takers, confident and objective. A main effect for sex showed the female sample of both nurses and GPs were higher in levels of the temperament trait Reward Dependence and the character trait of Cooperativeness compared with men. These results concur with the literature16,17,19 and support previous work that suggests men and women might be attracted to certain specialities.6 The most common example is that women tend to be attracted to person-oriented specialities such as primary care.20 However, a main effect also for ‘group’ showed that RNs were lower in levels of Cooperativeness than GPs. This was unexpected because our sample of RNs was 88% female compared with only 38% female GPs. Cooperativeness is indicative of an individual’s identification with and acceptance of others and is a measure of agreeableness. In other words, it is indicative of either empathy and tolerance (high Cooperativeness) or social disinterest and intolerance (low Cooperativeness). This finding suggests that although nurses certainly rate high in Cooperativeness, perhaps GPs should be more strongly identified with a cooperative nature than previously thought—highlighting good communication and collaborative skills. The basic concept of Self-Directedness refers to an individual’s ability to adapt or control behaviour to fit the situation in accordance with their goals and values. It also implies aspects of will power and determination. In our sample, levels of Self-Directedness were lower in nurses compared with GPs. Again, compared with population


norms, both RNs and GPs rank very high in SelfDirectedness, but with no other main effects detected we might speculate that within this sample, those who pursue medicine are more goal-oriented and selfconfident. This finding might be reflective of the higher competitive nature of medicine that attracts—indeed requires—individuals who are also highly competitive and goal-oriented. Self-Transcendence is a character trait that is often overlooked in personality investigations. It measures one’s awareness of being an integral part of the world around them. Although often referred to as spirituality, Self-Transcendence need not mean religious spirituality, but inner spirituality, for example someone who is humble and accepting of their life—feeling inner peace vs. someone who is conceited, materialistic and never satisfied. Our sample of RNs was significantly higher in Self-Transcendence than the GPs but lower in SelfDirectedness and Cooperativeness. This combination of character dimensions has important implications regarding ‘positive affect’.21 In particular, higher SelfTranscendence is consistently associated with higher positive affect regardless of the combination of SelfDirectedness and Cooperativeness.22 According to Maslow’s hierarchy of needs,23 descriptors of SelfTranscendence include ‘seeks to further a cause beyond the self’, and this might involve ‘service to others and devotion to an ideal’. People who rate highly tend to be unpretentious, fulfilled, patient, spiritual and selfless. They can tolerate ambiguity and uncertainty, but their idealism might be criticized as naiveté and interfere with materialistic pursuits. These descriptors are indicative of many stereotypical reasons to pursue for nursing as a profession. Comparing the temperament traits also showed some unexpected findings. Novelty Seeking tends to be a trait that elicits some of the more audacious or interesting features of personality. To possess the ‘right amount’ of Novelty Seeking often suggests a high-functioning professional who carries substantial responsibility, courage and leadership potential. Somewhat unexpected, in light of the extant professional stereotypes, was that our sample of RNs were higher in levels of Novelty Seeking compared with GPs. Considering that our nurse sample was predominantly female, these findings are dissimilar to previous work, which shows female GPs and medical students to be generally lower in Novelty Seeking compared with men.14,16,17

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These current findings might be indicative of professional qualities not previously attributed to those who become nurses. Individuals high in Novelty Seeking are exploratory and curious and tend to be more impulsive, extravagant and enthusiastic compared with individuals with low levels who tend to be more indifferent and detached, frugal and reflective. The advantages of high levels of Novelty Seeking are enthusiastic and quick engagement in whatever is new and unfamiliar. This notion certainly requires more investigation to uncover what about nursing might attract those with high levels of traits associated with Novelty Seeking behaviours. Results for Reward Dependence showed a main effect for sex which supports the accepted trend that women are higher than men in this trait.14,16–19 Additionally, a main effect for group showed that RNs were higher in Reward Dependence than GPs. Individuals higher in Reward Dependence tend to be more sentimental, warm, dedicated and dependent compared with those with low scores who tend to be more detached, independent and practical. An advantage of high Reward Dependence is the sensitivity to social cues, which facilitates warm social relations and understanding of people’s feelings. This description is congruent with common stereotypical characteristics associated with nursing. The TCI was developed through consideration of social and biological determinants of individual differences. Common characteristics between the TCI and other personality inventories, such as the five factor models,24 show high correlation and considerable overlap.13,25 The major advantage of the TCI is that it provides a valid measure of temperament and character, which are the two most fundamental aspects of personality.2 Temperament is a configuration of inclinations, whereas character is a configuration of habits. In other words, character might be described as ‘disposition’ and temperament as ‘pre-disposition’. This means that everyone develops the habits appropriate to their temperament but significantly—those habits are influenced by the innumerable external factors we are exposed to during our development. This research offers insight that might be used for training and career counselling as well as enhancing both individual and interprofessional practice. It also, as might be expected, implies questions for further research. We found that both temperament (nature) and character (nurture) traits were different between doctors and nurses. This then begs the question: are individuals © 2011 Blackwell Publishing Asia Pty Ltd

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attracted to certain professions because the professional requisites fit their personality traits (i.e. nature) or do they develop the requisite traits that fit with certain professions as a result of training and exposure (i.e. nurture). Further research into this concept is necessary and would provide a novel approach to education, training and interprofessional practice in the health sciences. That we detected differences in both character (developmental) and temperament (stable) traits is important. Because temperament traits are stable and therefore predictive, detecting the optimal level of a temperament trait in any given profession could reinforce the distinctiveness of that profession and serve as a predictor for these optimal traits. Equally useful would be knowledge of an individual’s level of character traits because of the potential to train or counsel for or against them. For example, individuals low in Cooperativeness might respond to increased teaching in communication and collaborative skills. Likewise, someone low in Self-Directedness might respond to training in goal setting and motivational skills. However, before predictive analysis can be useful, the psychobiological profiles of various disciplines need to be established. Furthermore, when trying to establish a profile of personality traits it is vital to consider the combination of those traits. The manifestation of a certain trait no matter what its level (high or low) could be very different depending on the context and which other variables it is combined with. The strongest example in this study is the high levels of Self-Transcendence among the RN sample in conjunction with low Cooperativeness and Self-Directedness. Our study serves as further acknowledgement of the different and sometimes obvious factors that attract individuals to particular areas of interest, in this case nursing and medicine. For example, that women have historically been drawn to ‘person oriented’ roles is evident in many professions besides nursing such as secretarial work, retail sales, etc. Whether this is partly indicative of decades of gender stereotype and a consequence of the slower progression of women in the workforce might be argued. Nevertheless, as a stable (temperament) trait, Reward Dependence, a measure of social dependence/attachment with its higher levels in women, fits well with the trend for more women in professions that require these traits such as primary care roles. Our findings, although preliminary, might begin to dispel some of the commonly held stereotypes between medicine and nursing—two professions so integral to © 2011 Blackwell Publishing Asia Pty Ltd

DS Eley and RM Eley

each other yet traditionally quite separate in the beliefs about the requisite attributes for each. We propose that these findings might lead to an enhancement of the everyday practice of nurses and GPs at both an individual and inter-professional level. Certainly there are particular personal traits that are crucial to being a competent, safe and ethical clinician. Identifying these dominant traits associated with various disciplines might provide insight into training strategies and provide maximum information for counselling students in career decisions. Therefore, providing clinicians and students with an understanding of their personal traits might encourage reflection on their own personalities and the implications for their career choices. For clinicians, in terms of life work or career plans, having a sense of one’s personal temperament and character can lead to a clearer understanding of their role and how they function in the workplace and likewise how their role is integral to other professionals in the workplace and visa versa. In other words, would knowledge of others’ professional traits foster greater mutual understanding and interprofessional practice? This understanding might also help individuals capitalize on strengths, manage failures and make decisions that are in synchrony with their natural personality. Only RNs with GPs were compared in this study and further work is underway to profile other health professions in order to generalize these findings. Our response rates although modest are quite acceptable considering the length of the questionnaire and the time to complete by busy professionals.26 Additionally, there is a recognized potential for bias in our self-selected sampling procedure. An important caveat is that our study explored personal traits—not behaviours. Further research is warranted to explore the relationships between trait profiles and behaviours in individuals.

ACKNOWLEDGEMENTS The authors wish to thank the Darling Downs—West Moreton Health Service District of Queensland Health, The Australian College of Rural and Remote Medicine and the Royal Australian College of General Practitioners for their assistance with distributing the research materials.

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