"I would love to work for myself. I don't have  a lot of experience running a business. I don't have a lot of money to start a business. I don't want to have to deal with the stress of billing, coding, credentialing and managing office staff. I'm not sure I could figure out how to have a cash only practice that works. Actually, I wouldn't mind having a part time business. Is this possible.?" 

Oh yes, it is certainly is. 

The key to running a successful NP business is find a niche that answers a community problem and fits you. My niche actually found me. As an avid traveler, my primary care patients would ask me about their trips, their kid's trips, their parent's trips. And I realized a couple of things....

First ,I wanted out after 30 years of running my own primary care practice. The administrative burdens, health care crisis and future uncertainties, never mind the long hours, billing, coding and management issues and all the  things that were taking...

Did you know that the majority of all travelers are over age 55?  I am seeing more and more people 85 and over taking trips to China, India and many other locales far away. Many of those I see are quite fit and healthy. Some, not so much...

I work in a travel clinic , so  I am  often seeing these patients for the first time. But if you work in primary care, the older traveler will likely be well known to you. Whether you provide full pretravel care or not, you play an important role in keeping your patient safe and healthy when they travel.

1. Make sure their routine adult immunizations are up to date, especially flu vaccines.

  2. Be sure their chronic health problems aren't just stable but optimized. The stress physically and mentally of travel pose unique effects on many chronic diseases.

 3.  Make sure they have a med list, a problem list and travel health insurance with emergency evacuation for care if needed abroad.

Interested in learning more...

Did you know that there is a new shingles vaccine available? It's called Shingrix and it is being shipped now to pharmacies and providers. 

So why do we have a new vaccine? 

• It's more effective
• It's approved for those 50 and older
• Private insurance will cover it for those 50-64
• It's easier to store - only needs refrigeration 

You'll be getting a lot of questions about this new vaccine and so Beacon Continuing Education made a free video to answer the most important things you need to know about Shingrix, now.

It will take about 5 minutes and you'll be up to speed to start preventing shingles and post herpetic neuralgia. Remember that most people with post herpetic neuralgia use opioids , so that everything you do to prevent it will reduce opioid use and potential abuse, too. 

 Watch the free video now.

I remember what it felt like when I got my nursing pin. I remember my first day of clinical and my very first patient. I remember that feeling I got in the pit of my stomach when a code was called. Mixing IV fluids, doing divided doses for narcotics on paper and having another nurse sign off on my math. Mixing chemotherapy (usually methotrexate) and doing narcotic count at the end of every shift. Adding up I and O's manually. Calibrating IV burettes every hour or sooner. I remember the first patient I had that died, a child and I wasn't even 20 yet myself. I remember having a patient with a fever and rash admitted on Friday and when I came back to work on Monday that eight year old was deaf and brain damaged from measles.

I remember thinking that we were practicing the most scientific and advanced level of nursing care, with the most sophisticated equipment. And back over 40 years ago, we were. If someone had asked me then, what would nursing look like 40 years in the  future,...

NP's are struggling to keep up with continuing education, CE as we are constantly learning to improve our skills.  Most CE  is offered in large chunks at single or  multi day live conferences. It's like being force fed an incredible amount of information. How much do you remember? How much do you apply to your practice? Are most of your CE programs clinical information? What about learning to improve communication, learning, empathy, compassion and avoiding burnout?  Can learning new things outside your role, your job, your organization and even your profession make you a better, more fulfilled NP? Can this type of knowledge bring fresh perspective and help improve patient care? 

Self Improvement and Self Awareness

Professionalism goes beyond nursing knowledge. It stretches to self improvement, self awareness, and improved listening and communication skills. It results in better leadership skills. To live life to the fullest, we must...

Going to volunteer on a medical service trip for a week or two? There is so much to plan and pack. After doing several of these trips to the Dominican Republic and Nicaragua, here are my top 10 tips to help you be better prepared.

1. Bring a hat (ideally a foldable one) and a bandanna. 
2. Small packages of personal wet wipes. Clean up and freshen up when it's hot and humid.
3. Take a picture of your passport, credit card (front and back) that you are traveling with, where you are staying, immunization record, location of embassy, etc. Keep on camera roll or email to yourself.
4. Bring snacks like peanut butter, crackers, granola, instant oatmeal, favorite teas,   etc. Store all in zip lock bags. 
5. Buy cheap scrubs at discount stores. Leave them behind. 
6. Pack extra shoes, glasses, contact lenses. 
7. Bring an inexpensive travel rain poncho. 
8. Women should bring pads or tampons and leave what you don't use behind. 
9. Don't forget a deck of cards, books, your...

There are four shots that every NP needs to know about to protect adults.  Every visit is an opportunity to check every adult's immunization status. It's as important as checking their vital signs. 

1. Influenza vaccines - While I bet this is no surprise,  most adults in the US are not properly immunized for influenza. You probably think to advise it for those over 65 but by immunizing all adults 18 and over, you are not only protecting your patient but decreasing influenza in your community better protecting vulnerable populations.

2. Pneumococcal vaccines- There are 2 different pneumococcal vaccines for adults over 65 but certain high risk adult populations need them sooner.

3. Tdap - One dose of Tdap is recommended once for all adults and then Td booster every 10 years thereafter unless they get a tetanus prone wound and  then they need a booster if it has been more than 5 years . Any adult who is around young children should receive a Tdap vaccine....

Ever have a patient say, "I am going on a trip. Do I need any shots?" Do you know where to get up to date, accurate information to all their questions about travel shots?Sometimes , they just want to know if any shots are required for their trip. Some people think if a shot isn't required they then don't need anything to protect themselves. Whether you administer travel vaccines or not, you need to know what to say when patients ask you about travel shots.

3  Categories of Immunizations

               1. Routine

               2. Recommended

               3. Required

For starters, everyone needs to have their routine adult immunizations up to date whether they are traveling or not.  Take this as a golden opportunity to update their routine vaccines. Next, look up what recommended immunizations are suggested for their trip at www.cdc.gov/travel. ...

Did you know there is a widespread measles outbreak in Europe?  Since most people don't think there are any travel alerts associated with going to Europe, they they don't visit a travel clinic or talk to their PCP's before they go.  So, many don't know this and aren't taking any precautions.

People of all ages can contract the measles.  Children are particularly vulnerable to morbidity and mortality from the measles and many children in the US are not fully protected against it.  We need to protect travelers from getting the measles and bringing it back home.

International Tourists Import Measles

In March 2018 there were 2 international travelers who were diagnosed with  measles who exposed hundreds of people in Detroit, Newark and Memphis airports. Measles is transmitted by cough and sneezes and can remain in an area for up to 2 hours after the infected person has left.  Most of the modern outbreaks of measles in the US were traced to...

Traveler’s diarrhea can be really miserable when people are far from home. Despite following food and water precautions, there is still a good chance of contracting it especially in low resource countries, and popular destinations like Mexico and the Caribbean. It doesn’t matter whether if your traveler is staying in a 5- star resort or a hostel. The water comes from the same source. 

In most cases, travelers' diarrhea clears up on its own within  a day or two. The majority of cases resolve within a week. 

There has been much debate about the best way to treat traveler’s diarrhea and to still be good stewards of antibiotic use. In the US, we rarely treat diarrhea with antibiotics because most diarrhea is viral in origin. In low resource countries, most diarrhea is bacterial, so there is a role for treatment with antibiotics.

What can you recommend for mild diarrhea?

According to the International Society of Travel Medicine’s evidence based ...