Q&A with Nurse Blogger and Public Health Nurse Keith Carlson, RN, BSN, NC-BC interviews nurse blogger and public health nurse Keith Carlson, RN, BSN, NC-BC. Keith has been in nursing over 14 years with experience in home care for those living with AIDS, diabetes and other chronic illness. He currently operates a health and wellness coaching company, Nurse Keith Coaching ( and maintains the blog, Digital Doorway (, where he shares information and experiences relating to the nursing field.

Q: What is your current position?

I'm a registered nurse with a bachelor's degree. I work for two different agencies. One is a home health agency that provides home health aides and homemakers for people maintaining their independence at home, and the other is an organization that has a contract with the federal government to care for injured mine workers.

Q: How did you become interested in this field?

I was originally an art-school dropout in my late teens and early 20s. I decided to pursue a career in massage therapy and yoga instruction. At a certain point, I realized that I wanted to work more within the system and bring more of a holistic viewpoint to the medical system. So, I pursued a degree in nursing. For the last 14 years I've been doing a large variety of different types of nursing.

Q: What does a nurse working in this area do?

It's basically 24-hour home care for gentlemen who have worked in mines. A lot of them worked in the mine without proper protection from the uranium that they were exposed to throughout their careers. I do a lot of respiratory therapy and respiratory assessment and help keep them comfortable and independent at home.

In my previous position, my job was to manage between 50-80 clients with chronic disease. About 25 percent of those had HIV and AIDS, and a percentage of those had dual diagnoses of HIV and hepatitis C, often from intravenous drug use. It was very complicated care management because these clients were living at home (sometimes they were in facilities for periods of time), and they really needed a great deal of very intensive recovery and treatment.

Q: What is an average day like?

It's a fairly low-key job because I'm working in a home, and I basically spend my day with the client. I do respiratory assessments every two hours. We spend time together. I do my regular assessments every four hours. I also do personal care, cooking and cleaning. I do a large range of activities during my 12-hour shifts at the client's home.

Q: What is it like working as a nurse in an urban environment as opposed to working in a rural one?

Working in an urban environment vs. a rural environment, there are some fundamental differences. I worked in a small to medium-sized city in western Massachusetts, and it was kind of an intense place. I think there are different energies in urban versus rural areas, and nursing is somewhat the same. You're seeing the same situations - the same disease processes - but people's lifestyles, and sometimes their outlooks can be somewhat different based on the environment in which they live.

Q: What kind of preparation does someone pursuing this career need?

It takes a certain amount of autonomy, independence, and confidence to walk into any situation and remain calm, maintain your equanimity, and be able to deal with whatever's in front of you. As a home health nurse, I've walked into situations in which a client is acutely ill and I've had to make what I considered a life-or-death decision. I've walked into situations, especially in the city, in which a home was an active shooting gallery and there were people using IV drugs, and I had to deal with something that felt dangerous or uncomfortable.

Q: What traits work well in this career?

You need to be confident and self-assured. You also need to have an understanding that when you go into clients' homes, that's their castle. Even though you're there to direct care, to advise them, or possibly to tell them what they should do, it's their call and their place. When you walk in there, you're a guest. When you're working in home health care, it's crucial to be able to deliver effective care, do it compassionately, and understand that you're walking into someone's life.

Q: What are some of the challenges that nurses in the field face?

Nurses face many challenges in the field. I think the media, especially Hollywood and television, portray nurses in ways that may not be realistic. A part of our job is to show that nursing is a science-based practice; it is not "the art of compassion." It's based on research and decades of really hard work by many incredibly intelligent nurses who have moved the profession forward.

Another thing I think that nurses face is, as health care reimbursement rates drop, a lot of nurses are forced into situations in which they're caring for more patients than they were used to. Care is sometimes compromised, and nurses are put into positions in which they can't necessarily deliver the kind of care that they want to give their clients.

Q: What do you see for the future of the field?

In home health, I think we will be affected to a great extent in the next 10-20 years as the baby boomers begin to retire. As technology advances, we'll see more advanced care happen in the home rather than in the hospital because it's more cost-effective.

Q: What should students ask themselves before entering the field?

One question is, "Do you really want to be a nurse?" Also, do you really understand what nurses do? Or, do you have an image of nursing that's been influenced by the media. Do you really understand what the practice of nursing involves?

Q: Any other recommendations for aspiring nurses?

I think students who are entering the field need to be realistic about the profession. They need to be realistic about earnings, public perception, and the difficulty of getting into some specialties of nursing. At the same time, if someone has the drive, I think there are always opportunities.