"Columbus Circle, 4:30 P.M"

Please feel free to surf on over to my fiction blog, "Fiction, Prose & Ephemera", to read my latest short story, "Columbus Circle, 4:30 P.M."

Wikio Ratings

Just a quick note to let my readers know that Digital Doorway is currently rated #65 of the top 100 health blogs on the Web (according to Wikio), and rumor has it that my ranking may improve more in the coming weeks. I am humbled and grateful, and hope that I can continue to be worthy of such ranking in the future!

Collaboration and Relationships

In my current position as a Public Health Nurse, I am seeing so clearly how the building of collaborative relationships is the key to success. Whether I am creating wellness programs for municipal employees, writing town-sponsored blogs, developing emergency preparedness protocols, fostering communication with other town health departments, or working with the local university and colleges, my work revolves around positive relationships and a collaborative spirit of cooperation and mutual benefit.

As I delve deeper into the areas for which I am responsible, there is precious little that I can satisfactorily accomplish without some form of collaboration. If I want employees of the town to exercise, then I have to develop positive relationships in order to motivate employees to take part in my programs. If I want to move forward with our emergency preparedness plans, then I have to work closely with town officials and school department personnel in order to conduct surveys of potential emergency shelter sites and Emergency Dispensing Sites. When there's a case of tuberculosis or salmonella in town, I have to use my contacts at the state Department of Public Health to fully undertake my investigation.

Every step I take here in my work is collaborative on some level. Every initiative I undertake suggests a way in which I might get the "buy in" of a key individual or group of individuals. With each idea I have or new program I wish to launch, some connections must be made, relationships must be fostered, and alliances forged.

This position of mine is not one in which I can thrive as a lone agent. Sure, I could act on my own, burning bridges as I run rough-shod over my colleagues and other innocent bystanders. But in order to truly create public health programs and initiatives of any intrinsic and lasting value, collaboration and relationship building is key.

I am building such alliances every day, feeding relationships, fostering connection, finding common ground, and building confidence within and without. I am gathering my forces and lining up my allies. And with these elements in place, success is assured.

Obama Administration and Congress Invest in Nurses

Several major American nursing organizations are applauding the support demonstrated by Congress and the Obama administration for the nursing profession, with newly allocated funding that should have a profound impact on every aspect of nursing, including the central focuses of education, practice, retention and recruitment.

As part of the American Recovery and Reinvestment Act (H.R. 1), $300 million were awarded to the National Health Service Corps and $200 million will be divided between the Nursing Workforce Development Programs (Title VIII of the Public Health Service Act) and the Health Professions Training Programs (Title VII). $10 billion will also be allocated for the National Institutes of Health, with $7.4 billion distributed to various Institutes, including the National Institute of Nursing Research, further demonstrating that nursing's contributions to both the clinical and research worlds is indeed taken seriously.

The provisions in H.R. 1 allow for money to be distributed directly to nursing students and schools of nursing, with allocations for Title VII programs like Scholarships for Disadvantaged Students and the Faculty Loan Repayment Program.

Additionally, the monies allocated for the National Health Service Corps will fund scholarships and loans to nurse practitioners, certified nurse-midwives, primary care physicians, dentists, mental and behavioral health professionals, physician assistants and dental hygienists.

In blog posts leading up to President Obama's inauguration, I voiced cautious optimism (and some considerable doubt) that an Obama administration would pay close enough attention to the nursing shortage, addressing not only the need for increased scholarships and education funding for nursing students, but also funding to address the lack of qualified nursing professors available to educate new nurses. Seemingly, multiple levels of the nursing profession have been addressed under the auspices of these new programs, and the money allocated will not only provide scholarships for nursing students, but will also offer loan repayment programs for those nurses who might wish to teach but would likely be dissuaded by the relatively low salaries offered to nursing professors.

I am heartened by this news, and foresee a blossoming of the nursing profession at a time when a universal nursing shortage (and an economy in apparent free fall) inform the overarching zeitgeist that currently casts a pall over the entire health care industry. Yes, most nursing schools are filled to capacity, yet that capacity is generally hobbled by a profound shortage of professors, a reality which very well may be addressed as these funds become available.

These are difficult economic times for many Americans, and as President Obama's economic recovery plan is actualized, we will begin to see the ways in which the plan may succeed and fail. Over all, I feel optimistic that, in terms of the nursing profession and the profound shortage therein,we will sense a discernible sea change if the allocated funds are targeted and distributed as proposed. While I have not seen the fine print (and we all know that the large print can giveth and the small print taketh away), my hope is that the fine print will in no way diminish the potential impact of such an historically and economically significant investment in the future of nursing.

Despite the dire warnings and the hand wringing occuring nationwide as the unemployment roles grow, perhaps some optimism, positive movement and job growth within the nursing profession will have a ripple effect throughout the health care industry. And for this we can only hope.

Return

Well, dear Readers, I'm back from a brief three-day Mid-Atlantic sojourn, visiting my aging parents, helping my mom, and making the rounds.

Being without Internet access for almost three days felt like an eternity, the electronic umbilical cord tugging at my nearly constant desire to email, blog, hop onto Twitter, update my Facebook page, and otherwise connect with the myriad people with whom I have a strictly electronic relationship.

As Digital Doorway has surpassed its fourth birthday, I realize how very important a venue it is for my self-expression. This space serves as a touchstone for me, and I indeed appreciate those of you who visit, comment, and make this blog come alive.

Stay tuned for continued adventures, and thanks again for your generous readership!

---Keith

A Valentine Change of Shift

Please surf over to This Crazy Miracle Called Life to peruse the newest edition of Change of Shift, everyone's favorite nursing blog carnival.

What We Take for Granted

Listening to a guided meditation today, I was struck by a statement reminding me about what happens each morning when we wake up. Every morning of our lives, we open our eyes and completely take for granted that our heart is still beating, our lungs are breathing without a second thought from us, our kidneys are churning out urine, and the blood and lymph and other vital fluids of our body are busily going about their work as we rub our eyes and set feet to the floor.

I, for one, am so often lost in the daily deluge of email, phone calls, papers, appointments and "things to do" that I completely forget what's happening right here inside my little envelope of skin. How can this be?

My wife often reminds me to be sure to feel, express and contemplate gratitude every day. Gratitude for what? For breathing, for another day, for our home, our dog, our son, our health, the money we have in the bank, the jobs that we're so very lucky to have. Gratitude, she says, for everything and anything, is what's most important to contemplate every day.

So, how do we remember to do this? How do we remember to feel grateful every day? Do we put Post-It notes on every surface, reminding us to be grateful? Perhaps. Do we tattoo "Remember to be grateful" backwards on our foreheads so that we remember every time we look in a mirror? (Perhaps a little extreme, but if you try it, please send me a photo!)

I admit that I am as guilty as the next person, and I am more likely to forget than to remember. Luckily, I have my own "Gratitude Guru" in my life, and I am reminded to be grateful more often than I would sometimes like! Still, I appreciate the effort, and am slowly making strides.

So, dear Reader, how do you remember to be grateful? Do you feel gratitude from time to time? What happens when your feet hit the floor each morning?

Health Care Without Harm

Imagine hospitals and other facilities built without cancer-causing materials. Picture a hospital that supports local sustainable agriculture and organic growing practices. Imagine health care facilities that offer full disclosure of materials used in the delivery of care that might be harmful to consumer health, and fragrance-free environments that do not harm patients with environmental sensitivities.

Health Care Without Harm (HCWH) is "an international coalition of hospitals and health care systems, medical professionals, community groups, health-affected constituencies, labor unions, environmental and environmental health organizations and religious groups" whose mission is "to transform the health care sector worldwide, without compromising patient safety or care, so that it is ecologically sustainable and no longer a source of harm to public health and the environment."

While this may seem like a tall order---or perhaps a pipe dream---HCWH is indeed a growing global coalition looking closely at health issues surrounding mercury, biomedical waste, green purchasing practices, healthy building practices, pesticides and fragrances, and the widespread toxicity of materials used in the delivery of health care.

The stated goals of HCWH are:

1. Create markets and policies for safer products, materials and chemicals in health care. Promote safer substitutes, including products that avoid mercury, polyvinyl chloride (PVC) plastic and brominated flame retardants.

2. Eliminate incineration of medical waste, minimize the amount and toxicity of all waste generated and promote safer waste treatment practices.

3. Transform the design, construction and operations of health care facilities to minimize environmental impacts and foster healthy, healing environments.

4. Encourage food purchasing systems that support sustainable food production and distribution, and provide healthy food on-site at health care facilities.

5. Secure a safe and healthy workplace for all health care workers.

6. Ensure patients, workers and communities have full access to information about chemicals used in health care and can participate in decisions about exposures to chemicals.

7. Promote human rights and environmental justice for communities impacted by the health care sector, while assuring that problems are not displaced from one community or country to another.

Here on Digital Doorway, I will be following HCWH's development and reporting on issues raised through the various campaigns already underway. The health care industry is not immune from the reverberations of its own environmental effects, and I am very grateful to have discovered this robust international campaign with a goal of reducing the toxicity created by the health care industry while increasing sustainability and responsibility in the health care arena.

A Valentine Treat

Here's a collage that I made for Mary as a Christmas gift a few years ago. I thought it would be a nice image to share with my readers on Valentine's Day. Enjoy!

The One and Only Campaign

Just today I learned of the newly launched "One and Only Campaign", the mission of which is to create zero tolerance for poor infection control practices in health care facilities.

Apparently, thousands of infections are caused by the inexcusable reuse of syringes by health care providers across the country, and many of these infections do indeed lead to unnecessary illness and death. In fact, in February of 2008, over 40,000 patients were exposed to potentially deadly bloodborne diseases at an endoscopy center in Las Vegas, Nevada due to the reuse of syringes that should have only been used for one patient and then properly disposed of.

According to the One and Only Campaign website, "the goal of the One & Only Campaign is to improve safe injection practices across healthcare settings. The practices within an organization are highly influenced by its culture or are an expression of its culture. Through education, outreach, and grassroots initiatives, the One & Only Campaign will seek to influence the culture of patient safety."

The description continues: "The One & Only Campaign is an education and awareness campaign aimed at both healthcare providers and the public to increase proper adherence to safe injection practices to prevent disease transmission from the misuse of needles, syringes, and medication vials in outpatient settings. While the campaign will be initially rolled out in targeted locations, the vision is to develop a concept that can be replicated nationwide."

At this late date, I am honestly personally shocked that there are still U.S. health care facilities who reuse medical equipment and disposable injection devices that are truly meant for one-time use. While nosocomial infections do indeed occur on a daily basis in health care facilities the world over, we are, after all, more than 25 years into the Age of AIDS, and I have apparently been mistakenly naive to think that health care facilities in the United States have all learned their lessons from the days before Universal Precautions were the norm of medical practice.

Let's hope that The One and Only Campaign is effective, and that health care providers and facilities learn from the thousands of grave errors that have been made, often with deadly results. And remember that, as a patient and health care consumer, you have a right to ask your health care facilities about their infection control practices prior to agreeing to treatment.

Does Emergency Preparedness Make Sense?

Yesterday, I spent eight hours with folks from the Centers for Disease Control, learning about how to communicate with the public and the media during public health emergencies. While this stuff can indeed be pretty dry, I must say I was quite impressed with the way the CDC puts these trainings together. The presenters kept it lively and interactive, and group exercises broke up the day nicely.

Although these trainings do indeed seem to focus on potential scenarios involving anthrax or other terrorist activity (something which I see as highly unlikely), having public health officials who know how to communicate with the public doesn't seem like such a bad idea, really.

While people don't generally want to think or talk about preparing for unknown dangers which may or may not happen some time in the future, I'm beginning to get a sense of the larger picture and how the government is striving to create a coordinated system in which metropolitan areas, small towns, and even rural areas are accounted for in emergency preparedness.

Billions of taxpayer dollars have been spent in order to create the Strategic National Stockpile (SNS), the Cities Readiness Initiative, and other very complex and, ultimately costly, programs. Many people would question whether this money would have been more well spent on creating jobs, improving infrastructure, green technologies and other important issues of the day. From my perspective, this would be an excellent question to pose, however the emergency preparedness train is fully out of the station since 9/11/01, and there's simply no way to reign this one in, for better or for worse.

So, taxpayers of America, be advised that, yes, there are huge warehouses of medications at strategic points throughout the country, ready to bring antibiotics and antivirals to your town in case they're needed in a hurry. There are also thousands of people like myself constantly undergoing training in order to be able to bring those medications to you in a real emergency.

Taking into consideration the likelihood of a terrorist attack, an influenza pandemic, or another scenario in which these assets would indeed be deployed, one might be led to wonder why so much money has been sunk into these efforts of preparing for that which may never occur.

These are good questions to ask and valid points to consider. The fact is, however, that the behometh of emergency preparedness is a beast with a life (and a budget) of its own, and even though I sometimes question the amount of money being set aside for such efforts at a time of economic turmoil, as a public health official I must fulfill my mandated mission of taking these tasks seriously as I increase my knowledge of such a new and complicated world.

Emergency Preparedness Day

Today was a day focused on emergency preparedness. At work, a colleague who is an emergency preparedness consultant went with me to three town schools in order to survey the buildings' potential to serve as Emergency Dispensing Sites (EDS).

An EDS is a facility designated to be the operations center wherein a town accesses emergency medications from the Strategic National Stockpile (SNS), a national repository of medications designed for a swift response to terrorism, epidemics, and other public health emergencies. The EDS can be a school, a community center or any building that can accommodate large crowds as they're shepherded through for triage and treatment in an orderly manner.

It was an eye-opening experience, and I came away with a much more robust understanding of what it means to set up an EDS in my town, and which buildings are more appropriate that others.

This evening, following a long day of work, I attended a training on Psychological First Aid, a key to helping people in the immediate aftermath of various types of disaster.

My baptism into the world of emergency preparedness continues, and it will only become deeper as I delve further into my (seemingly growing) responsibilities.

Change of Shift: Welcome to The Fishbowl

In the days leading up to hosting this edition of Change of Shift, I gave a great deal of thought to the phenomena of the internet, blogging, Twitter, iPhones, Facebook, and the many technological advances that now keep us all connected and communicating.

That said, as much as I love these manifestations of our Digital Age, I also see these forums as proverbial fish bowls in which we all stew ourselves in the waters of public communication, often rendering ourselves vulnerable and naked as the observing masses watch our every move.



Over on Twitter, many of us now communicate in a "micro-blogging" format, using 140-word posts to get our message across to our myriad "followers". Twitter is, for all intents and purposes the newest digital fish bowl, and as more and more of us jump into the water, the pool sure does get crowded!

But before Twitter and many other manifestations of Web 2.0 emerged from the depths of the collective technological consciousness (bear with me here, folks), blogging arose as the newest form of armchair journalism, rendering many of us health care professionals suddenly able to make our voices heard, singularly and collectively. Nurses, doctors, pharmacists and others suddenly found a venue in which their experiences, feelings and expertise could be readily shared with hundreds, perhaps even thousands of readers hungry for their fresh perspective. And for this opportunity, we are thankful, and we take full advantage of the digital soap box that blogging provides on a daily basis.

So, dear friends, welcome one and all to our Change of Shift Fishbowl, and thanks to Kim at Emergiblog for making it all possible. Feel free to swim with the school, make some new friends, and bask in the rich and teeming waters of the blogosphere.



Swimming over to the mental health section of the fishbowl, our favorite Therapy Doc bemoans the post-modern illness, Internet Asperger's Syndrome. Oh the irony of it all!

Speaking of mental health, my Twittering friend Strong One delivers two posts for this week's Change of Shift, the first being very wise advice for new grads and new nurses trying to care for themselves in the stressful world of health care delivery, the second being further advice for those same new nurses to avoid the trap of being a Know-It-All or its absolute opposite.




Meanwhile, Travel Nursing Blogs reminds us (for better or worse!) that tax time is here, and those ever-so-lucky traveling health care professionals can take advantage of significant tax benefits if they do their homework.

And as far from taxes as one could get, Miss-Elaine-ious regales us with the moving story of how an example of true caring makes her want to be the best nurse she can be.

Eschewing the written word, Robert Fraser of Nursing Ideas shares a video interview with a nurse who also advocates for environmental issues. Thanks for the multimedia post, Rob!




Lists seem to be a frequent theme in blog posts these days, and submissions to Change of Shift are no exception. So, for those of you who like their recommendations enumerated, swim over to the other side of our tempest in a teapot to peruse what's on offer:

A second submission from Travel Nursing Blogs gives us the Top 5 Reasons to become a travel nurse. What are we waiting for, especially in light of the aforementioned tax benefits!

USPharmD informs us of the Top 50 Genetics Blogs on the Internet.

And since iPhones are all the rage, Radiography Schools graces us with a list of 20 iPhone apps that can help you to improve your health.

Speaking of iPhones, there just seems to be no escaping their cultural domination, as Phlebotomy Technician Schools regales us with 20 iPhone apps for overwhelmed students.



Swimming on, we find Ultrasound Technician Schools discussing how the benefits of ultrasound far outweigh the potential negative effects.

And using laser therapy to help patients quit smoking is submitted for your consideration by Health and Nutrition Facts.

In terms of heart health in the face of menopause, Heartstrong shares the results of a new study that is certainly food for thought, as well as a second post outlining guidelines for preventing heart disease in women.

Dean Moyer of The Back Pain Blog offers up a two-for-one deal this week with his latest post entitled Health Care Reform and Sciatica Recovery. In Part One he covers what he (as a consumer) would like to see included in a national health care plan. Part Two is the continuation of an ongoing effort to answer reader questions about sciatic nerve pain.




Over at RehabRN, we are treated to a heartfelt post about the travails of nursing, of succumbing to winter illnesses, and the adaptation involved in order to be able to still love nursing at the end of the day.

Nearby, Nerdy (not-quite) nurse shares some very sage advice for women of all ages based on her experiences working in a OB/GYN office.

A guest blogger on NurseConnect discusses the stress faced by patients when they are transferred from one unit to another, especially in the ICU, a place that can certainly feel like a fishbowl.

And another guest blogger on NurseConnect discusses the ins and outs of writing letters of complaint to businesses that deserve them, as well as letters of satisfaction when all is well. This advice is well suited to experiences in health care facilities, so watch out!

The third offering from NurseConnect challenges us to assess the level of assertiveness practiced in our workplace. Are you ready to assert yourself with the big fish in your facility?


Meanwhile, over at Online Nursing Degrees, my blogger friend Jen wonders whether something fishy is going on, asking why there are so many hiring freezes when the nursing shortage is so dire.

Over near the coral, an interesting and thought-provoking post is offered by VP Medical News concerning medical providers who are reprimanded---or worse---for offering to pray with patients.

And on a very different subject, BookScoutLookOut brings us the story of being a first responder to the home of an overdosed heroin addict.



For myself, your host, I've been thinking and blogging about many subjects these days. On a personal level, my struggles with my health and recently chronic insomnia has been a preoccupation, ad nauseum.

On the macro scale, a recent Pentagon ruling to exclude veterans diagnosed with PTSD from being awarded the Purple Heart certainly raised my hackles, and the independent film "Ballast" brought my post-inaugural attention back to the plight of the rural poor in America.


So, my friends, it's abundantly clear to me that our blogging fishbowl is simply awash with talent, curiosity, compassion, and professionalism. These myriad forums for the sharing of information and opinion truly enhance our lives, and as long as we don't allow technology to usurp our humanity and our ability to connect face to face in the real world, we can hope to continue to benefit from this veritable flood of information for years to come.

Thank you for paying a visit to this edition of Change of Shift, and remember that there is life both inside and outside the fishbowl. So when the waters get too murky and visibility isn't so good, remember to draw a hot bath, take a walk, make a cup of tea, hug a friend, and jump back in when you've been refreshed. We'll all still be here, ready to welcome you back for a swim.



Note: The next Change of Shift will be hosted at This Crazy Miracle Called Life on February 19th. You can submit direct to the host or via Blog Carnival.


(All photos by NurseKeith)

Change of Shift at Digital Doorway, February 5th

I will be hosting Change of Shift, the premier nursing blog carnival, here on Digital Doorway on February 5th.

There is no specific theme for this next edition of CoS, and I welcome submissions from any blogger, as long as the post has something to do with nursing, medicine, health, health policy, health care, health care reform, disabilities, social justice, human services, human relations, or the human condition in general. (So narrow, I know.....)

Anyway, feel free to email me directly (my email is available through my Blogger profile), or submit via Blog Carnival, the user-friendly website for all things carnival. All submissions are due by noon on February 4th. Any submissions received after that time may or may not be included, depending on my mood, workload, and level of insomnia.

Thank you, and I look forward to hosting Change of Shift this Thursday, February 5th.