Learn the essentials of being an emergency room nurse

Making life-saving decisions in an instant is nothing new to Cathy McJannet. As an emergency department nurse, it is all in a day’s work. “My favorite saying is that you can be a nurse who works in the emergency department or you can be an emergency department nurse. I choose to be an emergency department nurse.” McJannet, who works at Sharp Coronado Hospital, is passionate not only about her career but sharing her hard-earned knowledge with other nurses. In fact, she has partnered with UC San Diego Extension to develop the Emergency Department Nursing Certificate program, which teaches emergency nursing skills for licensed nurses. “You don’t go to school, become a nurse and that’s it,” she said. “You go to nursing school, become a nurse and continue your education for the rest of your working life.” But for McJannet, emergency department nursing is not just a full-time job: It’s a calling — one that requires commitment and nerve. Here are the essential traits an emergency department nurse must have: Be comfortable with being uncomfortable. Emergency department nurses must deal with all sorts of unsettling situations. “You need to have the patience to handle those who verbally and physically abuse medical staff and be able to create calm out of chaos,” she said. Be able to prioritize. The ideal emergency department nurse has highly developed clinical judgment skills and is able to make decisions quickly. “To the outsider, the emergency department may appear to be chaotic and confusing,” McJannet said. “But emergency department nurses thrive on the challenge of providing care and compassion to their patients and families while performing life-saving interventions.” Stay healthy. It’s not enough to be mentally sharp — you have to be physically fit as well. “To work in an emergency department, you have to be able to sustain 12 hours of a Continue Reading

When Did Chris Christie and Andrew Cuomo Go to Medical School?

Just when you thought the Republican slime-ballers had run out of muck, you discover, no, they have more mud to throw at honorable people. And they are not just smearing Barack Obama. This time, they are disparaging the doctors and scientists at the National Institutes of Health and depicting them as weak-willed tools of the Democratic Party. If Americans fall for this, they may get the government they deserve—stripped of honest science and trustworthy decisions. Republicans are not stupid, but they are shameless. They know people are rattled by the stealthy emergence of Ebola and that media hype has reflexively pumped up the danger and public confusion. NIH experts calmly explained what has to be done to defeat the disease and assured nervous citizens that healthcare teams are on the case. The GOP saw opportunity in unfolding tragedy and rushed to exploit it. A political hack named Ed Rogers, corporate lobbyist and White House insider under Republican presidents, chortled gleefully over the political twist. His op-ed in The Washington Post hailed the brave governors of New York and New Jersey—Democrat Cuomo and Republican Christie—for intervening with a common-sense response. Any doctor or nurse who had gone to West Africa to treat Ebola victims should be automatically locked up in quarantine when they return home. Rogers boasted, “If there is a Republican wave in the elections next Tuesday, pundits may well claim that it fully formed when Christie and Cuomo decided to go their own way with an Ebola strategy, despite objections from the White House.” People will be reassured by their common-sense intervention, he said, because “voters don’t trust the president to do the right thing and they are less likely to vote for those who echo the president’s blasé response.” Actually, this know-nothing attack was launched by two well-known cynics of politics, both of whom lust after presidential ambitions. What Ed Continue Reading

About a Boy

For high-school seniors like Skylar—who live in prosperous suburbs, have doting parents, attend good schools, and get excellent grades while studding their transcripts with extracurricular activities—the hardest part of the college application is often the personal essay. They’re typically asked to write about some life-changing experience, and, if their childhood has been blessedly free of drama, they may find themselves staring at a blank screen for a long time. This was not a problem for Skylar. Skylar is a boy, but he was born a girl, and lived as one until the age of fourteen. Skylar would put it differently: he believes that, despite biological appearances, he was a boy all along. He’d just been burdened with a body that required medical and surgical adjustments so that it could reflect the gender he knew himself to be. At sixteen, he started getting testosterone injections every other week; just before he turned seventeen, he had a double mastectomy. The essay question for the University of Chicago, where Skylar submitted an early-action application, invited students to describe their “archnemesis (either real or imagined).” Skylar’s answer: “Pre-formed ideas of what it meant to have two X chromosomes.” No matter what people thought they saw when they looked at him, Skylar wrote, he knew that he “was nothing along the lines of a girl.” Skylar is an F.T.M., or “female-to-male,” transgender person, a category that has been growing in visibility in recent years. In the past, females who wished to live as males rarely sought surgery, in part because they could “pass” easily enough in public; today, there is a desire for more thorough transformations. Skylar took hormones and underwent “top surgery” at a much younger age than would have been possible even a decade ago. Yet, in his new guise, he doesn’t labor to come across as conventionally masculine. Like Continue Reading

Criticized, vilified and nearly crucified, University of Louisville’s accidental president has no regrets

He plays the piano – he says he’s a “very good amateur.” His favorite composers are Chopin and Scriabin.He served on the Louisville Orchestra board for a decade, but the 23-year University of Louisville professor and administrator didn’t have basketball or football season tickets until he was elevated to interim czar of health sciences in 2015.He can't define a “triangle-and-two defense” and was stumped recently when asked what years the Cardinals won their first two men’s NCAA basketball championships.But interim President Greg Postel said that with medicine constituting so much of the university's budget, “one could easily say that being a medical aficionado” is more important than being one of sports.  Related: Interim presidents get to audition for the job, but familiarity can breed contempt In a city that blurs the line between basketball and religion, Postel, 55, has been criticized, vilified and nearly crucified for firing Tom Jurich, his school's revered athletic director, and Rick Pitino, its Hall of Fame basketball coach.Threats against the mild-mannered radiologist, who seems to be perpetually smiling, grew so hostile that university police had to provide security at his home and office.Mail – some of it ugly – ran 15-to-1 against his Jurich ouster, which was later ratified by the board of trustees.“Reinstate Tom or resign,” wrote one angry alum who claimed to have rooted on the Cardinals since 1948. “On second thought, please do both.”Pitino complained that he’d never met Postel before his termination, while critics said the diminutive doctor didn’t know enough about athletics to make such monumental moves.Despite the attacks, Postel said he has no regrets about taking on the interim presidency last January.He said he understands the importance of college athletics, and he is a Louisville fan. So Continue Reading

Doc: Aftereffects of anesthesia can include delirium

Dear Dr. Roach: My wife, who is 72 years of age, has had a horrendous number of surgeries in her life. After one surgery, she had her first complication, delirium and hallucinations that lasted for days. Not knowing the cause, I was under the impression that it was possibly an overdose of morphine from the pain management not kicking in fast enough, but after other surgeries, I noticed the same complications. I have even had special consultations with all the surgeons and anesthesiologists to try to lessen any effects from a deep application of the anesthesia. Talking to many people, this seems like a common side effect in anyone with dementia, but I have not seen any reports on this. Nurses seem to see this very often.After one surgery, we were told that the surgery was successful and she was totally healed. She was seen on a stretcher, brought in by ambulance from a nursing home/rehab, unable to stand or walk due to delirium and hallucinations complicating her rehab therapy.Can you explain the effects of anesthesia and how it causes these effects in patients affected by dementia? I am 69 years of age and have had multiple surgeries with no reaction to any anesthesia. R.E.H.Dear R.E.H.: Let me explain the confusing terminology first.Dementia is a chronic condition of memory loss, sometimes with personality changes, cognitive loss and loss of spatial abilities. Alzheimer disease is the most common cause overall, but there are several other important causes.Delirium is a sudden change in mental status. The symptoms can be similar, but often wax and wane. Delirium is caused by many medical conditions, including infection, medications, low oxygen levels and metabolic abnormalities, such as low sodium levels. Delirium is a medical emergency.Delirium after surgery is common (one study says it happens 36 percent of the time), but usually only very transiently as people come out from anesthesia. Longer-lasting delirium is well reported after surgery (and can last as long Continue Reading

‘How long have I got?’: Why many cancer patients don’t have answers

In the past four years, Bruce Mead-e has undergone two major surgeries, multiple rounds of radiation and chemotherapy to treat his lung cancer.Yet in all that time, doctors never told him or his husband whether the cancer was curable — or likely to take Mead-e’s life.“We haven’t asked about cure or how much time I have,” said Mead-e, 63, of Georgetown, Del., in a May interview. “We haven’t asked, and he hasn’t offered. I guess we have our heads in the sand.”At a time when expensive new cancer treatments are proliferating rapidly, patients such as Mead-e have more therapy choices than ever before. Yet patients like him are largely kept in the dark because their doctors either can’t or won’t communicate clearly. Many patients compound the problem by avoiding news they don’t want to hear.Surprisingly, huge numbers of cancer patients lack basic information, such as how long they can expect to live, whether their condition is curable or why they’re being prescribed chemotherapy or radiation, said Dr. Rab Razzak, director of outpatient palliative medicine at Johns Hopkins Medicine in Baltimore.The result: People with advanced cancer don’t know enough about their disease to make informed decisions about treatment or how they want to spend their remaining time.“Avoiding these issues is really irresponsible,” said Dr. Ira Byock, executive director at the Institute for Human Caring of Providence Health & Services, based in Torrance, Calif.Even the oncologists who prescribe cancer treatment might not realize that so many of their patients are clueless about what’s going on. “I don’t think they recognize the enormity of it,” Razzak said.Some patients approaching the end of life are in denial, assuming that they’ll live much longer than is realistic. Yet doctors often have a far more pessimistic estimate of their life expectancy, said Dr. Robert Continue Reading

HEARTBEATS: Urgent Care Center to open in Flemington; Walgreens opens in Saint Peter’s

Hunterdon Healthcare will open an Urgent Care Center on July 25 in Flemington.The Urgent Care Center will be at 63 Church St. Hours of operation will be 8 a.m. to 8 p.m. Monday through Friday and from 8 a.m. to 6 p.m. Saturday and Sunday.“Situations calling for urgent medical attention cannot always wait for when your physician’s office is open, but often do not always warrant a trip to the Emergency Department. Hunterdon Healthcare Urgent Care is the perfect alternative and the center is staffed by the same board-certified emergency specialists who are caring for patients in our Emergency Department. We are committed to providing high-quality, convenient, efficient and affordable medical treatment to our residents,” said Robert P. Wise, president and CEO, Hunterdon Healthcare, in a news release.The best place to be treated for your acute problem is at your primary care office and urgent care is not a substitute for your medical home. But when your medical home is not available, Hunterdon Healthcare Urgent Care services include treatment for allergies and colds, cough/sore throats, acute illness, flu, pneumonia, bronchitis, urinary infections, injuries, conjunctivitis, cuts/minor burns, sprains/fractures, pains, animal bites/insect stings and more. Sports and camp physicals can be done at the Urgent Care Center“For our patients who currently see a Hunterdon Healthcare practice, the Urgent Care will be able to view that patient’s medical record from their primary care office or specialist so the care will be coordinated and seamless,” said Christine Bogard, executive director, Hunterdon Medical Practices, Hunterdon Medical Management, in the news release.Hunterdon Healthcare Urgent Care will offer onsite X-ray, EKGs, blood work/lab testing, immunizations, audiometric testing, spirometry and vision screening. The Urgent Care Center will also provide occupational health medical services to employers Continue Reading

State of emergency: Murky billing policies add to ER uncertainty

Timnath resident Jim Mullin didn't stop to think about his finances when his 9-year-old daughter, Masyn, doubled over with stomach pain.Worried her appendix might burst, Mullin rushed Masyn to Banner Fort Collins Medical Center's emergency room on Harmony Road, just a few minutes from their home.Doctors ran a couple tests, ruled out appendicitis and sent Masyn and her dad home. Mullin said his daughter was well cared for during the visit, and doctors reassured her there was nothing seriously wrong. Weeks later, Mullin's feelings about the visit changed when he received a bill for nearly $2,000: $214.90 for lab tests and $1,585.70 for the emergency room's facility fee.He waited for his insurance company — Anthem Blue Cross Blue Shield — to pay its share, only to be told the visit would not be covered.Banner Fort Collins wasn't contracted with his insurance plan, meaning Mullin would be required to pay for the more expensive "out-of-network" visit. And since he hadn't hit his $2,000 deductible, Mullin was stuck paying the entire bill.Masyn's temporary stomach pain turned into a lingering headache for her dad. Mullin's is a cautionary tale about the tangle of regulations and contracts that govern emergency rooms in Colorado, where a patient's view of how much an ER visit will cost, or if insurance will cover the bill, is often obscured.Had Mullin driven a few blocks west to UCHealth's standalone emergency room, his insurer would have covered the trip as "in network." More: Now at Safeway: Get your blood work done And while Banner's Fort Collins emergency room isn't covered by Anthem Blue Cross Blue Shield, its ER facilities in Greeley and Loveland are considered in network.Making the wrong choice can mean the difference between paying hundreds of dollars for a trip to the emergency room — or paying thousands.That's why Mullin and local lawmakers are on a campaign to alert Continue Reading

Detox center seeks to break the cycle of substance abuse

By 2015, “Kevin” had sunk into an abyss from which he feared he’d never emerge.Despondent over his mother’s death from cancer, the 27-year-old Middlesex County resident and IT project manager began abusing 30 mg tablets of oxycodone — an opiate also known as “blues” or “roxy” on the street — to deal with his stress, anxiety, and depression.“I started doing a few per week but eventually progressed to eight per day,” said Kevin of what became a consuming addiction that cost him nearly $250 a day to support and threatened his life, job, relationships, and self-esteem. “It was a vicious cycle – I didn’t want to do it anymore but I couldn’t stop because I knew that the withdrawal symptoms would be excruciating,” he said. “I knew I had a problem but I hid it and didn’t want to tell anyone. I was stuck in a trap.”For “Brian,” a 28-year-old Middlesex County resident and telecommunications worker, life had reached a similarly desperate low. In and out of jail and rehab since his mid-teens for abusing everything from marijuana, cocaine, heroin, and painkillers to alcohol, Adderall, and ecstasy, his parents had tried to help him but ultimately kicked him out. By late 2014, “the lying, stealing, and taking advantage of other people was just too much,” he said. “It was draining and I had nothing left; I’m musically talented but I put it all aside during my addiction.  I was spinning my wheels and saw no hope.”For these two young men, and more than 20 million others — according to the National Center on Addiction and Substance Abuse, more than one in seven Americans age 12 and older has a substance abuse problem — the throes of addiction are marked by debilitating physical dependence, emotional dysfunction, and shame and stigma from which many struggle to recover.But Continue Reading

The challenges of transgender transitioning

As a family nurse practitioner, Dana Delgardo sees more than a few adult patients who never have been to a primary care physician.Why not?They are transgender. MORE: Trans Youth Forum is April 9"Trans-patients face a stigma when seeking out healthcare," Delgardo said. "Visiting a medical clinic as a trans-male or trans-female patient can be a difficult thing to navigate because most health clinics are not culturally sensitive to the trans-community's needs. The clinic staff if not culturally sensitive, may address a trans person by the incorrect pronoun; if you’re not going to be respectfully addressed, you’re not going to feel comfortable.”Delgardo has experienced this cultural insensitivity personally.“If a patient identifies as a female their pronouns are feminine, her, and she. For instance, if your name is 'Christine,’ and the front desk staff are calling you 'David,' it is insensitive and disrespectful to the patient,” Delgardo said. “It is difficult for a trans-person to walk through the front door and sit down in a doctor’s office for care.”Earlier this month, transgender health care in New Jersey took a step forward with the opening of an LGBT initiative at Alliance Community Health Group in Jersey City, NJ.“The clinic’s mission is to deliver continually improved, patient focused quality of care measured by best practices in clinical performance, for all who seek and utilize our services. Including the LGBT population,” said Delgardo, whose specialty is primary care with a trans affiliation.“Unfortunately due to insurance issues many trans patients pay out of pocket for health care, and that’s not fair." Delgardo said. “At the clinic we take most insurances, including Medicare and Continue Reading