Digital Doorway

My Letter to the Arizona Board of Nursing in Defense of Amanda Trujillo

2012-01-25T11:28:00.000-05:00

Arizona State Board of Nursing
4747 North 7th Street, Suite 200
Phoenix, AZ 85014-3655
602-771-7800 Phone
602-771-7888 Fax
arizona@azbn.gov Email
http://www.azbn.gov/Default.aspx

To the Arizona State Board of Nursing:

I am a nurse, coach, nurse blogger and professional writer, and I have been following the case of Amanda Trujillo quite closely.

Having read the legal brief, Ms. Trujillo's statements, as well as other facts about the case, it is clear to me that Ms. Trujillo was acting completely within her scope of practice as a nurse when she provided the patient in question with information regarding her choices vis-a-vis her pending surgical intervention.

The fact that Ms. Trujillo is now being forced to undergo a psychiatric evaluation further supports the contention that no stone is being left unturned in efforts to undermine her credibility and her history as an exemplary nurse. It is ironic that the surgeon who demanded the suspension of her license and her ability to practice in the state of Arizona is undergoing no such evaluation or rigorous vetting process. The Arizona Board of Nursing and Ms. Trujillo's employers easily caved to demands by the surgeon that Ms.Trujillo be fired and lose her license, an action that once again demonstrates how the disparity of power between physicians and nurses continues to undermine nurses' ability to perform their duties according to a clearly stated scope of practice.

Ms. Trujillo was taken to task for "messing up" the surgeon's "hard work" of preparing for the scheduled surgery. Why was Ms. Trujillo not praised for providing necessary education to a patient who clearly demonstrated a startling knowledge deficit regarding what this surgery would entail for her? Nurses are trained to provide education and resources to patients, and that includes situations wherein physicians themselves fail to educate patients properly. Ms. Trujillo may have "messed up" this physician's "hard work", but she refused under these circumstances to "mess up" this patient's life by failing to educate her and provide the information that would elicit true informed consent, something that the physician in question clearly failed to accomplish.

The nursing community is rallying around Ms. Trujillo due to the facts that clearly demonstrate how Ms.Trujillo acted within her scope of practice and documented her actions clearly and concisely following her interactions with the patient. If the physician was inconvenienced by her actions, this issue could have been addressed by the facility's ethics committee. Instead, the Board of Nursing and Banner Health agreed to the physician's outrageous demands, allowing his power to prevent a measured and intelligent response to the situation at hand.

It would indeed have a chilling effect on the entire nursing profession if the Arizona Board of Nursing sets a precedent that redefines our profession and the collaborative health care model that has been the touchstone of professional nursing for decades.

As you by now understand, the actions against Ms. Trujillo and the suspension of her nursing license have ignited a firestorm of criticism regarding how this case has been handled by both the Arizona Board of Nursing and Ms. Trujillo's employer. The support is only growing, and those who are incensed by this situation will use the power of social media and the traditional media to bring the egregious nature of this case to the attention of the wider public.

I respectfully request that you consider dropping the complaint filed against Amanda Trujillo’s license and the case against her.

Sincerely,

Keith Carlson, RN, BSN, CPC

A Letter to the AZ Board of Nursing Regarding Amanda Trujillo

2012-01-25T09:54:00.001-05:00

Here is the text of a letter to the Arizona Board of Nursing posted by Anna Morrison of I Coach Nurses. Please disseminate widely. The original post can be found by clicking here.

Arizona State Board of Nursing
4747 North 7th Street, Suite 200
Phoenix, AZ 85014-3655
602-771-7800 Phone
602-771-7888 Fax
arizona@azbn.gov Email
http://www.azbn.gov/Default.aspx

To whom it may concern,

In the case of Amanda Trujillo, RN, a profoundly negative and chilling precedent threatens to silence nurses in their efforts to uphold their solemn oaths to protect, educate and advocate for their patients.

Additionally, a patient’s Right to Know and Right to Self-Determination are directly in jeopardy.

National Nursing groups, Patients’ Rights Advocacy groups, and the media have been put on alert and are watching this case carefully, hoping that the AZ BON makes the right choice to support the education and interventional activities of a nurse, who discovered a severe knowledge deficit in her patient and operated within her scope to rectify it.

It would be a shameful to set a precedent that re-defines our profession and the collaborative health care model that we thought we operated in for the good of our patients.

I respectfully request that you consider dropping the complaint filed against Amanda Trujillo’s license and the case against her.

Best regards,

Anna Morrison, BA, BSN, RN, CLNC

Amanda Trujillo: A Fellow Nurse on the Ropes

2012-01-24T18:34:00.000-05:00

Some readers of Digital Doorway may have already heard the story of Amanda Trujillo, an Arizona nurse who has lost her license based on nursing actions taken that were apparently fully within her scope of practice.

In the course of caring for a patient who was facing the potential of a liver transplant, Amanda offered this patient information regarding the availability of hospice as an alternative to this risky surgery with an uncertain outcome. It was clear to Ms. Trujillo that the patient did not understand the risks involved in this procedure, and she saw it as her professional duty to provide the appropriate resources and referrals to the patient so that she could make a fully informed decision. The patient subsequently chose to not undergo the procedure, and the physician who had planned and scheduled the surgery filed a complaint against Amanda and demanded that her license to practice be revoked.

Many of us in the nationwide nursing community are advocating for Amanda, and calling for the Arizona State Board of Nursing to cease and desist their actions which have deprived Amanda of her nursing license, brought her before the Board for disciplinary action, and requiring that she undergo a psychiatric examination. These actions are depriving Amanda and her daughter (she is a single mother) of their means of financial support, putting this small family at great risk of economic disaster.

The following is an open letter to the Arizona Board of Nursing, and was written by Kevin Ross of Innovative Nurse. I echo Kevin's sentiments, and urge all nurses and non-nurses who support Amanda's right to practice as a nurse to contact the Arizona Board of Nursing at 602-771-7800 or arizona@azbn.gov, informing them that we are watching this case closely and will not allow Amanda to be treated unfairly or unjustly.

Below Kevin's letter is a legal briefing describing the events in question. After reviewing the case details, please feel free to contact the Arizona State Board of Nursing on the behalf of Ms. Trujillo. The Board can be reached at 602-771-7800 or arizona@azbn.gov.

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An open letter to the Arizona State Board of Nursing.

Disclaimer, I have not been directly contacted by Amanda Trujillo, MSN, RN, DNSc-NP(s), nor do I know her personally or professionally. I am also writing to you based on the information that I have available to me.

To the Arizona State Board of Nursing:

To whom it may concern,

I am writing to you on behalf of Amanda Trujillo, MSN, RN, DNSc-NP(s) regarding the case attached below. I have not been contacted directly by Amanda Trujillo, and I have neither a personal or professional relationship other than that she is a fellow nurse in need of my support.

Based on the information I have (to my knowledge the same case documents that you also have), I would like to ask the board to carefully consider the information presented by both Ms. Trujillo and her legal team. From my understanding, it appears that Amanda Trujillo evaluated the health status of her patient based on her own clinical assessments and also data collected while being treated by the medical team at Ms. Trujillo’s place of employment during this time. It also appears from the information that Amanda Trujillo provided health teaching, counseling, and advocacy for her patient, which to my understanding of the Nurse Practice Act is well within her scope of practice.

As a nurse and patient advocate, I make certain that each and every patient I provide services to does in fact receive the highest quality nursing care while on my case. It should go without saying, but part of this care involves my ongoing support to ensure that my patient is knowledgeable about their diagnoses, medications, and ordered treatment plan. It is my job to protect the health and safety of each and every patient that I come into contact with, and to advocate for their needs based on my clinical judgement.

I am not in any way assuming that the treating physician was negligent, however considering that this is, and should have been a collaborative approach in the patient’s care, Amanda Trujillo was making her own nursing diagnosis based on her clinical assessment, which again to my knowledge is within her scope of practice as a registered nurse. She apparently discovered a deficit in her patient’s knowledge about their treatment options, and it appears that she acted ethically in supporting her patient’s wishes to seek additional information, and referred the patient to a case management specialist as per protocol.

I realize that these cases can carry with them a great deal of emotion due to the sensitive nature that our number one priority as licensed nurses is to protect our patient’s health and safety. It seems that Amanda’s duty to uphold the rights of her patient is being challenged, and the circumstances in which this transpired seems to have been initiated and fueled by emotion, and not based on facts. I just ask that you please consider all of the information presented to you, evaluate this case objectively, and if Amanda Trujillo is exonerated from these allegations, that she have the opportunity to continue to practice professional nursing.

Thank you in advance for your time and your consideration in this matter.

Sincerely,

Kevin Ross, R.N., BSN

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Please see the following for further details of the case:

BEFORE THE Arizona STATE BOARD OF NURSING

In the Matter of Registered Nurse License No. RN137552 issued to:
Amanda Trujillo, Respondent. )

RN/LPN INVESTIGATIVE QUESTIONNAIRE

DESCRIPTION OF EVENTS

(Nurse Practice Consultant, Ann Schettler)

Respondent Amanda Trujillo, by and through undersigned counsel, submits this Description of Events in response to a complaint filed against her in June of 2011 with the Arizona State Board of Nursing (“Board”) by Banner Del E. Webb Medical Center (“Webb”).

Description of Relevant Events
The allegations contained in the complaint arise from events that occurred on April 12th, 2011, when Ms. Trujillo was caring for a patient with end stage liver disease in the 3D Telemetry unit of Webb. Ms. Trujillo had been a registered nurse with Webb for approximately six months prior to the date of the alleged conduct and she normally worked the night shift from 7 a.m. to 7 p.m.

After assessing and communicating with the patient, Ms. Trujillo’s evaluation led her to believe that the patient did not fully understand what she had consented to when (pt) agreed to go forward with an intensive transplant evaluation scheduled to begin at Banner Good Samaritan Medical Center the following day. Based on her nursing assessment, Ms. Trujillo gathered patient education materials and spoke with the patient regarding the transplant evaluation, the waiting period and the commitment needed in following a lifelong self-care regimen. After their discussion, the patient expressed a desire to learn more about hospice care because (pt) was uncertain she was willing to take the necessary steps to maintain a successful organ transplant. Thus, the patient inquired into whether (pt) could speak with a hospice representative. Ms. Trujillo then placed an “order” for a case management consult with a hospice representative. Ms. Trujillo did not believe that requesting a case management consult was a medical order requiring physician permission; she believed the consultation was for educational purposes in order to give the patient a broad understanding of her options.

As a result of the additional information given by Ms. Trujillo, the patient determined (pt) did not want to go through with the liver transplant evaluation or resulting transplant procedure. When the doctor treating the patient found out about the patient’s wishes to forgo the evaluation he was unhappy that the patient had changed (pts) mind and determined that the education given by Ms. Trujillo was the underlying cause of the patient’s change of heart. He accused her of going beyond her scope of practice by entering a physician order without permission (“ordering” the case management consultation). As a result of the accusation, Ms. Trujillo was placed on administrative leave by her nursing director, Venus Gaines, and was eventually terminated by Webb.

Ms. Trujillo believes she was well within her scope of practice to assess the patient’s understanding of (pts) plan of care. She was not acting outside her scope of practice by educating the patient (deferring all questions outside of her scope to the medical team), once she determined the patient had a gross misunderstanding of what (pt) had agreed to participate in. Ms. Trujillo believed that the case management “order” she placed on the patient’s behalf was not a medical order that needed physician permission. Each step of the treatment provided by Ms. Trujillo to the patient will be analyzed below.

Patient Assessment
It is standard practice for Ms. Trujillo to ensure her patients understand their medications, plan of care and treatments. While fully reviewing the patient’s medical record Ms. Trujillo read a progress note entered by the patient’s primary care physician from earlier in the day that noted a “transplant evaluation is the only viable option outside of Hospice.” Utilizing the standard nursing process of patient assessment (assessment, diagnosis, planning, intervention, evaluation), Ms. Trujillo asked the patient a number of open-ended questions regarding (pts) hospital stay, medications, liver disease, procedures, etc. Ms. Trujillo asked the patient if (pt) had received any information or teaching regarding the proposed transplant evaluation. The patient, to Ms. Trujillo’s surprise, responded that (pt) did not understand (pts) disease, plan of care or what a transplant evaluation entailed. The patient asked Ms. Trujillo if she could provide some information regarding the disease and any less invasive choices that would allow (pt) to go home and be with (pts) family. Based on this request Ms. Trujillo determined the patient had a knowledge deficit regarding (pts) disease and the choice to receive palliative care.

Patient Education
Having assessed the knowledge deficit related to the patient’s routine medications, disease process, associated tests and procedures, the plan of care for transplant evaluation and palliative care options, Ms. Trujillo proceeded to print out patient educational material from Banner’s website that addressed those areas. Additionally, she printed out education materials from Banner’s transplant website pertaining to what to expect during a transplant evaluation and what to expect after a transplant. Ms. Trujillo also provided materials related to hospice care per the patient’s request. Ms. Trujillo, concerned about the patient’s lack of understanding of (pts) treatment regimen and the option for comfort care, discussed her education of the patient with her clinical manager, Frances Fausto, who readily supported Ms. Trujillo’s plan of care and interventions.

Ms. Trujillo and the patient reviewed the materials over the course of the night. After a full review of the materials the patient stated, “Had I known everything I would have to go through and the commitment I would have to make, I would not have agreed to the transplant evaluation.” The patient inquired into whether there was anything else (pt) could do besides enduring more tests, procedures or surgeries. Ms. Trujillo then explained hospice care services and the differences between symptom relief care and end of life care. The patient expressed serious concern that (pt) would not be able to commit to an extensive aftercare regimen following the transplant by stating “at this stage in (pts) life (pt) just wanted to be around family.” The patient requested to visit with a representative from hospice in order to ask some questions and gain additional information that would assist (pt) in making a more informed decision regarding (pts) course of care.

Ms. Trujillo placed a note in the chart pertaining to the assessment of knowledge deficit, the specific education provided and the palliative care discussion, in addition to, the patient’s request to see a case manager from hospice. She used the SBAR (Situation, Background, Assessment and Recommendation) format of report required in Banner policy when she handed off care of the patient to the dayshift nurse, alerting the nurse that the patient requested more information prior to being transferred to another facility for a transplant evaluation. She also alerted the dayshift nurse that there was a nursing note in the record for the doctor to read that detailed what occurred over the course of Ms. Trujillo’s shift with the patient.

Case Management Consult
As a relatively new nurse to Banner, Ms. Trujillo self-educated in order to work within Banner’s policies and procedures. She found no specific policy or procedure regarding end of life care that prohibited her from obtaining case management consultations for her patients. She also could not find any policy or procedure that gave a formal definition of a “physician order” or what nurses could order and what they could not. In fact, Ms. Trujillo had ordered hospice consultations for her patients on numerous occasions prior to this incident without any objections from other physicians or Webb administration. She entered the “order” with a note stating, “per patient request, patient wants to visit with hospice representative for more information.” In fact, the computer system in place at Webb allows her to click a box that further specifies “Nurse Ordered,” which she did on this occasion.

The only reason Ms. Trujillo’s actions turned into allegations of unprofessional conduct is because the primary care physician on this case, The Dr. initiated an angry public display when he found out that the patient had changed (pts) mind regarding the transplant. Ms. Trujillo was surprised when the nursing director, Venus Gaines, went so far as to tell Ms. Trujillo that the physician was angered because she had, “messed up all of the work they had done, and that the doctors were nowhere near going down the hospice route.”

Conclusion
This was not a medical order. This was a nurse trying to help a patient become better informed about a life changing procedure and (pts) right to choose what direction (pts) care would go. Ms. Trujillo’s actions were well within her scope of practice and she conscientiously kept her line of teaching within the boundaries of her scope of practice by taking care to utilize the proper channels to obtain patient teaching materials and advising the patient to ask the doctors about more complex questions she was unable to answer as a registered nurse.

The patient had the absolute right to self-determination regarding her course of treatment, as illuminated in Senate Bill S. 1052, the Bipartisan Patient Protection Act, after receiving additional information regarding her disease. Ms. Trujillo, working within her scope of practice and the nurse’s code of ethics, honored and protected that right when she abided by the patient’s requests to the best of her ability.

Accommodating a patient’s request for a consultation with a hospice case manager does not require a physician’s order. No medication was requested, no equipment was needed, and no procedures were required. A patient simply wanted to speak with an expert regarding her options for comfort care and end of life care, so that (pt) could make the best decision about (pts) future.

It is standard knowledge that the Cerner electronic health records system in place at Webb contains a box that states, “Nurse Ordered.” Why would this box exist if nurses were never allowed to “order” anything? The Complainant contends that Ms. Trujillo overstepped her scope of practice by ordering the consult; however, it is standard practice of the hospital to allow nurses the freedom to do the exact thing alleged in the Complaint.

Ms. Trujillo was allowed to order case management consults on numerous occasions prior to this and was never told by the hospital that this practice was not allowed or outside the scope of her practice. It is apparent that the hospital is simply trying to appease and placate an angry physician by filing this Complaint against Ms. Trujillo.

She looks forward to discussing this matter with the Board, if necessary, and hopes to conclude this matter expediently.

SUBMITTED: July 11, 2011
ROBERT CHELLE LAW
By: ______________________
Robert Chelle
Attorney for Amanda Trujillo

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

2012-01-19T09:03:00.000-05:00

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.
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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.

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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.

Seven Years of Digital Doorway

2012-01-18T14:41:00.004-05:00

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!

NurseFriendly on RN.FM Radio!

2012-01-15T08:09:00.000-05:00

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!

Book Review: "Confident Voices" by Beth Boynton

2012-01-11T18:41:00.001-05:00

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"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.

Summary

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.

Discussion

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.

Suggestions

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.

RN.FM Radio Launches Today!

2012-01-09T10:37:00.001-05:00

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!

National Nurse Act of 2011 Signatory Letter

2012-01-03T19:54:00.002-05:00

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 theNational Nursing Network Organization, whose contact information is listed below.

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To The Members of the United States Congress:

We,the undersigned, urge you to support HR 3679 TheNational Nurse Act of 2011. This legislationwould designate the Chief Nurse Officer of the U.S. Public Health Servicesas the "National Nurse for Public Health" to elevate the authorityand visibility of this position. Chronic conditions such as diabetes, asthma,obesity, and others pose the single greatest threat to the health of Americansand our nation's economy. Nurses provide key services for the prevention andmanagement of these conditions and this legislation is necessaryto support further work needed to promote prevention, improveoutcomes, and guide national, state and local efforts in addressingthe nation's health.

Thisis the ideal time to make a National Nurse for Public Health a reality.The current administration and Congress have a clear commitment to wellnesspromotion and illness prevention. There is convincing evidence that thehealth of our country can be dramatically advanced by deploying our greatestand most trusted national health resource, America's nurses. Establishing aNational Nurse for Public Health would be a practical step forward in publiclyacknowledging the need for a focus on wellness and prevention.This legislation would provide the nation witha trusted professional representative from nursing to kickoffthe move to prevention in whatever form of health-care system ourlawmakers deliver.

TheNational Nurse for Public Health would provide a visible nurse leader toadvocate for enhanced prevention efforts for all communities. Further, werecognize the potential of having the National Nurse for Public Health as arepresentative who would meet with health care leadersto determine ways to address continued health disparities andpoor health literacy.

We,as organizations and individuals, support this legislation as a means toachieve the goals of better health, decreased health disparity and improved healthliteracy and look forward to working with you on this important issue. Weapplaud your efforts in highlighting the important contribution of nursesand in your advocacy of improvement of the nation’s health. We stronglyurge your support of The National Nurse Act of 2011.

Thank you for your consideration and please call upon us if wecan be of further support as this bill moves forward.

TeriMills MS, RN, CNE

teri@nationalnurse.info

PresidentNational Nursing Network Organization

503-320-2385

http://nationalnurse.org

What We Leave at the Door

2012-01-02T22:59:00.000-05:00

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?

Nurse Keith Coaching is Born!

2011-12-31T01:13:00.000-05:00

In the last few days, my new website and coaching venture was officially birthed! Nurse Keith Coaching is now live, and the process of making it a reality has paid off! There has been a great deal of support from my community of friends, family and colleagues. Now the task is spreading the word that I am now available to provide professional coaching for nurses and nursing students who want more out of their lives and their careers.

As I say on my website:

As nurses, we spend a great deal of time caring for others and precious little time caring for ourselves. Our work can be all consuming, and in that process we can easily lose touch with our own health, happiness, and sense of balance. Toxic workplaces, heavy workloads, stressful work conditions, mandatory overtime and unhappy, cynical colleagues can all leave us feeling undermined in our attempts to be healthy and happy in our work and at home.

Nurses are caregivers, but we can only provide the best care when we are also taking care of ourselves properly. Exercise, nutrition, weight loss, stress management, leisure and fun, work-life balance, spirituality, financial prudence, relationships—all of these aspects of our lives impact our ability to be at our best when we engage in our work.

My skills allow me to hold space for where you currently are in your life, but also to challenge you to dig deeper and find the places where you still want to grow.

So, please stop by NurseKeith.com, visit and "Like" my Facebook page, and let me know how I might be of service to you.

Nursing and Transformation in the New Year

2011-12-27T12:09:00.000-05:00

As the dawn of 2012 beckons, I hold a new vision for the nursing profession.

Along with the rest of large segments of humanity, nurses are waking up. Nurses are realizing that the old paradigms no longer apply, and that the vestiges of Old World thinking (when it comes to nursing and medicine) are dying as we speak. Health care must be transformed, and since nurses are the largest segment of the American health care industry (and perhaps in the world), we nurses could indeed "occupy" health care in a way that could potentially turn the entire industry on its head. The political will of nurses will be tested, and I am encouraged by the rumblings that I hear as I put my ear to the virtual tracks.

Contrary to popular images propagated by the media (in Hollywood, television, the news, and other sources), nurses are not handmaidens to doctors, sex kittens in white uniforms, or background characters who simply serve as foils to George Clooney and other TV doctors. (Although we may notice on close inspection that only actors who play doctors on shows such as "ER" ever seem to move into the limelight.) Nurses are more than this, whether the media wish to portray us realistically or not.

As usual, nurses have ranked as the most trusted professionals in the United States yet again in the most recent Gallup poll. This is the 12th time out of 13 years that nurses have earned this honor from the American people. The only occasion when nurses were not the number one most trusted professionals was in 2001 when firefighters earned that top spot following their heroic efforts in the aftermath of the September 11th terrorist attacks.

From my own perspective, one way for nurses to be more effective is to be more vigilant in their own self care. That's why I have decided to offer my own coaching services for nurses to assist them in living the healthiest and most satisfying lives possible. Nurses can impact the health care industry when they are healthy and balanced. Thus, preventing burnout and adopting a healthy lifestyle can have a far reaching impact on patients, fellow nurses, other colleagues, and beyond.

I am proud to be a nurse, and I can see that the nursing industry is still in it infancy when it comes to embracing change, championing that change, and subverting the dominant paradigms that keep nurses and nursing care relegated to the past rather than focused on the future. Still, I'm hopeful, optimistic and looking forward to the ways in which nursing---and the world at large---will transform in 2012. These are momentous times, and we have only seen the tip of the iceberg as Americans---and people all over the world---wake up to the many disparities that are crying out for transformation. Nurses can lead the way in health care, and I hope to be part of the actions and conversations that bring that transformation into being.

RN.FM Radio is Coming!

2011-12-21T19:42:00.000-05:00

On January 9th, 2012, several esteemed nurse entrepreneurs and I will officially launch RN.FM Radio: Nursing Unleashed, a new internet radio station on Blog Talk Radio!

Our mission is to shake up the nursing profession and blow the roof off of the idea of a nurse as just a humble bedside servant. We're here to prove that you can be a nurse, be ultra-savvy and innovative, make a huge difference in patients' and other healthcare providers' lives, and improve your own life and experience of the profession of nursing, all at the same time.

We want to support bedside nurses in re-engaging their creativity and innovation to generate solutions to today's complex healthcare challenges, thereby improving patient and healthcare provider experience, while also elevating their own status, well-being and income as business owners and entrepreneurs.

RN.FM Radio will be hosted by Kevin Ross of Innovative Nurs e, Anna Morrison of I Coach Nurses, and yours truly. I am so lucky to be collaborating with these two nurse entrepreneur and blogger powerhouses!

Our inaugural broadcast will air at 9pm EST on Monday, January 12th, 2012 and every Monday thereafter. We plan to feature engaging and lively interviews with prominent nurse entrepreneurs, bloggers, writers, researchers, activists and thought leaders from the nursing world.

You can find us on Facebook, follow us on Twitter, or join us on Monday evenings (or listen to our podcasts and archived shows) beginning January 9th as we forge a new vision of the future of nursing! See you there!

National Nurse Act of 2011 Introduced

2011-12-17T16:57:00.002-05:00

PRESS RELEASE

Washington, DC – (Friday, December 16) – Yesterday, Congresswoman Eddie Bernice Johnson (D-TX) introduced the National Nurse Act of 2011, HR 3679. The bill, co-led by Congressman Peter King (R-NY), has garnered eighteen original co-sponsors. It would designate the Chief Nurse Officer of the U.S. Public Health Service as the “National Nurse for Public Health.”

The National Nurse would function alongside the Surgeon General and focus on health promotion, improving health literacy, and decreasing health disparities.

“The National Nurse Act of 2011 is an important piece of legislation that would establish a focal point for promoting health and disease prevention. There are currently 3.4 million nurses, making the demographic the largest sector of healthcare workers in the United States.

“As the first registered nurse in Congress, I believe that having a National Nurse focused on prevention activities will help reduce illnesses and decrease the costs for care and services,” said Congresswoman Johnson.

The National Nurse Act of 2011 is currently endorsed by dozens of prominent nursing organizations and key stakeholders.

Nurses' Voice, Nurses' Image: Nurses' Power

2011-12-16T01:23:00.000-05:00

Since it feels timely to do so, I am choosing to republish a previous blog post from 2009 that I feel is still poignant and worthy of discussion. Here is the post in its entirety, originally published under the auspices of the nurse blogger scholarship which I received from Value Care, Value Nurses, the nursing arm of the Service Employees International Union (SEIU).

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I have recently been re-reading From Silence to Voice: What Nurses Know and Must Communicate to the Public, by Bernice Buresh and Suzanne Gordon. What I am most struck by is that nurses still have not necessarily found their collective voice, and despite the media attention given to the global nursing shortage, I still believe that Buresh and Gordon's thesis still holds true: the public still does not fully understand what nurses do, and until that day comes, nurses' real value as clinicians will not be common knowledge.

Buresh and Gordon touch on many themes and areas of interest vis-a-vis nurses and their relation to the public, to doctors, and to one another. While I will not provide a review of the book---nor a comprehensive enumerating of its content---there are certain area which pique my interest, and I encourage curious readers to order a copy of the book and explore some of these issues for themselves.

Doctors Cure, Nurses Care

When I first heard this phrase, I was moderately disturbed by it for several reasons. Doctors, by and large, receive the lion's share of praise and gratitude when a sick patient is cured of an illness. Granted, doctors undergo a great deal of training and education in order to offer curative treatments for a variety of diseases, yet all too often, the work of nurses is grossly overlooked when it comes to successful treatment. While nurses do indeed carry out many orders originated from doctors, nurses use their own brand of critical thinking and autonomous action in order to perform specialized patient care. The public may not be aware of this fact, but many actions taken by nurses are initiated by nurses themselves, and the professional clinical assessments performed by nurses will often lead to changes in treatment and greater overall success.

Sure, nurses care, and nursing is seen by the public as a "caring" profession. However, nurses utilize scientific methods, skilled observation, and keen assessment skills to monitor patients' progress. Nurses are not just "the caring eyes and ears of doctors"---nurses are skilled professionals fully involved in patient care---and patient cures.

The Nurse as Angel, Teddy-Bear, and Child

In their book, Buresh and Gordon make one thing clear: nurses' self-presentation says a great deal to the public, and images of nurses that instill themselves in the societal zeitgeist are difficult to dispel.

Somewhere along the line, the "angels of mercy" moniker became attached to nurses as a group. Granted, in the early days of nursing, nurses' ability to act autonomously was extremely limited, and we were, by and large, the handmaidens of deified doctors. However, as much as that regrettable history has largely changed, the image of the nurse as angel unfortunately persists quite widely in our culture and websites galore promote gifts and baubles that continue to diminish nurses' professionalism. Images such as this one drive home the point: nurses are childlike individuals with starched white hats who love teddy-bears. Adding insult to injury, nurses can actually be depicted as winged angel/teddy-bears, further enforcing the infantilization (and deprofessionalization) of our profession. Would doctors allow themselves to be thus represented to the public?

Rather than being perceived as cherubic angels and childlike creatures, this writer feels that being perceived as the valuable and skilled professionals who we truly are would allow the public to have a much more accurate perception of what we do, and our importance to the care of millions.

The Clothes on Our Back

Nurses' uniforms have certainly changed over the years, and as scrubs have become the norm for nurses in most clinical settings, many companies have capitalized on the popularity of such utilitarian clothing. Now, designer scrubs covered with angels, teddy-bears (there they are again!), and any number of cartoon-like images adorn the hard-working bodies of nurses around the world. If nurses want to be taken seriously by the public---and by doctors and other professionals---how does the wearing of such (in my opinion) unprofessional clothing help our cause?

Picture this: a team meeting occurs midday to discuss a patient on the adult oncology floor. Present at the meeting: a medical resident, a medical student, the attending doctor, the oncologist, two unit nurses, a social worker and a respiratory therapist. Of all of the professionals in the room, who would possibly be wearing pink scrubs covered with teddy-bears and hearts, and a pin on her chest saying "Doctors Cure, Nurses Care"? And what message does this convey about the nurse's self-image and how the other professionals present in the meeting should perceive him or her?

What's in a Name?

In From Silence to Voice, Buresh and Gordon make their case that nurses being addressed by first name only is also a major image problem when it comes to the public's perception of us a collective whole.

When doctors introduce themselves to patients or other professionals, they always do so by using the title "Doctor" before their name. This practice immediately creates an impression that the doctor is a professional, that he or she has a name that should be remembered, and a hierarchy of power and authority is clearly established from the start.

Conversely, we nurses almost ubiquitously introduce ourselves by first name only, ostensibly to break down the barriers between patients and nurses, assisting the patient in overcoming fears and anxieties related to their treatment. While this tactic may have some limited benefit, Buresh and Gordon argue that "if nurses introduce themselves by their first names only, they are asking to be regarded as nonprofessionals because that is the conventional way that nonprofessionals present themselves."

The "first-name only convention", as the authors have named it, makes it significantly more difficult for individual nurses to receive recognition for their work when only their first names are known. It also creates a hierarchical structure in which the doctor stands alone as a figure of authority, towering above the patient and nurse with (patriarchal or matriarchal) power and authority.

Interestingly, many nurses will argue that introducing ourselves as "Nurse Smith" or "Nurse Cadmus" is awkward at best, but also brings to mind the infamous "Nurse Ratched" from "One Flew Over the Cuckoo's Nest". Granted, Nurse Ratched is a mythic and hated figure in the pantheon of film and modern literature, yet do we see doctors eschewing their well-earned title due to historical figures such as Dr. Kevorkian or Dr. Mengele (of Auschwitz fame)? Absolutely not. Doctors use their title so commonly and so frequently that the word "doctor" simply holds too much cultural power to be diminished by one literary (or real-life) character who used that title for ill.

As for "naming practices" between doctors and nurses themselves, further examples of an unequal playing field emerge, with nurses almost continually subjugated to a diminished status by always being addressed by first name by both patients and doctors, whereas doctors maintain their professionalism and authority through the use of their title and last name.

Taking Credit Where Credit is Due

All too often, the work of nurses is diminished by nurses themselves. When thanked for their work, nurses will frequently say, "Oh, I didn't do much. The doctors really did the hard part." Or when a nurse is asked what he or she does, the answer will often be, "I'm just a nurse." This diminution of nurses' worth does little to cement in the public's collective mind the utter importance---the crucial presence---of nurses in the healthcare system. The "just a nurse" phrase---used all too painfully often---hurts nurses' cultural standing and diminishes the profession in the public's eye.

Nurses need to stand up and take credit for the work that they do. Buresh and Gordon urge nurses to say "You're welcome" when they are thanked. "I am so glad that I could assist you in learning so much about your diabetes, Mr. Smith" or "It was my pleasure to provide your post-operative nursing care, Mrs. Jones"---these are statements that take credit for nurses' actions, acknowledge patients' gratitude, and accept responsibility for providing crucial nursing care that directly impacts patients' recovery and health.

Nurses' Agency

Buresh and Gordon recommend that nurses discover their "voice of agency". According the authors, "the voice of agency is the voice that says: 'I helped the patient to walk after surgery so that she wouldn't get blood clots in her legs' or 'I taught the patient how to take his medications so that they would be effective and produce fewer side effects.' The authors further illustrate their point by reminding us that "the voice of agency is the voice that conveys the message, 'I'm here. I am doing something important.' "

For nurses to develop their own agency---their own power---nurses must first claim and recognize the importance of what they do. As Buresh and Gordon elucidate so clearly in their book, patients do not learn self-care skills in a vacuum. Someone must teach them those skills, and it is nurses who bring their knowledge and education directly to patient care. When recovering from surgery, it isn't doctors who monitor patients every fifteen minutes, using a lifetime's worth of learning to perform important expert assessments. Nurses use a wide variety of skills---often on an autonomous basis---to provide patients with the care and attention they need for optimal health.

While nurses are indeed held in very high esteem by the general public in surveys and polls, most members of that adoring public would be hard pressed to actually describe what it is that nurses do. As Bernice Buresh and Suzanne Gordon make so abundantly clear, it is up to nurses to claim their rightful place of importance in the care provided to patients in a variety of settings. Nurses need to proudly speak of their work with a voice of agency and power, and communicate clearly---to the public, the media, their families, their friends, and their colleagues---that nursing is important, that it is meaningful, and that what nurses do contributes to successful patient care and positive outcomes. We must forgo the teddy-bears, the hearts, the flowers, the useless diminutive statements and self-deprecation, and claim our professionalism for our own.

Nursing's voice must be heard, and Buresh and Gordon feel that the time for that voice to be clearly heard is now.

Why Coaching For Nurses?

2011-12-13T12:06:00.001-05:00

When I speak with people about my newly launching coaching practice for nurses (which will shortly be live at NurseKeithCoaching.com and NurseKeith.com), they often ask why nurses might need coaching. There are many reasons that nurses can benefit from coaching, and when you take into consideration the fact that nurses are responsible for the care of millions of people worldwide, it makes sense that nurses should be healthy, balanced and happy at home and at work so that they can perform at their best.

As nurses, we spend a great deal of time caring for othersand precious little time caring for ourselves. Our work can be all consuming,and in that process we can easily lose touch with our own health, happiness,and sense of balance.

Coaching with me is meant to be all about you. It’s about rediscoveringthe things that you love about your work. It’s about reconnecting with what’sunderneath your desire to be a nurse. It’s also about finding balance in yourlife, and making your own health, happiness, relationships and life satisfactionthe focus.

Nurses are caregivers, but we can only provide the best carewhen we're also taking care of ourselves properly. Exercise, nutrition, weightloss, stress management, leisure and fun, work-life balance, spirituality,relationships---all of these aspects of our lives impact our ability to be atour best when we engage in our work. And when our lives are out of balance, wesuffer on multiple levels.

My intention is to provide coaching that lifts nurses' spirits, assists them in identifying their goals, their strengths and their areas of challenge, and creating a life that more clearly resonates with their spirit and their vision of the best possible life.

If nurses are the backbone of the health care industry, then that backbone needs the support to be the strongest and healthiest it can be. Nursing should be something you do, not just something that does you in!

Nurse Keith Coaching Is On The Way!

2011-12-09T00:46:00.001-05:00

Happy holidays, readers of Digital Doorway! I hope this finds you well and happy!

The purpose of this post is to inform you that the nature of my private coaching practice is changing, and I have decided to focus completely on the coaching of nurses. As an experienced nurse and coach, I feel that my coaching skills can serve in their greatest capacity by helping nurses to live the most satisfying and healthy lives possible. I plan to offer services ranging from health and wellness, weight loss and stress management to burnout prevention, burnout recovery and work-life balance, and I am already in discussion with others in the industry to create exciting partnerships and joint ventures to add even more value and power to my offerings.

Coaching with me is all about you. It’s about rediscoveringthe things that you love about your work. It’s about reconnecting with what’sunderneath your desire to be a nurse. It’s also about finding balance in yourlife, and making your own health, happiness, relationships and lifesatisfaction the focus.

Nurses are caregivers, but we can only provide the best carewhen we are also taking care of ourselves properly. Exercise, nutrition, weightloss, stress management, leisure and fun, spirituality, relationships---all ofthese aspects of our health impact our ability to be at our best when we engagein our work. And when our lives are out of balance, we suffer on multiplelevels.

You can work with me to improve your work-life balance, getyour health on track, set personal and professional goals, and make nursingsomething that you do and love, not something that does you in!

My new website---currently under construction---will be located at NurseKeithCoaching.com and also linked at NurseKeith.com. There will be a frequently updated Facebook page, as well as my continued presence on Twitter (as NurseKeith). My plan is also to eventually offer free downloads, audio podcasts, and perhaps branch into webinars, internet radio and live workshops here in Santa Fe.

At this point, I am requesting that you hold this endeavor in your heart, knowing that I am creating this coaching practice so that more nurses can be healthier, happier, and more successful and satisfied clinicians. I am so excited about the coming birth of Nurse Keith Coaching, and I will post a formal announcement as soon as the website is live!

Gratefully,

NurseKeith

Pathways in Nursing Infographic

2011-12-02T20:26:00.000-05:00

The good folks over at NursingLicenseMap.com have created an interesting infographic on the various pathways of a nursing career, including average salaries and other data. It is well worth perusing, and I include a copy of the infographic here for your enjoyment and edification. Brought to you by Nursing License Map and Nursing@Georgetown.

Book Review: The Millionaire Nurse

2011-11-30T17:21:00.001-05:00

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.

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Dr. Dean Burke, MD is a successful OB/GYN and author who has branded himself as a champion of nurses' financial freedom. Married to a nurse, Dean has an intimate understanding of the challenges and vicissitudes of the nursing profession, and he encourage nurses to leverage his knowledge and advice in the interest of their own financial well-being. Since nurses are so good at caring for others, Dean contends that they should also be just as good at managing their own lives, financially and otherwise.

The Millionaire Nurse is a book and companion website that walk nurses through the basics of financial management, using simple language and understandable examples to illustrate the subject at hand. Dean offers practical advice on a variety of subjects, relating the issues generally to nurses' lives, nurses' income levels, and the challenges that he knows many nurses face in the real world. While money management is foremost in Dean's writings, time management and the enjoyment of life also figure largely in Dean's world of wealth and financial freedom. Dean's writing leans towards the casual, with pithy puns and down-to-earth language not usually found in books about money.

The subjects covered in The Millionaire Nurse include calculating net worth, debt management, homeownership (including buying and selling), budgeting, salaries and benefits, insurance, saving money at home, saving and paying for college, retirement and investing. And while a great deal of this information could be gleaned from any number of books, websites or magazines about finance, none of those sources are written specifically for the nurse, using real-life examples from nurses' lives and data that reflect the reality of those lives.

Dean states in his introduction: "My plan in The Millionaire Nurse is to help you to prioritize and rearrange your financial dreams into reasonable and reachable goals. I also feel it is my duty to give back to you, the nurses who have saved my rear-end more than once."

Whether your financial situation is in need of intensive care, outpatient surgery or emergency resuscitation, Dr. Dean offers no-nonsense advice that I believe is sound, understandable, digestible, and practical. His free downloadable e-book, "Emergency Money Resuscitation", is a very helpful volume, as is his regular email newsletter that is sent periodically to subscribers.

Dean on investing: "Emotional decisions are the enemy of good investing. Just as when you're faced with an extremely ill patient, panicking never helps---especially the patient."

Dean on debt: "One of the most difficult aspects of retiring your debt is taking the ego out of your decisions."

Dean on setting financial goals: "Goals are necessary. In the long run, you'll begin to look forward to setting goals for yourself, not the least because they not only give you direction, they also act as self-fulfilling prophecies."

I recommend "The Millionaire Nurse", whether you plan to be a millionaire or not. We nurses work hard, serve the greater good, and many of us struggle financially like so many others, whether we live here in the United States or abroad. Dr. Dean offers a readable and user-friendly plan that can be shared with friends and family members alike. We should all be committed to our own financial well-being and freedom, and I'm grateful to Dean for caring enough about nurses to create products specifically geared towards our noble and valuable profession.

Book Review: Nursing 2012 Drug Handbook

2011-11-22T17:26:00.001-05:00

I will begin this review with the disclosure that Publisher Wolters Kluwer contacted me through a marketing agent and requested that I post a review of their new Nursing 2012 Drug Handbook here on Digital Doorway. I did not receive financial compensation of any kind for this review, but did receive a free copy of the guide in order to facilitate the review process.

Upon first glance, the new Nursing2012 Drug Handbook looks like any other drug handbook I have encountered in the past. However, on further inspection I was pleased to see several aspects of this book that are both useful and user-friendly.

Traditionally, nursing drug handbooks utilize a simple alphabetical listing of drugs that allows a nurse to easily use the book as an easy and quick reference tool. This book follows the same format, including new FDA-approved drugs, black box warnings, and other information that a prudent nurse would require and expect.

There are several aspects of this guide that I find especially useful and worthy of notice, and these include:

A color photo guide to "396 tablets and capsules, representing the most commonly prescribed generic and trade name drugs." These are listed alphabetically by generic name, and the photos are shown in actual size and color, with cross-referencing to drug information in other portions of the book.

Each drug entry includes a small table with route, onset, peak duation, and half-life clearly listed.

Overdose information is listed in red.

Look-alike and sound-alike warnings are given for appropriate medications.

The useful appendices include:

Pregnancy risk categories
Controlled substance schedules
Quick guide to combination drugs
Common combination drugs
Vaccines and toxoids: indications and dosages
Vitamins and minerals: indications and dosages
Therapeutic drug monitoring guidelines
Cytochrome P-450 enzymes and common drug interactions
Drugs that prolong QT intervals
Dialyzable drugs
Abbreviations to avoid
Herbal supplements
Drugs that shouldn't be crushed or chewed
Avoiding common drug errors: best practices and prevention
Pediatric drugs commonly involved in drug errors
Elder care medication tips
Additional new drugs: indications and dosages

The purchase of the book also provides the owner with a one-year subscription to Lippincott's online Nursing Drug Advisor, a site that provides online access to monographs of every medication in the text. This access also includes an online toolkit, with a dosage calculator, English-to-Spanish drug phrase translator, tables of equivalents and conversions, and discounted CE programs.

Overall, I am very impressed by the layout of the book, the appendices, and the online content.

Through the publisher, I have several offers to elucidate at this juncture.

The first nurse who leaves a comment on this post will receive a free copy of the book directly from the publisher. (The winner will need to provide me with their mailing address.)
Other nurses who wish to purchase the book can do so via this link, receiving an instant 20% discount as a reader of Digital Doorway. (I receive no remuneration for these purchases, and I am simply passing on these savings to my readers based on an offer from the publisher.)

This book is a worthwhile investment, and I am happy to have my own copy, as well as access to the very useful and user-friendly online resources.

My Newest Blog Is Live

2011-11-10T12:29:00.001-05:00

I am grateful to the good people at LPNtoBSNonline for inviting me to be their new resident "expert blogger". The blog is now live, and you can visit the blog by clicking here. The posts are generally geared towards nurses---both seasoned and novice---and those who wish to enter the field.

Please stop by regularly since there will be two new posts every week!

"So, Which Hospital Do You Work In?"

2011-11-08T13:58:00.002-05:00

Whenever I tell someone that I’m a nurse, the inevitablequestion follows: “So, which hospital doyou work in?”

While I have nothing against hospitals (well, maybe I do!)or nurses who work in them, I have chosen to forge a nursing career utterlyfree of the hospital environment. Although many colleagues assured me that itwas professional suicide to do so, I chose to eschew the one or two years ofMed-Surg that most nurses undergo after graduation, and I entered directly intocommunity nursing and never looked back.

My History

Over the last 15 years, I’ve worked as a nurse in two urbancommunity health centers that served low-income Latinos, held a position as aNurse Care Manager for several cutting-edge case management programs in thesame low-income urban neighborhoods, worked as a visiting nurse, a hospicenurse (inpatient and outpatient), as well as a stint as a nursing professor andas the sole Public Health Nurse for a New England town of 25,000 people. Meanwhile,I’ve maintained a popular nursing blog, have contributed chapters to severalbooks about nursing, been interviewed on radio and internet radio, and beenpublished on a variety of nursing websites as a regular contributor.

Despite my lack of hospital experience, I have never feltencumbered by a less-than-interesting career or by the sense that something ismissing from that career. Needless to say, if I was to seek a position in ahospital-based program or unit, I might have to first spend a year or so inMed-Surg, and that would be fine. Meanwhile, my career is wholly satisfying andI have never lacked for interesting and remunerative work.

The Public’sPerception

When someone reflexively asks me what hospital I work in, Iam immediately reminded that the public simply has no real idea what nurses doand simply base their image of nursing on images from television and themovies.

If you ask the average American what their image of a nurseis, they will most likely describe a nurse in scrubs working in a hospital, oran older American just might conjure up the image of a nurse in starched whiteswith a little cap on her head. Those images indeed still persist, despite theefforts of some in the nursing community to counter that outdated stereotype.

Sadly for us, Nurse Ratched (of “One Flew Over the Cuckoo’s Nest” fame), is probably the most famousnurse in the American zeitgeist after Florence Nightingale, so many Americansmay either see nurses as crazed sadists armed with arm-length needles or angelsof mercy who serve as a doctor’s handmaiden amidst the horrors of war anddisease.

What Does It AllMean, Anyway?

The public has a particular perception of nurses that isskewed by television and the media’s ability to create cultural icons that aredifficult to overcome. It is the mission of many nurses to change thatperception by providing a new paradigm in which nurses are perceived as trainedand competent professionals that work in a variety of clinical settings.

From a personal point of view, I feel it is equallyimportant for both nurses and the public to understand that, while hospitalnursing is a crucial aspect of the profession, there are scores of nurses whochoose to work in community-based positions that do not involve employment by ahospital. While some hospital nurses may see non-hospital nurses as somehowinferior (an erroneous perception that I have personally encountered during mycareer), non-hospital based nurses contribute a great deal to society and tothe nursing profession as a whole.

Whose ResponsibilityIs It?

Nursing has changed a great deal, especially over the last100 years, and I believe that it is in the collective interest of all nurses totake responsibility to mold and recreate the public’s perception of who we areand what we do, not to mention our own self-perception of the profession.

So, when someone asks me what hospital I work in rather thansimply asking me what kind of nursing I do, I see it as my personal mission toeducate that individual regarding the myriad functions a nurse can perform andthe many environments where that can occur.

Public perception of nurses does not necessarily negate ourefficacy or our importance, but it can indeed impact our self-esteem, ourprofession’s standing, as well as the cultural and societal significance of ourwork. It’s up to us to educate those around us that nurses are not akin to the nursesportrayed on television. We are real people doing real work. Nurses make adifference in people’s lives. We always have, and we always will.

My Recent Articles on WorkingNurse.com

2011-11-08T10:12:00.001-05:00

Here are links to my most recent articles published by WorkingNurse.com. My thanks to my editor at Working Nurse for her continued support and positive feedback!

My Specialty: Telemetry Nursing

My Specialty: Emergency Nursing

My Specialty: Nursing Educator

My Specialty: Hospice Nursing

In Stitches: A Memoir by Anthony Youn, MD

2011-11-02T19:35:00.002-04:00

Periodically, I receive unsolicited requests by publishers and media agencies to review books here on Digital Doorway. In return for my services, I receive a copy---or several copies---of said tome, and the satisfaction of thinking---and writing---like a critic. There have been a few books that I've decided to not review after having read them since I don't want to hurt the author's feelings, and there are several that have been equally a pleasure to read and to write about.

That said, a number of months ago, I received a request to review "In Stitches: A Memoir" by Dr. Anthony Youn, M.D., one of the most famous cosmetic surgeons in the United States. I did not peruse Youn's many websites until after finishing the book, although based on the personality communicated through the book, I was not surprised to find the sites ranging from significantly tacky to unsurprisingly tacky. The book, co-written with Allan Eisenstock, strives to rise above the glamorous veneer exuded by the websites, and manages to do so from time to time in its more sober moments, but the book is, in the end, a disappointment on many fronts.

In his memoir, Dr. Youn paints a portrait of a young, second-generation Korean-American who grows up in a household ruled by a nearly tryannical father (a successful OB-GYN) who Youn, along with his brother, both fear, respect and obey almost unquestioningly throughout their lives. Developing a jaw deformity as a teenager, Youn undergoes a series of surgeries that we are led to believe have an eventual impact on his decision to become a cosmetic surgeon. Sadly, although he briefly tells the story of his father's family, Youn's parents remain two-dimensional characters, as do most of the other individuals portrayed throughout the book (including his wife-to-be).

Unfortunately, Youn spends dozens of pages reminiscing over his sexual failures and inadequacies in the world of dating and women, and we are treated to multiple stories of the exploits---or lack thereof---of Youn and his adolescent and college-aged friends. This aspect of the book is most painful and tedious, and I found myself sighing in impatient consternation when faced with yet another anecdote about his hopes as a wannabe Romeo being dashed once again.

Youn makes it explicit that his Asian background and cultural heritage account largely for his feelings of being an outsider in a majority caucasian world. To his credit, he often uses self-deprecating humor to his advantage, and he clearly describes a moment in his life when his judgment and derision of another outsider (a gay roommate), causes him great shame and regret.

Still, although Youn rhapsodizes about realizing the errors of his ways and tells us how he has grown as a person through his many trials and tribulations, within this book he manages to propagate and give further power to many misguided notions regarding beauty and outward appearance. And while Youn clarifies that he has become a doctor---specifically a plastic surgeon---because he wants to "fix people", it is no surprise that he has become the "plastic surgeon to the stars", nipping and tucking his way into American living rooms via numerous television appearances.

Just as Dr. Youn refers consistently to women he wants to date as "knockouts" or "Penthouse hot", he demonstrates his judgmental attitudes regarding beauty and "otherness" by referring to an elderly professor as "an old witch" and a neighbor in his college dorm as a "mountain range of hairless flab". Youn could have taken the road less traveled, sharing tea and sympathy with other outcasts and societal rejects, but instead he takes the easy way out and utilizes cliche and occasional self-deprecation as a tool to elicit sympathy for himself while simultaneously attempting to elicit loathing by the reader for those less handsome, less rich, less successful than he wanted to be (and eventually became).

When he is serious and earnest, the author is at his best, as in this passage where, while in gross anatomy lab, he sees the humanity within the cadaverous body parts populating various plastic tubs:

"I drift over to the bodies that we will study, some under tarps, some lying naked, their innards exposed, and certain details that I'd never noticed jump out---tattoos, dental fillings, scars---and I feel lightheaded. I am in awe of these people. Most of all, instead of feeling detached from them, as I assume most doctors do, I feel attached to them. Committed to them.

"I can't say that I feel this way constantly, every second of anatomy class, every moment of medical school. I will often lose this feeling of reverence toward these bodies, especially when I'm grinding through my notes, preparing for an exam. But I'm able to bring myself back, to locate the humanity easily.

"Especially when I look into the bin of hands."

It is in moments like these that Youn's compassion shines through, as when he holds a crying baby all night or convinces a man who feels unloved to have a life-saving surgery.

Youn also uses humor well in certain passages, painting hilarious portraits/caricatures of medical residents, interns, doctors and surgeons that many in the medical field will most likely find highly entertaining and evocative of some of their own experiences.

Over all, Youn's book is a chatty, breezy and lightweight read with a modicum of entertainment value. He offers rather pedestrian and less than insightful advice about medical school, and apparently fails to grasp or elucidate the depths to which he could have plumbed the role of outsider and societal outcast that he managed to only hint at throughout its pages.

As an Asian American from a hardworking upper-middle class family with a father who works as a successful doctor, Youn is not exactly a kid from the other side of the tracks. Still, his theme of being an outsider---a theme driven home ad nauseum in the first half of the book----falls flat based on the life that Youn describes and the relative privilege that he enjoys. Sure, he once had a Thanksgiving meal from a convenience store, but there is no doubt that Youn had his sights set high and managed to achieve his goals, perhaps beyond his wildest dreams. I applaud the author's professional tenacity and his ability to create the life he always wanted, but Youn's attempt at a memoir offers too little in terms of moving passages describing humanity's many frailties, and too much of his sentimental and simplistic summing up of the world according to Anthony Youn.

This memoir is one to read, for example, when waiting in an airport during a long layover, and then leave on the seat for the next weary traveler who needs an unchallenging and moderately entertaining ---yet forgettable---memoir to pass the time.

The "Occupy" Movement and Healthcare

2011-10-25T13:33:00.000-04:00

For the last several months, I have been actively supporting the now worldwide "Occupy" movement that has swept the world following the initiation of the famous "Occupy Wall Street" action in New York City. Here in Santa Fe, New Mexico, my wife and I have taken part in marches, rallies, protests and teach-ins, and the "Occupy Santa Fe" encampment continues near downtown.

Although the issues broached by "Occupiers" throughout the country are seemingly disparate and multifaceted, I believe it is only through the communication of these different voices and concerns that central themes (and possible demands) can eventually be distilled.

As a nurse and healthcare professional, I have seen the face of the healthcare system up close, and it is (still) quite broken. With innumerable for-profit insurance companies dictating what doctors can and cannot do, and tens of millions of Americans living completely without health insurance, the system eschews the notion of universal coverage and leaves millions in the proverbial dust. And since almost every industrialized country in the world has some form of universal coverage, the United States lags far behind, not only in this respect, but also in infant mortality and other important markers of health and well-being of the citizenry at large. It is a shameful state of affairs.

Just today on National Public Radio, I heard a report quoting Republican candidate Ron Paul as he railed against the notion of universal coverage. When asked if an uninsured 30-year-old with a catastrophic illness should receive expensive care in order to save his life, Paul intimated that there are other ways for these sorts of people to be cared for (such as churches and neighbors). He stated, "That's what freedom is all about---taking your own risks." Although he wouldn't directly say that society should just allow this individual to die, some members of the audience loudly proclaimed that, indeed, this uninsured American's care should not be paid for and he should be allowed to meet his (uninsured) fate. A shocking notion, especially since doctors (and Ron Paul is himself an M.D.) take an oath to "do no harm". (I have always wondered about the relative similarity between the words "Hippocratic" and "hypocritical".)

When it comes to the "Occupy" movement, my sense is that a more fair distribution of wealth, corporate responsibility (in terms of taxes, etc), economic justice (an admittedly broad and relatively ill-defined phrase), jobs, the end of war, and the initiation of broader protections (such as universal health coverage) are some of the mainstays of the movement's demands.

As autocracies around the world crumble before our eyes, it was only a matter of time until such a popular people's movement erupted from its latent slumber here in the U.S.. People can only take so much, and when the number of uninsured Americans topped 52 million just last year (40% higher than in 2001), there was no reason for Americans to not decide to speak out and demand change. And if you couple the nationwide jobless numbers with the numbers of uninsured citizens (let alone the list of companies---like Wal-Mart---who are jettisoning their healthcare coverage), the recipe for popular unrest only grows.

Rates of obesity, diabetes and heart disease are ballooning in this country, and childhood obesity and chronic illness are equally on the rise. As Americans get sicker and fatter, the nation's largest employers are cutting their healthcare coverage and leaving millions of American workers (and their families) in the lurch.

Meanwhile, the American right proclaims that "Occupiers" are dirty hippies, unemployed and looking for a handout. From my perspective, this is both unenlightened thinking and plain ignorant hyperbole. I have marched and rallied with retired schoolteachers, nurses, housepainters, unemployed laborers, and gainfully employed citizens from multiple sectors of society. Yes, some "Occupiers" are unemployed, but every unemployed protester I have spoken with simply wants a job and benefits for them and their family, and they're willing to pay taxes to get what they want. (They just want wealthy Americans and American corporations to pay their fair share.)

The noise and perceived "inconvenience" of massive protests will, in my opinion, continue as the movement galvanizes a broader spectrum of Americans and gains clarity as it works internally to crystallize its main messages. And as the protests continue, those 50 million Americans still languish without health insurance, millions more look for work that cannot be found, and the corporate and political powers that be bide their time in hopes that the restless citizenry will fall back into a television-induced slumber. Aside from a nationwide campaign to taint drinking water with Ambien or Lunesta in hopes of a sleepier and more ignorant nation, the chances of this movement simply being lulled into complacency is more remote than Wal-Mart offering its workers the benefits they deserve.

Food: A Rumination for Blog Action Day

2011-10-16T00:00:00.000-04:00

On several occasions, I have participated in Blog Action Day, an annual event wherein bloggers from around the world post simultaneously about a chosen topic of global importance. This year, food is the topic of concern, and thousands of bloggers from more than 80 countries are posting about the subject food on this day, the 16th of October, 2011. The following is my own rumination about food, from the personal to the global and back again. You can read more entries at the Blog Action Day website and blog.

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Throughout my adult life, I have generally tended to viewfood as being medicinal in nature, and this tendency has only grown as I haveentered middle age. While food represents many things to manypeople---including culture, pleasure, sustenance, survival, identity, a senseof belonging---my connection with food remains solidly in the categories ofhealth and well-being, with a generous helping of pleasure.

Being from a family with a Jewish heritage reaching as farback as the genealogy can see, one would think that Jewish cultural foods wouldfigure strongly in my predilections and preferences. While my mother did indeedmake matzo ball soup and other Jewish foods when I was a child, that Jewishidentity never really took hold, especially since we were raised, ironically,with all of the Christian holidays, albeit celebrated in a thoroughlyassimilationist and secular manner. So, with no real cultural identity per se, I was unleashed into theworld to find my own gastronomic way, and, for the majority of my adult life,that road has been paved with health food.

The term “health food” is somewhat of a misnomer, since manyfoods can be readily associated with health, even as more and more foods havehad the health literally stripped out of them in the processing plant. Still,health food conjures images of bins of granola, honey, fresh fruits andvegetables, tofu, and any number of items that can be easily lumped into thatbroad category. “Whole foods” is, in my view, a much more apt definition of theway in which I like to eat, but a very large health food corporation (whichshall not remain altogether nameless in this case) has now trademarked thatname for its own. Thus, telling someone that you eat a “whole foods” diet willonly bring sneers and a chuckle, and perhaps a sense from the listener that youspend so much money on groceries that you probably have to give up other thingslike cars, gasoline, and a telephone. (They don’t call the aforementioned store“Whole Paycheck” for nothing.) Still,“whole foods” explains one’s dietary preferences much more aptly than “healthfood”, but we’ll leave the name issue for someone else to tease out.

For my wife and me, food is where the rubber meets the roadin terms of our health, and we have generally opted in our two decades togetherto spend more on good healthy food rather than put our money elsewhere. Whileother families eschew organic produce due to its relatively high cost, we wouldmuch rather cancel our cable or cut back on other expenses rather than buy themainstream non-organic alternative. We recognize that organic can be morecostly, and we understand which foods are most important to purchaseorganically and which are safe to buy that are conventionally grown. We alsorecognize that many people simply cannot afford organic food, and as a healthcoach and nurse, I would far prefer that a client purchase non-organic produce,wash it well and enjoy it, rather than processed foods with little redeemingqualities. And in areas that are known as “food deserts”, many people simplyhave no access to fresh produce or even a supermarket, relying on fast food andhighly processed foods from convenience stores.

Amazingly, the organic movement has grown (Wal-Mart is nowone of the largest vendors of organic produce in the United States), and asdemand has risen, prices have come within reach of more and more Americans. Andas more Americans wake up to the fact that genetically modified foods grownwith petroleum-based fertilizers on corporate farms are not in their bestinterest---or the country’s best interest, for that matter---demand will onlycontinue to rise.

In a world where food insecurity is increasing, famine isspreading across portions of Africa, and topsoil erosion and access to waterare increasingly problematic, the issue of food is central to our verysurvival. With free trade agreements decimating certain farmers’ ability tosell their crops at a profit, family farms being foreclosed in record numbers,and corporate agribusiness growing at an alarming rate, we are at a moment inhistory when the security, quantity and quality of our food supply is injeopardy. It’s all well and good to espouse the benefits of a healthy diet,proper hydration and plenty of aerobic exercise, but there is no getting aroundthe fact that millions of people around the world---many of whom live in yourhome town---go hungry every day, or simply don’t have the security of knowingwhere their next meal is coming from.

Food is a loaded issue, and it carries a great deal of baggagefor all of us. My memories of my mother’s matzo ball soup may linger in mycellular memory until the day that I die, and meanwhile I have the economicprivilege of buying just about anything I want at the grocery store (withinreason), never personally knowing the stresses and concerns of those whocannot even afford to adequately feed their children each morning.I can rail against Monsanto for genetically modifying corn and depleting thetopsoil through poor farming practices in favor of profits and high yields, yetI also need to remember that some unknown neighbor of mine just down the streetdoesn’t have enough cash flow to stock the fridge as his children clamor forthe sugary and marginally nutritious cereals they see happy people eating on television.

Yes, food consumes us just as we consume it, and it is thefuture of food itself that should truly consume us day and night. “Give us this day our daily bread” shouldbe our rallying cry, and if our collective moral compass was not somehow askewin this world out of balance, we would have already figured out how to feedevery person on the planet.

In the optimism that I have cultivated---or discovered---inthis second half of my life, I know in my heart that change is indeed coming.The “Occupy Wall Street” movement isonly one example of how the world is changing as people individually andcollectively wake up to the many stark realities that we face on a globalscale.

In my small world, it can feel like a crisis if I can’t findthe item I’m seeking when I walk the aisles of the health food store or Iforget something important during a shopping trip. But my personal crises holdno water in the larger scheme of things. Proportionality is the operative wordof the day, and the proportion of hungry people in this world must be contendedwith, lowered, and eventually brought under control. As we mine the humangenome and monitor the universe for signs of intelligent life, we continue todemonstrate that we have the collective intelligence and technology to solvethe food crisis for ourselves.

What we need now is a collective will to feed the world, andto transform this crisis into an opportunity. We can indeed feed the world, andif we decide to do so, there is no force on earth that can stop us from movingunequivocally towards that goal. Be it “whole foods”, “health food”, or justsimply “food”, the name is not as important as the intention. We know how togrow healthy foods, we know how to produce foods that are less processed, morenutritious, and more affordable, and we know that we have the ability to do soif we truly desire to. So we say again, “giveus this day our daily bread”, and when we say “us”, we realize that we truly understand the meaning of that word.

#bad11

Dare to Imagine

2011-10-07T23:13:00.000-04:00

To learn how to die is to learn how to live; to learn how to live is to learn how to act not only in this life but in the lives to come. To transform yourself truly and learn how to be reborn as a transformed being to help others is really to help the world in the most powerful way of all.

Let us dare to imagine now what it would be like to live in a world where a significant number of people took the opportunity, offered by the teachings, to devote part of their lives to serious spiritual practice, to recognize the nature of their minds, and so to use the opportunity of their deaths to move closer to buddhahood, and to be reborn with one aim, that of serving and benefiting others.

--Sogyal Rinpoche

Living, Loving and Dying

2011-10-04T20:20:00.001-04:00

A few months ago, I shared here on Digital Doorway that my mother had died suddenly from a massive and unexpected stroke which occurred while she was giving a piano recital with some of her music students. Five weeks prior, my father-in-law suffered a major heart attack, dying in his easy chair after enjoying dinner with his beloved wife and a few friends on the Cinco de Mayo. Their deaths reverberate in our lives still.

In the weeks between those two significant losses, my wife lost an uncle and a cousin, and not long ago my step-son lost his step-brother on his father's side. Just yesterday, we learned that a dear friend with whom we had lost touch was diagnosed with stage four liver cancer on a Thursday this past August and died the following Monday, surrounded by family. Meanwhile, one of our very dearest and oldest friends is struggling in her eighteenth month of ovarian cancer and we're not sure we'll ever see her again---in this life, anyway.

Losing loved ones and watching others grieve as they mourn their losses puts life into perspective and allows for a different view of one's personal priorities. As a nurse, I have walked many patients through their own illnesses and the process of facing their own mortality, and there are those whose faces are as clear in my mind now as they were when I was providing their care.

In the course of our lifetime, we see dozens, if not hundreds, of deaths acted out in movies and television shows in the name of entertainment, some quite realistically. Meanwhile, the news media graphically report famine, war, disease, natural disasters and violent deaths, and this regular diet of death can at times inure us to the reality and potential tragedy of lives lost. Film and television depictions of death can move us to tears, and can at times even help us to process our own personal losses through the artifice of cinematic drama.

Still, there is nothing more realistic than holding the hand of a dying person and looking in their eyes as they face the great unknown. Five years ago, we were all at the side of my step-father as he died in his own home from pancreatic cancer, and it was an honor to be his midwife in that very beautiful and graceful process.

As a father and husband, I occasionally experience fear regarding the loss of my wife, son or daughter-in-law, and I know that I will likely one day face the death of my father, my mother-in-law, and perhaps even my siblings or other family members. At the time of a death of a loved one, it has often seemed that I simply could not walk through the passage of grief that had opened up before my very eyes. When a dear friend of ours was murdered in 2001, it seemed as if our lives had ended, and indeed our lives as we knew them certainly had come to a resounding close.

However, even in the midst of terrible grief and loss, the urge to survive---and even to thrive---persists, and we somehow manage to renew ourselves again and again. I am personally on that path of renewal, and while I have no doubt that death will make its presence known at some point in the future, there's nothing else to do but focus on love, acceptance, and the knowledge that strength will come from a powerful wellspring, whatever one may choose to call it or however one might acknowledge it.

My own death holds no fear for me, but the great mystery of that passage and its ultimate meaning is strong. For now, I focus on the meaning that death and loss have given to my life, and the relative unimportance of the myriad trivial issues that clamor for space in my mind.

We the living can continue to live, and the dead want nothing more than our happiness. I choose to embrace my life and my happiness, remembering the saying that living well is the best revenge. I am not a vengeful person, but we can all take revenge on the violence, fear and panic that seem to so often encircle our world so vehemently. We can resist the fear. Our loved ones who have passed on want this for us, and while we can't live for them, we can live with them---in our minds, in our thoughts, and in our hearts.

Nursing: Beyond the Books

2011-09-08T12:54:00.000-04:00

The good people over at Online Nursing Degrees recently decided to conduct several in-depth interviews with nine nurse bloggers from various professional backgrounds in the nursing world. I am honored to have been chosen as one of the interviewees, and want to provide a link to curious readers to this smorgasbord of nurse opinion and story. The thoughtful interviewer obviously read through our nine blogs very carefully, posing interesting and thought-provoking queries well beyond the usual cookie-cutter interview questions so frequently bandied about.

The series, entitled Nursing: Beyond the Books, consists of nine interviews, with one interview posting each day for nine days until all nine are published. My interview---the third in the series---posts today, September 8th, and can be found by clicking here. The entire series will be available once the nine day roll-out is complete.

Thanks to Martin at Online Nursing Degrees for his interest and diligence in making this wonderful online event a reality!

Fresh Air Fund Still Seeks Host Families

2011-08-02T15:09:00.003-04:00

Many regular readers of Digital Doorway will remember that I have supported The Fresh Air Fund for several years. The Fresh Air Fund has provided opportunities for inner-city children in the New York area to experience summer vacation in the homes of host families in the Northeastern United States and Canada since 1877.

In 2010, Fresh Air Fund host families provided such opportunities for over 5,000 children between the ages of 6 and 18, and more than 65% of children are invited to visit their host families in subsequent years.

This year, there are still 200 mostly low-income inner-city children waiting to be placed with a host family before the end of the summer. If you or someone you know would like to host a Fresh Air child this summer (or next summer, for that matter), please visit the host family website page.

Johnson and Johnson Nursing Notes

2011-08-01T00:07:00.001-04:00

My thanks to Johnson and Johnson for featuring me in their recent "Nursing Notes" newsletter about nurse entrepreneurs. If you want to read the issue, click here and scroll to the bottom for my brief interview.

Book Review: Critical Care by Theresa Brown

2011-07-20T16:29:00.003-04:00

“Critical Care: A New Nurse Faces Death, Life, and Everything in Between” by Theresa Brown (Harper Collins, 2010), is a deeply personal book that details the transformation of an English professor into a oncology nurse. Honest and self-disclosing, Brown describes her decision to leave the cozy world of academia behind in search of more meaning in her professional life, embracing the mantle of “nurse”, her academic colleagues watching in disbelief as she abandons tenure for a stethoscope and scrubs.

Channeling her love of writing through the filter of her first year as a nurse on the oncology floor, Brown relates to the reader the challenges and joys of being a nurse and a writer, two identities with which I deeply resonate.

“People will say that being a nurse-writer is an odd choice, and I’ve even taken to calling myself a hybrid. But the combination works really well for me. Writing about nursing helps me to understand the intricacies of the job better than I would otherwise. Being a nurse who writes means that I pay attention at work in a more intense way than I used to.”

Brown uses her command of prose and her keen insight to paint a picture of nursing in all its glory and gore:

“Working as a floor nurse is messy and stressful, but I wouldn’t exchange it for a dream classroom full of well-read, hardworking, intellectually curious college students---not in a million years, not ever. For where else can I go to sample daily the richness of life in all its profound chaos? Where else can I comfort a cheeky eleven-year-old boy who has to confront his own mortality earlier than any of us ever should?”

And when confronted with the frightening novelty of life as a new nurse, Brown writes lines that could send a chill through the spine of any potential hospital patient:

“My challenge was figuring out what U didn’t know and how I could most efficiently learn it within the confines of a system so byzantine and idiosyncractic that at moments I really would have liked to bang my head on a wall in frustration, except that I never had time.”

Far from glamorizing the work of a floor nurse in a hospital, Brown makes it glaringly clear that doctors, patients, other nurses, and the medical system itself can often work against a novice nurse who simply wants to perform his or her job and learn what it is he or she is supposed to do in the course of a day. Whether facing a hemorrhaging patient or an inexperienced doctor equally fumbling through the novelty of a new career, Brown relates clearly how simultaneously maddening and sublime her work can be.

“When I first started as a nurse, the hospital seemed like the least ‘normal’ place I had ever been. We stick tubes in every possible human orifice, slice people open to save their lives, fill their veins with poison, measure their urine, count their bowel movements. The craziness is normal, and the only thing’s that’s really normal is the fundamental humanness that unites us all. Sometimes a patient needs his bum wiped twelve times in half as many hours, and sometimes he needs a Bible. Soup to nuts; shit to death---we’re all on the same continuum.”

Frustration abounds in Brown’s interactions with the medical and nursing worlds, and she minces no words about the nurses and doctors who eat their young.

“Like people from low-status groups everywhere, some nurses take their frustrations out on other nurses rather than trying to improve their own position. It’s not surprising that it happens, but it’s especially poignant that people in a caring profession sometimes have such a hard time caring for one another.”

But when it comes down to brass tacks, Brown’s nursing career is about her patients, her respect for them, and her desire to make things right even amidst a system that lets her down.

“I do not have time to chatter with rage, and no one else would have time to listen, but I have felt my eyes get hot and angry when my patients are not treated as I would like, and I will fight to make things better.”

When writing about death, Brown is unequivocal in her bafflement and her awe. She writes, “When you see a corpse, you learn what it means for something to really end.” Writing further about death, she adds:

“Death is the final stage (in that process), since in death the person’s body remains, but her spirit, or soul, the force that animated her and made her who she was, is gone forever. Perhaps if our bodies vanished when we died, death would be easier; part of the puzzlement of death is that the body stays, but the person we knew and loved will never come back.”

Brown uses her love of language and her love of nursing equally well in this book that spans just under 200 pages. While a novice or wannabe nurse may be taken aback by Brown’s raw honesty about her first year of nursing experience on the front lines, her forthright descriptions of what it takes to be a nurse and what’s wrong with the system at large are important lessons to hear.

This author describes the work and wisdom of nursing so eloquently, verbalizing clearly the caring, the science, and the humanity of her work. Her book is a gift to the nursing profession and those who respect it.

“At times this caring will ask so much of you that being devoted to the job is the only thing that will enable you to keep doing it….Each patient comes to us a blank canvas or a solid block of stone, and at first we will make only the simplest of brushstrokes, the most obvious chisels…….My masterpieces are all internal: ease given to a suffering human heart.”

The 25 Best Nursing Blogs

2011-07-20T11:27:00.003-04:00

Thank you to the website QI Exam Prep for including Digital Doorway on it's list of the 25 best nursing blogs on the Internet. I am humbled to be included in such stellar blogging company.

My Mother: Rest in Peace

2011-06-28T19:46:00.008-04:00

On May 26th, just over one month ago, I posted a blog post entitled The Ride of a Lifetime in which I ruminated about life, death, mortality, and my own coming of age as an elder. In that post, I paid homage to my recently deceased father-in-law, my newly widowed mother-in-law, and my deceased step-father, whose ashes sit in a makeshift urn on my mother's kitchen counter.

Not sixteen days later, I received a phone call from my sister that my mother, a relatively healthy 78-year-old woman with several well-controlled chronic health conditions, had suffered a serious stroke. A Juilliard-trained classical pianist, my mother was giving a recital with some of her students that afternoon, and in keeping with her desire to "die while playing the piano" (as she had often wished), she continued to play with her right hand as she lost all control of her left. Rushed to the hospital, she lost consciousness in the ambulance and was declared brain-dead by early evening, a ventilator maintaining oxygenation of her vital organs while our family made some important decisions. My sister and brother-in-law held vigil at her bedside for almost 12 hours, friends coming and going, bringing food and offering solace and prayers.

Arriving to Atlanta from Albuquerque at 2am, I arrived to the hospital to join my sister and her husband at the bedside, and we made the mutual decision to disconnect her from life support. We held her hands as her heart slowly stopped beating, and the life force left her body completely at 5:15am. Knowing that she would never have wanted to remain "alive" artificially, this decision was relatively easy to make.

I stroked her hand for some time in those early morning hours, marveling at the smoothness of her skin and remembering with my fingers all of those arthritic knobs that never seemed to compromise her musicianship. She was a consummate musician, and she would be thrilled to know that her final act on this earth was playing the piano as she encouraged young musicians to pursue their dreams and develop their talents.

Losing one's mother is a loss like no other, and I'm still digesting the fact that she's gone. Writing is not easy for me right now, and thus my output here on Digital Doorway (and elsewhere) has slowed to a crawl. Meanwhile, my grief comes in waves, and while I rejoice for her freedom, I recognize and honor the loss that I and my other family members have suffered.

Here is a copy of the eulogy that I read at her memorial service on June 15th in Atlanta, Georgia. Rest in peace, Mom. I love you.

It will come as no surprise to anyone in attendance today that our childhood had a soundtrack. From Gershwin’s “Rhapsody in Blue” to Beethoven or our mother’s original compositions, the music flowed throughout our lives. Whether we were attending one of mom’s many concert performances, serving as her ersatz “bodyguards” at Jersey Shore nightclubs, or listening to her practice as we did our homework, the pervasive soundtrack continued as a constant reminder of both our mother’s musical genius and her passionate vocation.

But in as much as my mother’s life was informed by music (and our lives by extension), the other parallel soundtrack was one of love, kindness, and unconditional support. Especially in my adult years, it became ever more apparent how my mother accepted my many incarnations with unperturbed aplomb. Whether I was announcing my desire to study yoga, travel to Europe, marry a single mother, or attend nursing school, she and Tulane both reacted with similar equanimity and words of support and enthusiasm. (But I must admit the one-way ticket to London at age 21 was likely the most difficult thing for her to accept, let alone my 11-month absence long before the days of cell phones and email, not that my mom ever mastered the use of a computer!)

Nonetheless, support and caring were indeed the ingredients that were essentially my mother’s modus operandi when it came to her children’s and grandchildren’s endeavors, and she personified unconditional love in my personal experience of her, especially in the final years of her life.

In her four years as a widow, mom was lonely at times, of course, and I very recently noticed the marked joy and surprise in her voice when on the receiving end of a telephone call. “Keithie!” she would say with childlike joy, “How are you?” She would never fail to tell me what she’d most recently been up to (oftentimes repeating stories that I may have already heard, perhaps during one of her very long voicemail messages), but also never failing to ask “And how are Mary and Rene and Bevin and Tina?” (Referring to my wife, my son, my daughter-in-law, and my dog).

Characteristically, she showed as much as interest in the welfare of our dog Tina as she did in any of her grandchildren (sorry, kids!) but the reality seemed to be that she saw dogs and grandchildren as equals when it came to doling out her enormous affection and interest, and Tina was as deserving of her grandmotherly curiosity as any of the kids in the family.

As a mother, a grandmother, a musician, and, I must add, as my lifelong friend, my mother was a force of Nature. That said, it may take me some time to digest the fact that her unconditional support and love will no longer come in the form of newsy telephone calls, thoughtful cards, and those ubiquitously long voicemail messages. I’ll miss her voice, the way she listened so intently on the phone, and the way she would hold my hand so very tightly with her piano-strengthened fingers.

Like any death, hers brings with it great sadness, a modicum of regret, and the sense that a life well lived has been rewarded with the ultimate peace that God and Heaven offer, especially as I imagine her being welcomed by an angelic Tulane, her loving husband who left her only four years ago. I can just picture a heavenly host gathered around a snow white concert grand as Tulane cajoles her to play The Moonlight Sonata. She’ll oblige, of course, and the tip jar (generally an over-sized brandy snifter if it were left up to Tulane) will be overflowing with the blessings and prayers of those who love and adore this remarkable and elegant woman.

NurseKeith on BlackDoctor.org

2011-06-07T11:55:00.004-04:00

Here are links to a number of my most recent editorials published on BlackDoctor.org. My thanks to BlackDoctor for their continued support and enthusiasm.

Do You Know Your Hospital Rights?

Are VOCs a Hazard to Your Health?

Hydrating for Health

Is Tea Tree Oil For You?

Living With Grieving

The Ride of a Lifetime

2011-05-26T07:56:00.000-04:00

Over the last six or seven months or so, mortality, health and illness have played a significant role in my personal life, and led to many musings about these weighty and universal subjects.

On Thanksgiving Day of last year, my father was hospitalized for a mysterious set of symptoms that left him bouncing between the hospital, a rehab facility and a nursing home for the better part of two months, his life a combination of miseries that brought him to the very edge of his tolerance of discomfort and physical and emotional exhaustion. Luckily for him, he has greatly improved, and while some symptoms persist, he is now happy to be home and relatively independent at the age of 82.

Two months ago, a rather garden variety respiratory infection sent my wife to the local hospital (on our moving day, no less) with a very aggressive bacterial bronchitis. Luckily, her infection was treated equally as aggressively, and she was sent home within a few days and eventually recovered after much rest and recuperation. Still, it was a wake up call on many levels.

Then, out of the blue on May 5th, Cinco de Mayo (which also happened to be my father's 82nd birthday), my wife's father had a massive heart attack and died in the living room of the home he shared with my mother-in-law. Although the paramedics attempted to revive him for thirty minutes (he had no advanced directives to request that they not do so), I am 100% certain that he was dead by the time they arrived. He was a large man in both the physical and metaphysical sense, and the loss of his presence on this earth is reverberating in the lives of many, many people who loved and admired him.

Since my step-father's death four years ago from metastatic pancreatic cancer (a death over which my wife and I presided as midwives, of a sort), we have become acutely aware of how our parents are indeed aging, and how their health and mortality are coming to the fore as they enter the winter of their lives. Other friends who have lost their parents understand our position, and we have watched as certain friends have become the new "elders" of their clans as their parents' generation makes it's exit.

Several weeks ago, sitting at a restaurant in a town outside of Austin with my now widowed mother-in-law and assorted family members, I was acutely aware of how my brother-in-law and I were, in effect, the patriarchs at this long table, a table at which, by all rights, my father-in-law should have been seated at the very head. However, in his absence, my brother-in-law and I had no one to fight with over the bill, so we calmly took out our credit cards and split the bill 50/50, starkly aware of how "The Colonel" (as he was affectionately known) would have never allowed us to do such a thing if he had been there to seize the check for himself. (In fact, in order to ever pay the check for a restaurant meal, I would always need to pretend to go the men's room, surreptitiously slipping my credit card to the server in advance, a sneaky yet highly effective endeavor.) But I digress.

This continuous movement along the life-and-death cycle truly brings home the fact that death---just like life---is itself inescapable, and our time on this mortal coil is blessed indeed. With the happy knowledge that I will eventually be a grandparent, God willing, my heart sings with the notion of life continuing in the very face of death and decay.

Sitting here this afternoon on the porch of an elderly patient's home where I work 12-hour shifts twice per week, I watch the clouds roll across the deep blue New Mexican sky. I observe the movements of the wind, trees, sun, dust, and tumbleweeds across the wide open expanse that surrounds me with a 360-degree view. A small lizard scurries across the worn wood planks of the porch, two birds alight in the bird-feeder, and a horse whinnies in the distance. I am grateful for the life that I have been given, and for the choices I have made that have brought me to this very place.

I think of my father-in-law, his large body now reduced to a small box of ashes interred reverently in a military cemetery in Texas. I think of the ashes of my step-father, some of which sit in a decorative vessel on my mother's kitchen counter, and a container of which awaits a trip to the Italian island of Capri where I promised him I would one day scatter them to the Mediterranean winds. I think of friends who have died, one by murder, one by his own hand, and others from illness and disease. I think of another friend who is currently waging a battle with cancer.

Human life is a beautiful, fragile, precarious and wonderful gift, and many of us waste countless hours, weeks and years frittering our time away in worry, regret, recrimination and remorse. In the final analysis, it's the quality of your living and your giving that counts, not the number of CDs in your collection, the balance in your checking account, or the make of your car. We humans get caught up in such shenanigans, losing track of what's important as we mindlessly chase that which is ephemeral and meaningless. It can be a long way from birth to death, and sometimes it's a short ride indeed, but the quality of the space in between these mysterious processes is truly the issue to deeply consider.

I have firmly and unequivocally entered middle age, and as my 50th birthday approaches in only three years hence, I look back and examine my life, realizing that it is likely more than half over. Regret is neither my friend nor my companion, and I realize that in order to honor the dead who have gone before me, it is my righteous duty to take this life by the horns and live it with the fiercest love and grace that I can muster. That is the greatest gift that I can give to myself, and it is the most fitting tribute to those who have moved on from this life to the next.

Our mortality is, in the end, one of the things that make living a fulfilling life so urgently sweet. Our time is limited, there's much to do and see, and there are hearts to touch and people to love along the way. Moving forward is indeed the only option, even when those we love leave us behind to wonder what is beyond that ethereal veil through which they have passed. I want my life to be a testament to what I love and what I value, and I believe that I am on the right path. I am grateful for my time on this earth, and I want to always rest in the knowledge that, despite the pain and suffering, it was truly the ride of a lifetime.

Nursing License Map

2011-05-25T14:14:00.002-04:00

A new website, Nursing License Map, offers an interactive map with the mission of clarifying the process of becoming a licensed nurse in any state of the country. The interactive site offers a detailed analysis of licensing requirements for various types of nursing, as well as average salaries, live links to the Boards of Nursing for each state, and information regarding various states' involvement in the 22-state Nursing Licensure Compact.

I highly recommend looking it over, as this is an excellent tool for new and seasoned nurses to explore the licensing process throughout the United States.

Volatile Organic Compounds

2011-05-05T20:45:00.003-04:00

For those readers interested in health, please click here to read my latest editorial for BlackDoctor.org on the subject of VOCs (Volatile Organic Compounds). From carpeting and paint to cars and new shower curtains, VOCs are the #1 source of poor indoor air quality. VOCs are worthy of attention, especially since the chemical ingredients in most consumer products are not required to be divulged to the public in the interest of "trade secrets".

Psychiatric Nursing on WorkingNurse.com

2011-04-22T00:20:00.004-04:00

My latest article for Working Nurse Magazine (on the subject of the specialty of Psychiatric Nursing) was recently published both in print and online. Please click here to access the online version of the article.

Press Release: The National Nurse Act of 2011

2011-04-16T21:09:00.002-04:00

Every American Needs a Nurse: The National Nurse Act of 2011 introduced in Congress

Washington D.C.-- On March 16, 2011 Congressman Anthony Weiner (NY-9), on behalf of nurses across the country, introduced The National Nurse Act of 2011 into Congress to establish a National Nurse for Public Health. HR 1119 will designate the existing position of the Chief Nurse Officer of the US Public Health Service to serve as the National Nurse for Public Health. This nurse will continue to work alongside the Surgeon General and focus on the priorities of health promotion, disease prevention, improving health literacy, and decreasing health disparities.

“Nurses play a vital role in the well-being of our country and their contributions should be recognized accordingly,” Rep. Anthony Weiner (D – Queens and Brooklyn) said. “It’s important that we create a National Nurse for Public Health to help better organize our efforts to combat the many pressing health issues we face today.”

Teri Mills RN, MS, CNE, a nurse educator at Portland Community College, who serves as President of the National Nursing Network Organization (NNNO) introduced the concept for a National Nurse in an op/ed published in The New York Times May 2005. "Agreement abounds on the nation's need for more emphasis on prevention in our quest for social justice and improved health outcomes, and the concept of having a publicly recognized nurse leader for prevention is the basis for the movement to create a National Nurse for Public Health," said Mills. "Members of Congress agree and already eleven US Representatives have agreed to co-sponsor this legislation."

A January 2010 Gallup Poll, conducted by the Robert Wood Johnson Foundation revealed that 86 percent of those surveyed stated they would like to see nurses have more influence in promoting wellness and expanding preventive care. According to the Institute of Medicine and Robert Wood Johnson Foundation report, The Future of Nursing: Leading Change, Advancing Health, more nurse leaders are needed throughout healthcare." Mills also believes that under the guidance provided by the National Nurse for Public Health, many nurses, including students and retirees, will be inspired to volunteer and advocate for prevention efforts in their local communities.

Alisa Schneider MS, RN, Vice President of the NNNO said the National Nurse could be instrumental in the fight against obesity. "Americans across the country and of all ages are struggling with obesity and its complications. With the cost of obesity projected at $300 billion per year, prevention must continue as a priority for this country. A National Nurse for Public Health would add an important voice in this discussion."

There are currently 3.4 million nurses who work on the front lines of practice in the United States healthcare system. Even though nurse are the largest group of healthcare providers in the nation, nurses hold too few positions of influence to have a national voice that is loud enough to impact the nation’s health.

Currently HR 1119 has the support of over 100 prominent organizations and nurse leaders. Four state legislative bodies (Massachusetts, New York, Oregon and Vermont) have passed resolutions urging Congress to enact legislation in order to establish a National Nurse.

If this campaign inspires you to get involved and become a part of this grassroots effort, please:

• Contact your US Representative and ask that they become a co-sponsor of The National Nurse Act of 2011.

• Write the NNNO Board of Directors (teri@nationalnurse.info) for talking points and a copy of the signatory letter (PDF).

• Publish an article about The National Nurse Act of 2011 in your organization’s newsletter to educate others about the bill.

• Request professional organizations that you belong to become an endorser of HR 1119.

• Stay updated by signing up to receive the National Nurse Newsletter

• Become a fan of the National Nurse Campaign on Facebook.

For more information please visit http://nationalnurse.org

Interview on The Nurses Station Podcast

2011-04-06T16:45:00.002-04:00

I was recently interviewed on The Nurses Station, a weekly interview podcast "by nurses for nurses" (although it is quite interesting for non-nurses as well, I must say).

It was an honor to be featured on The Nurses Station, and I encourage my readers to surf over and listen to the interview, which totals approximately fourteen minutes. You can also subscribe to The Nurses Station by clicking here. Thank you!

HR 1119, The National Nurse Act of 2011

2011-03-30T17:41:00.006-04:00

After many years of tireless advocacy on the part of some very dedicated individuals, the push to establish the position of a National Nurse for Public Health under the Office of the Surgeon General has gained considerable Congressional support (currently nine co-sponsors in the House of Representatives) and is now known as H.R. 1119: The National Nurse Act of 2011.

For those of you unfamiliar with the issue, here is some history of the Office of the Surgeon General and the drive for the establishment of the position of a National Nurse for Public Health (adapted from a previous post here on Digital Doorway):

Since 1871, the Surgeon General of the United States---the nation's "chief health educator"---has overseen and guided the health of Americans. Charged with overseeing the U.S. Public Health Service, the Surgeon General is appointed by the President and approved by Congress for a four-year term. According to the official website of the Surgeon General, this individual's duties include, but are not limited, to:

Protect and advance the health of the Nation through educating the public, advocating for effective disease prevention and health promotion programs and activities, and, providing a highly recognized symbol of national commitment to protecting and improving the public's health
Articulate scientifically based health policy analysis and advice to the President and the Secretary of Health and Human Services (HHS) on the full range of critical public health, medical, and health system issues facing the nation
Provide leadership in promoting special Departmental health initiatives, e.g., tobacco and HIV prevention efforts, with other governmental and non-governmental entities, both domestically and internationally
Administer the U.S. Public Health Service (PHS) Commissioned Corps, which is a uniquely expert, diverse, flexible, and committed career force of public health professionals who can respond to both current and long-term health needs of the Nation
Provide leadership and management oversight for PHS Commissioned Corps involvement in Departmental emergency preparedness and response activities
Elevate the quality of public health practice in the professional disciplines through the advancement of appropriate standards and research priorities, and
Fulfill statutory and customary departmental representational functions on a wide variety of federal boards and governing bodies of non-Federal health organizations, including the Board of Regents of the Uniformed Services University of the Health Sciences, the National Library of Medicine, the Armed Forces Institute of Pathology, the Association of Military Surgeons of the United States, and the American Medical Association.

From a nurse's perspective, what is missing from the Surgeon General's overall equation is the more robust input of a nurse who would serve more as an equal to the Surgeon General in terms of his or her ability to effect and implement health care policy in the interest of the American people. At this time, the U.S. Public Health Chief Nurse Officer (CNO) serves as Assistant Surgeon General, representing the Surgeon General's interests and opinions, and otherwise working in a subjugated role that the medical community might deem fit for a nurse.

The goal of the organizations and individuals behind the drive for a National Nurse of Public Health is "to elevate and enhance the Office of the PHS Chief Nurse to bring more visibility to the critical role nursing occupies in promoting, protecting, and advancing the nation's health."

The proposed role of the National Nurse for Public Health would be to:

Assist in the initiation of a nationwide cultural shift to prevention.
Bolster efforts to focus the public on healthy living.
Intensify roles for nurses, including students and retirees, in community health promotion.
Provide greater support to the Surgeon General in calling for improvements in health literacy and reduction in health disparities.
Encourage all nurses to spread prevention messages in their communities.
Encourage participation of nurses in Medical Reserve Corps (MRC) units.
Provide leadership to network with existing volunteer health promotion efforts.
Strengthen linkages with providers, nursing programs, and public health leadership.
Serve as a visible national spokesperson for professional nursing.
Increase public awareness of nursing roles and contributions.
Enhance nursing recruitment and education throughout all communities.
Support and justify additional funding for nursing education, research and service.

The National Nurse for Public Health would work to slow the growth of preventable diseases; promote health awareness, increase health literacy, and reduce health disparities; promote health careers and increased resources; enhance visibility and public recognition of nursing.

It is the opinion of many involved in the call for the establishment of a National Nurse for Public Health that it is time for nursing to have a equal seat at the nation's health care table. While some might argue that the aforementioned Chief Nurse Officer of the U.S. Department of Public Health already adequately fulfills that role, most still see that role as one of subservience to the Surgeon General rather than one of professional equality. Just as nurses are rarely consulted by the media for their expert opinions vis-a-vis the various challenges faced by the nation and its beleaguered health care system, the government also fails to fully utilize nursing's unique and crucial input to the fullest extent possible, in the interest of the health and well-being of the American people.

The establishment of the position of the National Nurse for Public Health would set a new standard for a more accurate and realistic recognition of nursing's importance to health and health care in the United States. If the federal government enthusiastically and publicly embraced nursing, making its crucial contributions crystal clear, perhaps the public, the media and the private sector would all then have a greater understanding of, and appreciation for, the multitudinous ways in which nursing positively impacts the health of millions of Americans.

Most importantly, however, the establishment of this position would certainly bring an important voice even more strongly to the ongoing conversation about health and health care in America. A National Nurse for Public Health could, in effect, deliver a unified message of preventive health at a time when millions of Americans---including millions of children---live without health insurance or access to regular primary care. At a time of crisis and uncertainty vis-a-vis the health of the country, the National Nurse could very well be a welcome, stabilizing and empowering voice of reason and prevention.

I fully support the passage of HR 1119, and I urge readers of Digital Doorway to contact their representatives in order to urge them to support this important health care legislation. For more information, please visit the website of the National Nurse Campaign, join their Facebook page, or visit the take action page on the National Nurse website.

Vulnerable Elders: The VNAA vs Medpac

2011-03-15T17:55:00.006-04:00

Just today, Medpac---the Medicare Payment Advisory Commission---issued a report to Congress recommending reinstatement of co-payments for elderly Medicare recipients receiving home health services. Medpac, an independent Congressional commission, is comprised of various professionals with expertise in health care delivery and financing, with two of the current members being nurses.

The Visiting Nurse Association of America (VNAA), has categorically denounced the recommendations, maintaining that "most home health patients are elderly, female, and living on fixed incomes." The VNAA further predicts that many patients without a Medicaid supplement will undoubtedly eschew home care services due to the additional $150 co-payment being recommended by Medpac, leaving them further vulnerable to unnecessary hospitalization and avoidable complications which could be prevented by timely and affordable home care services.

Based on information obtained from the VNAA and the Medicare and Medicaid Supplement for 2010, home health patients are overwhelmingly elderly, with 34.7% between the ages of 75 and 84, and 29.1% over the age of 85. Furthermore, 63% of these patients are female, the majority on fixed incomes. The co-payments in question were eliminated by Congress in 1972 in order to foster increased usage of home care services, which are astronomically more cost effective than care in hospitals and long term care facilities.

While both agencies obviously wish to facilitate the delivery of cost-effective high quality care for needy and vulnerable patients, re-imposing potentially prohibitive co-payments on predominantly elderly clients living at home on fixed incomes is not necessarily the most judicious choice for fixing the economic woes of the American health care system. Changes are certainly needed---many of them drastic---but I support the VNAA in its opposition to Medpac's proposed reinstatement of the home care co-payments.

As a nurse with 15 years of experience focused on home care, I have seen first-hand how elderly clients on fixed incomes must frequently make difficult choices, such as choosing between food and heating oil. Adding the differential of extra medical co-payments for elderly patients wishing to remain at home rather than become institutionalized is, in my opinion, a misguided recommendation that should be set aside in pursuit of more effective (and less draconian) economic measures.

Top Ten Nursing Blogs

2011-03-03T22:40:00.002-05:00

Allied Health World has chosen ten top nursing blogs for 2011, and I am honored and humbled that Digital Doorway has been chosen for this award. My gratitude to Allied Health World for their recognition of Digital Doorway, but even more for their recognition of the importance of nurses---and nurse bloggers---as essential components of health care and health care blogging.

Compassion From Day to Day

2011-03-01T13:54:00.005-05:00

I find that my days are simply filled with opportunities for feeling compassion for others. Consequently, it is those moments when I can connect with my compassion when I feel most connected, optimistic and part of something bigger than my little life.

As a nurse, one can often be consistently confronted with chances to be compassionate. In fact, nurses are often rated in surveys as some of the most trustworthy and compassionate people around, so I see my vocation as a professional doorway to practicing "compassion in action".

Working one-on-one with an elderly gentleman who lives with a variety of complaints and ailments, I use my compassion to see his suffering as no different than mine, and I strive to be free of judgment and frustration when he refuses to do what I think might be in his best interests. My frustration does bubble up from time to time, but I try to see the world through his blurry eyes, and I cultivate a gentle acceptance of his personal modus operandi.

In my other work, a woman with a history of a major stroke can say nothing more than "momma" over and over again, although we are aware that her mental and cognitive functions are fully intact. She frequently cries in frustration when she cannot make herself understood, and I do my best to look her deeply in the eyes and beam my love and admiration to her when we are face to face every other week when I come to see how things are going with the home health aides that I supervise. I think she and I have great love for one another, and although we cannot communicate conversationally like we might like to, we connect on a level that supersedes that of the spoken word.

Yet another client has a condition that puts her at great risk of repeat heart attacks or strokes, and she lives each day as if it might be her last. Her condition is uncorrectable, and although medications keep her alive, she walks a precipitously tenuous line with life on one side and death on the other. We talk deeply about her life, her past, and her fears for the future, and I listen to her with an open heart and a well of compassion for her suffering.

Aside from nursing, opportunities for compassion are everywhere: the homeless veteran begging for money on the street corner; the elderly widower making his lonely way through his latter years; the child home from school with the flu; a friend who loses a parent.

The human condition is almost synonymous with suffering, yet that suffering can be assuaged on many levels by the active practice of compassion for others, and the ability to see the suffering of another person as no different than one's own. "There but for the grace of God go I" is a crucial tenet to remember at time when one feels judgmental or impatient with the plight of other people, and it is in cultivating such an outlook that we truly embody our humanity.

Burn Nursing on WorkingNurse.com

2011-02-26T19:07:00.002-05:00

My newest article for Working Nurse Magazine, on the subject of Burn Care Nursing, is currently available for reading online. Please click here to read the article, and thanks!

Nurses' Voices, Nurses' Image: Nurses' Power

2011-02-22T19:28:00.003-05:00

I am republishing this post from 2008 because this subject of nurses' image still seems incredibly timely and worthy of thought and attention. Enjoy!

---------------

(Note: This is my sixth post under the auspices of the nurse blogger scholarship which I recently received from Value Care, Value Nurses.)

I have recently been re-reading From Silence to Voice: What Nurses Know and Must Communicate to the Public, by Bernice Buresh and Suzanne Gordon. What I am most struck by is that nurses still have not necessarily found their collective voice, and despite the media attention given to the global nursing shortage, I still believe that Buresh and Gordon's thesis still holds true: the public still does not fully understand what nurses do, and until that day comes, nurses' real value as clinicians will not be common knowledge.

Buresh and Gordon touch on many themes and areas of interest vis-a-vis nurses and their relation to the public, to doctors, and to one another. While I will not provide a review of the book---nor a comprehensive enumerating of its content---there are certain area which pique my interest, and I encourage curious readers to order a copy of the book and explore some of these issues for themselves.

Doctors Cure, Nurses Care

When I first heard this phrase, I was moderately disturbed by it for several reasons. Doctors, by and large, receive the lion's share of praise and gratitude when a sick patient is cured of an illness. Granted, doctors undergo a great deal of training and education in order to offer curative treatments for a variety of diseases, yet all too often, the work of nurses is grossly overlooked when it comes to successful treatment. While nurses do indeed carry out many orders originated from doctors, nurses use their own brand of critical thinking and autonomous action in order to perform specialized patient care. The public may not be aware of this fact, but many actions taken by nurses are initiated by nurses themselves, and the professional clinical assessments performed by nurses will often lead to changes in treatment and greater overall success.

Sure, nurses care, and nursing is seen by the public as a "caring" profession. However, nurses utilize scientific methods, skilled observation, and keen assessment skills to monitor patients' progress. Nurses are not just "the caring eyes and ears of doctors"---nurses are skilled professionals fully involved in patient care---and patient cures.

The Nurse as Angel, Teddy-Bear, and Child

In their book, Buresh and Gordon make one thing clear: nurses' self-presentation says a great deal to the public, and images of nurses that instill themselves in the societal zeitgeist are difficult to dispel.

Somewhere along the line, the "angels of mercy" moniker became attached to nurses as a group. Granted, in the early days of nursing, nurses' ability to act autonomously was extremely limited, and we were, by and large, the handmaidens of deified doctors. However, as much as that regrettable history has largely changed, the image of the nurse as angel unfortunately persists quite widely in our culture and websites galore promote gifts and baubles that continue to diminish nurses' professionalism. Images such as this one drive home the point: nurses are childlike individuals with starched white hats who love teddy-bears. Adding insult to injury, nurses can actually be depicted as winged angel/teddy-bears, further enforcing the infantilization (and deprofessionalization) of our profession. Would doctors allow themselves to be thus represented to the public?

Rather than being perceived as cherubic angels and childlike creatures, this writer feels that being perceived as the valuable and skilled professionals who we truly are would allow the public to have a much more accurate perception of what we do, and our importance to the care of millions.

The Clothes on Our Back

Nurses' uniforms have certainly changed over the years, and as scrubs have become the norm for nurses in most clinical settings, many companies have capitalized on the popularity of such utilitarian clothing. Now, designer scrubs covered with angels, teddy-bears (there they are again!), and any number of cartoon-like images adorn the hard-working bodies of nurses around the world. If nurses want to be taken seriously by the public---and by doctors and other professionals---how does the wearing of such (in my opinion) unprofessional clothing help our cause?

Picture this: a team meeting occurs midday to discuss a patient on the adult oncology floor. Present at the meeting: a medical resident, a medical student, the attending doctor, the oncologist, two unit nurses, a social worker and a respiratory therapist. Of all of the professionals in the room, who would possibly be wearing pink scrubs covered with teddy-bears and hearts, and a pin on her chest saying "Doctors Cure, Nurses Care"? And what message does this convey about the nurse's self-image and how the other professionals present in the meeting should perceive him or her?

What's in a Name?

In From Silence to Voice, Buresh and Gordon make their case that nurses being addressed by first name only is also a major image problem when it comes to the public's perception of us a collective whole.

When doctors introduce themselves to patients or other professionals, they always do so by using the title "Doctor" before their name. This practice immediately creates an impression that the doctor is a professional, that he or she has a name that should be remembered, and a hierarchy of power and authority is clearly established from the start.

Conversely, we nurses almost ubiquitously introduce ourselves by first name only, ostensibly to break down the barriers between patients and nurses, assisting the patient in overcoming fears and anxieties related to their treatment. While this tactic may have some limited benefit, Buresh and Gordon argue that "if nurses introduce themselves by their first names only, they are asking to be regarded as nonprofessionals because that is the conventional way that nonprofessionals present themselves."

The "first-name only convention", as the authors have named it, makes it significantly more difficult for individual nurses to receive recognition for their work when only their first names are known. It also creates a hierarchical structure in which the doctor stands alone as a figure of authority, towering above the patient and nurse with (patriarchal or matriarchal) power and authority.

Interestingly, many nurses will argue that introducing ourselves as "Nurse Smith" or "Nurse Cadmus" is awkward at best, but also brings to mind the infamous "Nurse Ratched" from "One Flew Over the Cuckoo's Nest". Granted, Nurse Ratched is a mythic and hated figure in the pantheon of film and modern literature, yet do we see doctors eschewing their well-earned title due to historical figures such as Dr. Kevorkian or Dr. Mengele (of Auschwitz fame)? Absolutely not. Doctors use their title so commonly and so frequently that the word "doctor" simply holds too much cultural power to be diminished by one literary (or real-life) character who used that title for ill.

As for "naming practices" between doctors and nurses themselves, further examples of an unequal playing field emerge, with nurses almost continually subjugated to a diminished status by always being addressed by first name by both patients and doctors, whereas doctors maintain their professionalism and authority through the use of their title and last name.

Taking Credit Where Credit is Due

All too often, the work of nurses is diminished by nurses themselves. When thanked for their work, nurses will frequently say, "Oh, I didn't do much. The doctors really did the hard part." Or when a nurse is asked what he or she does, the answer will often be, "I'm just a nurse." This diminution of nurses' worth does little to cement in the public's collective mind the utter importance---the crucial presence---of nurses in the healthcare system. The "just a nurse" phrase---used all too painfully often---hurts nurses' cultural standing and diminishes the profession in the public's eye.

Nurses need to stand up and take credit for the work that they do. Buresh and Gordon urge nurses to say "You're welcome" when they are thanked. "I am so glad that I could assist you in learning so much about your diabetes, Mr. Smith" or "It was my pleasure to provide your post-operative nursing care, Mrs. Jones"---these are statements that take credit for nurses' actions, acknowledge patients' gratitude, and accept responsibility for providing crucial nursing care that directly impacts patients' recovery and health.

Nurses' Agency

Buresh and Gordon recommend that nurses discover their "voice of agency". According the authors, "the voice of agency is the voice that says: 'I helped the patient to walk after surgery so that she wouldn't get blood clots in her legs' or 'I taught the patient how to take his medications so that they would be effective and produce fewer side effects.' The authors further illustrate their point by reminding us that "the voice of agency is the voice that conveys the message, 'I'm here. I am doing something important.' "

For nurses to develop their own agency---their own power---nurses must first claim and recognize the importance of what they do. As Buresh and Gordon elucidate so clearly in their book, patients do not learn self-care skills in a vacuum. Someone must teach them those skills, and it is nurses who bring their knowledge and education directly to patient care. When recovering from surgery, it isn't doctors who monitor patients every fifteen minutes, using a lifetime's worth of learning to perform important expert assessments. Nurses use a wide variety of skills---often on an autonomous basis---to provide patients with the care and attention they need for optimal health.

While nurses are indeed held in very high esteem by the general public in surveys and polls, most members of that adoring public would be hard pressed to actually describe what it is that nurses do. As Bernice Buresh and Suzanne Gordon make so abundantly clear, it is up to nurses to claim their rightful place of importance in the care provided to patients in a variety of settings. Nurses need to proudly speak of their work with a voice of agency and power, and communicate clearly---to the public, the media, their families, their friends, and their colleagues---that nursing is important, that it is meaningful, and that what nurses do contributes to successful patient care and positive outcomes. We must forgo the teddy-bears, the hearts, the flowers, the useless diminutive statements and self-deprecation, and claim our professionalism for our own.

Nursing's voice must be heard, and Buresh and Gordon feel that the time for that voice to be clearly heard is now.

The Fresh Air Fund NYC Half-Marathon

2011-02-17T17:28:00.003-05:00

On March 20th, 2o11, The Fresh Air Fund is once again hosting its annual Half-Marathon, an amazing 13.1-mile course through beautiful Central Park, continuing on through Times Square and ending with breathtaking finish-line views of the New York City harbor. More than 11,000 runners, of all ages and abilities, finished the NYC Half-Marathon last year, raising over $100,000 for the cause, with almost $400,000 raised in the last four years.

The Fresh Air Fund has been providing free summer vacations for youth from the five boroughs of New York City since 1877. Thousands of children have benefited from the volunteerism and kindness of their host families.

The Fresh Air Fund is looking for runners and sponsors for the upcoming Half-Marathon, as well as host families willing to take a Fresh Air child into their home for two memorable and rewarding summer weeks.

If you'd like to be involved in the Half-Marathon, please click here, and if you'd like to find out more about becoming a host family, click here and read more about the program. If you'd like to find out if your child is eligible to be enrolled in the Fresh Air Fund summer program, click here.

Enjoy this video about the Fresh Air Fund experience!

The Sweetening of America

2011-02-16T22:40:00.001-05:00

These days, it seems like sweeteners have made their sneaky way into almost everything. From soup to nuts, it's apparent that there can be no enlightened trip to the grocery store---or even the health food store---without the very careful reading of ingredient labels. Manufacturers are simply practicing the wholesale sweetening of America, and whether we like it or not, our food supply is increasingly infiltrated with useless calories and unnecessary sweeteners.

What's most maddening to me personally is my utter disappointment when shopping at the health food stores where I am dedicated to spending my money. The manufacturers of so-called "health food"---including companies that have always been at the forefront of the healthy eating movement---have jumped on the sweetener bandwagon in recent years, and everything from crackers to canned soups seem to be tainted with evaporated cane juice, and those extra calories are just adding to the American waistline, whether the cane is organic or not. The presence of these sweeteners is often lost on many consumers, who pull items from the shelves without a great deal of thoughtfulness. However, even a savvy health food consumer like myself can erroneously bring home an item that perhaps was previously sugar-free but is now chock full of sugar, much to my dismay and annoyance.

Like salt, one becomes accustomed to sweetened foods over time, and going back, for example, to unsweetened ketchup can be a huge leap after years of consuming ketchup loaded with sugar. It's a matter of taste, of course, but oftentimes the unsweetened versions are just as tasty as their sugary counterparts (with, admittedly, many exceptions---like soy milk, in my humble opinion).

Most recently, I have been trying to avoid dairy in my diet, so I've been looking for an unsweetened non-dairy creamer to use in my green tea, decaf coffee, or hot grain beverage. Sadly, every creamer on the market seems to be sweetened with evaporated cane juice or some other form of sugar, and I simply cannot fulfill this desire no matter how hard I try. (Do I detect a new market niche and business opportunity for an enterprising soul?)

With a personal goal of losing a few pounds this spring and a general desire to keep my diet as clean as possible, fishing for unsweetened forms of many common foods is a continuous exercise in patience and conscious shopping. Luckily, there are many products that I can count on to remain unsweetened, healthy and as unprocessed as possible. Sadly however, I am consistently dumbfounded as heretofore reliable companies decide to dump truckloads of organic evaporated cane juice into their manufacturing processes. Cane producers (both organic and conventional) must be rubbing their hands together with glee as their factories pump out more tons of their products each year. Want a good stock option? Try sugar futures---it's the future of America.

Online Nursing Degrees

2011-02-15T16:29:00.003-05:00

I just took part in writing a short article for BestNursingDegree.com regarding the benefits and challenges of online nursing degree programs as opposed to traditional "brick and mortar" programs. Please click here if you'd like to peruse this brief article.

Bringing The Mind Home

2011-01-03T15:12:00.000-05:00

When I teach meditation, I often begin by saying: “Bring your mind home. And release. And relax.”

To bring your mind home means to bring the mind into the state of Calm Abiding through the practice of mindfulness. In its deepest sense, to bring your mind home is to turn your mind inward and rest in the nature of mind. This itself is the highest meditation.

To release means to release the mind from its prison of grasping, since you recognize that all pain and fear and distress arise from the craving of the grasping mind. On a deeper level, the realization and confidence that arise from your growing understanding of the nature of mind inspire the profound and natural generosity that enables you to release all grasping from your heart, letting it free itself to melt away in the inspiration of meditation.

To relax means to be spacious and to relax the mind of its tensions. More deeply, you relax into the true nature of your mind, the state of Rigpa. It is like pouring a handful of sand onto a hot surface, and each grain settles of its own accord. This is how you relax into your true nature, letting all thoughts and emotions naturally subside and dissolve into the state of the nature of mind.

---Sogyal Rinpoche

A Red Scarf and a Cup of Tea

2010-12-29T19:36:00.007-05:00

"I know we've met before but I actually don't remember you," she says.

"That's OK. I remember you, and that's what matters. Nice to see you." I sit down at the table after she shakes my hand.

"I'm sorry I don't remember you, but you are very tall and handsome. Are you married?" She gives her ubiquitously flirtatious octogenarian smile.

"Yes, I've been married for 21 years." I take out my notebook and her client folder.

"Oh, too bad. I was hoping you'd stay with me." She sips some tea and folds her hands neatly in her lap again.

"Well, I don't think my wife or my boss would approve," I say, winking at her and getting out my blood pressure cuff and stethoscope.

"Did you have a nice Christmas?" I ask as I wrap the cuff around her arm.

"Oh, was it just Christmas? Oh, yes! I did," she says tentatively. "Thank you for asking." She looks confused.

As I inflate the blood pressure cuff, I watch her closely. Her respirations are normal---about 16 breaths per minute---and she seems at peace, but her mouth is quivering a little at the corner.

"Are you upset about something?" I ask, putting my supplies back in my bag.

"No, I feel fine," she says.

"Are you sure?" I ask again.

"Yes, I think so. I was upset about something this morning, but you know what?" She looks at me sharply.

"What?"

"I forgot what it was!" She laughs and drinks another sip of tea.

"Well," I say, "if you're ever upset about something, you can always talk to me."

"And what would I talk to you about?"

"Anything you like, my dear."

"Well, that's nice." She hesitates. "Are you going to stay with me?"

"No, I can't. But I'll be back next month, OK?"

"OK. Do you know what I forgot?"

"No, tell me."

"I forgot that Christmas is coming, and I didn't get my daughter anything." She begins to cry.

I hold her hand, and contemplate what to say. At this moment, the home health aide comes in, and intercedes on my behalf.

"You didn't forget your daughter, Mrs. ______. Don't you remember that we went shopping last week and bought her the red scarf? You told me she loved it."

My patient lets go of my hand, wipes her eyes, and looks up at the home health aide.

"A red scarf? You're sure?" She attempts a smile.

"Oh yes, I'm sure," the home health aide says. "You can ask your daughter about it later when she comes home. I think she's wearing it today."

"Oh, good. I thought I had completely forgotten. When is Christmas again?"

"It was last week, dear," I say, and the home health aide nods.

"Oh yes. That's right. Thank you." She sips her tea, wipes her eyes one more time, and it seems we've averted a crisis and an unnecessary dementia-related upset.

"Well, have a happy New Year, and I'll see you at the end of January." I take her hand and squeeze it gently.

"Thank you. I'm sorry you won't be staying with me. Are you sure you can't?"

I stand up and take my coat of off the chair. "No, I really can't. I have to get home to my wife. It's a holiday week and we have a lot to do. I'll be back to see you, though. I promise." I bend down to give her a hug, and she grabs the lapels of my coat.

"You're so handsome. Will you come back and see me on Christmas?"

"No dear, not on Christmas, but I'll be back soon. Happy New Year."

She smiles again, sips her tea, and picks up the paper. It's as if I've already left and she's forgotten that I was ever there.

I give the home health aide a hug and slip quietly out the door. Snow is falling again, and I look back at the house. My patient is sitting in the window, the picture of winter tranquility and coziness.

A red scarf, falling snow, a cup of tea, and the promise of a new year.

One Year Wanes, and Another Dawns

2010-12-27T21:28:00.004-05:00

Well, dear Readers, yet another year in our lives has slipped through the fingers of time, and we pause to consider our blessings, count our lucky stars, and plan for the New Year ahead.

For me, this has been a year of great and momentous change. As most of you know, in October of 2009, my wife Mary and I sold our house and most of our possessions, left our beloved New England, and hit the open road in a 29-foot mobile home in search of intentional community. We chronicled that journey on our travel blog, Mary and Keith's Excellent Adventure, and in the course of our travels we visited more than 30 intentional communities in seven months.

Since June, we are settled---at least for now---in a lovely cohousing community in Santa Fe, New Mexico. Looking back, we readily acknowledge that everything we set out to accomplish has been realized: we live in a multigenerational intentional community with many like-minded souls, we are nearby to our son and daughter-in-law, our financial lives are more secure, we work less, we play more, and our quality of life is vastly increased. Speaking of counting one's blessings!

While we are uncertain of what the future holds, we currently have good health, a sense of belonging, a new coaching business, and there is a renewed sense in our lives that just about anything is possible.

As a nurse, I have two part-time jobs that are relatively non-stressful, allowing me more time to develop myself as a coach and as a professional writer. The nursing profession has been kind to me, and I relish being able to pick and choose the positions that are most suitable for me.

For this New Year, I wish all of you much success, health, abundance, love, prosperity, and a sense of peace in your hearts. Thank you for making Digital Doorway what it is, and I look forward to celebrating this blog's sixth anniversary with you next month.

Happy Holidays, Happy New Year, and my blessings to you and yours, now and always.

NurseKeith

Pediatric Nursing Article on WorkingNurse.com

2010-12-14T13:00:00.002-05:00

My newest article for Working Nurse Magazine---on the subject of pediatric nursing---is currently available online. Although the print version has more photos, the article text is identical. Enjoy!

A Type of Suicide

2010-12-11T01:32:00.003-05:00

The other day, I had the opportunity to meet a very kind gentleman in his mid-forties, not one year younger than me. And like most people in our forties, we eventually got around to talking about our health.

During our chat, he pulled out a pack of miniature cigars and began puffing quite vehemently on one of them. I was surprised, and asked him why he smoked at his age.

"Well, I've been smoking two packs of these cigars every day for about 15 years and don't want to quit. I have a chronic cough that just won't stop, and I bust a rib every few weeks because I cough so hard."

I asked him if the coughing bothered him, and this was his reply.

"You see, I'm diabetic, so I'm not gonna live that long anyway. So why give up smoking now?"

I was shocked, and our conversation continued from there.

"Just a few minutes ago, you showed me some photos of your grandchildren," I told him.

"Yeah, that's right."

"Don't you want to live to see them graduate from high school? Don't you want to be there for them?"

"Hell," he said. "I don't control my sugars that good, anyway, so whether I smoke or not, I'm still gonna die. So what's the difference? I won't make it to their high school graduation no matter what I do."

Stunned into silence, I went about the business at hand, and I ruminated on what he had said. Basically, this man chooses to not focus on controlling his sugars, and he adds insult to injury by inhaling at least 10 of those cigars every day. Slightly overweight and sedentary, his ratio of body fat is also not doing him any favors. He is a walking time-bomb, and as he ages, his risk of blindness, amputations, kidney disease, and serious respiratory illness increases exponentially.

There are millions of Americans like this gentleman, millions of people who simply don't understand how (or why) to take care of themselves. Apparently ignorant of the proactive choices that they could make in order to halt (or even reverse) the forward march of their respective chronic illnesses, these individuals are destined for disability and/or institutionalization, costing taxpayers billions of dollars in health care costs that could have been altogether preventable had they willingly engaged in their own self care.

Nursing homes and hospitals are crawling with people who oftentimes make lifestyle choices that fly in the face of logic, poisoning their bodies with cigarettes, nutritionally unsound foods, excessive amounts of alcohol, and a sedentary lifestyle that certainly contributes to their eventual demise.

We are all footing the bill for people like my new acquaintance who simply choose to eschew their own well-being by pursuing a lifestyle that contributes to personal ill health as well as a society-wide health care crisis. When such a critical mass of people are drugged into oblivion by cigarettes, alcohol, TV, bad food and the mushrooming effects of ill health, it is a recipe for a nationwide disaster as well as a personal form of suicide.

Ben Franklin was prescient in saying that "an ounce of prevention is worth a pound of cure", but his admonition regarding the importance of prevention has apparently lost it's impact through the subsequent centuries. Most Americans seem to simply want a pill that will help them to eat less, quit smoking or lose weight, and that reliance on an outside source for the answer to one's personal health concerns is misguided and serves as a poison in the veins of the society.

Our health care system is in crisis, and our population is aging and growing more obese and ill with each passing year. As costs rise and quality of care decreases, a small few profit from the mess as most of us suffer the collective consequences.

The smoking diabetic described above is one of millions of Americans who choose to take the path of least resistance when it comes to their health, and if I explained to him that his choices are actually driving up the cost of health care around the country, he probably would have looked at me as if I had two heads.

Americans may be obsessed with health on one hand, but on a very deep level we seem to have basically given up the ghost. My diabetic acquaintance certainly sees no reason to change any of his habits, and as he slowly commits suicide, his care will consistently tax the system, adding to the sorry statistics that paint a picture of American health care that is anything but rosy. His premonition that he won't live to see his grandchildren's high school graduation is probably accurate, and when his grandsons wonder why Grandpa couldn't be there to watch them accept their diplomas, will anyone use his story as a cautionary tale? Most likely not, and the cycle will probably repeat itself in the next generation in a form of suicide that is, for all intents and purposes, more common than any of us would like to believe.

Cold Comfort

2010-12-05T20:35:00.007-05:00

Recently visiting my father in the hospital and participating in his transfer to an acute rehab facility, it brought home the ironic fact that hospitals and other inpatient facilities are often the last places where one would want to be in order to recuperate from illness.

Although hospitals offer an essential service, they can often be comfortless, cold and unwelcoming places that are polluted with noise, unnecessarily bright lights, the constant interruption of patients' desire to rest, and a dizzying array of providers with whom patients sometimes have little or no personal connection as they are poked, prodded and otherwise examined.

Observing my father in his room in the rehab facility, the first thing I noticed was the fact that he was being constantly barraged by noise that intruded on his well-being and his ability to rest. Staying in a two-person room, a patient is always subject to the vicissitudes of having a roommate, and my father was unlucky enough to be at the mercy of his roommate's intermittent groans of pain and complaint, and also the high volume of his television that was on from the moment he woke up in the morning until he turned out the light at bedtime.

To add insult to injury, nurses and aides laughed and talked loudly in the hallway, carts with squeaky wheels were pushed down the hallways at all hours, and intercoms and buzzers continuously added to the nauseating medical din.

My father, sitting with his head in his hands, accepted the offer of foam earplugs procured from the nurses station, but they sadly did little to block out the constant noise that infiltrated his world and rattled his already troubled brain. The poor guy just wanted to rest, and the very facility promising him "healing" offered an environment completely unsuited to that end.

In my mind, most hospitals, nursing homes and health facilities are built with the convenience and ease of its employees in mind. While the physical layout does indeed need to take the efficiency of health care delivery into consideration, the lack of consciousness around patient comfort is nothing short of appalling.

When it comes to noise pollution, every patient bed should be equipped with wireless (or wired) headphones connected to the television, eliminating the cacophony of two televisions tuned to different channels blaring simultaneously in every room.

Next, every cart and wheeled conveyance used in a health care facility should have the most state-of-the-art solid rubber wheels that provide the most silent movement possible. From mop buckets to gurneys, wheels should be as silent as a whisper.

Regarding nurses and other staff, voices should be as quiet as possible, and while laughter and joviality provide for a more lighthearted work environment, I have observed that many staff frequently seem oblivious to the fact that their place of work is also a place where patients come for rest and healing. Staff do not need to take a vow of silence, but conversational voices can convey information more readily and efficiently than raised voices loud enough to wake the dead.

And then there are the lights and the environment. Where are the full-spectrum bulbs, skylights, picture windows, fountains, options for soothing music, and views of the outdoors that are conducive to healing? Why are rooms not designed in a manner wherein each looks in upon a central courtyard of beauty? Where is the research on the use of color and light to induce a feeling of calm? So many hospital walls are adorned with awful colors reminiscent of the dull and uninspiring hues of vomitus and stale urine. Hospitals are not meant to be prisons.

Watching my father react to the noise, interruptions, bright lights and cheerlessness of the hospital and rehab facility, I was struck by the readily visible fact that many facilities simply ignore the creature comforts of patients, creating environments that neither inspire nor engender restful recovery. Feeling powerless to help him to be more comfortable, my visit came to an end, and it was little comfort leaving my poor sick father at the mercy of an environment ill-suited to his overall well-being.

While there are indeed some superlative hospitals out there that embody the very heart of the nature of the healing environment, most mainstream hospitals offer a pedestrian and uninspiring atmosphere that does little to assist the sick in their process of recovery. Those hospitals that do provide optimal care and a healing environment should be held up as an example to those who simply take the path of least resistance.

Leaving my father sitting alone in that rehab was one of the hardest things I have ever done, and I hope to never again be in the position to leave someone behind who is receiving care in a facility in which I do not have the utmost confidence. While there was one nurse who took a special interest in my dad, that was cold comfort in light of the suffering that he was experiencing, and I'll sleep better when he is safe and sound in his own home once again.

Cielo

2010-11-24T00:34:00.007-05:00

"My, you're tall and handsome. Will you be staying with me?"

She looks up at me from her seat next to the window.

"I'm the nurse and I'm just coming by to check on you. Besides, I'm married, and my wife wouldn't like it if I didn't come home." I sit down next to her on the couch.

She laughs. "What's your name again, my dear?" she says in Spanish.

"Keith," I repeat, for the third time in five minutes.

"Is it Christmas this week?" she asks. "Will you bring me a present?" Again in Spanish.

"No," I answer in Spanish this time. "This Thursday is Thanksgiving. Christmas is next month."

"Oh," she says, and takes my hand in hers. "Are you staying with me?"

"My dear," I reply, "I'm the nurse, and I'm just here for a few minutes. It's so nice to sit with you here and chat."

"What's your name again? You're so handsome!" She smiles at me.

"I'm Keith, and I'll be back to see you again next month, OK?"

"OK." Another smile.

We sit for a long minute or two, her hand in mine. Her live-in caretaker is frying eggs and sausage. The smell fills the room and I'm suddenly hungry. I think about stopping for a cup of decaf on my way to see my next client. Decaf with honey and cream.

"What's your name, dear?"

"It's Keith, cielo, and I'll see you in a month or so. Enjoy your breakfast and happy Thanksgiving." I stand up from the couch and I feel like a giant next to her small frame huddled on the couch below me. She seems Lilliputian, simply diminutive.

She looks up at me with wide eyes, her mouth open and smiling. I lean down and give her a kiss on the cheek. It's a risk since it's the first time we've met, but she's been flirting with me since I arrived, and a kiss on the cheek seems appropriate and safe. Her caregiver looks up from the stove and smiles.

"Happy Thanksgiving, dear," she says in Spanish.

"Happy Thanksgiving, cielo," I say in Spanish. ("Cielo" is "heaven" or "sky" in Spanish, and it's used as an affectionate term of endearment.)

I walk outside, and I look back at the window. She's holding the newspaper in front of her face, scanning the words and shapes in front of her. Can she understand what she sees? Probably not, but she's happy, clean, well fed, comfortable, and we had a thoroughly lovely visit.

Happy Thanksgiving, cielo.

Caffeine + Alcohol = Danger

2010-11-17T20:00:00.005-05:00

I am extremely pleased to hear that the FDA is standing up to the beverage industry and forcing the removal from store shelves of all energy drinks that contain the problematic and unhealthy combination of high doses of caffeine and alcohol.

A new study has already revealed that beverages containing high levels of caffeine can increase dependence on alcohol, and some data reveals that young people who regularly use energy drinks are more likely to indulge in binge drinking and high-risk behavior.

Beverage companies have recently gone out of their way to create products with catchy names like "Joose", products that are packaged in a flashy manner that belies their questionable and unhealthy contents.

While super-caffeinated drinks like "Red Bull" have been popular for years, newer drinks containing very high doses of caffeine coupled with a 12% alcohol content by volume bring a new problem to the fore. The FDA and other groups have found that young people under the influence of these volatile caffeine-alcohol mixtures are less likely to feel the effects of the alcohol that they are imbibing since it is mitigated by the excessive amounts of caffeine being ingested simultaneously. So, these individuals drink more and more, putting themselves at risk not only of alcohol poisoning but also from the cumulative effects of the stimulating herbs and amino acids contained in these beverages.

Many young people will no doubt feel that the government is overstepping, intruding on their ability to purchase products that are inherently legal yet contain dangerous mixtures of substances whose combination (and excessive use) create enormously dangerous situations.

As I write this post, the FDA has issued a warning to the manufacturers of caffeinated alcohol drinks that the products must be removed from shelves and reformulated. Meanwhile, many universities and colleges---along with some states---are banning these products of their own accord, and we can probably rest assured that energy drinks will continue to come under close scrutiny by parents, consumer groups, the FDA, and researchers.

In a country where the market and profits rule, manufacturers have taken advantage of the situation by marketing products that endanger the health and very lives of vulnerable (and frequently naive) young people. Just like the cigarette industry (which set such a nefarious example), these companies are, as usual, putting profits before safety and health, peddling unregulated products that feed the American addiction to speed, pleasure, and consumerism, not to mention the proclivity towards alcoholism and substance abuse.

The FDA took a stand this week, and I deeply hope that they will follow through on their actions further holding the beverage industry accountable for such a wanton display of poor judgment and corporate selfishness. Our young people don't need companies to hand them their own demise on a silver platter (or, rather, in a seemingly innocuous and brightly colored can), and we need the FDA and other regulatory bodies to walk their talk when it comes to protecting the public from products that create such utterly avoidable scenarios of danger, ill health, and reckless choices.

Sugar and Making Conscious Choices

2010-11-13T22:50:00.003-05:00

I just published a new blog post on our new coaching website, Rives Carlson Coaching! The subject of the post is sugar, our relationship to sugar, and making conscious choices about how and when we eat sugary foods. You can access the post by clicking here.

My wife Mary and I are busy launching our new business as Certified Professional Coaches, and I invite you, dear Reader, to visit our website, peruse the blog, and consider signing up for our free newsletter and periodic updates. We are offering holistic life and health & wellness coaching by telephone and Skype, as well as affordable group coaching experiences.

So, please stop by our new website, sign the guest book, and let us know you came to visit!

Cheers!

NurseKeith

Diabetic Eye Disease and Metabolic Syndrome

2010-11-11T17:55:00.002-05:00

My latest editorials on Blackdoctor.org are now published. Please feel free to read about Diabetic Eye Disease and Metabolic Syndrome at your leisure.

Pondering Loss, Gratitude and Life

2010-11-10T20:15:00.006-05:00

Having recently celebrated The Day of the Dead here in Santa Fe, I have been acutely aware of the power of loss in recent weeks. The celebration of the Day of the Dead in both the Southwest U.S. and Mexico brings the notion of death and loss into the light of day. This time of year is seen as a period where "the veils between the worlds" are somewhat thinner, leaving the dead and the living in closer proximity to one another.

That said, Autumn is often a time of loss for many of us. We grieve the death of Summer, the death of the warmer weather (if we live in an area with normal changes of season), and we either embrace or resist the coming Winter and the more internal hibernatory nature of the colder months.

For me, this Autumn certainly brings with it a sense of loss as Summer wanes and Winter begins to take hold. It also brings to mind past losses and future losses yet to be.

One year ago, my wife and I pulled up stakes in Western Massachusetts, sold most of our belongings, and set out on the open road in a used mobile home that we purchased as our ticket to freedom. That leave-taking was difficult after twenty rich years of life in one place, but it seemed like the right time to leave, and we seized the moment.

Not two weeks after our departure, a dear friend took his own life, forcing us to return to New England in order to mourn his sudden death. This week marks the one-year anniversary of his last desperate and violent act, and the falling leaves and chilly air conjure images of a cold November day last year when thirty of us stood outside the barn where he had hung himself, sharing stories of our dear friend David.

Now, another friend on the East Coast is battling metastatic ovarian cancer, and her poor prognosis and continuing decline give us pause as we note her long-standing importance in our lives and the distinct possibility of losing her.

As I write this post, my eighty-year-old father (who was, by the way, loathe to celebrate his 80th birthday for fear of what this new decade would bring) is beginning what seems to be a slow decline, showing signs of early Alzheimer's, physical weakening, and a general diminishing of the childlike and optimistic spirit that has been his lifelong calling card.

Just this afternoon, a neighbor underwent surgery, and although she is young, healthy and vibrant, it is yet another reminder of the transient nature of our bodies, and the risks we all run by simply being incarnate human beings.

I am grateful for this life, for the people and animals who inhabit it, and I am again and again reminded how, by the grace of God, I continue to be a healthy and intact person who has a roof over his head, money in the bank, food to eat, clothes on my back, a car to drive, and an abundance of loving people around me. It is no small miracle, and the ubiquitousness of loss and death are yet another reminder of just how lucky I truly am.

As David's spirit continues on it's journey and as our dear friend grapples with the cancer that may eventually end her life, I am cognizant of my own continued blessings and how they are not to be taken for granted.

The mysteries of life are legion, but the importance of appreciating that mystery trumps every petty complaint and worry that crosses the mind. For me, the greatest lesson is the need for consistent gratitude, even in the face of loss and grief. It is a steep learning curve, yet one well worth the effort and energy to surmount in the hopes of experiencing peace, acceptance, and the knowledge that life is a gift never to be wasted.

Immeasurable Compassion

2010-11-10T10:24:00.000-05:00

Evoking the power of compassion in us is not always easy. I find myself that the simplest ways are the best and the most direct. Every day, life gives us innumerable chances to open our hearts, if we can only take them. An old woman passes you with a sad and lonely face and two heavy plastic bags full of shopping she can hardly carry. Switch on a television, and there on the news is a mother in Beirut kneeling above the body of her murdered son, or an old grandmother in Moscow pointing to the thin soup that is her only food. . . .

Any one of these sights could open the eyes of your heart to the fact of vast suffering in the world. Let it. Don’t waste the love and grief it arouses. In the moment you feel compassion welling up in you, don’t brush it aside, don’t shrug it off and try quickly to return to “normal,” don’t be afraid of your feeling or be embarrassed by it, and don’t allow yourself to be distracted from it. Be vulnerable: Use that quick, bright uprush of compassion—focus on it, go deep into your heart and meditate on it, develop it, enhance and deepen it. By doing this you will realize how blind you have been to suffering.

All beings, everywhere, suffer; let your heart go out to them all in spontaneous and immeasurable compassion.

---Sogyal Rinpoche

Working Nurse: Emergency Nursing

2010-10-30T12:05:00.004-04:00

My newest article for Working Nurse Magazine---on the specialty of Emergency Nursing---is now published both in print and online. Feel free to wander over to WorkingNurse.com and give it a read!

New Articles on BlackDoctor.org

2010-10-28T22:00:00.000-04:00

I have three new editorials now published on BlackDoctor.org, and invite readers of Digital Doorway to feel free to peruse them for your edification. They are:

Breast Cancer: A Year-Round Survival Guide

Is Celiac Disease A Threat For Blacks?

3 Ways Your Pet Is Saving Your Life

My blog on BlackDoctor, NurseKeith's Corner, is also updated weekly, so feel free to visit there as well!

Continued thanks to BlackDoctor.org and my wonderful editor Whitney, for this ongoing opportunity!

Haiti, Cholera, Water, and a Crisis

2010-10-27T19:34:00.002-04:00

With the cholera outbreak making itself known in the streets and slums of Haiti, we are again reminded how those of us living in various industrialized nations take sanitation, health, clean water, and access to proper medical care for granted.

Here in the United States, an outbreak of cholera would be as unlikely as a massive epidemic of bubonic plague. But in the case of Haiti, deplorable conditions pre-dating the relatively recent earthquake have created a situation wherein otherwise preventable diseases can spread rapidly and dangerously from rural to urban areas (and back again) in a matter of days.

In the Western Hemisphere, Haiti remains a symbol of failed economic policies, illegal coups, and inappropriate interventions by the United States and other global bodies who have crippled this poor nation and left its citizens lagging behind as the poorest country in this half of the world, with the majority of its 9 million citizens living below the poverty level.

International aid organizations, many of whom have had boots on the Haitian ground for decades, are now scrambling to provide education, outreach and improved sanitation in order to head off an outbreak that has already killed hundreds and could very well kill thousands if the tide is not quickly stemmed. Some groups, like Doctors Without Borders, are building makeshift cholera clinics, and others are distributing chlorine tablets for the purification of water and oral rehydration fluids for those at risk of dehydration in the absence of clean drinking water.

Newly living in the American Southwest, I’ve recently been learning how contentious an issue water has become in the 21^st century. Native American tribes have been forced to utilize the courts in order to gain access to water to which they previously had the rights for generations, and just a few weeks ago, bloggers worldwide participated in Blog Action Day, this year focusing their attention on water as a global issue of critical importance.

In Haiti, an economically crippled country was only recently brought to its knees by a massive earthquake that left more than a million homeless Haitians living in various tent cities as they await a more permanent housing solution. According to reports, sanitation and hygiene is actually worse in the urban slums, where water used for drinking and washing is contaminated with fecal matter, proliferating the spread of diseases such as cholera.

As some of us here in the Southwest argue over how many rain barrels we can afford to buy in order to have enough water to irrigate our decorative gardens, millions of Haitians long for the opportunity to simply have sufficient water to provide proper sanitation, healthy hydration, clean and hygienic clothing, and irrigation for life-sustaining crops.

In this world of plenty, Haiti’s current state is a sign that the priorities of the human race are tragically askew. Meanwhile, the conspicuous consumption and epidemic obesity of those of us in the industrialized world only further illustrate our loss of a collective vision of how life should be for all.

Haiti needs our assistance, our empowerment, and our generosity. And we can only hope that, given time and adequate resources, the poorest country in the Western Hemisphere will one day be relatively free of disease, poverty, and the misguided geopolitical interventions of those who have only sought to exploit her.

Nursing Shortage Infographic

2010-10-22T14:16:00.004-04:00

This infographic on the current nursing shortage was sent to me via an online connection who requested that this information be shared with the readers of Digital Doorway. Please note that I did not create this infographic and cannot vouch for the figures quoted within it, but feel that it is worth sharing as interesting food for thought and discussion.

--------

Via: VeterinaryTechnician.com

Global Handwashing Day and Blog Action Day

2010-10-15T13:02:00.008-04:00

Today, October 15th, marks the first ever Global Handwashing Day (being celebrated in more than 70 countries around the world) and the fourth annual Blog Action Day, wherein bloggers from around the world post about a single topic of global interest, and this year's topic is water.

Every day, more than 5,000 children die from diarrhea, and this is largely due to lack of access to clean water and soap with which to practice hand hygiene. And over all, 42,000 people die every week from lack of access to clean water. With more than a billion people worldwide (that's one in eight human beings) lacking access to clean water, the proportions of this issue are staggering and the implications for public health, disease management, economic development, food production and simple survival are staggering.

From the dual perspectives of Blog Action Day's theme of water and Global Handwashing Day's emphasis on clean water to facilitate handwashing and the prevention of disease, there is a natural symbiosis. With drought and desertification becoming an increasing global problem, action is needed on all fronts to combat this issue and turn the tide, so to speak, on the global water crisis.

Here is the Blog Action Day YouTube video which is well worth watching for a quick synopsis of the movement's mission:

And please watch this video from The World Bank, and feel free to visit the Global Handwashing Day website to get involved.

A Grateful Kiss

2010-10-10T10:29:00.006-04:00

The stroke robbed her of the powers of speech, and walking is still a struggle as well. Previously a vibrant and gregarious professional and mother of two, she has now been waging a nine-year battle to simply express herself in a world devoid of her voice.

Her husband dotes on her with devotion and love, and though they both tire of the struggle from time to time, there is nothing to do but continue.

Although she cries every few days, most likely out of frustration, her smile can still light up a room, and her eyes sparkle with a keen intelligence and wit that she simply cannot express with language.

I have visited three or four times now to check on her and the assistance that the home health aides provide, and our connection becomes sweeter with each visit. At first, I would hold her hand as I talked with her, looking into her eyes, making as much contact as possible, always talking to her rather than talking about her in the third person. Her husband, standing nearby, observes our interactions and obviously approves.

This past week, I felt a compelling urge to give her a hug as I prepared to leave after a brief visit, and she made it very clear that only a kiss would do. Surprisingly, she kissed me on the cheek with gusto, hugging me tightly with her good arm, and as she let go, she beamed me a smile that would melt the coldest heart. It was one of those moments in life, and the gratitude and love in her eyes is something I will always remember.

This courageous woman and her husband daily continue the work of recovering the functions that were lost when the massive stroke tore through her body like a bolt of unfortunate lightning. Locked in her brain and unable to verbally communicate the feelings and thoughts that swirl in her mind, her deep hazel eyes still well with emotion, and she does indeed communicate in myriad ways.

Visiting this lovely woman and her husband is a pleasure, and on this particular day, she bestowed on me the gift of unabashed affection with a simple kiss and hug, and I left their cozy home radiant with delight and gratitude for the reward of being the nurse for such a courageous and wonderful woman.

Bill Clinton and Vegetarianism on BlackDoctor.org

2010-10-08T18:05:00.003-04:00

I recently wrote an editorial for BlackDoctor.org in reaction to Bill Clinton's announcement that he is now a vegetarian in the interest of his cardiovascular health and longevity. Celebrity diets are always something to take with a pinch of salt (no pun intended), but champions for vegetarianism and healthy lifestyle choices deserve some attention, in my humble opinion.

As a newly minted and certified Health and Wellness Coach, eating low on the food chain combined with exercise and good habits will be two pillars of my health and wellness "platform", so citing Bill Clinton's healthy epiphany is certainly helpful to the cause.

With heart disease still being the #1 killer of Americans of both genders, it's time for Americans to assess their predilection for fast food and processed food once again, and perhaps turn the tide on obesity, heart disease, diabetes and mushrooming health care costs secondary to the ravages of those particular disease processes.

So, please visit my article on BlackDoctor.org, and perhaps your own lifestyle revolution is also close at hand!

Food: Making Choices or Taking Chances?

2010-10-06T14:41:00.001-04:00

My latest editorial on BlackDoctor.org, "Food: Making Choices or Taking Chances?", is now published and can be found by clicking here. Feel free to pay BlackDoctor.org a visit!

Of Oatmeal and Mass

2010-09-30T19:30:00.005-04:00

She sits in her house all day, the heavy curtains closed against the New Mexican sun. Pictures of saints and the Pope adorn the walls, and other evidence of her religious belief fills the house. Her life revolves around watching Catholic Mass on television three times per day, and everything else seems to take a back seat to her faith. She rarely parts the curtains and even more rarely ventures outside.

"How are you?" I ask as I sit down on the seat opposite the couch where she spends her days and nights.

"Fine," she says, looking at the floor. She fidgets with the hem of her dress.

"How are things going with the home health aides? Is there anything new you need them to do for you?"

"No. It's fine." She fidgets some more.

"How are you sleeping these days? Do you get enough sleep?"

"I don't sleep too well. But I'm fine," she replies. Her lack of eye contact is unnerving and I fumble for ways to make a deeper connection, but this is only our third meeting and I know she needs time to build trust, so I'm patient.

"Is there anything I can do for you? Is there anything you need?"

"No, I'm fine." She looks over at the TV. "Mass starts soon and I still have to make my oatmeal."

The clock on the wall ticks and tocks in the silence between us.

"Your house looks lovely. You take such nice care of it. Have you lived here a long time?"

"My husband built it forty years ago. Every board and nail. He even did the adobe. We raised our children in it, and he died nine years ago." Her affect brightens as we look around the house.

"The woodwork is beautiful, and I love the counters in the kitchen. He did a brilliant job," I add.

"Thanks," she smiles.

"I really have to make my oatmeal now. I don't want to miss Mass."

"OK," I say. "I'll come by and see you at the end of October, and I hope you have a good month til then." We shake hands.

I open the front door and light comes streaming in. She squints, shades her eyes, and says goodbye as she closes the door. Mass and oatmeal await.

The Fresh Air Fund 2010 NYC Marathon

2010-09-22T12:29:00.002-04:00

Every year, I try to promote the Fresh Air Fund's annual marathon which is held in New York City, and this year is no exception.

The Fresh Air Fund has been helping disadvantaged inner city children have memorable and healthy summer experiences since 1877, and the Fresh Air Fund Marathon is a major fund-raiser for these important programs. In 2009, more than 5,000 children from New York City visited host families in more than 13 states, and 3,000 children participated in a special Fresh Air summer camp in rural Pennsylvania. The Fresh Air Fund also promotes career awareness for children and teenagers, has additional camping experiences for children with special needs, and many Fresh Air children participate in these programs through their 18th birthday.

To find out more about the marathon, please click here, whether you would like to register as a runner or simply make a donation to a very worthy cause with a stellar history of helping children experience the health benefits and camaraderie of a healthy and fun summer vacation.

Your Healthiest Life

2010-09-20T21:29:00.004-04:00

My newest editorial, "Essential Tools For Your Healthiest, Happiest Life" is up on BlackDoctor.org. Feel free to surf over and learn about healthy aging and longevity! And my continued gratitude to BlackDoctor for having me aboard the editorial team!

Change of Shift, Vol. 5, Number 6

2010-09-17T10:32:00.002-04:00

The newest edition of Change of Shift, the premier nursing blog carnival, is now up and running over at Emergiblog.

I'm pleased to again be included as a contributor, and my thanks as always to Kim at Emergiblog for being a champion of nurse bloggers around the world. Kim has worked tirelessly to promote the many nurse bloggers who pour out their hearts and souls to describe the joys, frustrations, challenges and rewards of the incredibly varied profession of nursing. She remains ahead of the virtual curve, and inspires us all to continue writing and sharing our experiences with the world.

Ashes to Ashes

2010-09-14T13:24:00.005-04:00

Cruising into the office after seeing a few patients for home evaluations, I walk into my supervisor's office to pick up some documents from the printer. On her desk, there is a white cardboard box with printing on the top, and I immediately know what it contains: ashes, or what is known euphemistically in the funeral industry as "cremains".

Stopping in my tracks, I approach the box, my mind flashing back to the day when I picked up my step-father's ashes from the funeral home, overwhelmed by the fact that his 72-inch tall body weighing 180 pounds in his prime was now reduced to a box of detritus weighing in at less than 10 pounds. I recall driving home with that box in the passenger seat of my car as I cried in relief for the end of his suffering, despite the surreal notion that all that was left of his physical body now fit in a small container that bounced nonchalantly on the seat as I raced towards home.

Returning to the present, I gently opened the white box bearing my deceased patient's name, and reached in to grasp in my hand a clear, thick plastic bag containing her remains. I lifted the bag out of the box, weighed it in my left hand, and closely examined the small chunks of bone interspersed in the grayish ash. Closing my eyes, I conjured her face in my mind's eye and sent her a prayer of comfort as I returned the bag to the box and closed the flaps tightly.

I had only met this patient once, and although I had heard that she was dying, my next visit was not scheduled quickly enough, and she died before I could make a final visit. Our agency's home health aides knew her well, providing intensive personal care as her illness progressed. An intellectual, writer and retired professor, her body and mind had deteriorated greatly over the last five years, and those who knew her well understood that this mental and physical deterioration had been incredibly difficult for her to accept. Unable to read, write or speak, she was trapped in a body that had become, for all intents and purposes, a vestige of itself, a shell almost entirely incapable of personal expression. Despite having no living family, she did not die alone, and this is a comfort to all who knew and loved her.

Leaving my supervisor's office, I was flooded with memories of my step-father and his final days, especially that last day of his life when we all gathered around his bed to witness his last intake of breath. He never exhaled, and it was as if the six of us expectantly gathered around his bed had exhaled for him, sending his spirit out from his body on its journey into the unknown.

Next, my old dog Sparkey came to mind, and I pictured that day in late summer when the vet came to our house and assisted him to leave his pained and wasted body behind. As the medication entered his veins, he licked each of our faces in turn and a single tear ran down his furry cheek. It was a difficult goodbye, but his suffering was due for a humane and timely end.

Now a dear friend of ours struggles with cancer as she grapples with what treatment regimen will be most effective and least toxic, and her phone messages and our conversations across the country reflect the potential of loss that we are all facing vis-a-vis her mortality.

Recently, another dear friend's sister took her own life, and another acquaintance died after a brief but heroic battle with leukemia.

That little white box and its contents of ash and pulverized bone were a provocative reminder, a physical and unexpected talisman of the final ride that we all must eventually take. Bearing this in mind, I considered my own complaints and their relative pettiness, and was once again reminded of what a brief and wonderful privilege it is to inhabit a human body, walk the earth, and breath in the air of life.

We arrive to this world empty-handed and leave with nothing but our soul. They say you can't take it with you when you go, so we have to make the most of this fleeting earthly sojourn of ours. I am grateful for the time I have, and when it's my turn to take my place in a little white box of ash and bone, I will do so with gratitude and the knowledge that this was a life well lived.

As the saying goes, ashes to ashes.

"How to Slow Down" on BlackDoctor.org

2010-09-13T17:11:00.002-04:00

My most recent editorial on BlackDoctor.org, "How to Slow Down", offers some simple suggestions for mindfully taking a pause for the cause during your busy day.

Cookies

2010-09-12T12:29:00.004-04:00

"I'm getting old and lazy," she said as she sipped her coffee and nibbled on a chocolate chip cookie.
"After ninety-five years, I figure I have a right to be lazy."

"So," I responded, smiling, "what does old and lazy look like to you, my dear?"

"Well, I get up in the morning at my leisure, take my time getting washed and dressed, sip on some coffee, look out the window, and eventually make my way to the living room or the patio. Sometimes I eat lunch, sometimes I don't, and then the rest of the day I can do whatever I want, really." She sips some coffee and has another bite of a cookie, offering me one from the plate.

Taking a cookie, I bite into it as we look into each other's eyes and smile, sharing the simultaneous experience of the flavor of the cookie, the brilliant New Mexican light, and the fresh September breeze coming through the dining room screen door.

"Do you feel like your needs are being met? Are you happy with the care you're receiving? Is there anything you need?" I put my cookie down on the plate in front of me.

She looks very thoughtful. "After so many years, I have no complaints. It's been a wonderful life. My kids love me and care for me. You people come to help me. The house is beautiful and I can see the sky and the mesa out there." She points vaguely towards the window. "I'm happy. I really am."

We each take another bite of a cookie, and she pats the head of the family dog who has buried his head in her lap.

"Have another cookie," she says, and smiles.

Smoking: Time to Quit! on BlackDoctor.org

2010-09-07T22:55:00.002-04:00

My newest editorial on BlackDoctor tackles the health effects of cigarette smoking. Do people really still smoke in the 21st century?

Three New Editorials on BlackDoctor.org

2010-09-04T00:03:00.002-04:00

Three of my latest editorials are now up on BlackDoctor.org for your edification and reading pleasure. They are as follows:

Naturopathy: a basic primer

Tweets, Likes and Links: the benefits of relationships and connections

Nature: Doctor Approved: a brief article on the benefits of making time for nature in your life

Change of Shift, Vol. 5, Number 5

2010-09-03T00:32:00.001-04:00

Please pay a visit to the newest edition of Change of Shift. I am very happy to once again be included in this fine collection of blogging by nurses.

Did I Miss Something?

2010-08-25T22:25:00.003-04:00

The call came on my day off, asking me to go see a client who was not feeling well but was refusing to go the emergency room. So, I delayed my shopping and errands, changed my clothes, grabbed my bag, and headed cross town to her home, which was located about fifteen minutes from my neighborhood.

When I arrived, she was supine in bed, the home health aide by her side. Questioning her, I could perceive nothing more than neck and leg pain, something that the orthopedist had recently confirmed as being caused by worsening chronic osteoarthritis.

"Have you been taking your pain medicine?" I asked.

"Not really," she replied. "I don't like to take that stuff." She made a face.

"Well, you might want to think about taking it at least a couple of times a day when the pain is this bad. You might not like taking it but it may help you to feel a little more functional."

"Maybe you're right. I'll try it and see how it goes. They're sending me to the pain clinic, anyway."

I did a thorough head to toe exam. She was neurologically intact, her bowels were normal, her urinary function was normal, and her lungs were clear. All vital signs were perfect. She denied reports that she had vomited the day before, but her mild dementia could be the reason she couldn't remember. Checking the home health aides' notes, I realized that no vomiting had been documented, so who knows if it happened or not? A few recent falls were documented though, and the bruises on her shin and ankle told the story.

"Did you hit your head when you fell? Was it scary?"

"No," she replied. "Not particularly. I caught myself but I knocked down a lot of papers and magazines in the process." Her house is covered with piles of mail, papers and magazines that the aides are constantly trying to reduce. As if to illustrate that fact, the home health aide made a move to retrieve the bottles of medications from the bathroom, and yet another pile of magazines cascaded to the floor. We both stooped to pick them up as our client watched from her bed.

Sitting on the edge of the bed and chatting with my client and the home health aide, I evaluated her speech, made certain that her facial features seemed even and smooth, and had her push her feet against my hands to test her strength. All reflexes were normal, her grip was strong and even on both sides, and I could see nothing wrong aside from the chronic pain that has dogged her for years. I was perplexed that the home health aides had made the assessment that she was acutely ill.

"Well, I know you're not scheduled to have an aide on Saturday and Monday, but I'm going to recommend that you have daily care for the next week, at least until you feel a little bit better and can see your primary doctor and get that referral to the pain clinic." I began to pack up my things.

"OK. That sounds fine. It's just so frustrating to be so limited. The pain is horrible, and I'm lonely."

I held her hand, chatted for a few more minutes, and took my leave. The home health aide was going to stay an extra hour, and I called the office to have daily care approved for the coming week, and drove home to continue my day off.

The next day, my supervisor called to tell me that the morning aide arrived to the house, let herself in, and found our client dead in her bed, reclining in the same position in which I had left her the day before.

I was shocked at the news, and immediately began to question my assessment. Had I missed something? Was there a clue I had overlooked? Was I remiss at not sending her to the emergency room? Would my skills and license be brought into question?

There has been no answer as to the cause of death for this woman who appeared, for all intents and purposes, to be suffering from chronic pain, loneliness, and a slowly progressing dementia. I am certain that my assessment was accurate and that she was not acutely ill that day when I was called to her home to assess her. Still, the questions linger, and they are most likely questions that will never be adequately answered.

May she rest in pain-free peace.

Change of Shift, Vol. 5, Number 4

2010-08-21T17:28:00.003-04:00

Yet another edition of Change of Shift is up and at 'em, bringing the world some of the best nurse bloggers on the web. So, make yourself an iced tea (or maybe a gin and tonic), curl up on the hammock, and help yourself to some good summer reading!

Of Birthdays and Death

2010-08-16T10:25:00.003-04:00

Celebrating my 46th birthday this week has been a wonderful exercise in being grateful for all of my blessings, and the need to take grateful stock of my life is underscored by the persistent presence of sickness and death that is such an intrinsic part of human existence.

As a nurse, I have worked with the dying and the chronically ill for many years, and their struggles are a reminder that our hold on this mortal coil is tenuous, at best. Several years ago, my wife and I spent about three weeks living at my mother's house in New Jersey, caring for my step-father as his body slowly diminished in its power and presence at the hands of pancreatic cancer. Presiding over his dying process and his death was a powerful and moving experience, and despite my many years of nursing, his was the first death that I witnessed firsthand. That last gasping intake of breath was profound in its finality, even as we waited for the exhalation that never came. I noted how quickly the life force left the body, and how quickly we shifted from care-taking to grieving in the space of one breath.

In 2001, a very close friend of our family was gunned down by the police in a circumstance that might be plausible in a movie or novel, yet was wholly unreal to those who witnessed it and those who survived his horrible passage from this world to the next. Distressed, he had called our home to solicit our assistance moments before the police burst in and riddled his body with seven bullets, and we heard his dying cries of love on our answering machine as he lay bleeding. His death was indeed something almost beyond belief, and the post-traumatic stress that followed was life-altering.

Last year, a dear friend took his own life after years of struggling with chronic pain, depression, and an undiagnosed cognitive condition that robbed him of the ability to use his brilliant brain in the way in which he was accustomed. Memory failed him, words were slow to come, and the loneliness that he experienced was simply too profound for him to see a way to continue on. His 51st birthday would have been last Friday, and I miss the opportunity for him and I to celebrate our August birthdays together, Leos in heart and spirit.

Another close friend was diagnosed with an advanced cancer a few months ago, and this shocking news of urgent surgery, treatment and the potential for death from the ravages of the disease were yet another wake-up call. She is literally fighting for her life while she also faces her own mortality square in the face with courage and understanding that our time on this earth is indeed limited, either by illness, fate or irreversible circumstance. She is a shining example of grace and courage in action.

The other day, it was revealed that a close friend's sister died suddenly at 42, leaving a young daughter without a mother and a confused group of family members and friends. Sudden death is perhaps the most difficult to digest and understand, but acceptance is still the eventual goal, no matter how challenging the path to that state may be.

So, birthdays come and birthdays go, and we move forward in our lives with our petty complaints, our desire to do better, and the courage to continue on even in the face of monumental loss and grief. Birthdays are indeed a time for celebration, but they are also a moment for reflection, atonement, and the realization that this very birthday may very well be our last.

In light of that reality, why then do we waste such precious time with the minutiae of our complaints, problems and apprehensions? This is one of the puzzles of human life, and perhaps this year I will learn even more deeply that my time on this earth is limited, that these days are precious beyond description, and that it's time to live life without regret and hesitation. Perhaps this is the year when I will realize the enormity of the gift, embracing life with the open-eyed wonder that its many mysteries deserve. Happy birthday indeed.

Change of Shift, Vol. 5, Number 3

2010-08-09T23:30:00.002-04:00

I am honored to report that my most recent submission to Change of Shift (everyone's favorite nursing blog carnival) is featured as the "editor's choice" at the top of this week's edition. I hope you can stop by, peruse this week's offerings, and praise Kim from Emergiblog for her consistently excellent work.

The Point of Acupuncture on BlackDoctor.org

2010-08-03T15:02:00.001-04:00

My new editorial on the basics of acupuncture is now published on BlackDoctor.org. Feel free to pay a visit.

We're All in This Together

2010-07-31T16:47:00.006-04:00

She is delightful. Her eyes twinkle when she talks, and her stories---often repeated, I'm told---reveal her cultured European upbringing and her very good memory.

She sits in her chair most of the day, looking forward to happy hour at five. She's lived a good life, and there's nothing that will change her habit of drinking a bourbon and water (or two) at the end of each long afternoon. Nearing 100, she's even taken up smoking a cigarette with her bourbon, and there's nothing that will change that, either.

"I never expected to live this long. Who could have imagined it?" she says with apparent sincerity. And when questioned about the new habit of smoking, she says, "And why not?" with a smile.

"My life has been lovely, my children are wonderful, and I have no complaints other than my loss of mobility. Still, life is good and my days are my own."

I inspect her toenails and decide that a podiatrist should be the one to tackle their impenetrable thickness. Her ankles are without swelling, her abdomen is soft and non-tender, and her cognitive functions are intact. Her vital signs are stable, her pacemaker works like a charm, and her positive attitude certainly makes up for the deficits that have significantly reduced her independence.

"Life has been an adventure, and now I get to sit in this chair, look out at this wondrous view, and have myself a nice stiff drink at the end of the day."

Her daughter winks at me knowingly, and acknowledges in a whisper that there's now more water and less bourbon than ever at happy hour.

"Well," I say, "I wish I could make up excuses to stay here all afternoon and chat, but you're doing so well there's nothing more to say. I'll come back in a few months to see how things are going with the home health aides. Call me if you need anything, OK?"

I shake her hand, but it's apparent that she wants a kiss, so I lean down and peck her on her powdery cheek. She smells like lemons.

"Thank you, dear," she says. "Please come back soon, and don't just wait til they tell you that you have to come back. The door is always open." We smile at one another widely as I exit her immaculate bedroom.

"She's a wonderful woman," I say to her daughter as we walk to the driveway. "She's lucky to have you and your brother."

"Yes, she is wonderful. We love her, and we're just as lucky as she is. We're all in this together." She beams at me as we shake hands, and I walk to my car, sinking into the driver's seat with a satisfied sigh.

Chiropractic on BlackDoctor.org

2010-07-31T00:05:00.001-04:00

My new editorial on chiropractic is now published on BlackDoctor.org. Feel free to swing by.

Attitude on BlackDoctor.org

2010-07-29T16:10:00.001-04:00

My newest article on BlackDoctor---"Want a Happier Life? It's All About Your Attitude!"---was published today on BlackDoctor.org. Enjoy!

Change of Shift, Vol. 5, Number 2

2010-07-24T00:39:00.003-04:00

The latest edition of Change of Shift is now published over at Emergiblog. I actually managed to submit two blog posts to this edition, and I'm pleased to have been included.

In the ER.......

2010-07-20T18:38:00.010-04:00

The emergency room is busy, but we're ushered in quickly after registering. My client was having liquid diarrhea and vomiting after I arrived to his house this morning, so I called the case manager and she came right over. She agreed to transport him to the ER in her car as I followed close behind.

It's the usual ER scenario: the same questions asked multiple times, a desultory exam by the attending Physician Assistant, and a long wait for blood to be drawn and an IV started. As the nurse starts the IV and draws the labs, we chat about nursing.

"I've been a nurse for thirty years, and it's just gotten worse and worse," she says as she pokes my client and draws five vials of blood before starting the IV.

"I almost always work without a break, and when I complain, they tell me that this is the ER, and if I don't like it, I should go somewhere else." She places the vials of blood on the counter near the sink and fingers the IV until it's running at the rate she desires.

"They treat us like shit," she continues, "and there are always new grads ready to take our place. I don't know why I put up with it. I don't even have time to eat, and you'd think the management would care that their nurses' basic needs are met. But they don't. They just don't."

She leaves the room, the vials of blood still sitting by the sink. Contrary to safety protocol, she leaves the rail down on the side of the bed where she's been working. She also leaves all of the detritus and trash from the blood draw and IV setup in my client's lap, and dirty gloves on the floor. It's the end of her shift and she's ready to give report and go home.

I overhear a conversation in the hall, the nurses paying no heed to the fact that patients and visitors can hear their every word.

"How's your day going?" one nurse asks her.

"Terrible. It's one of the worst shifts ever. I can't wait to get out of here. I hate this."

She shuffles off to give report, my patient's blood vials still on the counter by the sink. I try to catch her eye but she's already down the hall.

Almost an hour later, she's back, and the blood is finally sent off to the lab, and then she's scribbling madly in charts as the new nurse comes on duty.

The eight hour ER shift has obviously taken a toll, and our original nurse seems fried beyond reason. I quietly excuse her lapses and hope that she can go home and rest.

The new nurse who has just come on duty bustles into the room, greets my client, introduces herself, asks some questions, and shakes her head as she realizes that the previous nurse failed to hook up an automatic heart monitor and oxygen saturation machine on my client when he was first admitted. She untangles the IV, smooths his forehead, offers me a drink and a snack, and bustles out as cheerily as she came in. Meanwhile, I wonder how she'll look and feel in eight hours.

With telephones ringing, bright lights, loud conversations and the constant beeping of monitors, machines and intercoms, the emergency room is no place to rest. In fact, it's not a place anyone ever wants to be, even most of the people who work there. Still, it's an essential place, a human place, and a place where the ill, the broken and the traumatized come for succor and emergent care. But if the nurses and others who staff these emergency rooms are truly treated like so much expendable waste, then how can things ever really change?

New Articles on BlackDoctor.org

2010-07-17T12:05:00.002-04:00

For readers who are interested, I have several new articles published on BlackDoctor.org this past week:

"Easy Ways to Get Your Daily Ounce" (of Prevention)

"A Guide to Nurses: Who They Are and What They Do"

A Visit to the Doctor

2010-07-14T19:56:00.004-04:00

The case manager and I have brought our client to see his new doctor, who enters the room smiling, his gray lab coat worn over a white shirt and tie decorated with multicolored stethoscopes and faux ECG readouts. He shakes each of our hands, in turn.

"So, you're Mr. __________. Very nice to meet you. I believe your son is my patient, as well."

My client is solicitous, friendly and smiling as the doctor greets him. "That's right. Nice to meet you."

"You seem very healthy for a man of your age," the doctor says. "We should all be so lucky."

As we talk, review our client's history and relate our concerns and needs, the soft-spoken doctor listens----really listens----and reflects back to us what he hears. Performing a cursory yet thorough exam, he listens to our client's heart and lungs, prods his belly, inspects his limbs, checks his eyes, and otherwise gives him the once over with gentle and learned dexterity.

"I think you're all doing an excellent job caring for Mr. _________. He's a lucky man to have such a team looking after him 24 hours a day." He leans over and speaks very loudly into our client's ear. "You're a lucky man!"

Our client smiles broadly.

After the exam, the doctor recommends a tetanus booster and a pneumonia vaccine, and we're stunned when he comes back into the exam room to prepare and administer the vaccines himself.

"I'm sorry," I say, "but I've never seen a doctor give an immunization before. Do you always do this?"

He looks up at me as he flicks one of the syringes with his finger to remove any errant air bubbles. "Oh, when the nurses are busy I like to help out. It's no big deal, really." He leans down and administers the two injections deftly, one in either deltoid. Mr. _______ never flinches.

"Well, it's a big deal to us. Most doctors would never dream of doing such a thing," my colleague says to him as he places the used syringes in a sharps container. "You've been very kind and attentive."

"It's my pleasure, truly." The doctor shakes each of our hands once again, hands us prescriptions, referrals and a signed application for a handicap placard, and slips quietly out the door.

"That is one fine doctor," my colleague says to me, shaking her head. "What a positive experience."

We wheel our patient to the elevator, all of us quiet, knowing that we have just had what might be seen by some as a very unusual experience. The doctor was efficient, kind, thoughtful, thorough, paid great attention to detail, and listened to everything we had to say. As nurses, being really listened to by a doctor is simply a coup d'etat, and we left that office beaming with our collective good fortune.

A fine doctor, indeed.

A Kind of Life

2010-07-10T16:02:00.005-04:00

He stares out the window, fumbling with his belt and drumming his fingers on the arms of his portable wheelchair. Wheeling himself to the table, he leafs through a magazine, the pages worn from days of similar activity, the corners greasy from his fingers. Unwilling to draw, refusing to be read to, staring past the TV towards the empty wall, eschewing the Play-Doh that we thought might be a fun and therapeutic diversion, engaging with him is significantly challenging. Throughout our 12-hour shift, he generally refuses food, readily accepts water or juice, and otherwise chooses to keep to himself with occasional brief conversational interludes.

And so the days pass.

Recently, he was saved from a deplorable situation where he was taken advantage of by acquaintances looking for money or alcohol, rarely washed or bathed, and lived a life that most people would find appalling in its squalor. Now, living with family in the countryside, he is safe from ill-meaning neighbors and so-called "friends", yet he pines for that other life with all of his might. Stripped of his freedom, his drivers license and his car, he is at the mercy of nurses and social workers who mind his every move with a keen and earnest intent to help him stay clean, dry, well fed, hydrated and happy.

It is without a doubt that this individual was truly a danger to himself and at risk of injury or death without the proper intervention. Still, assessing his current situation, it's also quite clear that his quality of life leaves a great deal to be desired. We do our best to provide for him, keep him comfortable, and afford him some level of contentment. Still, it's so difficult to witness a person who seems to glean so little enjoyment from life, made even more keen by the sudden loss of his independence. Yes, it's a life, but how can we make it better? How can we bring him joy? And how can we make up for the changes that have stripped him of his ability to make decisions for himself? These are not easy questions to answer, and as we grapple with the possible answers, he stares out the window wishing that things had never changed.

Change of Shift Turns Five!

2010-07-09T14:07:00.002-04:00

Change of Shift, everyone's favorite nursing blog carnival, has just celebrated five years of publication with it's most recent edition. Congratulations and gratitude to Kim at Emergiblog for being a tireless advocate on behalf of the many talented nurse bloggers who pour their hearts out and share their stories time and time again.

Happy 5th birthday to Change of Shift, and may there be many years to come!

Home Health and Hospice

2010-07-02T18:48:00.002-04:00

My latest article written for Working Nurse Magazine is now published both in print (in Southern California) and online. The article covers the specialty of home health and hospice nursing, and features interviews with three special nurses.

My next article for Working Nurse (on the specialty of nursing informatics) will be published later this month, and in August I will be providing yet another article on the specialty of oncology nursing.

I am very grateful to Working Nurse Magazine for these opportunities, and am pleased that my writing career continues to flourish, even in these uncertain economic times.

100 Blog Posts That Will Make You a Better Nurse

2010-07-01T01:37:00.002-04:00

One of my blog posts from 2009---The Nurse as Sisyphus---has been featured in a list of "100 Blog Posts That Will Make You a Better Nurse" over at NursingSchools.net. I greatly appreciate being included on this list, and hope that some inspiration is indeed gleaned by those who peruse the many offerings included there.

Change of Shift, Santa Fe Style!

2010-06-24T00:01:00.004-04:00

Well, after a long hiatus, I'm finally hosting Change of Shift once again, and I'm happy to do so from the comfort of our new home here in Santa Fe, New Mexico! (For those of you unfamiliar with Change of Shift, it is a nursing blog carnival wherein nurses from around the blogosphere are featured in an "online magazine" that is hosted on a different nursing blog every two weeks.)

For those readers who are new to Digital Doorway, my wife and I sold our home in Massachusetts last summer, sold or gave away most of our things, bought an RV, and have been traveling the country for seven months and almost 10,000 miles in search of a new place to call home.

For the moment, we've settled (perhaps temporarily, perhaps not) here in Santa Fe, New Mexico, and you can read about our travels here. That said, this episode of Change of Shift (that most venerable of nursing blog carnivals) will be peppered with photographs from around northern New Mexico for no other reason than the fact that they're nice to look at, entertaining, or simply a visual break from all of those pesky words that I'm making you read (unless, of course, you just look at the pictures!).

My thanks, as always, to Kim (of Emergiblog fame) for making Change of Shift a reality, and for putting nurse bloggers on the blogosphere map. Let's hear it for Kim (cue virtual applause, please).

So, without further ado, here are the participants in this week's edition of Change of Shift, Volume 4, Number 26..........

For whatever reason, it seems that lists are incredibly popular these days, whether it be for iPad apps or the best ways to darn socks, so here's a list of blog posts that feature lists about things that their authors think are worth our while to peruse........

At NursingSchools.net, we learn 50 things you never knew about babie s (who would have thought that babies cry before they're born?); while over at The Health Harbinger, we are privy to 25 online startups that are democratizing medical data and information.

Speaking of iPad applications, CNA Class Online shares 5 Excellent iPad apps for "Dr. Mom".

And while we're talking about new technology, RN to MSN Programs submitted a list of 10 awesome Android apps for nurses (Android being Google's answer to Internet-based applications for cellular phones, more or less).

Sadly, we all do indeed need to think about the oil spill in the Gulf of Mexico, and NursingSchools.net submitted a sobering list of the 10 biggest health dangers behind the oil spill, which includes neurological disorders (and chemical sensitivity, I'll add) among the workers dealing directly with this toxic nightmare of the century.

Thinking globally, The Health Hawk shares with us 17 intriguing infographics about global health, which, apropos of the oil spill, describes the fact that the average American driver uses 500 gallons of gasoline per year! (And we wonder why we're still addicted to oil?)

And the lists go on.......

Aging Healthy submits a list of the top 50 aging and gerontol ogy blogs for those of us who want to prolong our time on earth (oil spills or no oil spills....), and NursingSchools.net submits yet another post for our enjoyment and enlightenment, this time with 100 entertaining and inspiring quotes for nurses, one of my favorites being "Health is the state about which medicine has nothing to say" (W.H. Auden).

And speaking of NursingSchools.net, we received yet another list (don't they work over there?), this time regarding the 100 best blogs for exploring alternative medicine.

Moving away from lists towards actual prose (cue English teachers cheering in the background), we were happy to receive a submission from Barbara Olson of Florencedotcom fame, this particular piece on "Good Reads About Medication Misadventures" being recently published on Medscape (for which a username and password may be necessary in order to gain access).

And when it comes to those of us who might like a career change from direct care, Master of Health Administration shares with us "The Ultimate Guide to Health Administration Careers" (and the salaries don't seem half bad.......). Alternatively, Online LPN to RN delivers The Ultimate Guide to Nursing Agencies for those nurses who would like some assistance in landing their next job or plotting a career move.

Nurse Teeny at The Makings of a Nurse offers a very personal post about "transition shock" and a new job, something we can all probably relate to.

And over at Nurse Me, the author struggles with a situation wherein a patient's religious beliefs impact her ability to deliver the care that's needed in a post entitled Science vs Jesus.

Author Peggy McDaniel at The American Journal of Nursing's Off The Charts blog chimes in for a post entitled "Protection or Harm----What Are You Doing at the Bedside?", and there is much sobering food for thought here vis-a-vis poor hand hygiene and hospital-acquired infections.

In a post entitled "Fingerprints, Ad Nauseum", yours truly posits that there is utter bureaucratic insanity behind the need to be fingerprinted for every job application and license change that one must undergo (especially here in the Western US). Can't there be a central databank of fingerprints, or does the FBI just adore receiving multiple fingerprint cards for the same person over and over again? (It's your tax dollars hard at work, folks!)

And from the Land Down Under, Nurse In Australia shares a post entitled "Sheepish, Demure Nurses Pander to Inflated Egos". The nurse-doctor relationship is always something worth talking about, isn't it?

Our final two posts for this edition of CoS are well-written missives that address two very important issues worthy of our individual and collective attention.

First, Katie Morales of NursesNetwork.com (where my blog currently feeds automatically via RSS) discusses the legal and ethical notion of how companies profit financially with the use of our tissue and blood, whether we donated it willingly or not. In her post entitled "Not Much Has Changed, Katie offers several examples wherein companies benefited significantly from the cells or tissues of private citizens who then have no rights whatsoever to also benefit from the millions of dollars made from tissues harvested from their own bodies. What's the matter with this picture?

And last but certainly not least, our beloved Kim McAllister, the maven of Emergiblog and the creator of Change of Shift itself, delivers a passionate and convincing open letter to the American Nurses Association that rightly questions the ANA's refusal to endorse the creation of the Office of the National Nurse.

HR 4601 is an important piece of legislation currently making its way through Congress that would elevate the Chief Nursing Officer of the Public Health Service to the position of The National Nurse, a move that would bring nursing to the fore in terms of preventive health and the public's understanding of what nurses actually do. In March of this year, I wrote a blog post delineating how the National Nurse would benefit the country in myriad ways, and I invite you to read that post, read Kim's letter, visit the website of The National Nurse organization, and get involved in this important fight for recognition of nursing's rightful place at the American health care table.

Teddy Roosevelt once coined the term "the bully pulpit" to signify a position of authority or rank that gives it's holder the right and privilege to pontificate and share his or her opinions without reserve. While I hold little authority or rank in society as a simple nurse and writer, this blog is my own bully pulpit, and hosting Change of Shift is yet another opportunity to speak my mind and reach a larger audience, if only for a fleeting digital moment. I am grateful for your attention, and I urge you to contact your member of Congress about wholeheartedly supporting HR 4601!

Thank you to Kim for this opportunity, thanks to those of you who are taking the time to read this, and a special thanks to the bloggers and writers whose contributions made this edition of Change of Shift what it is.

And in the words of Garrison Keillor, "Be well, do good work, and keep in touch."

Fingerprints, Ad Nauseum

2010-06-22T01:08:00.008-04:00

Since coming out West, it seems that I can barely do anything at all pertaining to medicine or nursing without having to get my fingerprints taken.

When I applied for my Texas nursing license, I obediently went to the local sheriff's department near my in-laws' home in Georgetown and had three FBI fingerprint cards done by a clerk who seemed relatively uninterested in the proceedings.

Six weeks later, I received notice from the Texas Board of Nursing that those prints were poor quality and unreadable (no surprise there), and was thus requested to have them done yet again. Since my wife and I were traveling at the time, I stopped into the court house in Silver City, New Mexico where a friendly but overworked sheriff's deputy expertly took my prints and sent me on my inky way. (Those prints were subsequently accepted and I received my Lone Star State license soon thereafter.)

Following my licensing fingerprint debacle, I applied to be a board member of a new medical marijuana clinic in northern New Mexico (they needed a nurse on the board), and of course, yet another set of fingerprints was demanded for the privilege of applying for membership. Still traveling, I stopped into the Sedona, Arizona police station where friendly volunteers happily collected my money and greased up my fingers yet again.

Now, having settled in Santa Fe, New Mexico, I have applied for several nursing jobs, and each of those positions requires a set of fingerprints to be sent to the FBI, and these sets were luckily simultaneously taken on an electronic machine that creates a digital facsimile that can be transferred to paper.

Maybe it's just me, but there appears to be an enormous waste of resources involved in sending multiple individuals for repeat fingerprint screenings ad nauseum. When one considers the human hours wasted, the gasoline burned, the reams of paperwork filed and the extraordinary effort and energy expended in the name of bureaucracy, perhaps there's some addiction to bureaucratic chaos (a la the Terry Gilliam film, Brazil) that precludes the powers that be (local, regional, state and national) from creating a central database in which each individual's fingerprints could be simply recorded once.

I'm sure there are those whose trust in the government has waned to the point at which even submitting to fingerprinting in the first place would seem absurd at best (and dangerous at worst), but since I've already allowed my personal information to be submitted to the FBI innumerable times, I would thus have few qualms allowing my prints to finally sit in an electronic repository for access by potential employers and others interested to know that I am indeed who I say I am.

With these latest sets of prints behind me, I have no doubt that I'll once again be visiting the state police or a local sheriff when the next demand for fingerprints rolls around. Til then, I'll give thanks that my spate of fingerprinting adventures is over for now, and my ink-stained digits can finally rest on their (positively identified) laurels.

Jobs Galore

2010-06-19T01:25:00.003-04:00

After living here in Santa Fe for just under two weeks, it seems that Craig's List has provided exactly what I needed in terms of part-time work as a nurse. Even when the local newspaper demonstrates a dearth of open positions, online sources of job postings are apparently where employment can be found.

Now, after the byzantine process of obtaining my Texas nursing license (our permanent domicile is currently in Texas), jobs here in New Mexico themselves provide a plethora of hoops through which to jump in order to receive that first paycheck. From having to obtain yet another set of fingerprints to having to take several different exams to further (and unnecessarily, in my opinion) test my knowledge of nursing practice, obtaining employment as a nurse here in the Wild West entails a labyrinthine to-do list that threatens to eat up leisure time like there's no tomorrow.

Still, finding remunerative and (hopefully) satisfying work is very nice, and I'm grateful to have made it through the application and interview processes relatively swiftly. My new jobs should prove to be interesting and relatively well-paying (but less than my previous hourly wages as a nurse in Massachusetts), and I hope that the experiences are also fecund fodder for blogging and writing (with complete adherence to HIPAA, of course!)

Working as a nurse again will be interesting after such a long hiatus, and I look forward to writing about the experience as it unfolds, so stay tuned.....

Digital Doorway

My Letter to the Arizona Board of Nursing in Defense of Amanda Trujillo

A Letter to the AZ Board of Nursing Regarding Amanda Trujillo

Amanda Trujillo: A Fellow Nurse on the Ropes

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

Seven Years of Digital Doorway

NurseFriendly on RN.FM Radio!

Book Review: "Confident Voices" by Beth Boynton

RN.FM Radio Launches Today!

National Nurse Act of 2011 Signatory Letter

What We Leave at the Door

Nurse Keith Coaching is Born!

Nursing and Transformation in the New Year

RN.FM Radio is Coming!

National Nurse Act of 2011 Introduced

Nurses' Voice, Nurses' Image: Nurses' Power

Why Coaching For Nurses?

Nurse Keith Coaching Is On The Way!

Pathways in Nursing Infographic

Book Review: The Millionaire Nurse

Book Review: Nursing 2012 Drug Handbook

My Newest Blog Is Live

"So, Which Hospital Do You Work In?"

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In Stitches: A Memoir by Anthony Youn, MD

The "Occupy" Movement and Healthcare

Food: A Rumination for Blog Action Day

Dare to Imagine

Living, Loving and Dying

Nursing: Beyond the Books

Fresh Air Fund Still Seeks Host Families

Johnson and Johnson Nursing Notes

Book Review: Critical Care by Theresa Brown

The 25 Best Nursing Blogs

My Mother: Rest in Peace

NurseKeith on BlackDoctor.org

The Ride of a Lifetime

Nursing License Map

Volatile Organic Compounds

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Press Release: The National Nurse Act of 2011

Interview on The Nurses Station Podcast

HR 1119, The National Nurse Act of 2011

Vulnerable Elders: The VNAA vs Medpac

Top Ten Nursing Blogs

Compassion From Day to Day

Burn Nursing on WorkingNurse.com

Nurses' Voices, Nurses' Image: Nurses' Power

The Fresh Air Fund NYC Half-Marathon

The Sweetening of America

Online Nursing Degrees

Bringing The Mind Home

A Red Scarf and a Cup of Tea

One Year Wanes, and Another Dawns

Pediatric Nursing Article on WorkingNurse.com

A Type of Suicide

Cold Comfort

Cielo

Caffeine + Alcohol = Danger

Sugar and Making Conscious Choices

Diabetic Eye Disease and Metabolic Syndrome

Pondering Loss, Gratitude and Life

Immeasurable Compassion

Working Nurse: Emergency Nursing

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Haiti, Cholera, Water, and a Crisis

Nursing Shortage Infographic

Global Handwashing Day and Blog Action Day

A Grateful Kiss

Bill Clinton and Vegetarianism on BlackDoctor.org

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Food: Making Choices or Taking Chances?

Of Oatmeal and Mass

The Fresh Air Fund 2010 NYC Marathon

Your Healthiest Life

Change of Shift, Vol. 5, Number 6

Ashes to Ashes

"How to Slow Down" on BlackDoctor.org

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Smoking: Time to Quit! on BlackDoctor.org