Here is how I use the Intuos tablet--really a weird setup but, it
seems to work:
I have the big Intuos Pro. I place it front and center--centered
between me and my big monitor. I set the tablet workspace to be
about 2/3 size of the tablet, anchored in the lower right corner. I
am right handed, and this seems comfortable. So, I don't use the
whole tablet for my work, just the lower right 2/3. Then I place
my keyboard along the top edge of the tablet, above the area that I
use to draw. This way, I can easily access the keys I need with my
left hand (Alt, Ctrl, Shift), or can easily type when I need to.
I don't use a mouse, I have a trackball instead, which is off to the
right, so I can navigate as needed (mouse could be here). As for
the tablet's dedicated navigation buttons, I have found that they
are a bit cumbersome to use, because on mine I need to push too hard
to activate them--so I use the keyboard instead. But the tablet has
one thing I absolutely love--the navigation wheel, which I use to
scale my photoshop brushes on the fly--it is really good for this,
and has become second nature. This is a fairly ergonomic way to
work, no long reaches, and it works well for a rightie.
Does this make sense? If you need visual clarification, I could
send you a photo of my setup.