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What's medical tourism?

Recently a patient told me she was going overseas for a medical procedure to save on costs. What do I need to know about patients who go to other countries for treatment? For instance, what are the risks?-C.J., VA.

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Traveling to another country for medical care is known as medical tourism. Patients may go outside the United States to get care not offered here, to get care in their country of origin, or like your patient, to save on out-of-pocket costs.1 Many patients go to other countries for cardiovascular, cosmetic, bariatric, orthopedic, or dental procedures or surgery.2


Patients should know the risks of this practice. Misunderstandings may arise if the healthcare providers aren't fluent in the patient's preferred language. In some countries, medications may be of poor quality or counterfeit, and antibiotic-resistant infections may be more of a problem, according to the CDC.1 Also a concern are bloodborne pathogens, either from improper use or reuse of equipment such as needles or unsafe blood transfusion practices.2 She should be aware that some countries use U.S. trade names for different drugs, which can cause dangerous errors.3 Finally, because flying soon after surgery raises the risk of a venous thromboembolism, patients may need to extend their stay until it's safe for them to fly.1


For more information about how your patient should prepare for such a trip and what she should do after returning to the United States, see the CDC's website on medical tourism shown below. For instance, she should visit a travel medicine practitioner 4 to 6 weeks before the trip or earlier to go over the risks of travel and the specific procedure.1



1. CDC. Medical tourism. 2016. [Context Link]


2. Association for Professionals in Infection Control and Epidemiology (APIC). Medical tourism: risks and safety considerations. 2015. [Context Link]


3. Institute for Safe Medication Practices. Drug brand name may not have same ingredient in another country. 2012. [Context Link]



Helping out after a disaster

I'd like to volunteer my nursing skills and expertise in areas affected by hurricanes and other disasters here in the United States. I have an RN license in good standing in my home state. Do I need a temporary license to practice in another state, and, if so, how do I get one?-R.S., N.M.


Advice specific to your situation will depend on where you live, where you hold your license, and where you want to volunteer and for whom. But to answer your question, let's take Texas as an example. According to the Texas Board of Nursing website, "any out-of-state nurse may practice in Texas for the purpose of rendering aid, provided the nurse holds a current license in good standing in his/her home state." This covers "practicing nursing in a disaster relief effort operation setting." Good standing means you don't have a current disciplinary action on any state license.1


Texas and the U.S. Virgin Islands are 2 of over 15 states, territories, and districts that permit out-of-state healthcare professionals to practice during a declared emergency without applying for a license, under the Uniform Emergency Volunteer Health Practitioners Act.2


Additionally, because Texas is a Nurse Licensure Compact state, nurses in participating states can practice there under their home state licensure.1 See the National Council of State Boards of Nursing website for a list of states that participate at


Florida's governor has signed an executive order authorizing medical professionals' good and valid out-of-state licenses be accepted due to Hurricane Irma. They can render services given free of charge under the auspices of the American Red Cross or the Florida Department of Health.3


Remember to take care of yourself as you care for others, and good luck.



1. NCSBN. Original Nurse Licensure Compact. [Context Link]


2. Uniform Law Commission. Emergency Volunteer Health Practitioners. [Context Link]


3. State of Florida, Office of the Governor. Executive Order No. 17-235. Emergency management-Hurricane Irma. Section 8. 2017. [Context Link]



Peering into peer review

I've been asked to be an expert peer reviewer for a professional nursing journal. Can you tell me what's expected of me in this role?-N.N., UTAH


First of all, congratulations for being recognized for your expertise as a professional nurse. When you receive an invitation to review a manuscript submission, read and follow any specific instructions or guidelines provided by the journal. You may be asked to rate various aspects of the manuscript and to recommend accepting it as is, accepting it after revisions, or rejecting it.


Here at Nursing2017, we ask our reviewers to focus on the clinical content. Is it accurate and up-to-date? Is it appropriate for the audience? Do you see any errors or omissions?


For our journal, we ask reviewers to note if medical terms are misspelled or misused, but don't mention each typo or grammatical error you see because the journal's editors can easily fix these. Do mention any general concerns about the article's structure or content, such as poor organization or lack of focus. Note any essential content that's missing. If you think any content is inappropriate or unnecessary, mention that too.


Carefully review the references to see if they're current, reliable, and professional. Have the most recent clinical guidelines been cited, if appropriate? Have any important sources been left out?


Finally, be sure to respond promptly to review requests you receive from the publisher, and meet or beat all deadlines. Thank you for stepping into this role and helping to advance the practice of nursing.