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New Infectious Diseases - This Time It's Coronavirus.

New and re-emerging infectious diseases are not uncommon. The latest coronavirus from China has gotten lots of attention very quickly. I'm in New Hampshire where we are awaiting lab confirmation of 2 suspected cases. Will your community be next?

It is important that we deal with facts and not fears. This isn't easy as the story unfolds and new information contradicts the information we saw in the media two days ago. So, as clinicians how do we deal with this?

1. Get up to date, accurate information-  Everything you need is right here. Go to the CDC often for updates.

2. Be sure that you ask about recent travel for every patient with a fever or flu like symptoms you see, always.  (Hint- You should be doing this anyways).

3. Use proper precautions to prevent spread of all infectious diseases. Sick? Stay home. Tell your patients this. Your child has a fever? Stay home from school, social events and sports...

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Are you still prescribing fluoroquinolones?


Want to know what's scaring me this Halloween week? Read on....

This week I had a patient who had seen her primary care provider prior to  coming to my travel clinic. She needed a vaccine her PCP couldn’t provide. While in my office I did a quick review of the information she had received about malaria chemoprophylaxis and self-treatment of traveler’s diarrhea. She had been given a prescription for ciprofloxin.  She said her PCP gave it to her because she also uses it for occasional UTI’s. She said several other people  going on this same tour of South East Asia had been given it by a variety of providers in my community.

I was very concerned about this because of safety and efficacy issues. First off, the FDA has several black box warnings against the use of fluoroquinolones. The most recent being for the increased risk of ruptures or tears in the aorta. Just a reminder here that an aortic dissection or rupture of an aortic aneurysm can lead to...

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Prescribing for Mental Health Conditions


In my community there is a huge need for mental health services and not enough providers to meet these needs and so by default, these patients get seen in primary care settings. NPs in primary care need to be current with psych meds. Many patients come to us first  with depression, anxiety, sleep disturbances, loss of interest in life, and changes in eating patterns.  They are  looking to us for help. How do you evaluate these patients? Who should you treat and with what? What kind of followup do they need? When should you refer?

What about the patients who come to you already taking medications for their mental health? Are they appropriate medications? Are they safe? Effective? How do you titrate, taper or discontinue these medications? Are you comfortable with the responsibility you have managing them? 

So, what should you do to feel more confident about treating mental health issues?  First, develop rapport with your patient. Get to know them...

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Titers and Immunity

How many times do come across patients who don’t know their vaccination history? Whether or not they had measles? Chickenpox? Completed an immunization series? if you work in health care, I bet you’ve have titers for measles, rubella, mumps, varicella, hepatitis B. What of your titers are subpar? Or zero? 

Here’s a great, short video about whether titers should replace vaccines, definitely worth your time. Watch it here.

How do you determine immunity to hepatitis B? Ideally 1 month after completing a hepatitis B vaccination series, a titer should be draw. If the HBSAg is greater than 10 then that person is immune and will be for life, regardless of the result of future titers. In fact, that person never needs future titers. If the titer was not done 1 month post vaccination series completion, draw a titer, if less than 10 repeat the vaccine, do a titer 1 month later. If over 10, they are immune for life.

If you or a patient has had the series of...

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Old as Dirt - Happy Nurses Week!


He said. "Take my picture with you. I don't want you to forget me. I am so happy for what you did for me."  I've kept that picture, blurry as it is for several years now.

To be honest, I don't remember his name but I will never forget that face. He didn't remember how old he was. "I'm just as old as dirt," he said and laughed. His grandson brought him to our mobile clinic in the Dominican Republic on the back of his motor scooter. To be honest, I've done a lot more for other patients over the 40 plus years I've been a nurse than I did for him that day.

But there are people who you touch and who touch you in quiet ways. They touch your soul and it's why you do the work you do. I know you know what I mean. I know you've felt it. Take a few moments this week and think about someone you've connected with and how it changed you both. Smile or maybe shed a tear and be proud you are a nurse.


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On the Road- BCE Live Programs in 2019


Conference season is ramping up and we wanted to share with you a few of the live programs Beacon Continuing Education will be participating in this year. We have programs for small groups like our CE trip to Amsterdam, medium groups like state conferences and  to huge groups, like national conferences. Don't miss out seeing us live!

April 11-12  New Hampshire Nurse Practitioner's Association Annual Conference in Nashua New Hampshire. 

June 4  American Travel Health Nurse's Association Networking Education and Development Conference  in Washington, DC. 

June 18- 23 AANP National Conference in Indianapolis, Indiana. 

July 22-25  NPACE Primary Care & Pharmacology Conference in Hollywood, Florida.

September 28- October 5 Advanced Practice Nursing in the Netherlands, Amsterdam, the Netherlands 26 CE pending.

Registration for the CE trip to Amsterdam is filling fast. So don't delay, sign up today. Be sure to check all these links...

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Burn Out? No, It's Moral Injury.


It’s hard to talk among any health care providers today without hearing all kinds of angst.

   I can’t get my charting done and have to take it home.

   My EHR is impossible.

   I spent more time on my computer than actually interacting with my patients.

   Is it normal to see ____ (fill in the blank) patients in a day?

   I hate that my prescribing practices are based on formularies and prior authorizations and not on what’s best for my patients.

   Why do Epi Pens and insulin cost so much?

   I know I am ordering tests the patient probably doesn’t need and maybe can’t afford, but I am afraid of being sued if I don’t.

   This billing and coding stuff is not what I went to school for….

Providers are talking about finding an exit plan, retiring early, or starting alternative type practices, including direct pay practices. Many are depressed and miserable and...

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Register Now for CE Trip to Amsterdam September 28-October 5, 2019


The Netherlands is rated the third best health care system in the world by WHO, way above the US (#37). The NP role  there is well established. I am curious to learn how they achieve this and get ideas I can bring home to improve care here.

Want to join me? It will involve learning in a variety of ways - some online ahead of travel,  panel discussions with Dutch NPs, time for one on one networking session, visits to health care facilities and a college of nursing, a journal club and much more...

Looks like we will be offering 26 CE  for this trip. Since this is a CE program, it is likely tax deductible (ask your tax preparer) and you could use your CE money. 

We will learn about Dutch art, culture and architecture by taking a walking tour of Old Amsterdam, visit the Anne Frank House, the Van Gogh Museum, the Delft Factory (yes, it has a gift shop), a day trip to Bruges, Belgium, and of course, take a canal cruise.

Traveling solo? No problem, we’re a small...

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4 Tips to Help NPs Get thru This Winter


Winter is certainly here. It's - 23 with the wind chill today in New Hampshire. And we've got a few more months to get through. Here are 4 tips to help NP's navigate through the unique challenges winter poses to delivering health care and maintaining our sanity.

  1. Confused about Pneumonia Vaccine Schedules?  There's an app for that and it is one of the most useful apps I've seen. Read all about how to use it and download it now. 
  2.  Still need help sorting out flu vaccines? We've got you covered. It's not too late to vaccinate. What you need to know about flu shots this year.
  3.  Need help managing pediatric asthma patients? We've got that, too. Outpatient Pediatric Asthma  Management online CE course. Short and sweet with pharm credit.
  4.  Oh, and need something to look forward to? This fall we will be going to offer another learn and earn CE abroad trips. Full details coming soon but here's what I can tell you now.


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Confused About Complicated Pneumonia Vaccine Schedules? There's an App for that!

The CDC has come out with an app that will help you figure out who needs what, when for pneumonia vaccines. It's called  PneumoRecs VaxAdvisor and you can get it for Android or iOS devices and it's FREE.

Here how it works. A patient comes in to see you and you want to figure out what they need for pneumonia vaccines. You just

  • enter a patient’s age
  • note if the patient has specific underlying medical conditions
  • answer questions about the patient’s pneumococcal vaccination history

It's that easy. The app  then provides specific guidance  for that patient consistent with the immunization schedule recommended by the U.S. Advisory Committee on Immunization Practices (ACIP).

The app will save you time and frustration as it  eliminates the challenge of interpreting and synthesizing multiple vaccination recommendation statements.  And don't worry, the app doesn’t request or collect any personal identifying data. It also does not store any...

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