Tuesday, January 31, 2012

Internet Radio for Nurses Takes Off!

Our newly birthed internet radio station for nurses---RN.FM Radio---is maturing into a reliable weekly source of inspiration, encouragement, interviews and nursing news that many nurses are flocking to every Monday evening at 9pm EST. 

Thursday, January 19, 2012

Book Review: Davis's Drug Guide for Nurses, Twelfth Edition

As always, I begin my book reviews with the disclosure that I did not receive financial compensation of any kind for this review, but did receive a free copy of this drug guide from Majors Books in order to facilitate the review process.
Some frequent readers of Digital Doorway will recall that I posted a review of the Nursing 2012 Drug Handbook on November 22nd of last year, and I was quite pleased with the overall layout and presentation of that particular drug guide for nurses. Since I happen to have both the Nursing 2012 Drug Guide and my review of said book in the forefront of my mind, the following review of Davis's Drug Guide for Nurses will be written as I take the differences and similarities between these two recently published drug guides for nurses into consideration.

General  layout

The 12th edition of Davis's Drug Guide for Nurses appears to be extremely similar to its brethren, both in size, layout and general offerings.

Both Davis's guide and Nursing 2012 use almost the exact same color scheme for their drug monograph pages, with slight differences in font size and type. I find Nursing 2012 slightly easier on the eye in terms of font choice, but Davis's is also relatively readable without strain.

Drug monograph layout

Comparing drug monograph layout, there is generally little difference between these nursing drug guides, but I will take the time to elucidate several small differences which may or may not have a great impact on the user.

If we consider indications and dosages, I appreciate that Nursing 2012 combines both of these attributes of every  drug at the beginning of each drug monograph, clearly delineating the pertinent details for both adults and children. Meanwhile, Davis's guide lists indications first and offers dosages and routes much later in each monograph. Personally, I prefer having the dosages and indications up front as soon as I begin reading about a drug, but the publishers and writers at Davis seem to feel that action, pharmacokinetics, contraindications and precautions, adverse reactions, side effects and interactions come first. I assume it is a matter of personal preference.

The Davis drug guide uses a red maple leaf symbol to specify medications that apply specifically to Canadian clinicians and nursing practice. This is a nice touch, and our Canadian brethren may very much appreciate this attention to detail on their behalf.

While Nursing 2012 uses boldly-lettered "Black Box Warnings" to indicate a warning that necessitates caution and attention, Davis prefers a red "High Alert" warning label.

Both books include the steps of the nursing process within the monographs, warnings regarding interactions of drugs with foods and herbs, and various aspects of IV medication administration. 

Drug photographs

Many drug guides now offer photographs of commonly used medications, and this can be an invaluable tool for identification of medications and patient education. Nursing 2012 offers a photo guide to 396 common tablets and capsules. The photographs are full color, life-size, alphabetized, and located in the center of the book. The edges of the pages are shaded a different color so that this section can be handily and quickly utilized.

Davis's Drug Guide offers photographs only of medications with "Tall Man Lettering Changes" which have been recently mandated by the FDA. There are 33 medications with look-alike names and spellings which have now been changed to identify them and reduce confusion and medication errors. Examples of these "Tall Man" lettering changes are CycloSPORINE and CycloSERINE or GlipiZIDE and GlyBURIDE.

While having these mandated changes delineated clearly for readers is an excellent edition that Nursing 2012 lacks, having photographs of only 33 medications compared to the 396 medications displayed photographically in the Nursing 2012 Drug Handbook leaves little room for comparison. Nursing 2012 wins hands down for its use of photographic images.

Of note, the photographs of the "Tall Man" drugs in Davis's book are lumped together with other sections of special information. The edges of the pages of all of these special information sections are shaded with the same color, thus the pages of medication photographs are awkward to find and consequently less than handy.

Digital Offerings

The Davis guide comes with a CD -ROM (compatible with both PC and Mac) that offers an audio library of drug names, a drug search program, updated tutorials on medication errors, wound care and psychotropic drugs, as well as calculators for BMI, metric conversions, IV drip rates, and other features. There is also a free mobile device download of 100 drug monographs and resources available online at DavisPLUS.

Meanwhile, Nursing 2012 delivers access to an online drug advisor, patient teaching sheets, CEUs, as as well as detailed monographs of every drug listed in the book and some medications not included in the print version. This can all mostly be downloaded or viewed on a mobile device. Still, I feel it would behoove the publishers of Nursing 2012 to consider the addition of a CD-ROM in subsequent editions.

The Summing Up

For overall readability, layout and design, I definitely prefer the Nursing 2012 Drug Handbook over Davis's Drug Guide for Nurses, Twelfth Edition. Nursing 2012's inclusion of far more photographic images of medications and its slightly better font choices make it preferable for me, however Davis's inclusion of the CD-ROM, Canadian specifications and "Tall Man" lettering changes mandated by the FDA are also important features to consider.

These two guides are quite comparable, and both offer nurses the information they need in not dissimilar formats and designs. In terms of most of the differences, personal preference may be the deciding factor for many nurses. And for those enamored of the photographic images of drugs, Nursing 2012 is the best choice. Still, a prudent nurse cannot go wrong with either guide, and both will certainly lend themselves to safer care, fewer medication errors, and nurses who have the information they need at their fingertips.


If any readers of Digital Doorway would like a 10% discount on the Davis Drug Guide from Majors Books, please use the code "nursekeith" when checking out. This offer is valid for 30 days. I receive no compensation for sales of this book through Majors Books. This is simply a gift to my readers from me, and a thank you from Majors Books for the review. 

That said, the first commenter on this post who can tell me the name of two famous nursing theorists and their main theories of nursing will win a copy of Davis's Drug Guide for Nurses from me!  The winner will be announced within the "comments" section, and that individual will need to send their mailing address to kc@nursekeith.com.

Wednesday, January 18, 2012

Seven Years of Digital Doorway

Well, it may seem like a blink of an eye at times, but Digital Doorway has been alive and well for seven years today, born from a simple suggestion by my prescient brother as we sat in front of the woodstove on a snowy New England night. I can hardly believe that so much time has passed since that January day when I dived headfirst into the blogging world with no idea of where I was going or, honestly, what I was doing.

When Digital Doorway launched, it was not clear to me that it would be a blog mostly about nursing. Although my online moniker at the time was indeed "Nurse Keith", I had no notion of branding, hadn't heard of SEO (Search Engine Optimization), and the blogosphere was an enormous and cavernous unknown.

Over time, Digital Doorway began to distill itself into a somewhat more cohesive entity, and 1520 posts later, it has become one of the more well-known blogs in the nursing blogosphere,. Yes, it's garnered a fair amount of attention and notoriety over time, although it's still somewhat small potatoes compared to the blogging giants out there. (You know who you are!)

Back in the day, I didn't know about keywords and never gave much thought to such things. In all actuality, I still don't write my posts with keywords in mind, and I just let my blog's relative influence online do the job. However, with hundreds of backlinks that point here to Digital Doorway, it's a given that my writing will have a moderate audience out there in blogland. That said, with my new mentors, colleagues and friends over at RN.FM Radio, keywords, SEO and such animals are now making their way into my lexicon and writing practice, and as we grow RN.FM Radio and its cousin LLC, Unbound Media Group, our presence online as coaches, bloggers and nurse entrepreneurs is sure to grow. And no doubt that Digital Doorway will itself benefit from that vertical and horizontal expansion.

As NurseKeith.com continues its slow and steady launch, Digital Doorway is becoming the repository of much more focused thoughts on nursing, the profession's present and future, new books on nursing. and the impact that coaching can have on nurses' lives, among other topics of note. I look forward to continuing to deliver quality content that's informative, timely, and easy to read (and perhaps periodically entertaining).

Thank you for supporting Digital Doorway. Thanks for reading, thanks for the many comments, for following me on Facebook and Twitter, and for the encouraging words I've received since launching NurseKeith.com.

Yes, it's been a long, strange trip, and I have a feeling 2012 will be no different. Come along for the ride, and let's see what the next seven years brings!

Sunday, January 15, 2012

NurseFriendly on RN.FM Radio!

Just a reminder that tomorrow, January 16th, 2012, Andrew Lopez of Nursefriendly.com will be our guest on RN.FM Radio. Andrew is the consummate connector and promoter of nurses, and we look forward to his appearance on RN.FM Radio! Tune in or listen to the archived show afterwards.

Also, please take a peek at our new RN.FM Radio website! It's growing by the day!

"See" you there! 

Wednesday, January 11, 2012

Book Review: "Confident Voices" by Beth Boynton

A note to the reader: As always, I have received no remuneration for posting this book review. As a point of disclosure, I did, however, receive a free copy of the book from the author in order to facilitate the review process.

"Confident Voices: The Nurse's Guide to Improving Communication and Creating Positive Workplaces", was published in 2009 by Beth Boynton, RN, MS and edited by Bonnie Kerrick, RN, BSN.


In Confident Voices, Boynton strives to give nurses the understanding and skills to navigate the workplace in a way that fosters improved communication, healthier workplaces and a more supportive and safe environment for them and their colleagues. Boynton achieves her goal, and delivers information that is useful, well-organized, easy to digest, and potentially possible to put into practice immediately.

The book walks the reader through three distinct sections covering various topics of interest to the nurse who wishes to work in an environment that supports positive relationships and respectful communication.

Part I addresses workplace dynamics, and identifies the characteristics of toxic workplaces, and delves into theories that explain human behavior, especially in the context of the workplace. Organizational culture is explained and dissected, and workplace violence---be it physical, verbal or emotional---is also addressed.

Part II is focused on "building assertiveness and respectful listening skills" and explores "strategies for creating organizational cultures where effective communication and respectful relationships can thrive".

Part III integrates the theories, insights and skills covered in Parts I and II in the context of nurses' experiences which were gleaned from interviews with nurses in the field. Common toxic behaviors are described and various revisions of the encounters in question are offered as examples of improved communication and healthier outcomes for all involved.


Toxicity in the workplace is an important subject rarely given its due, and Boynton succeeds in communicating her mission clearly in this very useful book. We all know that the health care system is suffering from various forms of overload and dysfunction, and the result for nurses is that we often feel powerless in the face of old patriarchal systems of organization, entrenched methods of communication, and hierarchical relationships that apparently strip us of our power and leave us literally speechless in the face of workplace violence, bullying, top-down management, and organizational failure.

Boynton gives nurses concrete examples of common situations wherein nurses can practice their assertiveness and respectful communication skills. She also provides practical tools for nurses within a theoretical framework that takes into consideration the characteristics of toxic workplaces, the ways in which workplace violence impacts nurses, and how effective communication can cut through the static to a place of greater clarity, personal empowerment, and professional satisfaction.

In a future edition of "Confident Voices",  I would like to see the author make use of a more diverse selection of real-life scenarios in order to address potential gender and power issues that her examples fail to take into consideration.


The nurse interviews used in the book to illustrate Boynton's thesis all feature female nurses who are interacting with male physicians in the hospital setting. While this gender dynamic may be common (and may be a deeply and culturally embedded knee-jerk reaction when we think of "nurse and doctor") there are now a plethora of female physicians working alongside male nurses, and male nurses working alongside male physicians.

Additionally, it would be interesting to explore workplace dynamics when we consider male and female nurses working together, as well as combinations of male nurses alongside male nurses, and female nurses collaborating with female doctors. It could also be enlightening to explore the dynamics of workplace violence, bullying and communication when considering comparisons between male and female supervisors and administrators, and the ways in which gender differences impact communication in health care. Several books have been written about the effects of feminism on the nursing profession, most notably "Daring to Care: American Nursing and Second-Wave Feminism" by Susan Gelfand Malka. Perhaps an exploration combining the effects of feminism on nursing and changes in communication would be an interesting follow up to "Confident Voices".

Within "Confident Voices", Boynton also does not address cultural, ethnic and racial differences in communication that could greatly impact nurses and those who work in health care institutions. Asians, Native Americans, Hispanics and other groups may have cultural practices and norms vis-a-vis communication that differ widely from white American culture. From eye contact to body language, communication in the workplace also needs to take these differences into consideration.

My Recommendation

Overall, I would highly recommend "Confident Voices" to any nurse who wishes to improve his or her own communication skills, share those skills with colleagues, and attempt to understand organizational culture with an eye towards creating positive workplaces for all concerned.

On the Radio

Beth Boynton will be appearing as a guest on RN.FM Radio: Nursing Unleashed on March 12th, 2012 at 9pm EST. Please tune in and you will be able to call into the show and ask Beth questions about her work as a nurse, writer, and workplace communication expert.

Monday, January 09, 2012

RN.FM Radio Launches Today!

Today, on Monday the 9th of January, 2012 at 9pm EST, RN.FM Radio will launch its inaugural broadcast on Blog Talk Radio. RN.FM Radio is the newest voice to emerge vis-a-vis the cutting edge of the nursing profession, and RN.FM Radio will bring to the airwaves the most diverse mix of entrepreneurs, bloggers, coaches, writers and thought leaders within the nursing community.

The show will be hosted by myself, as well as Anna Morrison of I Coach Nurses, and Kevin Ross of Innovative Nurse. As nurse entrepreneurs, our mission is to forge a new vision of nursing and what it means to be a nurse in the 21st century.

Upcoming guests will include: 

*Andrew Lopez of NurseFriendly.com on January 16th

*Laurel Lewis, Hospice Nurse and host of Death and Dying Dinner Parties in the Los Angeles area   on January 23rd

*Annette Tersigni, The Yoga Nurse on January 30th

........and many more thought-provoking and inspiring nurses!

Please tune in tonight, January 9th at 9pm EST on Blog Talk Radio, or listen to the archived shows afterwards. All shows will include the opportunity for listeners to call in and offer questions or comments, or participate in live chats with other listeners.

Please watch for the launch of our website, RNFMRadio.com, and you can also connect with us on Facebook and Twitter

RN.FM Radio is the new voice of nursing. Join us as we forge a new vision of nursing in the 21st century!

Tuesday, January 03, 2012

National Nurse Act of 2011 Signatory Letter

The following letter is being sent to all members of Congress to enlist their support of The National Nurse Act of 2011. If you would like to be a signatory to this letter, please contact Terri Mills, President of the National Nursing Network Organization, whose contact information is listed below. 
To The Members of the United States Congress:
We, the undersigned, urge you to support HR 3679 The National Nurse Act of 2011. This legislation would designate the Chief Nurse Officer of the U.S. Public Health Services as the "National Nurse for Public Health" to elevate the authority and visibility of this position. Chronic conditions such as diabetes, asthma, obesity, and others pose the single greatest threat to the health of Americans and our nation's economy. Nurses provide key services for the prevention and management of these conditions and this legislation is necessary to support further work needed to promote prevention, improve outcomes, and guide national, state and local efforts in addressing the nation's health.
This is the ideal time to make a National Nurse for Public Health a reality. The current administration and Congress have a clear commitment to wellness promotion and illness prevention. There is convincing evidence that the health of our country can be dramatically advanced by deploying our greatest and most trusted national health resource, America's nurses. Establishing a National Nurse for Public Health would be a practical step forward in publicly acknowledging the need for a focus on wellness and prevention. This legislation would provide the nation with a trusted professional representative from nursing to kickoff the move to prevention in whatever form of health-care system our lawmakers deliver.  
The National Nurse for Public Health would provide a visible nurse leader to advocate for enhanced prevention efforts for all communities. Further, we recognize the potential of having the National Nurse for Public Health as a representative who would meet with health care leaders to determine ways to address continued health disparities and poor health literacy.
We, as organizations and individuals, support this legislation as a means to achieve the goals of better health, decreased health disparity and improved health literacy and look forward to working with you on this important issue. We applaud your efforts in highlighting the important contribution of nurses and in your advocacy of improvement of the nation’s health. We strongly urge your support of The National Nurse Act of 2011.
Thank you for your consideration and please call upon us if we can be of further support as this bill moves forward.
Teri Mills MS, RN, CNE
President National Nursing Network Organization

Monday, January 02, 2012

What We Leave at the Door

As nurses, when we are preparing to walk into an exam room, a hospital room, or a patient's home, we bring with us a veritable toolbox of skills, ranging from biopsychosocial analysis to keen physical assessment skills. We are trained to look at the whole patient, the family system, and the multifaceted aspects of patients' lives.

However, we can also walk through that door with judgments, suspicions, preconceived beliefs, fears, projections, and a host of other "baggage" that may or may not serve the therapeutic relationship---nor our patient's chances of healing.

In my own work, I have witnessed patients and their families engaged in drug addiction, prostitution, child neglect, elder abuse, financial exploitation, and numerous other social conditions or actions that could often make my skin crawl. I also witnessed patients simply making poor choices, living in squalid conditions, refusing treatment, and otherwise choosing chaos over order, illness over health, and hell over healing.

When possible and necessary, I would intervene, and sometimes that meant calling the police or the local protective service organization. Sometimes it meant just listening and trying to get to the root of the behavior. At others, it was a call to a therapist, a psychiatrist, or a drug counselor.

No matter the situation, we health care providers bring to the situation our own life experiences, our own traumas, and a unique personal history. In this line of work, transference and projection are not just quaint vocabulary terms memorized during a requisite Psych 101 class, and if you're a nurse and you can't tell me what projection and transference are, then it's time to do some brushing up. (Perhaps that Psych 101 textbook is still in your garage somewhere.)

No matter where you are in the course of your career, you are subject to the same psychological forces as a novice nurse, and at times it is exactly our experience as seasoned nurses that can harm us the most. Cynicism, jadedness, and a sense of "I've seen it all before" can actually get in the way of our seeing the patient for who they are in the first place, so looking beyond our experience with fresh eyes and an open heart can work wonders for actually "seeing" the patient or situation in front of our very noses.

Before you walk in that door, think about what it is that you bring to the therapeutic relationship and the situaton at hand. What is the baggage that might get in the way? What are the stresses and worries from outside of work that need to be set aside? And once you're in that room, keep a sharp eye out for those projections, that sneaky transference, and the judgments that undermine your ability to be objective and most clinically effective.

And remember to ask yourself: What am I bringing to this encounter? What are the skills that I most need to activate at this time? And what do I need to leave outside that door