Digital Doorway: Interview with Keith Carlson

08/09/11 2:00 AM

Nursing: Beyond the Books

Part three of our series connects with Keith Carlson, an outspoken and popular nurse blogger who has been adding ideas to his personal blog Digital Doorway since 2005. His bio states: “I am a nurse, writer, Laughter Yoga Leader, and Certified Professional Coach. Originally interested in pursuing a career in the arts, my disposition has led me to a life in healthcare and service. One of my life goals is to live a simple, community-oriented existence in a Spanish-speaking country with my lovely wife, some dogs, good friends, good wine, an organic garden, and a pile of books (and a laptop with a fast Internet connection, of course!).”

The bold statements are taken directly from his posted works, followed by our questions and his responses.

Digital Doorway

I have dedicated most of my nursing career to working with vulnerable and under-served populations, and have used my Spanish-language skills to work extensively with the Latino community. If a student wanted to expand their potential here, other than being bilingual, what do you suggest?

If a nurse wants to work with so-called vulnerable populations, there is nothing better than hands-on experience in that particular clinical and cultural arena. I recommend urban community health centers, homeless outreach programs, under-served rural areas, Indian reservations under the Bureau of Indian Affairs (BIA), and venues where those most in need are served. You cannot serve your patients’ needs in a vacuum, thus the importance of understanding the historical and socioeconomic circumstances that caused a particular population’s present-day situation. You also cannot step into this sort of situation out of pity or some erroneous notion of self-sacrifice. Embracing and understanding the challenges that others face is paramount, as well as understanding your own motivations for choosing to serve them as a health provider.

I am not meaning to say that my work as a nurse is thankless, pointless and unrewarding. Far from it. But the Sisyphean aspect of nursing resides in the notion that whatever we do, however we do it, it never seems to be enough. How does a single force in this storm determine what they are doing “helps” and is part of the solution rather than more of the same old, same old? How do we get past the rock?

As an individual serving within a larger health care system, one can only exercise a modicum of control over your circumstance, as well as the circumstances of others. While it is also true that there are many variables at play vis-à-vis patients’ health as well as their relative chances of recovery, we can bring our skills, compassion and intelligence to bear through the exercise of critical thinking, simple kindness, and intuition (an important yet often overlooked skill in nursing and medicine). As nurses, we can also question the system, stand up for the things that we believe to be right, and speak truth to power when we feel that things are not as they should be. Whether it is safe staffing levels, questionable working conditions, a corrupt administration, or sloppy sterile technique in the OR, our voices are important and need to be heard. Additionally, the media often propagates a false image of nurses that we nurses can choose to undermine and change when given the opportunity to do so.

When it comes to patient care itself, at times it is the quality of our interpersonal interactions with our patients—rather than our actual nursing skills—that are remembered most by those under our care. Anyone can be a skilled technician since those skills can be learned and practiced. However, being a skilled listener with an intuitive and compassionate ear is another thing altogether, and this is where we can sometimes have the most memorable and significant impact on the trajectory of another person’s life.

I inherited a multifaceted position that was poorly explained and passed on in a manner that created the steepest possible learning curve as I dipped my toes in the waters of local public health. In your experience, do most positions nurses will fill fit this description? How do you fend against being unprepared, or can you?

Many nursing positions are inherited complete with a manual, job description, as well as supportive colleagues who will assist the nurse in fulfilling his or her duties. However, certain positions are sometimes passed on with poor documentation, minimal training, and a sense that one is being “thrown to the wolves.” Your best defense against being poorly prepared for a new position is interviewing the person you are replacing, if possible, having frank conversations with your new supervisors and colleagues prior to your first day, and gaining as much of an understanding of your new responsibilities as you can manage before you punch the clock for the first time. Requesting a preceptor or mentor can sometimes be helpful, and many workplaces have programs whose aim is to make sure nurses succeed in their newly acquired positions. At other times, you simply dive in feet first, cross your fingers, and hope for the best as you apply your best skills and knowledge.

[from 2008] Nursing is certainly the career track upon which I have been treading since 1996, and it is indeed a viable, flexible and (sometimes) attractive way to earn a living. Of course, when push comes to shove and money needs to be made, a job as a nurse will certainly pay the bills, but only time will tell if there is indeed a nursing job out there that can truly feed my soul, for that is what I have decided work should really do. In the three years following this statement and reflecting on your past experiences again today, are you finding that nursing does answer to your hungry soul – or are you still longing for this today? If still hungry, how would you advise students to quench their own hungers?

Nursing intermittently feeds my soul, however, to be honest, it is also sometimes simply a means to a financial end. At this point in my life, I have found that work cannot provide me with the spiritual and emotional fulfillment that I seek, thus I’m endeavoring to find that elsewhere. While I do indeed put my heart and soul into my work as a nurse, I also pour my heart and soul into my daily life, and I have found that relationships, my marriage, family, and the pursuit of optimal physical, spiritual and emotional health are what truly feed me. I advise other nurses to seek the fulfillment of their spiritual hunger through whatever healthy means are necessary, but certainly seek it outside of the workplace. We all need a place to rest, a place where we feel safe, healthy and whole, and it’s very important to not expect our work (nor our colleagues) to fulfill our multifaceted needs.

I feel that we overvalue the importance of work and career in our culture, and this is underscored by the fact that, when meeting someone for the first time, we tend to ask the question, “So, what do you do?” This question obviously seeks to define the individual not by their personality or predilections, but by their choice of career. Sometimes when I am asked this very question, I refuse to reveal my profession for as long as possible, focusing instead on other things I “do”, thus forcing the questioner to judge me not by my work, but by my hobbies, likes, and interests. I feel that this is a truer indication of who a person truly is.

I have enjoyed many positions in the outpatient world, namely hospice, community health centers, home care, case management, and public health. Was it easy to start in these fields, or was there a specific prerequisite of education or experience that seemed to open doors for you?

Whether it was hospice, an urban community health center, case management, or public health, none of these positions required specialized training other than my nursing experience and my desire and willingness to learn while applying myself. Each of these positions provided varying amounts of on-the-job training, and some involved a steeper learning curve than others. However, as a bilingual (Spanish-English) nurse with strong references, good computer skills, and a solid resume, these factors have all contributed to the general ease with which I usually find employment.

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. Nurses are not just “the caring eyes and ears of doctors”—nurses are skilled professionals fully involved in patient care—and patient cures. Do you find in home/hospice-types of care scenarios, that a nurse’s role is significantly different than it would be in community or hospital settings?

In home care, the nurse is generally on his or her own to some extent, acting relatively autonomously in the absence of a doctor or other colleagues. The hospice nurse is charged with a much larger degree of autonomy, with standing orders allowing for individualized actions within the parameters of those orders. Home care and hospice call for autonomy, initiative, and the ability and willingness to act independently as needed. The thing that most home care and hospice nurses must adjust to is the lack of nearby colleagues to assist in assessments or decision-making. While a supervisor may be available by phone, there is no one at the nurse’s side to give their opinion on a wound’s status, for instance, so you have to be willing to make those judgment calls on your own. Hospital nurses have the luxury of colleagues upon whom they can lean, while home care nurses ostensibly fly solo.

[New Year, 2011] 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. What do you feel makes this a field with opportunity for you – is it your own skill set and years of service, the market demands, or a combination?

Nursing in general provides a large breadth of varied positions and specialties from which to pick and choose, and this allows the motivated nurse a fair amount of mobility and career flexibility. Having specific skills does give nurses some additional power when it comes to picking and choosing the best positions, but the nursing profession offers all nurses the ability to change their careers, pursue specialized training, and seek personal and professional fulfillment within the industry. My varied experience and resume definitely help, and I’ve been careful to build a resume and references that speak to my career goals and strengths.

While not being self-congratulatory, nurses can count themselves as members of a profession which holds compassion, caring, and healing as three of its central ideals. Saying that one is a nurse is something I encourage the graduates to do with pride, as well as with humility. Has there been times in your career when carrying the mantle, title and responsibilities of a nurse felt less rewarding?

As a nurse, one can sometimes feel obligated to provide care for neighbors, family and others despite your lack of willingness or ability to do so. Having strong personal boundaries is important so that you do not feel taken advantage of. Providing care for others on a “casual” basis can also raise interesting and worrisome liability issues. Interestingly, I have noticed that doctors who I know rarely give opinions or assistance for free, whereas nurses are quick to jump in and offer help or advice to neighbors and friends. This is a double-edged sword and one to use judiciously.

Nurses are highly trusted in our culture, and while establishing one’s identity as a nurse generally elicits a positive response, many individuals often have a misguided image of what nurses are and what they do, and this erroneous image can be a difficult thing to overcome. Television, movies and print media portray nurses as sex objects, doctors’ handmaidens, or as angels of mercy. This can be frustrating and maddening to those of us who take nurses’ public image seriously.

More and more, the management of information has become part and parcel of my job, something they never really mentioned in nursing school. How would you instruct a student to be best prepared for this?

Having a good facility with information technology is important for any nurse since most systems are now digitized. More than ever, managing information is an enormous part of most every nursing position, so understanding various computer systems and being willing to learn to use unfamiliar systems is simply crucial in the current health care climate.

A sick and depressed caregiver is no use to anyone in this world. Given that so much of the nursing profession is spent dancing on a very highly-tensioned wire, how does one successfully fight-off the depression, stress and anxiety incumbent to this line of work?

Self-care is paramount for any caregiver, especially since caring for others from a place of woundedness or poor health does little to serve anyone. Nursing can be very physically and emotionally stressful and demanding. The healthy nurse uses wholesome food, exercise, proper hydration, stress management techniques, and other forms of self-care to mitigate the stressors of work. At times, taking advantage of Employee Assistance Programs (EAPs), individual psychotherapy and other tools can also relieve the stress brought on by the challenges of a career in nursing. If one works in hospice, the ED, or other venues where death and dying figure largely, finding a place to process those feelings and nurture one’s spiritual life is certainly a priority.


keith carlsonThanks for sharing your experiences and wisdom, Keith! Be sure to check out Digital Doorway to read more of his award-winning work.

Come back tomorrow, as our series talks to a nursing student (Lovlei McKinnie) who is very close to reaching the end of her schooling.

Nursing: Beyond the Books

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