national nurses week 2016 howard county general hospital judy brown

Retiring nurse Judy Brown has spent 34 years in health care at Howard County General Hospital. Here, she poses in her first nursing uniform holding her nursing graduation photo. She shares her insights on nursing, health care and Howard County in this farewell blog.

In 1982, I found myself working at a hospital in the community I called “home.” I wanted the quality of care to be the best it could be, and for the past 34 years, I have committed to doing just that.

Medicine runs in my family. My son is an emergency department physician in Pittsburgh, and my husband is a professor and medical researcher at Johns Hopkins Bloomberg School of Public Health. My mother attended nursing school during World War II. She never finished school and that was her biggest regret. She was my inspiration and the reason I chose to become a nurse.

Data collected from an aptitude test Bryn Mawr Hospital School of Nursing gave me during the application process said that I had a strong data analysis trait—which is true, and that I should be an accountant—which I didn’t want to do. I knew I wanted to work with people. Instead of following the path the data directed, I pursued my diploma in nursing and followed my nursing degree with a bachelor’s in business administration. Management was for me–after all, I wanted my first boss’s job. For two years I was a full-time student by day and a full-time nurse at night.

My work at Howard County General Hospital (HCGH) started as a shift director. Over the years, I continued my education with a master’s degree in administrative science from Johns Hopkins University and worked my way up in nursing at HCGH. During my tenure as the chief nursing officer, I felt strongly that HCGH should be moving toward magnet status, and my degrees were in business. I didn’t want my education to keep the hospital from achieving magnet status, so I went back and got my master’s in nursing.

To nurses today – I encourage you to achieve your education—one course at a time if that is what it takes—to progress, even if you want to stay at the bedside. No one can ever take it away from you.

Over the course of my career in nursing operations, I spearheaded the implementation of numerous programs at the hospital including the Sexual Assault Forensic Examiner (SAFE) Program and, with my team, launched The Center for Wound Healing at HCGH.

Today, I am the senior vice president of Outcomes Management and I provide oversight of performance improvement and am responsible for risk management, patient safety, infection control and The Joint Commission and CMS regulatory compliance. It was not my choice to move to the quality and regulatory role. But I had the clinical background and excruciating attention to detail–so I guess the aptitude test was accurate after all.

When I think about life after retirement in July 2016, it’s the people that I will really miss.


Judy Brown, MSN, MAS, RN, NEA-BC, FACHE, a 34-year employee of Howard County General Hospital, is the senior vice president of outcomes management. She retires in July 2016.

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national nurses week howard county general hospital

Howard County General Hospital Emergency Department nurse Emilia Alvarez-Negron, RN, (right) in 2010 with her mother, Vilma E. Grevi Rosario, at her nursing pinning ceremony.

Reflections for National Nurses Week 2016

You reach an age in life where you reminisce…where am I? What have I done with my life? Where am I going? Am I on track for what I set out to do? I was 31-years-old when I was reminded in an instant that I had not embarked on my lifelong dreams yet.

It was 9-11. The day the towers came down. I watched it happen. From 1993-2000 I worked in and around the World Trade Center. I knew the city that was underneath the towers and the intricacies of the offices above ground. I wanted to do something. I wanted to help but had no training. That day reminded me that I needed to find a way to end my career as an executive assistant and begin my journey to become a nurse. I wanted to take care of people—not corporate executives—anymore.

Ever since I was a little girl, my mom called me Joan of Arc. I was always taking up other people’s causes and helping people. I have always been empathetic and sympathetic, although coming from the Bronx, working in corporate America and running with the bulls, you wouldn’t believe so.

By the age of 27, I was married and had three children. My focus was on daily life and taking care of their needs and working hard to survive life in New York. I knew that sitting in a classroom was not an option for me, but the online education era was beginning to take hold.

At the age of 34, I began my nursing career journey. I took as many courses as I could online, in the evenings, on the weekends—all while working full-time and being a mom. I had ignited a fire and it just kept getting bigger and bigger with each class I tackled. I had discovered my passion. With my first patient encounter, I knew I had found my calling in life. It took me five years, but at the age of 39 I graduated nursing school at the top of my class with my husband, parents and children by my side and my first grandchild in my arms.

As a nurse, I knew it started with teaching. I discovered in nursing school the best way for me to learn was to teach others. My schoolmates helped me recognize the pure joy in helping others learn and watching them grow. I also knew I wanted to get my master’s in science of nursing and then continue to nurse practitioner. I wanted to go as far as I could. Along the way I discovered just how few Spanish- speaking health care providers there were and the needs that existed.

I moved to Maryland with my family six years ago and worked in the Emergency Departments of several Baltimore-area hospitals before I landed at Howard County General Hospital (HCGH). I chose to work at HCGH because, when I walked in the door, I was welcomed with open arms in such a way that I felt I was home. It was warm, it was welcoming, it was a Johns Hopkins-affiliated community hospital and it had a feel to it that said, “we are here for you.” If you knew me, you’d know I strive for excellence in everything that I do. I wanted to align myself with people who think the same way I do, and I have to say I made the right choice.

As I finish my master’s degree as a nurse practitioner this August with an emphasis on acute care for adolescents and gerontology and a post master’s in nursing education, I have an opportunity to not only teach the public about disease processes—as I have done as a nurse these six great years—but now I can also help to treat them by actually managing their disease processes and prescribing medications when they are acutely ill.

I believe things happen for a reason, and certainly everything that has occurred in my life has not been by accident. I believe God put me on this planet to become a nurse and everything that I have ever experienced has been so that I can be the bilingual Spanish nurse that I became.

When a patient comes into the Emergency Department, they may be experiencing their worst moment possible and you do something that changes their world. You have made an impact. They probably won’t remember you but when you go home at night, you know you made a difference. That is nursing.

I had a career as an executive assistant and, although I was good at what I did, I can’t say that I loved my job. I can say that I absolutely love what I do now as a nurse and I wouldn’t change it for the world.

Emilia Alvarez-Negron, RN
HCGH Emergency Department

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With another flu season approaching, now is the perfect time to get a flu shot! Flu vaccines are now being offered at doctor’s offices, pharmacies and health fairs in Howard County, and are often offered free of charge or covered by insurance. This Friday, they are available at the 50+ Expo at Wilde Lake High School in Columbia, courtesy of the Howard County Health Department.

The flu can be a serious illness. According to the Centers for Disease Control (CDC), during recent flu seasons, between 80 and 90 percent of flu-related deaths have occurred in people age 65 years and older. Children and those with other health conditions may also become more seriously ill with the flu.

To get more facts about the flu and get all of your questions answered about the vaccine, visit the CDC for Key Facts About Seasonal Flu Vaccine.

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pain relievers

Acetaminophen or aspirin are safer alternatives to manage pain than relying on ones like ibuprofen and naproxen, which can increase the risk of heart attack or stroke. [© Monkey Business Images |]

The U.S. Food and Drug Administration (FDA) recently announced it is “strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs)­—including ibuprofen, naproxen, diclofenac, and celecoxib as well as others—increase the chance of heart attack or stroke. The risk of heart attack and stroke with NSAIDs, both of which can lead to death, was first described in 2005 in the Boxed Warning and Warnings and Precautions sections of prescription drug labels.”

We knew that long-term use of NSAIDs increased the risk of heart disease and stroke, but this new study discovered that short-term use could also pose a significant threat. This warning is especially important for high-risk groups that include males over age 50, females over age 60 and those who have high-risk factors of developing coronary artery disease such as diabetes, high blood pressure, high cholesterol, smoking or obesity.

For my patients with diagnosed coronary artery disease, a stent, history of a heart attack or bypass surgery who are suffering from a headache, arthritis or backache, I recommend that they take NSAIDs for no more than a few days. If you are a high-risk cardiac patient, but have not had a cardiac event, you can take NSAIDs for a few weeks but no longer.

If you want to avoid the risks associated with NSAIDs, Tylenol (acetaminophen) or aspirin are safer alternatives to manage pain. If you have concerns, you should call your doctor to discuss your risk of taking NSAIDs versus the benefit they may have in treating your pain.

If you are taking NSAIDs and experience symptoms such as chest pain, shortness of breath or trouble breathing, weakness in one part or side of your body or slurred speech, call 911.


According to the FDA, new prescription NSAID labels will be revised to reflect the following information:

  • The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID.
  • The risk may increase with longer use of the NSAID. The risk appears greater at higher doses.
  • It was previously thought that all NSAIDs may have a similar risk. Newer information makes it less clear that the risk for heart attack or stroke is similar for all NSAIDs; however, this newer information is not sufficient for us to determine that the risk of any particular NSAID is definitely higher or lower than that of any other particular NSAID.
  • NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.
  • In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.
  • Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack.
  • There is an increased risk of heart failure with NSAID use.
Keith Freidman, M.D., is a cardiologist with Cardiovascular Specialists of Central Maryland in Columbia.

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childhood diseases, measles, mumps

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How you can avoid the outbreak of childhood diseases, and what to do if you develop one

As if the flu and Ebola weren’t enough to worry about, now we’re hearing increasing stories of outbreaks of childhood diseases among adults. Angelina Jolie misses the premier of her new film due to a case of chickenpox. NHL hockey players sit out games because they’re coming down with the mumps, along with approximately 1,100 other Americans in 2014. In California, there’s an outbreak of whooping cough, among kids and adults. There’s also a multi-state outbreak of measles, 102 cases in January alone, most linked to Disneyland. Most of the measles cases were among people who were not vaccinated. (Measles cases in 2014 were triple the number from the previous year.)

Even adults who were vaccinated against these diseases as kids are contracting them at record rates. So, what’s happening and why are adults becoming victim to diseases we thought only children could catch?

Waning immunity
People old enough to remember the days before vaccines for mumps, measles and chickenpox probably contracted these diseases when they were young, so they have natural immunity and will be unlikely to succumb to the maladies. But adults who were vaccinated as young children, and therefore didn’t contract the diseases, may become vulnerable again because immunity can fade over time.

If you are concerned that your immunity may be wearing off, ask your doctor about a blood test that checks for antibodies to see if you are still immune. This is especially important for people with chronic medical conditions or who do a lot of foreign travel. And be sure you are up to date on vaccinations the CDC recommends for adults: a booster shot every 10 years for tetanus, diphtheria and whooping cough, and an annual flu shot.

Lower vaccination rates for children
The best defense against childhood diseases is to have your children vaccinated. In some parts of the country, skepticism regarding the safety of vaccines has resulted in fewer children being vaccinated for chickenpox, measles, mumps and whooping cough. Among parents of kindergarten children in California, “personal belief exemptions” rose from 1.56 percent in 2007-08 up to 2.79 percent in 2012-13. With fewer children being vaccinated against these diseases, they are much more likely to spread from one person to another.

Childhood diseases that are affecting adults
Causes fatigue, irritability, itchy rash that progresses to raised red bumps and then blisters. Adults who get chicken pox are more likely to contract pneumonia, hepatitis or encephalitis. This virus can also resurface years later as shingles.

Treatment: Bed rest, lots of fluids, a fever-reducer and an antihistamine to relieve itching. Calamine lotion or an oatmeal bath may also relieve symptoms.

Whooping Cough
Causes violent coughing accompanied by a “whooping” sound, nasal discharge, fever, sore and watery eyes. Lips, tongue and nail beds may turn blue during coughing spells. It can last up to 10 weeks and can lead to pneumonia and other complications.

Treatment: Antibiotics, keeping warm, plenty of fluids and reducing stimuli that provoke coughing.

Causes a rash, fever, runny nose, conjunctivitis, cough, swollen lymph nodes and headache. It can have serious complications in adults and can be fatal for children and adults with compromised immune systems. Complications include ear infection, pneumonia, vomiting, diarrhea and encephalitis.

Treatment: Plenty of fluids, fever reducer and antibiotics if a secondary infection develops.

Causes discomfort and swelling of salivary glands in front of neck, difficulty chewing, fever, headache, muscle aches, tiredness and loss of appetite. In males it can cause pain and tenderness of testicles, and, on rare occasions, sterility.

Treatment: Bed rest and analgesics (acetaminophen, ibuprofen) for fever and pain and applying cold packs to the swollen and inflamed salivary gland region may reduce symptoms and pain.

Fifth Disease
Causes cold-like symptoms and bright red rash that spreads from the cheeks to trunk, arms and legs. There may also be fever, headache, sore throat, nausea or vomiting and diarrhea. It can be associated with persistent fevers and arthritis in adults.

Treatment: Plenty of fluids,­­­ fever reducer and antihistamine for itching.

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sneezing father and daughter

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The flu season started earlier than usual this year, and most states are reporting continued and widespread outbreaks. Here are some commonly asked questions answered by a Johns Hopkins infectious disease specialist.

Q. Is it true that the flu season is turning out to be more severe than expected this year?
A. The flu season started off earlier and stronger than in several previous years, and the Centers for Disease Control and Prevention (CDC) says state-by-state reports of flu cases, hospitalizations and deaths are elevated. But it is still too early to tell if there will be more flu cases than is typical in the United States this flu season, which runs from October until May. That said, influenza is widespread in most states, so everyone should take precautions to avoid getting the flu.

Q. If people become sick with flu symptoms, should they go to an emergency room?
A. The flu can make you feel pretty lousy, but the best thing to do is first consult your personal doctor or health care provider. If you don’t have one, visit a community health clinic. Your personal health care provider is best able to determine, based on your symptoms, age and medical history, whether you need specialized care in an emergency department or hospital setting. Emergency departments are primarily set up to address urgent and critical medical issues.

Q. The flu vaccine available this year isn’t very effective. Why?
Flu vaccines are developed in advance to protect against several strains of flu virus that epidemiologists who track worldwide flu virus outbreaks do their best to predict. Unfortunately, the strain infecting most people this season — known as H3N2 — mutated, something viruses often do. As a result, the vaccine available this season isn’t as effective as hoped in protecting against the H3N2 strain.

Q. Does that mean the vaccine is useless? Should people still get it?
A. The vaccine still has significant value. Definitely ask your doctor or health care provider for a flu shot, because even this late in the season, it may still offer some protection or moderate the flu if you get it. The CDC recommends that everyone 6 months or older get a flu shot every year because it is an effective way of boosting the immune system to fight circulating strains of flu virus. In addition, by protecting yourself, you may also help protect others who could be exposed if you don’t get a flu shot and come down with the flu.

Q. Other than a flu shot, what other steps can we take to keep from getting the flu?
A.Yes. Wash hands often or use alcohol-based hand gel, especially after shaking others’ hands or being around someone who has cold or flulike symptoms, such as high fever, cough and fatigue.

Q. Should people who have the flu take Tamiflu?
Antiviral drugs like Tamiflu are best and typically prescribed for those most at risk for serious flu complications, including the young, elderly, or those with other serious health conditions or compromised immune systems. Antivirals are only available by prescription and can’t be purchased over the counter. No one should take an antiviral unless a doctor specifically prescribes it. Most otherwise-healthy people can beat the flu by staying home and resting in bed, taking medicines to reduce fever and drinking plenty of water or other clear liquids to stay hydrated.

Q. What can health care workers do to keep themselves and patients healthy in flu season?
A. First and foremost, health care workers who have direct patient contact should get the flu vaccination. They also should practice good hand hygiene with frequent hand-washing or the application of sanitizing hand gel. Health care workers who feel sick with cold and flu symptoms should stay home and rest to avoid exposing patients to a flu or cold virus.

Lisa Maragakis, M.D., is an infectious disease expert and director of the Department of Hospital Epidemiology and Infection Control at The Johns Hopkins Hospital.

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