Editor-in-Chief: K. Sue Hoyt, PhD, RN, FNP-BC, CEN, FAEN, FAANP, FAAN
Jean A. Proehl, RN, MN, CEN, CPEN, FAEN
ISSN: 1931-4485
Online ISSN: 1931-4493
Frequency: 4 issues / year
Editors' Remarks

  Editor Karen Sue Hoyt


 Editor Jean A. Proehl

 Editor Karen Sue Hoyt


Editor Jean A. Proehl 

Editors' Remarks


Dear Colleague,

Welcome to the American Academy of Emergency Nurse Practitioners!


The newly formed American Academy of Nurse Practitioners (AAENP) has adopted the AENJ as their official journal. Both AENJ and the AAENP seek to promote high quality, evidence-based care so this relationship is a natural fit. There are many opportunities for collaboration and mutual gain which will translate into improved resources for ENPs and improved care for patients.

Members will have free on-line access to AENJ as a benefit of membership and may also subscribe the print journal at a deeply discounted rate.  AAENP Founder, Elda Ramirez, is a long-time AENJ board member and AENJ Editor, K. Sue Hoyt, is now an AAENP board member so our collegial relationship is well established.

If you're an ENP who doesn't already belong to AAENP, you can see what you're missing at www.aaenp-natl.org.

Sue and Jean

Online Editor's Suggestions

The Largest Organ . . .


We live within a remarkably intelligent and protective bag of tissues, without which we could not exist, that protects us from many illnesses and injuries, and helps maintain our homeostasis. It provides our external appearance and contributes to our sense of self, and although subject to some afflictions, it can be a window of internal health; ---yet is little thought of by most, and few realize that it is the largest organ of our body.


… and by a sleep to say we end
The heart-ache and the thousand natural shocks

 That flesh is heir to Hamlet Act 3, scene 1. Wm. Shakespeare

A gateway to the killer rashes | EM Blog Mayo Clinic


Melanoma Skin Cancer | American Cancer Society


Burns | MedlinePlus


Burns | World Health Organization


Dermatology Section | Medscape Emergency Medicine


Dermatology Articles | Medscape


Morgellons Disease, or Delusional Parasitosis? | CNN Health


A Family Scabies Infestation | Larry Mellick, MD - YouTube


Lyme Disease | CDC


Common Adult Skin Problems Pictures slideshow | MedicineNet


Dermatology Practice Today | Advance Healthcare Network


Solving Skin Rash in Primary Care; use of a diagnostic decision tree | Advance Healthcare Network


Clinical Update: Skin Infections | Lippincott Nursing Center




                        Tom Trimble, RN CEN

                        All opinions are solely those of the author.
                             Users are responsible for the validity to their own practice.



Advanced Emergency Nursing Journal is always looking for authors, articles, and suggestions for topics that inform the work of our specialty and excite the readers. If you have an article or concept to propose, or suggestions and opinions that would help us meet your needs, please use our "Feedback" form to contact the Editors. It's a direct line of communication, and the free registration of your email allows us to respond to your suggestions, and makes the entire website and all other LWW Journals more useable and functional for you.


Current Issue Highlights



Official Journal of the American Academy of Nurse Practitioners



Clinical Tips from AENJ
# 105 Against medical advice 

Patients may have legitimate, scrupulous, or even irrational reasons to refuse the offered treatment or hospitalization. With few strictly delimited exceptions by law, it is their right to do so. (Not discussed here.) However, just as “informed consent” is required, it is wise to negotiate within a framework of “informed refusal.” Ethically, we want the patient to understand the choices and consequences, nor do we wish to abandon them if they wish to limit or refuse treatment.

It is rash to say “just sign this before you go” and assume that the “AMA” form gets you off the hook. It is not a “Get out of Jail free” card from the Monopoly® game. The form, if used, is a springboard for discussion; which if documented, provides evidence of your care, concern, and attempt to seek agreement or alternatives.

First, ascertain, if possible, the patient’s felt need or reasoning, and negotiate upon that. Offer an acceptable lesser treatment or medicine to temporize, while his business is settled, and facilitate a direct admission return or referral. Thoroughly explain the “benefits” and “risks” of proposed and lesser treatments chosen. Try to involve a trusted companion to help the patient with his needs and his return. (Document that you have done so.)

Although the patient may be, for now, limiting or ending his relationship with you, convey a sense that he’s welcome to return without penalty, that you care for a good diagnosis and outcome, and a willingness to help in the meanwhile. Essentially, you provide as full a normal discharge process as permitted, with the patient’s concerns and limitations noted, his apparent capacity to do so, and efforts that you’ve made to give a proper understanding.


“Against medical advice.” Wikipedia. May 6, 2015 

Levy, F., Mareiniss, D. P., & Iacovelli, C. (2012). The importance of a proper Against-Medical-Advice (AMA) discharge: how signing out AMA may create significant liability protection for providers. [MedScape Critical Care]  The Journal of emergency medicine, 43(3), 516-520. PDF

DeLaney, Matthew, MD.The proper way to go Against Medical Advice (AMA): 8 Elements to Address. ALIEM – Academic Life in Emergency Medicine. {blog} January 13th, 2014 {Excellent comments follow.} 

Alfandre, D. J. (2009, March). “I'm going home”: Discharges against medical advice. In Mayo Clinic Proceedings (Vol. 84, No. 3, pp. 255-260). Elsevier. 

Darves, Bonnie. What should you do for AMA patients? Few doctors write prescriptions or come up with a care plan. January 2014 issue of Today's Hospitalist [reports study by Jason Edwards, MD, of Wright State University.] viz.
Edwards, J., Markert, R., & Bricker, D. (2013
). Discharge against medical advice: How often do we intervene?. Journal of Hospital Medicine, 8(10), 574-577. PMID: 24101542

Al Ayed, I. (2009). What makes patients leave against medical advice?. Journal of Taibah University Medical Sciences, 4(1), 16-22. 

Schumann, John, MD. Does leaving against medical advice stick patients with a bill? KevinMD.com March 8, 2012 [argues that saying “insurance won’t pay the bill if you leave” is untrue and unnecessary.]



Click to download 2015's Collected Tips (#85->)
Click to download 2014's Collected Tips #34 -#84
Click to download 2013's Collected Tips (#1 - #33)


Guidelines & Scientific Statements
Upcoming Conferences
NCNP - National Conference for Nurse Practitioners
May 6th - 9th, 2015
Philadelphia Downtown Marriott
NPACE Primary Care Conference
May 11th - 14th, 2015
Austin, Texas
AANP - 2015 National ConferenceJune 9th- 14th, 2015 
Ernest N. Morial Convention Center
New Orleans, Louisiana
Contact us with information upon conferences of interest to the readership.
Author Alert!

Advanced Emergency Nursing Journal is seeking authors, articles, and topics. If you are interested in writing for publication, please check our current (2015)  "Topics of Interest" for your project. Please contact our Editors if you have an additional proposal or suggestion.