Real World NP

Podcast Hiatus, Accreditation & We’re Hiring!

Thu, 13 Feb 2025 16:00:00 GMT

Hey! We’re taking a hiatus from the podcast while the team focuses on becoming an accredited organization for continuing education. We’re developing new courses to bridge the gap between graduate education and real-world practice.

In the meantime, we’re inviting clinicians to contribute to paid blog posts and articles— we want to build a community dedicated to quality education and patient care.

Stay informed of upcoming content by subscribing to our email list at www.realworldnp.com/guide.

Apply to become a blog post writer here!

For a full transcript and conversation chapters, visit the blog http://www.realworldnp.com/blog/podcast-break

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Navigating Confrontation at Work as an NP

Thu, 28 Nov 2024 16:00:31 GMT

This episode focuses on leadership and role transition questions, specifically addressing a scenario where a new nurse practitioner is struggling with confrontational conversations with nursing staff. The host provides advice on how to navigate these situations using a framework called nonviolent communication. The framework involves expressing observations, feelings, needs, and requests in a clear and non-confrontational manner. The host also emphasizes the importance of building rapport and facilitating open communication within the team. Additional resources and episodes on leadership are recommended.

Key Takeaways:

-Leadership is a challenging skill to navigate, especially in the healthcare field where there is often a lack of training.

-Using the nonviolent communication framework can help facilitate difficult conversations by expressing observations, feelings, needs, and requests.

-Building rapport and open communication within the team is crucial for effective collaboration and patient care.

-Seeking support and additional resources on leadership can further enhance leadership skills and strategies.

For a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/confrontation

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Path to Overcoming Disillusionment in Healthcare with Rebecca Arnold

Thu, 14 Nov 2024 16:00:22 GMT

Rebecca Arnold, a holistic leadership coach, discusses the challenges of disillusionment and burnout in mission-driven professions like nursing and medicine. She emphasizes the importance of addressing emotions and processing them in a safe and titrated manner. Rebecca highlights the concept of the window of tolerance and suggests practices like meditation and mindfulness to expand it. She also emphasizes the value of emotions as sources of information and intuition. The path from disillusionment to fulfillment involves sitting with emotions, seeking support from professionals, and making small changes within the system. In this conversation, Rebecca and Liz discuss the path to overcoming disillusionment in the medical field. They explore the importance of addressing emotions, internal mechanisms, and finding opportunities for wins. They also discuss the role of grief and the need for self-compassion. Rebecca shares examples of clients who have transformed their experiences and found fulfillment in their work. They also discuss Rebecca's book, 'The Rooted Renegade,' which offers practical tools and strategies for navigating disillusionment and finding alignment in life and work.

Takeaways

Addressing and processing emotions is crucial in combating disillusionment and burnout.
Expanding the window of tolerance through practices like meditation and mindfulness can help handle emotions.
Emotions provide valuable information and intuition that should not be ignored.
Seeking support from professionals is important, especially when dealing with trauma or intense emotions.
Making small changes within the system can contribute to a sense of fulfillment and well-being. Addressing emotions and internal mechanisms is crucial in overcoming disillusionment in the medical field.
Finding opportunities for wins and recognizing moments of success can help combat feelings of disillusionment.
Grief is a common experience in the medical field, and it's important to acknowledge and process it.
Self-compassion and self-care are essential in navigating disillusionment and finding fulfillment.
Rebecca's book, 'The Rooted Renegade,' offers practical tools and strategies for overcoming disillusionment and finding alignment in life and work.

For a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/burnout-in-nursing.

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How to Negotiate a Raise for Nurse Practitioners with Amanda Guarniere

Thu, 24 Oct 2024 15:00:06 GMT

In this conversation, Liz Rohr and Amanda Guarniere discuss negotiating a raise as a nurse practitioner. They emphasize the importance of collecting data about your job performance and your value to the organization. They also highlight the need to consider the employer's perspective and understand what matters to them. The conversation covers productivity metrics, RVUs (Relative Value Units), and the importance of building a case for a raise. They also discuss the different factors to consider in a compensation package and how to approach the conversation with your employer. In this conversation, Liz Rohr and Amanda Guarniere discuss negotiation strategies for healthcare professionals seeking salary increases. They emphasize the importance of preparation, including researching market rates and determining one's value. They also discuss the dynamics of negotiation and the need to disarm the other person and maintain a positive, collegial tone. They provide tips for requesting a meeting, presenting a case, and handling non-committal answers. They also address the challenges of negotiating within a group or tier system and offer advice for advocating for oneself while maintaining a collaborative approach. They discuss the importance of follow-up and provide strategies for handling requests for additional data or delaying decisions. They also mention the NP Salary Report, a resource for healthcare professionals to anonymously submit and access salary data.

Takeaways

- Collect data about your job performance and the value you bring to the organization when asking for a raise.

- Consider the employer's perspective and understand what matters to them.

- Build a case for a raise by highlighting your productivity metrics, such as patient volume and revenue generated.

- Take into account the different factors in a compensation package, including salary, bonuses, benefits, and work schedule.

- Approach the conversation with a partnership mindset, focusing on achieving mutual goals. Research market rates and determine your value before negotiating a salary increase.

- Disarm the other person and maintain a positive, collegial tone during the negotiation.

- Request a meeting without disclosing the purpose, and present your case in a positive and data-driven manner.

- Be prepared for non-committal answers and follow up to close the loop.

- Advocate for yourself within a group or tier system by discussing the issue individually with the lead NP and going through the proper chain of command.

- Be open to alternative forms of compensation or recognition if a salary increase is not immediately possible.

- Use the NP Salary Report to access salary data and support your negotiation efforts.

For a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/how-to-negotiate-a-raise/.

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Unexpected Mentorship Questions from New NPs - Interview with Kara Pesola, NP

Thu, 10 Oct 2024 15:00:32 GMT

In this conversation, Liz Rohr and Kara Pesola discuss the challenges and common experiences of new nurse practitioners (NPs). They highlight the importance of support and mentorship for new grads and address the imposter syndrome many NPs experience. They also discuss the common questions and concerns that new NPs have, such as managing complex conditions and navigating controlled substances. The conversation emphasizes the need for new NPs to trust their judgment, seek guidance when needed, and prioritize patient safety. In this conversation, Liz Rohr and Kara Pesola discuss the challenges and considerations in primary care practice. They touch on topics such as bias in medication management, the importance of safety assessments, and the need for patient-centered care. They also highlight the significance of long-term patient-provider relationships and the stages of change in healthcare decision-making. The conversation emphasizes the importance of meeting patients where they are and supporting their well-being.

Takeaways

- New nurse practitioners often experience imposter syndrome and may feel unprepared for the challenges of practice.

- Support and mentorship are crucial for new grads to navigate the transition to practice.

- Common questions and concerns for new NPs include managing complex conditions and navigating controlled substances.

- It is crucial for new NPs to trust their judgment, seek guidance when needed, and prioritize patient safety. Bias exists in medication management, and it is essential to address it in primary care practice.

- Safety assessments and goals of care conversations are crucial in patient-centered care.

- Long-term patient-provider relationships are valuable in managing chronic conditions.

- Understanding the stages of change can help guide healthcare decision-making.

- Meeting patients where they are and supporting their well-being is essential in primary care.

For a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/mentorship-questions

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Advice for Creating New NP Mentorship Programs

Thu, 26 Sep 2024 15:00:21 GMT

In this episode, I share my experiences and insights on starting a mentorship program, drawing from my own journey as a nurse practitioner and founder of Real World NP. I discussed the context of mentorship, the structure of one-on-one and group mentorship programs, the frequency and duration of mentorship meetings, and the topics to cover. Additionally, I covered the importance of creating a safe psychological space for mentees and the value of peer support in mentorship programs.

Takeaways

- The importance of creating a safe psychological space for mentees in a mentorship program

- The value of peer support and not feeling alone in a mentorship program

- Considerations for mentorship frequency, duration, and topics to cover in a mentorship program

For a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/mentorship-programs

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Advice for New Grads Interested in Urgent Care with Michelle Lew, NP

Thu, 12 Sep 2024 15:00:51 GMT

Michelle, a board-certified family nurse practitioner with experience in urgent care, shares her journey and insights into the field. She discusses the differences between urgent care and primary care, the challenges of not having access to medical records in urgent care, and the importance of collaboration between the two. Michelle also provides advice for those interested in working in urgent care and recommends resources for further learning.

Takeaways

- Urgent care is a bridge between primary care and the emergency room, providing care for acute conditions that can't wait for a primary care appointment.

- There is a disconnect between urgent care and primary care, with urgent care often lacking access to patients' medical records.

- It is important for urgent care and primary care to have a better partnership to ensure continuity of care for patients.

- New grads interested in urgent care should work with another provider and have a ramp-up program to ensure success.

- Being able to determine if a patient is sick or stable is a crucial skill in urgent care.

- Resources for learning about urgent care include Hippo Education's Urgent Care Bootcamp, EKG resources by Jen at Cardiology Made Easy, and Michelle's own Instagram account for urgent care resources.

For a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/urgent-care-nurse-practitioner

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Assessing Chest Pain: New Red Flags & Risk Factors - Interview with Jennifer Carlquist, PA

Thu, 22 Aug 2024 15:00:25 GMT

In this conversation, Liz Rohr interviews Jennifer Carlquist, a physician assistant with extensive experience in cardiology, who discusses the assessment and management of chest pain.

They covered:

- Assessing cardiac versus noncardiac chest pain

- Assessing risk for MI and when to send patients to the ED or not

- What EKG findings to watch out for, and how to learn more to build your ekg reading confidence (and what’s new!)

- What we can do for patients to assess and manage heart disease risk, including labs and tests to check in primary care (including the coronary calcium score, LPa, and homocysteine)

- How to communicate and collaborate effectively with ER providers

- Further resources to learn if you’re in cardiology or interested in making the switch from primary care

Takeaways

- Consider both cardiac and non-cardiac causes of chest pain, especially in female patients with atypical symptoms.

- Take a detailed history, including risk factors and family history, and be aware of red flags that may indicate a more serious condition.

- Recognize the limitations of certain diagnostic tests, such as EKGs and troponin levels, and consider a CTA with FFR for outpatient testing.

- Collaboration between primary care providers and the ER is crucial, and concise reporting of findings is key to effective communication.

- Differentiating between hyperkalemia T-waves and hyperacute T-waves can be challenging, but hyperkalemia T-waves are pointy and hyperacute T-waves are more blunted and broad-based.

- Inverted T-waves in leads other than AVR and V1, especially if they are symmetric, can indicate the need for urgent evaluation.

- Q-waves can form within an hour of an infarction, and a small Q-wave in lead III without other abnormalities may be a normal finding.

- When learning EKG interpretation, it is important to start with understanding what a normal EKG should look like and then focus on high-risk findings.

- Inflammation is a significant risk factor for heart disease, and non-traditional risk factors such as psoriasis and early menses should be considered.

- Lab tests such as the coronary calcium score, LPa, and homocysteine can provide valuable information in assessing heart disease risk.

- Magnesium supplementation can be beneficial for patients with palpitations and hypertension, but the specific type and dose should be tailored to the individual.

- Primary care providers play a crucial role in assessing heart disease risk and can collaborate with cardiologists to order appropriate tests and make informed decisions.

- The three-day EKG challenge and the Cardiology Fundamentals Mentorship program are valuable resources for learning and advancing in cardiology.

- The importance of fostering a supportive and collaborative environment in healthcare to provide the best care for patients.

For a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/assessing-chest-pain

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Treating Substance Use Disorder: Stimulants & How to get Addiction Histories - Interview with Shelby Pope

Thu, 08 Aug 2024 15:00:30 GMT

In this conversation, Liz Rohr and Shelby Pope discuss the importance of taking a comprehensive history of substance use, and how to assess and treat stimulant use disorder. They cover the challenges healthcare providers face in asking the right questions, and emphasize the need for open conversations and non-judgmental approaches.

They cover screening for addiction, how to elicit a substance use history, including types and routes of substance use. Shelby covers the mechanism of action of cocaine and methamphetamine in the brain, the withdrawal symptoms associated with stimulant use disorder, and the next steps for primary care providers in managing patients with stimulant use disorder. They also explore the use of psychosocial interventions and off-label pharmacologic treatments for stimulant use disorder.

Takeaways

Open and non-judgmental conversations are essential when discussing substance use with patients.
Screening practices, such as using screeners like PHQ-2, SBIRT, and DAST, can help identify substance misuse or struggles.
Taking a comprehensive history of substance use, including the type, amount, frequency, and motivation, is crucial for providing appropriate care.
Healthcare providers should be aware of the different routes of administration and the potential risks associated with each.
Stimulant use disorder, particularly cocaine and methamphetamine use, can have significant adverse effects and poor outcomes. Cocaine and methamphetamine are both monoamine neurotransmitter reuptake inhibitors, increasing serotonin, norepinephrine, and dopamine levels in the brain.
There is a withdrawal syndrome associated with stimulant use disorder, characterized by depression, fatigue, and sleep disturbances.
In managing patients with stimulant use disorder, primary care providers should consider triage based on severity and acuity, and refer patients to appropriate resources such as rehab or the ER.
Psychosocial interventions, such as cognitive behavioral therapy and contingency management, are the mainstay of treatment for stimulant use disorder.
Off-label pharmacologic treatments for stimulant use disorder include mirtazapine, bupropion, injectable naltrexone, topiramate, and psychostimulants.
It is important for healthcare providers to be aware of state regulations and their own comfort level in prescribing off-label medications for stimulant use disorder.

For a full transcript and conversation chapters, visit the blog: https://www.realworldnp.com/blog/treating-substance-use-disorder

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Treating Opiate Use Disorder in Primary Care - Interview with Shelby Pope, NP

Thu, 25 Jul 2024 15:00:09 GMT

In this episode, Liz Rohr interviews Shelby Pope, DNP, APRN, FNP-BC, they discuss the stigma around addiction, the importance of supporting patients with opiate use disorder while exploring Shelby’s journey into addiction medicine and impacts of this field.

This episode includes discussion of various treatment options for opiate use disorder, including naltrexone and buprenorphine, including the importance of medication-assisted treatment (MAT) for opioid use disorder, while emphasizing the effectiveness of methadone and buprenorphine in reducing the risk of overdose and mortality.

Liz and Shelby explore the process of induction and the importance of assessing withdrawal symptoms, ongoing monitoring and support for patients on MAT, including addressing cravings and harm reduction strategies.

Key takeaways:

Exploring the stigma around addiction, and the importance of supporting patients with opiate use disorder.
Addiction medicine is a beautiful and impactful field that can be accessible in primary care.
Naltrexone and buprenorphine are two treatment options for opiate use disorder.
Open conversations with patients and providing support and resources are crucial in primary care.
Methadone may be necessary for some patients with extreme cases of opiate use disorder. Medication-assisted treatment (MAT) with methadone and buprenorphine is highly effective in reducing the risk of overdose and mortality in individuals with opioid use disorder.
Assessing withdrawal symptoms is crucial before starting buprenorphine to avoid precipitated withdrawal.
Ongoing monitoring and support are essential for patients on MAT, including addressing cravings and providing harm reduction strategies.
Tapering off medication should be done slowly and on an individualized basis, considering the patient's stability and goals.
Individualized care and empathetic communication are key in building trust and supporting patients on their recovery journey.

For a full transcript and conversation chapters, visit the blog: https://www.realworldnp.com/blog/opiate-use-disorder.

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Bridging the Gap: Primary Care and Specialty Care Courses for Nurse Practitioners - Need Your Input!

Thu, 11 Jul 2024 15:00:46 GMT

We’re expanding our course catalog at Real World NP! This time, we’re collaborating with specialists, making courses tailored for primary care providers. Our goal is to provide comprehensive and practical courses for nurse practitioners and PAs, and to bridge the gap between primary care and specialty care. We want NPs to have the knowledge and resources to provide the best care within their scope of practice.

Share your input about what courses you want to see first! Head over to realworldnp.com/blog/courses-nurse-practitioner to share your thoughts

For a full transcript, check out the blog.

Timestamps:

00:00 Introduction and Background

02:12 Expanding the Course Catalog

03:34 Addressing the Gap: Primary Care and Specialty Care

05:45 Creating Comprehensive and Practical Courses

08:06 Community Input and Feedback

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

Grab your copy of the Digital NP Binder: https://www.realworldnp.com/binder

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Come follow along for even more tips and inspiration:

Instagram: https://instagram.com/realworldnp

Facebook: https://facebook.com/realworldnp

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Please note: This episode is intended only for medical providers and students learning to be medical providers.

While anyone is welcome to view and listen, for legal and safety reasons, we are unable to diagnose, treat, or answer medical questions for individuals through this channel. We always refer individuals back to their primary care providers for medical care.

If you’re a medical provider or student and have specific patient cases you have questions about, I cannot answer those here but would love to help you inside our mentorship program! Join the waitlist at https://www.realworldnp.com/mentoring.

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Real World NP: Redefining Continuing Education for Nurse Practitioners

Thu, 27 Jun 2024 15:00:12 GMT

Welcome back to Season 3 of the Real World NP Podcast!

This episode is an interview with yours truly - I want to share a bit of a “reset” with what’s going on with Real World NP, where we started, where we’re going, and how you can be involved. I also want to share a bit that has changed behind the scenes, and how we’re incorporating more of a social justice and equity lens— not just inside the clinical teaching, but overall practices inside the company.

One of the core reasons behind the company is not just to make the transition to practice for nurse practitioners easier, but also make an impact on the healthcare and education industries. We want to do continuing education for nurse practitioners differently than the status quo.

Some real talk: I feel like I repeat myself a lot, and part of me is like “they know this already.” They know that it’s important to be a whole human, and that they get to do that in their personal and work lives. That they’re not just a machine in the cog of healthcare, and things are starting to change. That they deserve to be supported and held in safe spaces while they learn this extremely important and difficult field of medicine. It’s old news.

But I’m reminded of the number of times I’ve counseled patients on their medications - at LENGTH and REPEATEDLY - and they still need to hear it again.

Like the time my patient with new-onset afib needing anticoagulation still ended up in the ER for overdosing his meds. Or after three visits for my patient with diabetes, they still did not understand their diagnosis and what it meant.

I truly, truly believe that even when things feel daunting and overwhelming, whether it’s the clinic day ahead, the severity of illness of the patient in front of you, or the state of the healthcare industry, individual actions make a big difference.

I’d love for you to be a part of the movement of change to make healthcare and education better — listen in to this episode to get a sense of where we’re going and what you can expect from us going forward. It’s also a helpful introduction to the backstory behind the company if you’re new here!

Giving Yourself Permission, Season 2 Recap & What's Next

Wed, 27 Mar 2024 19:49:03 GMT

On this week’s episode I want to give you some permission if you feel like you need it—

To be a whole human with needs, feelings, desires, and cares. To do what feels authentically right to you.

We’re plopped into a healthcare system that is specifically NOT set up for humans to be humans, and is designed for us to operate like machines.

And it takes a LOT of courage to stay true to ourselves and what we want and need when we’re also trying to stay safe— financially, emotionally, physically.

Sometimes it’s helpful to see and hear from others doing the same so we can see what’s possible for us.

Here’s this week’s episode, sharing a bit of permission to give yourself, some highlights from this season’s podcast if you want to peruse previous topics, and upcoming plans for what’s next.

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Investing In Your Future: Financial Planning for NPs

Tue, 05 Mar 2024 13:00:11 GMT

In this week's episode, I'm thrilled to share my conversation with Lauryn Williams, an extraordinary individual who has not only achieved greatness on the athletic track but also in the realm of financial planning. Lauryn's story is a powerful example of how discipline, dedication, and a willingness to learn can lead to success in multiple arenas of life. Her transition from an Olympic athlete to a certified financial planner is not just inspiring; it's a lesson in reinventing oneself and finding purpose beyond one's initial calling.

Lauryn opens up about her journey, revealing the pivotal moments that led her from winning medals to advising clients on financial health. We explore the mindset shifts required to excel in two vastly different fields and the common threads of discipline and perseverance that link them. Lauryn's candidness about the challenges and triumphs along her path offers invaluable lessons on adapting to life's changes and seizing new opportunities with courage and enthusiasm.

One of the most enlightening parts of our discussion revolves around Lauryn's passion for financial literacy. She shares her vision of a world where financial knowledge is accessible to everyone, empowering individuals to make informed decisions about their money. Through her work, Lauryn is breaking down the complex world of finance into understandable and actionable advice, showing that it's possible to achieve financial wellness with the right guidance and mindset.

Lauryn provides listeners with practical strategies for managing their finances, from budgeting and saving to investing and planning for the future. Her advice is for anyone looking to improve their financial situation and build a more secure future.

Lauryn also discusses how her experiences have fueled her desire to give back and make a difference in the lives of others. Whether it's through her financial planning practice or her involvement in community initiatives, Lauryn is committed to contributing to a better, more financially savvy world.

Don't miss this incredible episode filled with lessons sure to support you on your financial journey.

In today’s episode, we talk about:

Lauryn's seamless transition from an Olympic athlete to a certified financial planner, and the motivations behind her career change.
How Lauryn is making financial planning accessible and empowering for everyone, regardless of their background.
Practical financial advice from Lauryn, including strategies for debt management, savings, and investment.
Understanding the value and impact a certified financial planner can have on your financial health and long-term goals.
Lauryn's personal and professional growth, and how she uses her platform to advocate for financial literacy and freedom.

Read the blog post here.

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Empowering Equity: Transforming Clinical Spaces with Community Care

Tue, 20 Feb 2024 14:00:34 GMT

Welcome to our latest podcast episode, where I had the immense pleasure of sitting down with the incredible Dr. Omolara Uwemedimo.

Today's conversation is a testament to the power of resilience, innovation, and community in healthcare.

Dr. Omolara shares her journey from being a pediatrician to founding two revolutionary organizations aimed at transforming healthcare for under-resourced communities. Through Strong Children Wellness and Melanin and Medicine, she is not just treating patients but also addressing systemic barriers to access and sustainability in healthcare for BIPOC communities.

Our dialogue covers the challenges of funding in primary care, the importance of community partnerships, and the innovative business models that can empower healthcare professionals to serve better and more sustainably. Dr. Omolara's story is one of overcoming personal and professional hurdles, including a diagnosis that led her to reevaluate her approach to work and life, underscoring the importance of self-care in our mission to care for others.

For those inspired by Dr. Omolara's vision, she shares valuable advice on building interprofessional collaborations and leveraging community resources to create impactful healthcare solutions. Whether you're a student, a new grad, or a seasoned clinician, there's much to learn from Dr. Omolara's approach to making healthcare more equitable and accessible.

Connect with Dr. Omolara on LinkedIn for more insights and resources on building a more inclusive healthcare system. To learn more about her work, visit Melanin and Medicine and Strong Children Wellness. Let's continue to support each other in our journeys, fostering a healthcare community that's not just about treating illness but building a healthier, more just world.

Let's keep the conversation going and work together towards a brighter, healthier future for all communities.

In today’s episode, we talk about:

Dr. Omolara's transition from pediatrician to healthcare revolutionary.
Strategies for building interprofessional collaborations and leveraging community resources.
Efforts through her organizations to overcome healthcare access and sustainability challenges.
The crucial role of community collaborations and innovative business models in enhancing healthcare delivery.
Dr. Omolara's personal challenges highlighting the importance of self-care for healthcare professionals.

Read the blog post here.

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Navigating The Drama Triangle As An NP

Tue, 06 Feb 2024 14:00:14 GMT

In this episode, I had the pleasure of sitting down with Brooke Nielsen to explore a topic that is both fascinating and incredibly relevant to our work as healthcare professionals—the Drama Triangle. We've all seen it, whether we recognized it at the time or not. Those moments when interactions with colleagues or patients suddenly feel like a scene straight out of a play, with clear roles of victim, rescuer, and persecutor taking shape.

Brooke and I explored how these roles influence our work environment, especially for nurse practitioners. We shared stories, insights, and, most importantly, practical strategies for stepping out of these roles. The goal? To foster a more supportive, healthy work environment where we can all thrive, professionally and personally.

Understanding the Drama Triangle isn't just academic; it's about making real changes in how we interact every day. From recognizing when we're slipping into one of these roles to setting boundaries that protect our well-being and the quality of care we provide, this conversation is a stepping stone to more effective, fulfilling professional relationships.

Tune in to find out how you can start recognizing and changing these dynamics in your own clinical setting. It's an episode packed with insights for nurse practitioners and anyone keen on creating a healthier workplace culture.

In today’s episode, we talk about:

Understanding the Drama Triangle
Impact of the Drama Triangle in clinical settings
Strategies for recognizing and changing dysfunctional dynamics
The importance of boundary management for healthcare professionals

Read the blog post here.

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Caretaker Fatigue: What Is The Root Cause?

Tue, 23 Jan 2024 13:00:04 GMT

In this episode, I explore a crucial topic shaping healthcare today - caretaker fatigue. Join me as I delve into an enlightening conversation with my dear friend and Executive Coach, Catherine Wood.

Cat shares invaluable insights about balancing work-life commitments and the importance of recognizing and meeting our personal needs for sustainable career longevity.

Even if you feel like you've heard all there is about burnout, I promise this conversation brings fresh perspectives and tangible steps you can incorporate in your daily life.

In today’s episode, we talk about:

How to caretake without losing yourself
The sneaky patterns in caretaking
How to stop putting yourself last
Setting boundaries that take care of YOU

If you liked this video, also check out:

Timestamps:

00:00 Intro

00:43 Discussing Caretaker Fatigue

01:18 Meet Catherine Wood

02:32 The Impact of the Pandemic on Caregivers

03:41 Caregiving and Burnout

05:16 Burnout Prevention

05:56 Caretaking and Codependency

06:53 Caretaking in Relationships

07:56 Meeting Your Own Needs

13:41 Overcoming Caretaking Habits

28:45 Understanding Your Needs

29:41 The Impact of Ignoring Your Needs

31:21 The Journey of Self-Discovery

34:36 Boundaries

34:54 Building Self-Trust

38:26 Nonviolent Communication

44:50 The Challenge of Change in Relationships

54:29 Transparency in Communication

Read the blog post here.

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Are NP Careers Changing?

Tue, 09 Jan 2024 13:00:30 GMT

Are you a nurse practitioner feeling lost, uncertain, or unfulfilled in your career? This raw, honest, and needed conversation with Amanda Guarniere, the founder of Resume RX, explores:

The career challenges NPs are facing
Alternative career paths many NPs are considering
Changing power dynamics between employers and employees
How to think about career changes and honor YOURSELF in the process

We dive into the growing concerns among NPs regarding stagnant wages, shifting power dynamics between employers and employees, and the desire for personal fulfillment beyond traditional clinical settings.

We chat about the rise of entrepreneurship, side hustles, and non-clinical roles that allow NPs to leverage their expertise and pursue their passions.

We encourage NPs to challenge societal expectations and professional scripts that may stop them from doing what they love.

If you liked this post, also check out:

Timestamps:

00:00 - Introduction

02:45 - Practical Strategies on Navigating NP Clinical and Job Search

03:55 - Are Nurse Practitioners Okay?

05:25 - Dissatisfaction and Desperation Among NPs

07:55 - How Can ResumeRX and Real World NP Support NPs

12:39 - Personal Reflection on the Impact of COVID

13:29 - Challenges Faced By Nurse Practitioners

17:04 - Evolving Career Landscape for NPs

25:29 - NP Burnout

28:36 - Self-Judgment and Criticism

34:35 - What’s The Next Best Thing

Read the blog post here.

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Primary Care Nurse Practitioner Roundtable: How Are We Doing After Covid?

Tue, 12 Dec 2023 13:58:01 GMT

In this video, I sit down with two incredible NP colleagues and friends, Kara and Heather, for a candid conversation about the rollercoaster ride of being a nurse practitioner.

We delved deep into our shared experiences, tackling everything from the highs of fulfilling our calling to the challenges that can sometimes leave our compassionate hearts feeling a bit weary. Burnout, boundary setting, and the beautiful power of teamwork — it's all on the table.

💖 Join us for a heart-to-heart chat that's raw, relatable, and peppered with a good dose of humor. Because, let's face it, sometimes laughter is the best medicine.

🌈 Whether you're a seasoned NP or just starting your journey, this episode is a virtual hug, a reminder that you're not alone.

👂 Tune in, share your thoughts, and let's keep the conversation alive. In this community, your story matters, and we’re in this together.

Timestamps:

00:00 - Introduction

07:32 - Kara’s NP Background

11:10 - Residency Program

13:41 - Heather’s NP Background

19:00 - What is it like after Covid?

25:02 - New Grads Challenge

28:51 - Real-World Experience In Covid

36:14 - Changes That Were Advocated

43:35 - Funny NP Stories

56:51 - Parting Thoughts to New Grads NPs

Read the blog post here.

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Cardiology In Primary Care With Midge Bowers

Tue, 05 Dec 2023 13:00:16 GMT

I am thrilled to introduce you to Midge Bowers.

Not only is Midge a Clinical Professor and Director of the cardiovascular specialty at Duke University School of Nursing, she practices as a nurse practitioner in a Heart Failure Access Clinic.

She’s an expert in cardiology, a seasoned healthcare educator, and shares so much incredible knowledge in this jam-packed episode.

In this episode, we covered:

The importance of looking beyond creatinine levels
How to focus on practical aspects of echos
Demystifying anticoagulation choices
Practical tips on adjusting Warfarin dosages
Reversal agents and safety measures

This barely scratches the surface of the wealth of information Midge provides.

0:00 - 3:35 - Introduction and Overview
3:36 - 8:39 - Importance of Monitoring Creatinine and GFR
8:40 - 15:06 - Impact of New Medications on Kidney Function
15:07 - 20:30 - Understanding Echo Results: Akinesia, Hypokinesia, and EF
20:31 - 25:01 - Interpreting Trends in Echo Reports
25:02 - 31:17 - Anticoagulation Choices: Warfarin vs. DOACs
31:18 - 38:15 - Adjusting Warfarin Dosages and INR Monitoring
38:16 - 42:42 - Assessing Bleeding Risks with CHADS-VASc and HAS-BLED
42:43 - 46:03 - Reversal Agents and Safety in Anticoagulation
46:04 - 53:41 - Managing DOACs in Different Clinical Scenarios

Read the full blog here.

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Please note: This episode is intended only for medical providers and students learning to be medical providers.

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Navigating NP Burnout with Cait Donovan

Thu, 30 Nov 2023 13:00:37 GMT

This week, I have an episode for you that I think is even MORE important than the clinical knowledge that I share — navigating NP burnout.

Meet Cait Donovan, an International Keynote Speaker, host of “Fried – The Burnout Podcast,” author of the book "The Bouncebackability Factor", and an acupuncturist with a master’s degree in Chinese medicine. Her creative burnout recovery solutions have been featured on podcasts and online magazines such as “Forbes”, “NPR,” and “The New York Post.”

We chat not only about recognizing NP burnout but also about understanding, navigating, and bouncing back stronger than ever.

In this episode, we cover:

How Burnout Impacts Your Brain: Unveiling the neurological aspects of burnout and how it affects our cognitive functions.
The Surprising Factors Causing Burnout: Exploring the unexpected factors that contribute to burnout, both for seasoned professionals and new grads.
The Role of Trauma in Burnout: Recognizing the impact of trauma on burnout and understanding how it influences us.
The Burnout Recovery Process: Providing actionable steps for recovery and discussing how embracing self-compassion can transform your experience as an NP.

I hope this episode can provide a little comfort, knowing that you're not alone, and maybe a little permission to take the best care possible of YOU, not just your patients.

Resources mentioned in this episode:

If you liked this post, also check out:

Nurse Practitioner Stress, Burnout and Compassion Fatigue

Read the blog here

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What Is Your Philosophy Of Practice As A Nurse Practitioner?

Wed, 22 Nov 2023 13:00:11 GMT

Whether you're a recent NP graduate or someone transitioning between specialties, this video will help ease that overwhelming feeling and help you discover your unique approach to practice.

If you liked this post, also check out:

Timestamps:

00:00 - Introduction
01:22 - Purpose of the Episode
02:35 - Understanding Philosophies of Practice
04:23 - Evolution of Practice
08:21 - Navigating the Transition

Read the blog post here.

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New Nurse Practitioner Pillars of Primary Care

Tue, 14 Nov 2023 13:00:51 GMT

If you’re a new NP grad making your way into practice, I think you’ll find today’s video super helpful.

(And even if you’re not a new grad, it’s still worth the watch — both to understand what we’ve been through and to help us mentor students and new grads ourselves.)

In this episode, I talk about the challenges new grads face — from sneaky imposter syndrome to the overwhelming clinical knowledge demands.

It can feel like an absolute rollercoaster from one moment to the next.

It wasn’t until I started to mentor new grads myself that I understood what was so challenging and why.

It seems obvious in one way — learning medicine is endless. But there are some other sneaky things that make it SO much more intense.

If we can orient ourselves to what is actually happening, we can:

Make a plan to get support
Help our NP mentees and students adjust better, and
Understand the role transition challenge on a high level.

I truly believe we can all contribute to making this profession better and it starts on an individual then interpersonal level.

Which is why in this video, I talk about the three pillars of practice that can help you:

Tackle the fear of the unknown and build a foundation for continuous learning in real-world practice.
Navigate the system beyond diagnosing and treating illnesses.
Embrace the unexpected leadership role and the skills you need.

And remember, you're not alone - we see you and we're cheering you on!

Timestamps:

00:00 - Introduction

00:46 - Pillars of Nurse Practitioner

01:30 - First Pillar: Clinical Knowledge

02:30 - Second Pillar: Navigating the HealthCare System

04:40 - Third Pillar: Role Transition & Stepping Into Leadership

06:31 - card link: Challenges of Primary Care playlist

08:39 - Recap

10:38 - RWNP Mentorship (card link: mentorship waitlist)

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The New Season Is Here

Thu, 09 Nov 2023 13:00:31 GMT

Welcome to our brand new podcast season! We're absolutely pumped to bring you a fresh wave of episodes that will be a game-changer for Nurse Practitioners (NPs) on their journey. Whether you're a seasoned pro or just starting out, we've got you covered.

In this season, we're introducing some exciting changes behind the scenes to make your listening experience even more rewarding. Expect enhanced content, engaging interviews with healthcare experts, and an interactive community that fosters connection and learning.

Timestamps:

00:00 - Intro

00:47 - Seasons

01:42 - Life of A Nurse Practitioner

02:58 - Specialist Interviews

Read the blog post here.

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Season Pause

Wed, 10 May 2023 15:13:10 GMT

Hello there, we are actually going to be taking a season break on the Real World NP Podcast. But don’t worry, we’re coming back!

We’re taking some time to do some regrouping, work on some things behind the scenes, and get ready for a whole new season of episodes for you. If you want to be involved with us, in the meantime, myself and the Real World NP team, I definitely recommend that you head over to the Real World NP email list. And you can join over at realworldnp.com/guide.

What we’re going to be doing because we don’t want to leave you hanging, and we love to give support and connect with you. We’re actually going to be sending out weekly emails of a Tip Of The Week instead of a podcast episode. If you’d like to join us for that, definitely head over to that site, realworldnp.com/guide.

And then also know that we’re still around for all of our products and services – the Lab Interpretation Crash Course, the Diabetes, Hypertension and CKD Course Management course, as well as Mentorship Programme. We are doing all of those things while the podcast is on its little season pause. If you want to check out any of those things, head over to realworldnp.com/shop and you can find all of those products. And then when it comes to the mentorship, you can join our waitlist, if you’d like to and if you’re interested in that and if you’d like to be a part of that – it’s realworldnp.com/mentoring. And so as we form new group, small group cohorts, we can definitely let you know about that as well as any one-on-one mentorship opportunities that we have.

Thank you so much for being a Real World NP podcast listener. I so appreciate you, the team so appreciates you, and I’m definitely looking forward to releasing some new episodes in a couple of weeks.

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Legal Questions from Nurse Practitioners Answered

Tue, 25 Apr 2023 12:00:36 GMT

It’s hard not to worry about malpractice when you’re taking on new levels of responsibility as a new nurse practitioner.

Irnise Williams is not only a health law lawyer, she now focuses on the education and legal work to help prevent malpractice cases in the first place.

AAAAAND she’s a nurse herself! Still taking care of patients as a covid float nurse while also running her legal practice, she’s truly a unicorn.

She and I sat down and discussed the questions nurse practitioners and students had in the Real World NP community!

(PS. if you want the chance to submit questions for future interviews, join the email list at https://www.realworldnp.com/guide)

We covered so many things, including:

Most common reasons for malpractice cases
How to document appropriately
Should I have my own malpractice insurance?
Scope of NP Practice and more

Note, some of the audio came out uneven, so apologies about that.

Read the full blog post here.

Download the FREE Ultimate Resource Guide for NP

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New Nurse Practitioner: When You Don't Know the Answers

Tue, 18 Apr 2023 13:15:50 GMT

One of the biggest fears I hear from new nurse practitioners and students is not knowing the answers when you're in the room with a patient.

In this video, I'll tell you the many reasons why this is actually okay (and why we should probably even celebrate it), and the simple strategies I use to handle it.

Leave me a comment below, what is a strategy that you use to handle these situations? Or, what is one of the major insights you took away from this video?

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Timestamps:

00:00 - Intro

00:42 - Reason 1

01:57 - Reason 2

03:20 - Reason 3

03:56 - Simple Strategy

Read the full blog post here.

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Ortho in Primary Care: Hacks for New Nurse Practitioners

Tue, 11 Apr 2023 12:00:33 GMT

If you're feeling like you don't know enough, and still have to see patients with ortho complaints (especially in telemedicine) -- here are the "hacks" of primary care ortho management.

You'll learn:

The main 4 steps to managing almost all ortho complaints in primary care
The top red flags overarching most ortho complaints
How to triage ortho complaints
When to send to ortho (and what to do first)

If you liked this post, also check out:

Read the full blog post here.

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Diagnosing and Managing Shoulder Pain in Primary Care

Tue, 04 Apr 2023 12:00:51 GMT

As a new nurse practitioner, I used to find shoulder pain pretty overwhelming. While you can *see* all the musculoskeletal structures and how they work together, there’s a lot more going on beneath the surface and dealing with orthopedics can require a real depth of knowledge.

But I’m going to help give you a jump start on that! In this week’s video, I’m taking a high-level view of diagnosing and managing shoulder pain for new nurse practitioners. We’ll talk about:

Which history questions are most valuable to ask
Why traumatic vs. non-traumatic presentation differentiates treatment
The four steps to treatment used to treat *most* musculoskeletal issues in primary care (and why you might to reconsider them)
And one clinical pearl that blew my mind when I learned it!

Want to follow up on the resources I mentioned? Find them 👇

Read the full blog post here.

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Atopic Dermatitis Treatment for New NPs | Pearls of Practice

Tue, 28 Mar 2023 11:56:01 GMT

Atopic dermatitis may not be the most glamorous topic in medicine, but you've got an enormous opportunity to change lives for the better in primary care.

It can feel frustrating for both the patients and providers when they keep coming back without getting any better.

I got to chat with a pediatric dermatologist and added a TON of clinical pearls to my arsenal of "real world" NP knowledge-- which I'm sharing with you in this week's video.

You'll learn:

What treatment ACTUALLY works, especially when they've told you they've "tried everything"
What skincare to recommend, which steroids, and what unconventional treatments can help keep flares at bay
Answers to popular questions these days: who actually need food allergy testing, to bathe or not to bathe, and more.

Download the cheat sheet here: https://www.realworldnp.com/pl/237660

Read the full blog post here.

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Managing COPD Exacerbation In Primary Care

Tue, 21 Mar 2023 12:00:00 GMT

Walking into an examination room and seeing a patient hunched over with labored breathing, audible wheezing, and an oxygen tank can be intimidating for any nurse practitioner.

And if you’re a nurse practitioner in primary care, it is essential to understand the management of COPD exacerbations to provide the best care you can to patients.

COPD exacerbation can look scary, but the management is fairly straightforward. So is the choice of whether or not to prescribe antibiotics (and which ones!)

This week, we’re sharing a case study about the management of COPD exacerbation in primary care. We’ll cover:

How to know who should go to the ER
When to give antibiotics (and which one, for how long)
The general management you should be doing in primary care as a PCP for someone with COPD

PLUS! You can also download the COPD Management Cheat Sheet that you can keep at your desk to help you in your clinical practice!

Read the full blog post here.

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Contraceptive Counseling For Primary Care NPs

Tue, 14 Mar 2023 14:09:25 GMT

Some people feel really uncomfortable talking about anything that has to do with reproductive health. Some of these people are patients, and some of them are healthcare professionals. Are you one of them?

If you thought that you might be off the hook because you work in primary care - you’re not. It’s a part of taking care of the entire patient. When you know and understand your patients’ goals for family planning a lot of other pieces of the clinical picture can become more clear.

Having a plan for the conversation is a good way to get more comfortable. If you get stuck just trying to think of where to start, there are tips in this week’s video that will help with the conversation. Imagine having just three questions to ask that not only guide the whole conversation, but that make the whole thing easier and less awkward for both you and the patient.

In this video, we will cover easy-to-use strategies for contraceptive counseling in primary care. Including:

How to actually talk with primary care patients about contraceptives
Questions to ask the patient about contraceptive methods
How to match contraceptive options with the patient’s preferences
How having this conversation actually empowers patients

You don’t have to know the perfect thing to say when it comes to contraceptive counseling. But having a roadmap for the conversation will make a big difference for you and your patients.

💫 A presentation I reference in the video is here: http://www.ctcfp.org/wp-content/uploads/APPROVED_Cason_Patient-Centered-Reproductive-Goals-and-Contraceptive-Counseling-pc-edits.pdf

💫 And here are two other websites to help with patient reference:

Reproductive access project: https://www.reproductiveaccess.org/resource/bc-fact-sheet/

💫 Bedsider.org: https://www.bedsider.org/

If you liked this post, also check out:

Read the full blog post here.

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How To Diagnose and Treat Abnormal Uterine Bleeding

Tue, 07 Mar 2023 13:00:31 GMT

It’s easy to think the worst when your patient mentions abnormal bleeding. It can mean so many things! Context is everything for the patient with abnormal uterine bleeding. Their age, their history, when it started, how long it lasted, their other diagnoses, even their other medications. These are all factors to consider in the patient with abnormal uterine bleeding, and will point you in a starting direction for your assessment and help you to build your differential.

Abnormal uterine bleeding often doesn’t mean the same thing for a young person in their twenties compared to someone who is past menopause. Do you know when people tend to start having periods (menarche)? Do you know when people tend to stop having periods (menopause)? Are you solid on what stopping having periods even means? Once you are solid on what is normal, you will get up to speed with abnormal things much faster.

This week, we will cover the history questions to ask, the labs to order, and the imaging to order - and we will go even deeper. We’ll also talk about:

Normal versus abnormal uterine bleeding
The anatomical factors that are key to your assessment
Potential causes of abnormal uterine bleeding
Other conditions that could cause or contribute to abnormal uterine bleeding
Pearls related to imaging (what to order, and how)

Like so many other concerns in healthcare, abnormal uterine bleeding can be scary, for patients as well as providers. Increasing your knowledge level will increase your comfort level. This will help you to build a strong differential, guide your patients, and address their concerns effectively.

If you liked this post, also check out:

Read the full blog post here.

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Preventing Burnout As A New Nurse Practitioner: Interview with a Self-Care Strategist

Tue, 28 Feb 2023 13:00:00 GMT

Burnout is a hot topic in all aspects of healthcare. You might be thinking that it’s something that affects other people. You might think it’s something that impacts Nurse Practitioners who are more established in their careers. You might think it’s one of the last things that you need to think about as a new grad Nurse Practitioner. Until you start to experience symptoms of burnout.

This week, we are talking with Diana from Catalyst for Self Care. She’s a well-seasoned Nurse Practitioner and a self-care strategist. What makes her an expert? Because she also has experienced burnout as a Nurse Practitioner. In this interview, we will cover:

Recognizing the signs and symptoms of burnout
The benefits of addressing burnout
Resources for preventing, assessing, and/or managing your burnout
The importance of regular reflection as a part of your practice as a Nurse Practitioner
Self-care and why it is so important

Learning about burnout sometimes happens the hard way, but it doesn’t have to. Watch this interview and get tips that you can start using right away. Understand what boundaries are, how to define yours, and why they are so vital to preventing and treating burnout. Self-care can mean a lot of things and is very unique to each of us. One thing is universal: we need to identify what works for us in a constructive way and make a plan to implement it for ourselves. When we care for ourselves, we can take the best care of our patients.

If you know a colleague who is being stretched really thin, suggest this interview.

If you liked this post, also check out:

Read the full blog here.

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Interview with a Pulmonologist

Tue, 14 Feb 2023 13:00:38 GMT

Have you ever wondered how best to manage your patients with pulmonary diagnoses? How much steroid use is too much for these patients? What happens after you refer your patients to pulmonology? How do we bridge the gap between primary care and pulmonology?

You gave us all the questions that you have for pulmonology – and we have answers. In this high yield interview, we will go over the answers to all of your questions and a lot more. We talk in depth with pulmonologist Dr. Daniel Seifer about your questions and more. From what to be thinking about when referring your patient to pulmonology to patient teaching techniques, we cover a lot in this interview. We talk about:

What your patient’s steroid use can tell you about the status of their chronic condition
Which tests to order for your patients, and what they mean for your patient
The right way to use inhalers, and common mistakes many patients make
Inhalers versus nebulizers – which is right for my patient?
What to be thinking about when you refer your patient to pulmonology

This interview is like a crash course in next-level care for your patients with a pulmonary diagnosis. If you have felt pulmonology is a growth area for you, this interview should help. If you want to have better strategies for patient teaching, this interview should help. Grab a notebook and get ready to learn a lot in a little time – and improve the care that you give to your pulmonology patients in primary care.

If you liked this post, also check out:

Read the full blog here.

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What To Do When You Have Bad News For Patients

Tue, 07 Feb 2023 13:00:28 GMT

Have you had to give a patient bad news? Did you feel prepared or scared? It is a necessary part of being a Nurse Practitioner, and it’s always going to be challenging, but it is better if you are prepared.

Not all bad news is created the same. In some cases, bad news is life changing information, but in other cases, it might be life limiting information. What we might consider serious news, like a new diagnosis of diabetes, might be catastrophic to the patient. Doing our best to understand and anticipate the patient’s perspective will benefit us both.

This week, we have a video that covers so much of the ins and outs of delivering bad news to your patient. We will talk about all of the things to consider when you have these conversations with your patient. We’ll cover:

How to prepare yourself
How to prepare the setting
How to have the actual conversation with the patient
The difference that trauma-informed care can make in having these difficult conversations with patients
A framework to guide the experience for you and the patient
Some specific language to use in these conversations

Getting and giving bad news is always tough; having a plan for the visit will make a big difference. Develop a plan for follow up and next steps with the patient before you give them the news will also make a big difference. Using as much empathy as you can, keep the patient at the center of the conversation and give space for any emotions that might show up.

If you liked this post, also check out:

Read the full blog here.

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Timestamps:

00:00 - Introduction

01:06 - Establish Framework (SPIKES)

02:12 - Setting Up

04:41 - Perception

05:56 - Invitation

07:48 - Knowledge

13:12 - Emotions and Empathy

13:41 - Strategy/Summary

15:32 - PEARL of Practice

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Nutritional Counseling for Diabetes Patients - What You Need to Know

Tue, 31 Jan 2023 13:00:03 GMT

Diabetes might be one of the most challenging chronic conditions to manage. It definitely requires a lot of partnership between provider and patient; you may find yourself spending more time with your diabetic patient than any other group of patients in your practice.

We talked with Nurse Practitioner and Registered Dietitian, Meghan Kavanaugh, about her work with diabetic patients. The interview was such a hit that we brought her back again to answer all of your questions about the nutritional aspects of helping your patients with diabetes. This week, we get answers to your questions, and more, including:

Where to start with nutritional counseling for diabetic patients
How motivational interviewing can help with nutrition counseling
Realistic strategies that patients can start using as soon as they leave your visit
The importance of understanding the patient’s lifestyle in order to optimize their diabetes management

Diabetes can be a tough condition to manage; nutrition is at the foundation of good management, but not all patients have the same experience when it comes to food. Patients that travel, patients that have limited access to certain foods, patients who have religious reasons for eating or not eating certain foods, patients who simply have preferences for certain foods over others – all of these things must be kept in mind as we create strategies to help our patients manage their diet and their diabetes.

If you liked this post, also check out:

👉 Ask A Diabetic Educator Nurse Practitioner

👉 Diabetes Case Study in Mentorship for Nurse Practitioners

👉 Chronic Care Conversations

Read the full blog here.

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Ask A Cardiology Nurse Practitioner

Tue, 24 Jan 2023 13:00:40 GMT

As a nurse practitioner in primary care, there are SO many things I’ve wanted to ask a cardiology nurse practitioner. This week, I had the lovely pleasure of interviewing Scott Pasquale, FNP and cardiology nurse practitioner, with questions from the RWNP community.

In this episode, we covered:

What cardiologists wish primary care providers knew
A breakdown of common cardiovascular tests, how to explain them to patients, and how to choose between each one!
Review of how to order holter monitors the right way!
Common cardiovascular topics like atrial fibrillation, anticoagulation, and heart failure
Resources for nurse practitioners interested into going into cardiovascular medicine

If you liked this post, also check out:

Read the full blog post here

Timestamps:

00:00 - Introduction

03:13 - How Scott Pasquale choose Cardiology

04:14 - What NP Cardiologist Wish That Primary Care Providers Knew

06:51 - Ordering a Stress Test

11:57 - Other Names for Nuclear Scans

12:54 - Example Situation

18:57 - Type of Monitor to Use

24:45 - EKG Learning Resources

29:14 - A-Fibrillation

31:14 - Anticoagulation

33:56 - Cold Calling

35:20 - Coronary Calcium Score/Scan

36:54 - Hypertension Management and Their Side Effects

39:55 - Resources/Recommendations for New Nurse Practitioners Getting into Cardiology

41:32 - Heart Failure

44:24 - Diuresis Management

48:20 - Time in Specialty Practice vs Primary Care

Download the FREE Ultimate Resource Guide for NP

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Starting Insulin In Type 2 Diabetes

Tue, 17 Jan 2023 13:00:51 GMT

Feeling comfortable with treating type 2 diabetes can be overwhelming as a new grad Nurse Practitioner – and even as a seasoned Nurse Practitioner, especially if you don’t have a lot of diabetic patients in your practice. Some patients will be able to improve their diabetes and get their A1C down with lifestyle changes alone; others will need to add oral medication; others will need to add insulin to get optimal control of their diabetes.

When the time comes to have a conversation with your patient about starting insulin, they are likely to have lots of questions. If you want to be sure that you have answers, you have come to the right place. This week, we will walk through what you need to know when you have a patient who will be starting insulin for diabetes management. We’ll talk about:

✅ The other options for treating type 2 diabetes before you start insulin

✅ How much improvement you can expect with various approaches to diabetes treatment

✅ A framework for when to start insulin, and how to adjust the dose

✅ Managing hypoglycemia after starting insulin

✅ Why in-person visits are so beneficial for managing diabetes

Diabetes is a complex diagnosis for providers and patients. When you feel confused and overloaded with information, imagine how your patient feels. Being prepared for these conversations and clinical scenarios will help you to feel more confident, which will help you to be an even better resource for your patients.

✨ If you'd like support learning about how to manage Diabetes, including medication management, most recent guidelines, when to refer and examples of real-life patient cases, join us for the Managing Diabetes, Hypertension & CKD Review Course. Comes with 10.35 hours of continuing education, including 2.8 pharmacology hours, downloadable cheat sheets and lifetime access! Click here

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP

More Resources:

Lab Interpretation Crash Course

Digital NP Binder

Diabetes Medication Workshop

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Preoperative Assessment for New Nurse Practitioners

Tue, 10 Jan 2023 13:00:55 GMT

What does it mean to “clear” a patient for surgery? Every patient needs to have a visit with a healthcare provider before their surgery in order to assess their health and verify that it is relatively safe to proceed with surgery. When they end up on your schedule, it’s up to you whether or not they will get the go ahead (no pressure). If you are wondering how, as someone who has not been trained to perform surgeries, you are supposed to understand a patient’s ability to tolerate a surgery or procedure, this video should help.

Patients and surgeries each have varying levels of risk (low, medium, high), and the preop visit is the place to get an understanding of how the pairing of the patient and the surgery is most likely to pan out. Many times, your judgment will be adequate and you can determine whether or not the patient should proceed with surgery; other times, more information will be needed, and it may be wise to send them to a specialist for the final word.

In this week’s video, we will talk about the particulars of the preop patient and the preop exam.

The elements of a preop exam in primary care
Relative risk levels of surgeries, and how to understand them for the purpose of a preop exam
How to factor in the comorbidities when considering the patient’s safety for surgery
The role of preop testing and imaging
How to get feedback from a collaborating physician for tricky cases

Not all preop examinations are created equal, and so much of it depends on the surgery the patient is planning. Try not to get overwhelmed by the prospect; improving your understanding of the patient and assessing them for surgery, and when you should send them somewhere else, gets better with time and practice.

Read the full blog post here.

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How To Know When To Change Jobs As A Nurse Practitioner

Tue, 03 Jan 2023 13:00:45 GMT

The thought of your Nurse Practitioner job not being the right fit can be scary. You’ve invested a lot of time, money, and energy – not to mention all the things that you have sacrificed – to get to this point, and now?

You may have spent a lot of time imagining what it would look like to be working as an NP, and this isn’t it. Whether you are working with a collaborator or on your own, whether you are in primary care or a specialty, whether you have your own panel of patients or not – sometimes it’s just not the right job for you, and the grass is looking a lot greener on the other side.

Scary as it may be (and as surprising as it may sound), this is very common, especially for new grad Nurse Practitioners. In this week’s video, we will talk about not being in the right job for you, and how to know when it’s time to change jobs. We’ll discuss:

Questions to ask yourself if you are considering a job change
What a normal first-year experience as a Nurse Practitioner looks like
What to expect from the transition from student to clinician
When to consider a job change

Sometimes the need to make the change is very clear, other times it is not. If you are feeling like the assistant to your more experienced colleague or collaborator (and don’t want to), or if you are feeling like the setting is not right for you, or if you are feeling completely over your head every day and wondering whether you will always feel this way – consider whether what you are experiencing is standard first year growing pains or something deeper.

Read the blog post here.

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Diagnosing Wrist Pain for New Nurse Practitioners

Tue, 27 Dec 2022 13:00:17 GMT

Wrist pain is a SUPER common chief complaint in primary care. Most of the time, luckily, it’s chronic wrist pain that’s from overuse (versus the more acute, dangerous differential diagnoses with injuries), but it’s still a lot to work through as a new nurse practitioner.

In this week’s episode, I’m covering the overview approach to diagnosing wrist pain in primary care for new nurse practitioners:

✅ What first triage questions to ask

✅ Red flags to watch out for

✅ History questions, physical exam and special tests to perform

✅ When to refer and when to consider getting imaging

Read the blog post here.

______________

Don't forget to grab your free Ultimate Resource Guide for the New NP

Grab your copy of the Digital NP Binder

Get your medication management right with the Diabetes Medication Workshop

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Come follow along for even more tips and inspiration:

Instagram: https://instagram.com/realworldnp

Facebook: https://facebook.com/realworldnp

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The Right (and Wrong) Way to Ask Questions as a New Nurse Practitioner

Tue, 20 Dec 2022 13:00:28 GMT

When you're a new nurse practitioner, you need to make thousands of decisions a day.

(Which usually translates to thousands of questions).

I made mistakes as a new grad, and luckily for me, I had a very patient colleague who was there to help guide me.

In this video, I'll share:

Some of my mistakes (I'm a little embarrassed)
Three easy steps to make sure you ask questions the right way (so you get the answers you're looking for and build and maintain your colleague relationships)

Leave me a comment below, what are some of the strategies you use to collaborate with your colleagues and supervisor?

Read the full blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

More Resources:

Lab Interpretation Crash Course: https://www.realworldnp.com/labs

Digital NP Binder: https://www.realworldnp.com/binder

Diabetes Medication Workshop: https://www.realworldnp.com/diabetes

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Come follow along for even more tips and inspiration:

Instagram: https://instagram.com/realworldnp

Facebook: https://facebook.com/realworldnp

Hosted on Acast. See acast.com/privacy for more information.

Syphilis Laboratory Diagnosis for New Nurse Practitioners

Tue, 13 Dec 2022 13:00:56 GMT

Syphilis lab interpretation can be confusing, and it’s a BIG topic, but in this episode, I review the most common scenario that I see in primary care.

I cover treponemal and non-treponemal tests, how to interpret them most specifically in the context of slightly abnormal, asymptomatic patients (the most common scenario in primary care), as well as the treatment and follow up, and when to refer to a specialist.

How to cold call a specialist (you can do it!!): https://www.youtube.com/watch?v=xoFAYS0YN_U

Read the blog post here.

-----------------------

Don't forget to grab your free Ultimate Resource Guide for the New NP

More Resources:

Lab Interpretation Crash Course

Digital NP Binder

Diabetes Medication Workshop

------------------------

Come follow along for even more tips and inspiration:

Instagram: https://instagram.com/realworldnp

Facebook: https://facebook.com/realworldnp

Hosted on Acast. See acast.com/privacy for more information.

How To Choose Which Oral Contraceptive Pill for New Nurse Practitioners

Tue, 06 Dec 2022 13:00:12 GMT

When it comes to choosing which oral contraceptive pill to prescribe, there are SO many options. How do you know which one is the right one? As a new nurse practitioner, you’ll usually get different recommendations from different providers.

In this video I’ll be covering:

The first step to prescribing that’s easy to forget
What criteria to consider when choosing
The two main routes to follow (and how to know which one to go down)

Plus, check out the resources I reference in this video to help you decide:

CDC Medical Eligibility Criteria

List of Progestins by Androgen activity

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP

More Resources:

Lab Interpretation Crash Course: https://www.realworldnp.com/labs

Digital NP Binder: https://www.realworldnp.com/binder

Diabetes Medication Workshop: https://www.realworldnp.com/diabetes

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Come follow along for even more tips and inspiration:

Instagram: https://instagram.com/realworldnp

Facebook: https://facebook.com/realworldnp

Hosted on Acast. See acast.com/privacy for more information.

When to use antibiotics Persistent Cough Case Study for New Nurse Practitioners

Tue, 29 Nov 2022 13:00:12 GMT

It's 2 p.m., the medical assistant comes to your office and lets you know your next patient is ready, and they're here because they "need antibiotics"...

... But do they? Or don't they?

They've "had a cold" or "a nasty cough" for over three weeks now.

... they've "tried everything," and "got an antibiotic last time."

Are you seeing this every day now, too? 'Tis the season.

This week's case study is all about that sticky situation--

✔️ Productive cough for over 3 weeks ("subacute")

✔️ What the differentials are, and

✔️ What to do about it (and who actually needs antibiotics).

Please note that this case study was made pre-Covid pandemic so does NOT include Covid/long Covid as a differential.

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

Hosted on Acast. See acast.com/privacy for more information.

Treating Anticoagulated Patients

Tue, 15 Nov 2022 13:00:10 GMT

So many things in primary care are deceptively complex. There may be a few genuinely simple things that we treat, but so many things that come into our exam rooms are complex and sometimes downright confusing.

Anticoagulated patients are one of those situations. While the concept itself is pretty simple – medication that thins the blood so that they don’t get clots, got it – the reality of managing an anticoagulated patient is something else. In primary care, we are often either inheriting the patient who is on anticoagulation, or we are following up after someone else started them (maybe after a trip to the emergency department).

It is completely normal to question yourself with anticoagulated patients. If you have been there, or if you would like to be prepared before you see your first anticoagulated patient, this week’s video is for you. We will talk about:

✅ Where to start with the anticoagulated patient – and then where to go

✅ Different types of anticoagulants

✅ Everything you need to consider to prescribe anticoagulants safely

✅ How long to keep a patient on anticoagulants

✅ How to monitor the anticoagulated patient, and what to watch for

Anticoagulation has so many benefits for the patients that need it, but like anything else in medicine, it comes with risks. Building up your knowledge about what to look for (and what to do if you find it) when working with anticoagulated patients will make such a difference in building your confidence as a provider.

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP

______________________________

Please note: This episode is intended only for medical providers and students learning to be medical providers.

_______________________________

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Determining The Cause Of Microscopic Hematuria

Tue, 08 Nov 2022 13:00:03 GMT

It’s not unusual to be taken by surprise when you see microscopic hematuria on urine dip results. The patients who end up with this as part of their presentation are often asymptomatic, and may even be giving you a urine sample for another reason – which can make chasing down the cause even more of a mystery.

If you don’t know where to start when it comes to determining the cause of microscopic hematuria, you’re not alone. In this video, we will cover a high-level approach to investigating a finding of microscopic hematuria. We will go over the workup for microscopic hematuria, and lots more:

✅ What is the difference between microscopic and macroscopic hematuria?

✅ When a urine dip is enough, and when you need to send the sample out

✅ What white blood cells and protein in the sample can tell you

✅ Essential history and symptom questions to ask

✅ When to repeat the urine dip at another time

Having a simple framework for approaching the sometimes mysterious microscopic hematuria will increase your confidence and help you to take the best care of your patients. Getting to the root cause of microscopic hematuria is another critical part of taking great care of the patients you work with.

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

______________________________

Please note: This episode is intended only for medical providers and students learning to be medical providers.

_______________________________

Hosted on Acast. See acast.com/privacy for more information.

Talking About Disability Rights - An Interview with Andrea Dalzell, Disability Rights Influencer

Tue, 01 Nov 2022 12:00:40 GMT

Getting comfortable talking with patients or other healthcare professionals about disabilities can be challenging. It’s not something that is typically covered in school, and if you don’t have personal experience with the subject, you may find yourself floundering trying to find the right thing to say – or to avoid saying the wrong thing. And when you don’t feel comfortable, how can you expect your patient to feel comfortable?

We asked our Real World NP community their questions for working collaboratively with disabled patients. In this week’s episode, we got answers from Andrea Dalzell, Disability Rights Influencer to those questions and more.

· What is person-first language, and why it is so important

· Things that you may not have considered about accessibility

· What workplace accommodations are – and are not

· How to advocate for people with disabilities

Words matter. The way that we, as clinicians, receive and interact with our patients with disabilities translates to how they (and their disability) are perceived in so many other aspects of their life. Working to develop an understanding, in a deep way, of how a patient’s disability impacts their overall life is a vital part of this. Likewise, improving understanding of how the language we use can positively or negatively impact patients, along with the ways that we interact with those same patients, is an important part of our roles as clinicians.

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP

Grab your copy of the Digital NP Binder

______________________________

Please note: This episode is intended only for medical providers and students learning to be medical providers.

_______________________________

Hosted on Acast. See acast.com/privacy for more information.

Discussing Sexual Health With Your Patients - An Interview With A Sexual Health Educator

Tue, 25 Oct 2022 12:00:59 GMT

Awkward conversations are common in healthcare settings. Learning how to actually have these conversations (or start these conversations, or navigate these conversations)…that’s much more rare. Discussing sexual health doesn’t have to be challenging for patients or providers; with some preparation and some practice, it can become as second nature as any other discussion you have in the exam room.

Making assumptions, or avoiding the topic altogether, can create missed opportunities and serious gaps in the patient’s care. A common misconception is that the patients will bring up anything that you should know – in reality, many patients are hoping that you will start the conversation. This week, we talk with Genesis, a college health Nurse Practitioner and sexual health educator, and get some great strategies for handling these conversations. We’ll discuss:

✅ How to obtain a patient’s sexual health history

✅ The Six P’s – what they are and how you can use them to guide your conversation

✅ Strategies for getting comfortable discussing sex with patients

✅ Which patients are candidates for discussing sexual health

While the conversation is important, addressing sexual health with your patients means more than just talk. We also cover strategies for helping your uninsured/underinsured patients, as well as how to increase your effectiveness with STI (sexually transmitted infection) testing and treatment.

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP

Grab your copy of the Digital NP Binder

______________________________

Please note: This episode is intended only for medical providers and students learning to be medical providers.

_______________________________

Hosted on Acast. See acast.com/privacy for more information.

What I Wish I Asked At My Job Interview As A Nurse Practitioner

Tue, 18 Oct 2022 12:00:07 GMT

You know that moment in the job interview when they ask if you have any questions? Have you ever been totally stumped? Not fun. Even worse is when you get home afterward and think of all the questions that you wish you asked.

If you are on the job hunt, or about to be, we have the questions to ask that will give you lots of information about the job and the workplace, and really help you to understand whether it is the right fit for you.

This week, we have some secret strategies to set you up for success in your Nurse Practitioner job search. We’ll cover:

· Outside the box ways of finding a job

· Spotting warning signs in the interview

· Orientation – and why you want to ask about it

· Why you should ask about protocols

· What is team-based care, and what does it mean to you as a Nurse Practitioner?

Job searches can be exciting and stressful at the same time. Investing the time in advance to gather background information on a prospective employer, asking high-yield interview questions, and then reflecting on what you have learned will put you in the best possible position to pick the job that is right for you.

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP

______________________________

Please note: This episode is intended only for medical providers and students learning to be medical providers.

_______________________________

Hosted on Acast. See acast.com/privacy for more information.

Understanding New Grad Nurse Practitioner Job Offers

Tue, 11 Oct 2022 12:00:55 GMT

You knew some things would be different when you decided to become a Nurse Practitioner. You would need more education; you’d have a whole host of new job-related responsibilities; you would probably even have different work hours. But did you expect the job search process would also be drastically different as an NP?

This week, we’ll talk about some of the differences between RN and NP job searches, how to navigate the differences, and find the job (and job offer) that is best for you.

What to do if you end up in a toxic work environment·
How to really calculate your hourly rate as an NP·
What does scheduling have to do with a job offer?·
Thinking beyond salary when evaluating your job offer·
The role of productivity and RVUs

You deserve to go into the job search – and negotiation – process with as much preparation as possible. Whether you are on the hunt for your first job as a new grad Nurse Practitioner or you are an experienced NP looking for a workplace with a better fit, having a good understanding of the ins and outs of

Nurse Practitioner job offers will benefit you.

If you liked this post, also check out:

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP

______________________________

Please note: This episode is intended only for medical providers and students learning to be medical providers.

_______________________________

Hosted on Acast. See acast.com/privacy for more information.

Managing Diabetes, Hypertension & CKD Course Q&A: Bonus Podcast Episode

Thu, 06 Oct 2022 09:49:45 GMT

In this Livestream, I share about our newest course Managing Diabetes, Hypertension & CKD over at https://www.realworldnp.com/courses.

After lab interpretation, the three main topics that new NPs struggle with managing are DM, HTN & CKD-- so I decided to review the 100+ page guidelines cover to cover, do a deep dive on all the meds, cold-call specialists with my questions and report back with all the info I wish I could have had as a new NP.

It's got 10.35 hours of continuing education (including 2.8 hours of pharmacology!) from AANP -- also works for ANCC accredited NPs!

It's for adults only in primary care, comes with lifetime access, cheat sheets, algorithms to download, and is completely self-paced! Check it out here: https://www.realworldnp.com/courses

Read the blog post here.

Timestamps:

0:20 - Introduction

0:45 - Background/where this course came from

5:55 - Overview of the course

6:30 - Diabetes module overview

9:17 - Hypertension module overview

13:53 - Renal lab interpretation module overview

15:55 - CKD module overview

19:09 - How the course works & bonus live calls

24:39 - Q&A

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Don't forget to grab your free Ultimate Resource Guide for the New NP

______________________________

Please note: This episode is intended only for medical providers and students learning to be medical providers.

_______________________________

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Your Urology Questions - Answered!

Tue, 04 Oct 2022 12:00:01 GMT

How much did you learn about urology in school? If your answer was “not a whole lot,” welcome. Most Nurse Practitioner programs do not cover urology concerns in great depth, which can contribute to a real lack of clarity once you start practicing. You may double or triple your knowledge of common urology concerns today.

This week, we talk with Dr. Joseph Acquaye, who answers all of the questions that you submitted about urology. In this interview, we talk about:

When to refer your patient to urology, and what happens when you do
Urinary incontinence
Testosterone replacement
PSA screening – how to interpret, and when to stop screening
Imaging – should you order it before sending your patient to urology?

Dr. Joseph Acquaye says that his favorite part of working in urology is the wide variety of topics that he encounters on a daily basis. Whether performing a procedure, working with a couple to understand and address the impact of erectile dysfunction on them, or coming up with an approach to treat the tricky interstitial cystitis, there is always something different waiting in the urology office.

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP

Grab your copy of the Digital NP Binder

______________________________

Please note: This episode is intended only for medical providers and students learning to be medical providers.

_______________________________

Hosted on Acast. See acast.com/privacy for more information.

Time Management Tips: An Interview With The World's Most Productive Nurse Practitioner

Tue, 27 Sep 2022 12:13:56 GMT

Ever find yourself at work until all hours finishing your charting – or, even worse, taking charting home with you? Wondering how you might possibly get a handle on all of this stuff before you drown? You are most definitely not alone; time management challenges are super common (especially in primary care) for new grads, seasoned NPs, and almost everyone in a patient-facing position.

This week, we talk with Jessica Reeves, a Nurse Practitioner with a knack for time management (and author of Secrets From The World’s Most Productive Nurse Practitioner). We’ll cover:

Where to start with time management
The impact of the schedule on your time management – and what you can do about it
The life-changing magic of dictation
Using body language to manage the flow of the visit
Setting limits (focused visit = focused note)

When it comes to clinical topics, things often get better over time and with experience. Time management is different; if you are struggling with time management now, you will likely continue to struggle unless you change your approach. With reflection, time, and practice, you can get your time back into your control and find the work-life harmony that works for you.

Read the blog post here.

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Timestamps:

0:00 - Introduction

7:07 - Charting Tips

13:00 - Charting Templates

20:15 - Time Management Practice

22:45 - Time Management in the Visit

30:18 - How to redirect the patient

37:43 - Dictation

41:46 - Scheduling Challenges

53:15 - Advocacy

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Download the FREE Ultimate Resource Guide for NP

______________________________

Please note: This episode is intended only for medical providers and students learning to be medical providers.

Hosted on Acast. See acast.com/privacy for more information.

Ask A Diabetic Educator Nurse Practitioner

Tue, 20 Sep 2022 12:00:12 GMT

Why can’t diabetes management be like we learned in school? That was complicated enough.

Now you’re on your own, and there are so many questions with your patients to manage diabetes. Symptoms that don’t necessarily follow a straight line. All of the elements of managing diabetes that are beyond your control – patient’s motivation, cost of medications, how realistic a plan may be, how long until they can be seen by the specialist that you referred them to –it gets more complex by the minute.

[Spoiler alert: these are not issues faced exclusively by new grads, either; this is the state of play when it comes to working with diabetic patients.]

This week, we have a great interview with Meghan Kavanaugh. She is a Registered Dietitian AND Nurse Practitioner that works exclusively with patients with diabetes. We cover a lot of ground, including:

Taking the stigma out of diabetes and diabetes management
Continuous glucose monitoring – what it is, the double-edged sword that it can sometimes be, and practical tips for patient teaching about it
Tips for the administrative challenge of working with patients with diabetes
Addressing cost for un- and underinsured patients with diabetes
Answers to the questions that YOU submitted

Get your Diabetes Resource Sheet here.

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP

_____________________________

Please note: This episode is intended only for medical providers and students learning to be medical providers.

Hosted on Acast. See acast.com/privacy for more information.

Heart Failure Management In Primary Care

Tue, 13 Sep 2022 12:00:20 GMT

Heart failure is, without a doubt, one of the more complex topics that you will encounter in primary care. Two types, four stages, four classes, evolving guidelines for treatment, and a host of medications – it’s a lot to wrap your head around. Especially in a 15-minute visit. Let’s talk about the core concepts of heart failure and increase your confidence. We’ll cover:

✅ The two types of heart failure, and how the different types impact the approach to treatment

✅ Diagnostics – which labs, which tests, and the crucial role of ejection fraction in heart failure

✅ The questions you don’t want to forget to ask the patient

✅ Medications used to treat heart failure

✅ What to look for in the chart BEFORE the first visit

Like so many other things with primary care, managing heart failure gets less stressful with time. But until then, having a strategy will increase your efficiency in the visit, your confidence on the subject, and give you clarity about co-managing with cardiology.

Heart Failure Guidelines 2022

If you liked this post, also check out:

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP

------------------------

Please note: This video is intended only for medical providers and students learning to be medical providers.

_______________________________

Hosted on Acast. See acast.com/privacy for more information.

Treating Patients With Symptoms Of Recurrent UTI

Tue, 06 Sep 2022 12:00:02 GMT

For patients and providers, few things are more frustrating than recurrent UTIs.

This week, let’s talk about recurrent UTIs and how to get real results for your patients.

Gender - and how to approach all patients in an inclusive way
The difference between recurrent and relapsing UTI
Evidence-based versus anecdotal risk factors
Labs to order, what to look for (and how to look)
Strategies for management

Adding to the tools in your toolkit will lead to strategies for success, which will make it MUCH easier to work with the frustrated patient with recurrent UTI. Feel confident in your approach and help your patients to break the cycle of recurrent (or relapsing) UTI.

If you liked this post, also check out:

Read the blog post here.

-----------------------

Don't forget to grab your free Ultimate Resource Guide for the New NP

Grab your copy of the Digital NP Binder

------------------------

Please note: This episode is intended only for medical providers and students learning to be medical providers.

Hosted on Acast. See acast.com/privacy for more information.

Managing Chronic Cough In Adults

Tue, 30 Aug 2022 12:00:35 GMT

You have a patient who has been coughing for weeks, maybe even a couple of months. You’ve already ruled out COVID; where do you turn next?

This week, let’s talk about chronic cough – what it is, how it differs from acute cough, when to refer the patient, and more:

✅ Common causes – things like GERD, asthma, allergies

✅ The special history questions to ask and how they will help with your differentials

✅ What to watch for in the physical exam

✅ Labs and other tests to order

✅ Red flags

Coughs are common in primary care, and you will see them frequently. Knowing whether you are seeing a more common presentation or something more unusual will help you to create the best plan to take care of your patients in the most appropriate setting.

If You Liked This Post:

Read the blog post here.

-----------------------

Don't forget to grab your free Ultimate Resource Guide for the New NP

Grab your copy of the Digital NP Binder

------------------------

Please note: This episode is intended only for medical providers and students learning to be medical providers.

_______________________________

Hosted on Acast. See acast.com/privacy for more information.

Managing Lower Limb Numbness In Primary Care

Tue, 23 Aug 2022 12:00:54 GMT

What could be causing your patient’s lower limb numbness? And more importantly – how do you figure it out?

This week, we’ll talk about some strategies to help narrow down the cause of your patient’s symptoms, share some clinical pearls, some assessment techniques that can point you in the right direction (FAST), and more:

✅ The most essential history questions to ask

✅ Special questions just for lower limb numbness

✅ A quick assessment that will rule in or rule out a variety of causes

✅ Where to focus your physical exam for best results

✅ Common causes of lower limb numbness, and what you definitely want on your differential

Like so many other things in the clinical setting, assessing and managing lower limb numbness does get easier with practice. Having some pointers will also help to speed that process up and boost your confidence as a provider.

If you liked this post, also check out:

Read the blog post here.

-----------------------

Don't forget to grab your free Ultimate Resource Guide for the New NP

Grab your copy of the Digital NP Binder

______________________________

Please note: This episode is intended only for medical providers and students learning to be medical providers.

Hosted on Acast. See acast.com/privacy for more information.

Monkeypox Treatment for Nurse Practitioners - Part 2

Wed, 17 Aug 2022 11:00:26 GMT

With the most recent global Monkeypox outbreak in May of this year, there’s been a lot of confusion among patients and providers about treatment options and vaccination.

With about 7,000 cases in the United States as of this recording, luckily the treatment options are starting to become more available. As I mentioned in the first episode of this series, thus far the treatments and vaccines have been only available through the Strategic National Stockpile, a government supply created to prepare for outbreaks. However, we’re starting to see more availability as the weeks go on.

If you haven’t already watched the last episode about Monkeypox Overview Part 1, definitely go back and check it out!

Monkeypox Treatment Options

In this week’s episode, we cover:

✅ Who needs treatment (and who doesn’t)

✅ The two main categories of treatments

✅ What vaccines are available

✅ Antiviral treatment options

✅ Where to access treatments

Luckily, the vast majority of patients will have mild, self-limited illnesses, but it is helpful to understand all the treatment options out there so you can confidently answer patients’ questions and connect patients to treatment who need it.

If you liked this video, also check out:

Read the blog post here.

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Please note: This episode is intended only for medical providers and students learning to be medical providers.

_______________________________

Hosted on Acast. See acast.com/privacy for more information.

Monkeypox Explained for Patients

Mon, 15 Aug 2022 12:00:41 GMT

Monkeypox has been confusing and scary for a number of patients, especially on the heels of the Covid pandemic that we’re still facing. Even though we usually make videos for primary care providers, we decided to make this episode, especially for patients, to help clear up some confusion for them, as well as show clinicians an example of how we have these conversations with our patients.

In this episode, we answer the questions:

What is Monkeypox?
What the symptoms are and how bad are they?
Who is getting this and why?
Will I die from this?
How does it spread?
Is there a vaccine and who gets it?

For any patients watching, please seek out medical care from your primary care providers. This episode is for educational purposes only, is not medical advice, and we cannot advise individual people on their health concerns!

Here is where you can find out further information:

👉 Safe sex guidance from the CDC

👉 How it spreads from the CDC

👉 FAQs for patients from the CDC

If you liked this post, also check out:

Read the blog post here.

Please note: This episode is intended only for medical providers and students learning to be medical providers.

_______________________________

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Monkeypox for Nurse Practitioners - Part 1

Wed, 10 Aug 2022 12:00:00 GMT

**ERROR UPDATE** I mistakenly said that cotton swabs can be used but it's ONLY synthetic swabs for monkeypox testing!! Link for testing instructions here.

Monkeypox has been confusing and scary for patients and providers alike, especially on the heels of the Covid pandemic that we’re still facing. The WHO named it a public health emergency and global outbreak, as has the CDC, but that doesn’t necessarily mean it’s as scary as it sounds.

At the time of this episode, there have been about 7,000 cases in the US, predominantly in patients who are cis-male and have sex with other cis-males (MSM), although this is a virus that can affect any patient. It’s not sexually transmitted, as has been reported in the news (misinformation).

Even though any person can be infected with monkeypox, we need to make sure that the most vulnerable populations are getting the access to care, education, and support they need-- at the current time means especially our patients who are men who have sex with men.

In this episode, we cover:

Key background information you need to know
Symptoms & Diagnosis
Transmission of Monkeypox & Infection control
Differential Diagnosis
Approach to testing
Overview of treatment

Check out the links we referenced in this episode for images of monkeypox on a variety of skin tones and stages, and link to phone numbers of the departments of public health by state.

CDC images of monkeypox

Department of public health numbers

Further information from the CDC for medical providers is here

Read the blog post here.

______________________________

Please note: This episode is intended only for medical providers and students learning to be medical providers.

Hosted on Acast. See acast.com/privacy for more information.

Pap Screening in Primary Care

Tue, 02 Aug 2022 12:00:15 GMT

Paps. How can such a common primary care intervention cause so much confusion? How often to screen, how to understand any findings that are not black and white, how to advise your patient about next steps – you would not be the first NP to feel overwhelmed with abnormal pap results in your inbox.

This week, we’ll take some of the mystery out of this challenging clinical topic, and help you understand the main points that will guide your treatment. We’ll talk about:

✅ Current guidelines, and how they apply to your patient, (and our favorite plug-and-play tool to make interpreting pap results super easy!)

✅ The role of HPV in understanding pap results

✅ Next steps for the patient with an abnormal pap result

✅ Colposcopies, LEEPs, advanced sampling – what they are and how to explain them to your patient

✅ Pro tips for interpreting results and guiding your patient

It’s true that even seasoned providers get stumped trying to navigate abnormal pap results. With time, practice, and a few tools in your toolbox, you will get more clarity on interpreting abnormal pap results and knowing the right next steps for your patient.

If you liked this post, also check out:

✨ Interview with a Women's Health Nurse Practitioner

✨ Diagnostic Approach to Abnormal Uterine Bleeding

✨ IUD Counseling for New Nurse Practitioners

Read the blog post here.

Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

Grab your copy of the Digital NP Binder: https://www.realworldnp.com/binder

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AANP President Interview

Tue, 26 Jul 2022 12:00:32 GMT

Whether you are a brand-new NP or you have been practicing for a while, the AANP has likely done something that has made your job easier.

But what does the AANP actually do and how does it work?

In this special one-on-one interview with Stephen Ferrara, President-elect of the AANP, we got the opportunity to ask him questions from the Real World NP community.

We talked about:

✅ What AANP is (and what it isn’t)

✅ How the NP educational system works

✅ Key differences between medical and NP education and how it’s related to AANP

✅ Current issues facing our profession

✅ The goals Stephen has as the new president-elect of AANP

Join us and learn about the AANP’s current and upcoming initiatives; some of their possible solutions to the challenge of finding a preceptor; some of the barriers to NP practice that are on their radar, and – maybe most importantly – how you can get involved, how the AANP can help you as an NP, and how you can help others in our profession.

If You Liked This Post, Also Check Out:

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

Grab your copy of the Digital NP Binder: https://www.realworldnp.com/binder

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Managing Depression In The Primary Care Setting

Tue, 19 Jul 2022 12:00:51 GMT

Depression in the primary care setting – super common. With a shortage of mental health providers and increasing numbers of patients with symptoms, depression is becoming a leading primary care health concern. If you feel unsure or unprepared for these patient encounters, you are in the right place.

This week, we’re taking some of the mystery out of working with patients with depression in the primary care setting. We’ll cover:

✅ Red flags of depression assessment, and how to handle them when you find them

✅ Key resources you need to know out at your clinic (and outside your clinic)

✅ What differentials to watch out for

✅ Approach to medications, and important factors to consider

There is an entire specialty track within the Nurse Practitioner world (PMHNP) that is designed to treat patients with mental health concerns. As Family Nurse Practitioners, there are limits to what is appropriate for us to treat – but we can certainly help our primary care patients experiencing this very common concern.

SI assessment tool here: https://www.counseling.org/docs/trauma-disaster/fact-sheet-6---suicide-assessment.pdf?sfvrsn=2

PHQ-9 screening here: https://www.mdcalc.com/calc/1725/phq-9-patient-health-questionnaire-9

Mood disorder questionnaire (MDQ): https://www.ohsu.edu/sites/default/files/2019-06/cms-quality-bipolar_disorder_mdq_screener.pdf

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

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Treating Patients With Insomnia

Tue, 12 Jul 2022 12:00:22 GMT

By the time the patient with insomnia makes it to primary care, they have probably been struggling with sleep for a while, and have probably tried some things on their own – without luck. And now they’re hoping YOU can fix it, preferably…tonight?

Insomnia is a murky clinical topic; it’s not always as simple as not getting enough sleep. If you aren’t sure where to start with the patient with insomnia, let’s get you sure. This week, we’ll talk about:

✅ Sleep hygiene – what it is and why it’s important in patients with insomnia

✅ The role of substances (alcohol, caffeine, nicotine) in sleep issues

✅ Getting an insomnia/sleep history

✅ Comorbidities that can be causing or contributing to their insomnia

✅ Pharmacological approach to treating insomnia

✅ Non-pharmacological approach to treating insomnia

There aren’t any tests or labs for diagnosing insomnia. Digging deep and getting a very good history is the biggest part of understanding what is going on and developing the best plan to get your patient the relief they need.

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

Grab your copy of the Digital NP Binder: https://www.realworldnp.com/binder

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Does it Get Better as a Nurse Practitioner?

Tue, 05 Jul 2022 12:00:20 GMT

Let’s be real: the first few years of practice as an NP can be TOUGH. Not only do you have this vast amount of new clinical knowledge to put into practice, you’re also learning the ins and outs of how a clinic runs (for better or worse), and adjusting to being the place where the buck stops. Is it really surprising that you are wondering if it gets better?

It’s a kind of taboo topic, even though it’s a common question that most NPs ask (if only to themselves). It’s also time to put a spotlight on it.

This week, let’s talk about how it gets better as a new NP:

✅ How long does it take to get better?

✅ The role transition from RN to NP

✅ How the complexity of the US healthcare system impacts transition to practice

✅ Examples of what it looks like when it DOES get better

You’re not alone, and you’re doing better than you think. And at some point, the day will come that it will get better – either naturally or because you made the adjustments that you need so that it IS better.

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

Grab your copy of the Digital NP Binder: https://www.realworldnp.com/binder

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Please note: This episode is intended only for medical providers and students learning to be medical providers.

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Simple Hypercalcemia Workup (with Case Study): Lab Interpretation for New Nurse Practitioners

Tue, 28 Jun 2022 12:00:30 GMT

Labs interpretation for new nurse practitioners can be confusing, and most new grads don't feel well-prepared by what they learned in NP school.

In this podcast episode, I break it down with a SUPER interesting case study from my first year as an NP, and make the approach super simple with 3 steps, including the top do-not-miss diagnoses.

Join us for the Lab Interpretation Crash Course for Nurse Practitioners here.

Read the full blog post.

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Managing Anxiety in Primary Care for New Nurse Practitioners

Tue, 21 Jun 2022 12:00:26 GMT

Managing anxiety in primary care is super common, but especially now during the pandemic quarantine.

In this podcast, you'll learn:

✅ When it's anxiety... and when it's not

✅ How to assess symptoms, history and the best tools to make it faster and easier

✅ The step-by-step to manage anxiety, and what to do if it's not working.

There's SO much I could say about anxiety and mental health, let me know what questions you have or topics you want to hear more about.

Grab your cheat sheet here: https://www.realworldnp.com/033-opt-in

Read the blog post here.

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Videos I mentioned:

HOW TO GET A PATIENT HISTORY: https://www.youtube.com/watch?v=UGrDbC3X2oc&t=196s

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Diagnosing Migraine in Primary Care

Tue, 14 Jun 2022 12:00:14 GMT

Your friend, your aunt, your patient in your primary care office - everyone seems to be talking about migraines. But is it a headache or is it a migraine? How do you know the difference?

As a new grad, it’s not unusual to feel like you have been thrown into the deep end when patients present with a migraine or a headache. It’s not a super black and white topic, and patients sometimes have a hard time describing their symptoms, which adds to the challenge.

This week, we’ll talk about what makes a migraine different from a headache, and how to approach your patient who just knows that their head hurts and wants relief.

✅ Differentiating headaches and migraines

✅ Migraine red flags

✅ Other diagnoses that can be mistaken for migraine

✅ A word about auras

✅ The importance of a headache diary for you and your patient

When you have a good handle on the red flags, and what makes a migraine different from a regular headache, managing migraines will get easier for both you and your patient.

Check out the links that I referenced here: https://www.realworldnp.com/blog/diagnosing-migraine

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

Grab your copy of the Digital NP Binder: https://www.realworldnp.com/binder

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Diagnosing Headache in Primary Care: Red Flags

Tue, 07 Jun 2022 12:00:32 GMT

Patients who come into primary care for a headache are often worried that it’s something very serious - and it’s your job to know whether it is or not. Many headaches are nothing overly serious, but as a new grad, it can be hard to know just how concerned to be and what to do with your concern.

Let’s build your confidence and demystify some of the grey areas of headaches. In this video, we’ll cover:

✅ A simple tool that you can use to guide your visit, assessment, and plan

✅ Specific headache red flags, and what to do if you encounter them

✅ When to worry and what to worry about

✅ When to refer patients out

Headaches in a primary care setting can be confusing when you are getting started, but the more you see and the more you manage, the more clarity that you will gain. Use these tips to prepare for your next headache patient and be confident in your assessment, treatment, and referral.

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

Grab your copy of the Digital NP Binder: https://www.realworldnp.com/binder

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Please note: This episode is intended only for medical providers and students learning to be medical providers.

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LGBTQIA+ Competency for Healthcare Providers: Interview with Terra Anderson

Tue, 31 May 2022 12:00:02 GMT

LGBTQIA+ cultural competency helps not only our patients to feel safer, seen, and supported, but it also improves health outcomes. Many providers aren’t sure what that competency looks like, or even where to start. It’s more than the correct pronouns and language – but how much more?

In this week’s episode, we talk with Terra Anderson, who uses they/them pronouns, is a somatic therapist, and LGBTQIA+ educator about how providers can improve their competency when working with LGBTQIA+ patients.

✅ What LGBTQIA+ patients wish their healthcare providers knew

✅ What is affirming care, and why it is important

✅ How to approach sensitive exams

✅ How to frame questions so they feel less awkward for you and your patients

✅ The role of assumptions when working with patients, especially LGBTQIA+ patients

✅ Differentiating biological sex, gender, and sexual orientation – and why we need to

Cultural competency is not about a defined endpoint, but about the journey and the willingness to confront known, unknown, and implicit bias. Let’s talk about starting the journey, and let’s keep working on it for all of our patients.

When you are ready for a deep dive into how to best serve LGBTQIA+ patients, Terra offers a Queer Competency for healthcare providers through their company, Embody Emerge. Check out their courses here: https://embodyemerge.com/online-course-shop/

Read the blog post here.

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Please note: This episode is intended only for medical providers and students learning to be medical providers.

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Workup for Syncope in Primary Care

Tue, 24 May 2022 12:00:47 GMT

If even thinking about a patient with syncope makes you feel a little lightheaded yourself, you are in the right place.

Your patient passed out, so their family insisted that they see their PCP. Now they’re in your exam room, and you need a roadmap to see what happened, what is going on, and how we got here.

Let’s talk about how to approach the visit for the patient with syncope in primary care, why you will want to work backward to assess them, the four main categories of syncope, and more.

✅ Things that can look like syncope – but aren’t

✅ Specific, targeted questions to ask the patient with syncope

✅ Medications that can play a role in a syncopal episode

✅ Why family history is important in syncope, and which questions to ask

✅ Red flags in a patient with syncope

Syncope can seem like a huge problem to solve as a new grad, but with some guidance and plenty of practice, it gets easier to narrow down. Having a framework to approach the visit will boost your confidence and make these visits more manageable.

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

Grab your copy of the Digital NP Binder: https://www.realworldnp.com/binder

______________________________

Please note: This episode is intended only for medical providers and students learning to be medical providers.

_______________________________

Hosted on Acast. See acast.com/privacy for more information.

How to Give Feedback to Your Medical Assistant

Tue, 17 May 2022 12:00:42 GMT

Have you found yourself needing to give feedback to your MA or support staff – with no idea where to start? You are not alone. As an NP, your role is unique; you’re not the boss, yet you are expected to give some level of guidance and leadership. And when what a staff member is doing isn’t working, that message usually needs to come from you.

Let’s talk about how to give feedback to your MA or support staff in a way that is constructive, positive, and won’t leave either of you feeling like you want to crawl under a rock.

In this episode, we have a real-world example of a tough conversation with an MA – and a step-by-step approach for how to handle it.

We’re covering:

A framework that will give you confidence when giving feedback
The right time to have these conversations
What to do when the conversation doesn’t go so well
When to involve other team members

Being prepared is a major part of any delicate conversation. Learn these actionable tips before you need to have this talk so you can take away a lot of the stress – and get to the good stuff, coming up with a solution without feeling any of the cringe.

Read the blog post here.

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Decreased Appetite in Children

Tue, 10 May 2022 11:00:10 GMT

Context is key for the pediatric patient with decreased appetite. Getting a sense of what is normal for the patient and their overall health goes a long way in deciding how to approach the visit.

This week, let’s talk about where to start when you see these patients, and how to get the context that is so essential for these visits.

✅ What to know about the patient before you even walk into the exam room

✅ When to ask broad questions, when to ask targeted questions – and why

✅ Which body systems you must assess

✅ Considering the behavioral and social context

✅ The use of medication for children with decreased appetite

✅ Red flags and worst-case scenarios

Decreased appetite can seem like a scary chief complaint for a pediatric patient, but it doesn’t have to be. A good handle on what is normal, what is urgent, and when to send these patients to a specialist, will take a lot of the pressure off and increase your confidence in the visit.

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

Grab your copy of the Digital NP Binder: https://www.realworldnp.com/binder

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Come follow along for even more tips and inspiration:

Instagram: https://instagram.com/realworldnp

Facebook: https://facebook.com/realworldnp

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Please note: This episode is intended only for medical providers and students learning to be medical providers.

If you have questions about, I cannot answer those here but would love to help you inside our mentorship program! Join the waitlist at https://www.realworldnp.com/mentoring.

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Well Child Check Hacks for Nurse Practitioners

Tue, 03 May 2022 19:41:41 GMT

Well child visits can be very intimidating for new Nurse Practitioners, even if you love working with children. There are so many questions to ask, so many developmental elements to consider – it’s easy to feel a lot of pressure not to miss anything in these visits.

This week, let’s talk about ways to come into these visits with tools to make it easier for you and to set your mind at ease.

✅ Top things to know for well child visits

✅ My favorite resources for pedi milestones

✅ How to plan your well child visit so that you don’t miss anything

✅ How to involve staff to help these visits go more smoothly

✅ A few simple questions to ask at any pediatric visit that will give you tons of information

Don’t feel like you need to know everything perfectly right away. Instead, prepare yourself, develop a strategy, and practice, practice, practice. These are visits that take a lot of practice and a lot of time to get comfortable with. Don’t give up!

PS. Here’s the link from Natalie PNP! : https://www.nursenat.com/shop-1

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Read the blog here: https://www.realworldnp.com/blog

Watch the video of this episode here: https://www.realworldnp.com/videos

Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

Grab your copy of the Digital NP Binder: https://www.realworldnp.com/binder

______________________________

Please note: This resource is intended only for medical providers and students learning to be medical providers.

Hosted on Acast. See acast.com/privacy for more information.

Diagnostic Approach to Fatigue in Primary Care

Tue, 26 Apr 2022 22:00:37 GMT

Fatigue is a tricky clinical topic that can seem overwhelming in a primary care visit – sometimes even for the seasoned NP. Having a game plan can help with the stress of these visits and increase your confidence when you see these patients.

In this week’s episode, let’s talk about what you need to know to be prepared for the patient with fatigue.

✅ Strategies to approaching diagnosis

✅ How to get the history you need

✅ The body systems you MUST assess

✅ Chronic causes to rule in/out

✅ Top questions to ask to be both comprehensive and efficient in the visit

✅ Which labs to order

What to do when the assessment is inconclusive

You will be able to develop a strong plan for the patient without overwhelming yourself - or missing any red flags.

Read the blog post here.

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Pancreatitis Diagnosis for New Nurse Practitioners

Tue, 19 Apr 2022 12:00:38 GMT

Epigastric pain as a chief complaint happens ALL the time in primary care. And we all order labs to help rule out pancreatitis, but most clinicians feel uncomfortable with diagnosing pancreatitis in primary care. Even though it’s not that common, it’s certainly a red flag diagnosis to watch out for.

In this episode I cover:

✅ The main causes of pancreatitis

✅ What labs to order and what to look out for

✅ The criteria for diagnosing pancreatitis

✅ The next steps to take when you suspect it

Read the blog post here.

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Diagnosing Abdominal Pain for New Nurse Practitioners

Tue, 12 Apr 2022 12:00:40 GMT

Some chief complaints are more stressful than others. Abdominal pain is CERTAINLY one of them, especially for new nurse practitioners.

In this episode, I give my top systematic hacks for diagnosing abdominal pain in the primary care setting to make sure you’re not missing anything and are providing safe care.

Read the blog post here.

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Download the FREE Ultimate Resource Guide for NP

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Acute Diarrhea Diagnosis for New Nurse Practitioners: Part 2

Thu, 07 Apr 2022 12:00:09 GMT

Patients presenting with an acute diarrheal illness is one of the MOST common chief complaints in primary care. They’re also typically worried, wondering if they need antibiotics AND usually want some sort of testing.

My last episode was part one of assessing this chief complaint, and I focused on the important history questions, physical assessment and the most important risk factors and triage components. Definitely go back and check that out if you haven’t already here: https://www.realworldnp.com/podcast

In this week’s episode though, I’m covering:

The most common presentation to watch out for in primary care
What types of stool testing there are, and why you’d order them
The most common pathogens you’re looking for, and how to order them
Guidance for patients looking for antibiotics (and if they’re appropriate or not)

Here’s the reference I mentioned with the printable table! It’s a few years old but it’s free! Up-to-Date also has a great table resource but I don’t have rights to share unfortunately :) https://www.aafp.org/afp/2014/0201/p180.html#afp20140201p180-t1

Read the blog post here.

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Acute Diarrhea Diagnosis for New Nurse Practitioners

Tue, 05 Apr 2022 12:00:18 GMT

Acute diarrhea is SUCH a common chief complaint in primary care. In this week’s episode I’m covering acute diarrhea diagnosis for new nurse practitioners in primary care.

Including:

The approach to diagnosis
What “doorways” to keep track of
The most important history questions
Triaging the most dangerous presentations
Whether to order labs or not!

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How to Manage Nurse Practitioner Stress, Burnout and Compassion Fatigue

Tue, 29 Mar 2022 12:00:54 GMT

The transition from RN to NP is TOUGH. It's exhausting, stressful, but oh so worth it.

We need to be careful, though, because too much stress and not enough strategic prevention can lead to burnout and something called compassion fatigue, which can fizzle out our drive and passion-- and worse, may even lead to leaving the profession altogether.

In this episode, I'm covering:

- The risk factors, signs and symptoms of stress, burnout and compassion fatigue (it's not necessarily what you think)

- How to know if you're having any of these (or all three)

- And what to do about it (prevention AND treatment).

Take your ProQuol self assessment here: https://www.proqol.org/ProQol_Test.html

Definitely check out the book To Weep for A Stranger: Compassion Fatigue in Caregiving by Patricia Smith if any of this is resonating with you: https://www.amazon.com/Weep-Stranger-Compassion-Fatigue-Caregiving/dp/1448658691 (not an affiliate link)

Read the blog post here.

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Weight Management Part 2- Medication Management

Thu, 24 Mar 2022 12:00:24 GMT

Prescribing weight loss medications in primary care is SUCH a common challenge for new nurse practitioners. It feels like there are so many options and things to keep track of.

This week’s episode is a follow up from the last episode about weight management counseling-- all about weight loss medications in primary care.

This week I cover:

✅ Which patients are candidates for weight loss medication

✅ The three main types of medications, side effects to watch out for

✅ Goal setting and what to expect with patients

✅ Monitoring of patients and how often to have them come back to clinic

PS. I said most of the studies are heterogeneous but I meant to say that the studies are too homogeneous-- they’re not reflective of the diverse communities of patients we serve.

Read the blog post here.

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Weight Management Part 1- Lifestyle Intervention and Counseling

Tue, 22 Mar 2022 12:00:28 GMT

Weight management counseling in primary care is such an important skill, and it’s truly the foundation that patients need before we can start addressing weight loss medications.

In this week’s episode, I’m covering my approach to weight management counseling in primary care, that will hopefully help you feel more confident in your visits.

I cover:

✅ How to talk to patients, including actual easy scripted phrases to use so you get the information you need and they feel supported

✅ Special considerations with using the BMI calculator (who knew??)

✅ One key to actually move the needle forward in weight management conversations

✅ The hidden beliefs we need to address with patients that will set them up for success

✅ The mindset shift that will help you and your patients set realistic expectations and plans of care so they reach their goals

Read the blog post here.

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Pelvic Floor Dysfunction for New Nurse Practitioners

Thu, 17 Mar 2022 12:00:10 GMT

I’m SO excited to share this interview with you. I’m interviewing two pelvic floor therapists -- a family nurse practitioner who has gotten additional training, and a physical therapist with a specialty in pelvic floor therapy.

This is SO IMPORTANT. It seems like a hidden corner of medicine that we don’t learn about in school, or maybe it’s touched on when it comes to dyspareunia or urinary incontinence, but it’s so much more than that and we have the power to be so helpful for patients.

In this episode we cover so, so many gems, including:

✔What is pelvic floor therapy?

✔What is pelvic floor dysfunction?

✔When would someone need that?

✔What do you wish primary care providers knew?

✔What resources do you recommend to learn more or to get patients access?

✔Why should we not give exercise handouts?

Here are Melissa and Kathy's website and YouTube channel:

http://www.instituteforpelvichealth.com

https://www.youtube.com/channel/UCVH9Cd-W5YPHoz4cFGZQ3Xw

Read the blog post here.

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Interview with a Physical Therapist

Tue, 15 Mar 2022 12:00:17 GMT

Interdisciplinary collaboration is SO important in primary care. It’s a tragedy when we’re each rockstars in our own bubble of a profession, but aren’t collaborating or communicating enough to fully understand what each profession actually does.

I’m absolutely obsessed with physical therapy, and it’s a HUGE key to success for patients with musculoskeletal complaints in primary care-- but I didn’t really see how it worked on the other side until I was a patient myself.

In this week’s episode, I’m interviewing Stephanie who’s been a physical therapist for 10 years, and we’re answering questions from the email list about physical therapy. We cover:

✅ What physical therapy is and how they can help patients

✅ Who’s a good candidate (or not) and what patients should go that aren’t being referred

✅ The role of imaging before sending to physical therapy

✅ How to manage cost/time/insurance concerns patients have

✅ What we can do in primary care to counsel patients and prepare them to set them up for success with a physical therapist so they can finally feel better

Read the blog post here.

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How to Delegate Effectively as a Nurse Practitioner

Thu, 10 Mar 2022 13:00:54 GMT

When we’re nurse practitioner students, we’re so focused on the clinical aspects of our jobs that most of the time when we graduate, we’ve caught by surprise.

There’s an entirely new role we need to step into as well: delegating, supervising and managing staff members.

It’s especially tricky when you’re supervising someone, but you’re not technically their boss-- like medical assistants and nurses.

And it’s also difficult because as nurses, we’re so used to working as a team, pitching in, and it feels like we should just “do it ourselves” when it comes to delegating.

In this week’s episode, I’m interviewing executive and leadership coach Jackie Kindall with the questions from the audience about delegation and managing team members as a new nurse practitioner.

We cover:

✅ Why it’s actually a not helpful for us to “do it ourselves” and how delegation is actually helpful and important to do

✅ The common pitfalls new nurse practitioners and leaders experience when it comes to delegation and supervision

✅ How to effectively delegate and troubleshoot when things are not going well

Read the blog post here.

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How to Navigate Scheduling Issues for Nurse Practitioners

Tue, 08 Mar 2022 13:00:06 GMT

When I became a new nurse practitioner, I was so focused on learning the clinical pieces that it never occurred to me to learn more about the business of primary care.

Once I was on the job, I realized how crucial it is to understand those pieces and how I fit as a clinician in the primary care office ecosystem.

This is particularly relevant when it comes to scheduling patients. It seems like a minor thing, but it causes a lot of nurse practitioners painful headaches, and can be tricky to both understand the problems and navigate out of them unless you understand the full picture of how it fits into the day-to-day running of the practice.

In this week’s episode, I’m building off of last week’s video where I talked about the business foundations of primary care. I cover:

✅ The foundational pieces to understand when it comes to scheduling patients

✅ The way that it can look ideally, and the less-than-ideal “real world” way it can look

✅ Examples of issues new nurse practitioners face, and ways to navigate out of them

Read the blog post here.

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How Primary Care Offices Work for New Nurse Practitioners

Thu, 03 Mar 2022 13:00:31 GMT

As nurse practitioners, we primarily learn the clinical aspects of practice. For good reason-- we’re taking care of real patients’ lives. But there’s a whole lot more to learn on the job, from delegation and leadership, to navigating day-to-day challenges in the ecosystem of a clinic.

I was SO focused on learning the clinical parts as a new NP, that I was caught by surprise at my first job. I didn’t realize how primary care offices work-- the business of running a clinic -- and the role I now played.

Understanding how primary care offices work from a business perspective can help you in SO many aspects of your job as a nurse practitioner-- from asking the right questions during a clinic interview, to negotiating salary, to making improvements in clinic workflow or requesting more support.

In this week’s episode, I’m covering the foundations of how primary care clinics work from a business perspective, your role, and it will serve for the basis of a few upcoming videos where I address the “ideal world” and the “real world” of primary care offices, and how to navigate the common issues that come up.

Read the blog post here.

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Interview with a Women's Health Nurse Practitioner

Tue, 01 Mar 2022 13:00:16 GMT

One of the struggles for new nurse practitioners in primary care is managing women’s health topics, and knowing if and when to refer to an OBGYN specialist. We want to do things the right way and use resources we can trust.

In this week’s episode, I’m interviewing Monica Carter, who is a family nurse practitioner who has practiced in the women’s health setting for the last 13 years. She dropped SO many pearls and pitfalls of practice, and is truly a gem of a human. We answered questions from the community for a women’s health provider, including:

Tips for finding cervixes on pap smears, when to do a pap post-hysterecomy, and how to assess the variable appearances of cervixes on exam
Tips and resources for managing menopausal symptoms, abnormal pap results, choosing contraceptives (such great insights!) and medications in pregnancy
Getting into GYN as a family nurse practitioner
When to refer to maternal fetal medicine
Initial workup for infertility and pearls of practice

Check out the resources she mentioned inside the video here:

Menopausal symptoms

ACOG green journal (need an ACOG membership or you can purchase)

https://journals.lww.com/greenjournal/Abstract/2014/01000/Practice_Bulletin_No__141__Management_of.37.aspx

Menopro

https://www.contemporaryobgyn.net/view/nams-launches-free-mobile-menopause-app

Choosing birth control & best resources - Contraceptive technologies - book and conference

http://www.contraceptivetechnology.org/

ASCCP app

https://www.asccp.org/mobile-app

Reprotox app

https://reprotox.org/

Read the blog post here.

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Time Management for Nurse Practitioners: Inbox

Thu, 24 Feb 2022 13:00:49 GMT

There’s SO much to manage as a new nurse practitioner, on top of developing your clinical knowledge, making a thousand decisions a day and becoming a leader in the healthcare space. The better your time management, the more time to get your work done and ACTUALLY rest at the end of the day.

In this episode, I’m covering the rest of what we do in a day in the life as nurse practitioners-- inbox management and the time management strategies to make it all easier.

I go over:

✅ The types of documents and tasks we need to manage when we’re not seeing patients

✅How to prioritize them, and how to use your EHR to support YOU

✅What to look for, what to ask for, and how to bring suggestions to your team if it’s not going well

As always, if you want help with your lab interpretation, join us inside the Lab Crash Course! It comes with 8.7 hours of continuing education, it’s self-paced and you get lifetime access. Learn more: https://www.realworldnp.com/labs

Read the blog post here.

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HSV Diagnosis for Nurse Practitioners

Tue, 22 Feb 2022 16:58:35 GMT

So often in primary care, patients come in asking for testing for herpes, whether they have symptoms or not. Sometimes it’s because they “want to be tested for everything,” or are concerned about an exposure from a partner. As a new nurse practitioner, I wasn’t always confident about the best approach.

In this week’s episode, I’m covering:

✅ When to consider HSV, and the unlikely ways it can present

✅ What the difference between primary, non-primary initial and recurrent infections are, and what it means for the patient

✅ The top differential diagnoses to consider

✅ How to test for HSV, what the gold standard tests are and what NOT to use

Read the blog post here.

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Updated Billing and Coding for Nurse Practitioners

Thu, 17 Feb 2022 13:00:13 GMT

Billing and coding clinic office visits are probably not the first thing nurse practitioners think of when they graduate. It's probably more like:

Phew! I’m so so so glad that's over.
What comes next?!
How am I going to find a job?
I’m not going to worry about that right now because...
...I'm finally done with NP school! 👩‍⚕️🦄💪

But unfortunately, the skill set of medical billing and coding is one of the first major frustrations that new nurse practitioners encounter on the job.

And doing it right makes a big difference -- there are serious consequences with chronically under or over-billing!

It tends to feel really hard for new grads at first, but once you get the hang of it, it's much simpler than you think.

Start with the Basics of Billing and Coding for Nurse Practitioners

We did our first episode on Billing and Coding for Nurse Practitioners last time. I refer to it a few times in this episode, so definitely go and check it out first, if you aren't familiar with how it works.

In both episodes, I'm talking about the bread and butter of coding -- new and established office visits, E&M codes. I don't get into procedures or coding for physical exams or coding modifiers. If you're interested, I'd totally be into hosting a Billing and Coding workshop to get more into those!

The Good News About Billing and Coding

Once you've listened to that episode, I need you to head straight back here because we’ve got some good news — The 2021 CMS updates for billing and coding just made life a LOT simpler for nurse practitioners.

They've streamlined it quite a lot — it's still relevant to know the more "complicated" billing and coding method (from the previous episode) since it can help you more accurately code and get reimbursed for all your hard work. But hopefully, this will overall give you back some time in your day.

In this episode, we chat about:

✅ Main branch points for determining strategies for billing and coding in-office visits

✅ Choosing the appropriate documentation to support coding

✅ Options for billing based on levels of decision making OR time spent with a patient

✅ And other significant updates!

Also! Get your Billing and Coding Cheat Sheet here: https://www.realworldnp.com/026-opt-in

Read the blog post here.

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Billing and Coding for Nurse Practitioners

Tue, 15 Feb 2022 13:00:27 GMT

Billing and coding your office visits for for your office visits can feel overwhelming, tedious and too-hard-to-learn. But, one under-charge here and there may not seem like much, but when you add them all up...

In this week's episode, though, I'm breaking it down SUPER simply (with a cheat sheet!)

Plug the data in and out pops the right E&M code to use.

You'll learn:

✅ How to accurately bill for new and established office visits (primary care only!)

✅ The key differences between level 3&4 (and the most common pitfall I see!)

✅ A few patient examples to apply it to (and a walk-through of the plug-and-go cheat sheet)

Download the cheat sheet here: https://www.realworldnp.com/026-opt-in

Read the blog post here.

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When you Want to Give up as a Nurse Practitioner

Tue, 08 Feb 2022 22:45:00 GMT

I recently got the question from a new nurse practitioner, “what do you do when you want to give up as a nurse practitioner?”

I’ve definitely been there before myself, and with the stress of this last year and a half, I know a lot of other new nurse practitioners and NP students are feeling that way, too.

In this week’s episode, I’m covering what to do when you feel like this, including:

The most important questions to ask yourself to help sort through your feelings and get to the root of feeling like yourself again
Real life contexts of what this may look like for you, and the options to consider
A few personal stories about how I experienced burnout and what I’ve done to cope with it

Read the blog post here.

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Approach to Hair Loss for New Nurse Practitioners

Tue, 25 Jan 2022 22:49:00 GMT

Patients coming into primary care with a chief complaint of hair loss can be so stressful as a new nurse practitioner.

First, let’s normalize this. It’s a broad differential and can be tricky to parse out. It can also feel really stressful and emotional for your patient presenting for care, which adds even more pressure.

In this week’s episode, I’m covering how to approach hair loss in primary care, the differential diagnoses, history, physical exam and testing highlights for new nurse practitioners in primary care.

Read the blog post here.

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Diabetes Case Study in Mentorship for Nurse Practitioners

Tue, 18 Jan 2022 19:43:16 GMT

So many new grads are most worried about building their clinical knowledge base-- for good reason!

But it’s one thing to prepare for clinical topics-- researching algorithms, choosing the best practice based on the evidence-- but an entirely different experience trying to apply them to the “real world.”

Through Real World NP, I have the awesome privilege to work with new grad nurse practitioners on-on-one in mentorship calls.

Some of mentorship is reassuring new grad NPs about their clinical judgment decisions, and it also involves discussing the most up to date guidelines.

But there’s another level to mentorship and “real world” practice that you just can’t get in school.

This week, I want to share with you some of the “behind the scenes” of what our mentoring conversations are like. I’m covering an example patient case with complex diabetes and medical conditions that I reviewed with a real-life new grad nurse practitioner during a mentoring conversation.

Full disclosure: I hope to someday record a call with a new grad NP (with consent and voice-masking, of course), but for now, it’s just me talking, reviewing what we talked about and the variety of ways we approached the situation.

Hopefully this helps you apply these lines of thinking to your own patient cases!

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

Grab your copy of the Digital NP Binder: https://www.realworldnp.com/binder

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New Nurse Practitioner Transition - You're Not Alone

Tue, 21 Dec 2021 20:00:07 GMT

This has been on my heart this week - between working 1 on 1 with mentees and seeing the landscape online of new grad nurse practitioners, I see this ALL the time.

Feeling like you're the only one feeling this way. Feeling behind, not knowing enough, and then beating yourself up for it.

If this sounds like you, take a listen-- sometimes just naming and acknowledging what's ACTUALLY going on makes a difference in how you're feeling about it.

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

More Resources:

Lab Interpretation Crash Course: https://www.realworldnp.com/labs

Digital NP Binder: https://www.realworldnp.com/binder

Diabetes Medication Workshop: https://www.realworldnp.com/diabetes

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Come follow along for even more tips and inspiration:

Instagram: https://instagram.com/realworldnp

Facebook: https://facebook.com/realworldnp

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Time Saving Tips for New Nurse Practitioners

Tue, 14 Dec 2021 20:00:59 GMT

How did your entire visit get eaten up by getting the HPI? What are you supposed to do in a visit with the complicated patients with 17 chronic conditions?

I learned many time-management lessons the hard way in my first year of practice, and they're the same patterns I see in my NP students and new grads I've worked with.

In this episode you'll learn time-saving tips to help before, during and after your visits so you can be more timely with your patients (and do less charting at home and on the weekends!).

PLUS, download another cheat sheet for patient visit "quick text" templates and a sample complicated patient note. Check it out here: https://www.realworldnp.com/011-opt-in

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

More Resources:

Lab Interpretation Crash Course: https://www.realworldnp.com/labs

Digital NP Binder: https://www.realworldnp.com/binder

Diabetes Medication Workshop: https://www.realworldnp.com/diabetes

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Come follow along for even more tips and inspiration:

Instagram: https://instagram.com/realworldnp

Facebook: https://facebook.com/realworldnp

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New Nurse Practitioner Visit Routines

Tue, 07 Dec 2021 21:00:46 GMT

Keeping your head on straight while juggling so many moving pieces in a typical day as a nurse practitioner is TOUGH.

I heavily rely on structure and routines to make sure I keep it all straight — and I don't miss anything!

In this episode, I go over my routines with new patients, annual physicals, follow-up visits and sick visits, so you can stay on track and make sure you've got all the info you need.

PLUS: my cheat-sheet I give all my students (and I used for the first year+ ... literally bringing it into my visits and checking things off as we covered them).

Download it here: https://www.realworldnp.com/011-opt-in

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

More Resources:

Lab Interpretation Crash Course: https://www.realworldnp.com/labs

Digital NP Binder: https://www.realworldnp.com/binder

Diabetes Medication Workshop: https://www.realworldnp.com/diabetes

------------------------

Come follow along for even more tips and inspiration:

Instagram: https://instagram.com/realworldnp

Facebook: https://facebook.com/realworldnp

Hosted on Acast. See acast.com/privacy for more information.

Chronic Care Conversations

Tue, 23 Nov 2021 20:00:00 GMT

I love caring for patients with chronic conditions now, but it wasn’t always the case. Like so many new grads, I struggled with caring for patients managing chronic conditions -- where to start, how to proceed, feeling like we weren’t making any progress towards “control” of those conditions (diabetes, chronic kidney disease, hypertension, etc).

When I was a new nurse practitioner, I was incredibly focused on the diagnostic algorithms and medication management. Which, of course, is crucial to know, but isn’t truly what moves the needle in chronic conditions.

In this episode, I cover:

What moves the needle in chronic conditions
Normalize what and why this is so hard
What my dog has taught me about caring for patients (and can help you too)
A practical framework for navigating the management of these conditions

Read the blog post here.

**PS our brand new course Managing Diabetes, Hypertension and CKD in Primary Care is available now at realworldnp.com/shop

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Chronic care visits for new nurse practitioners

Tue, 16 Nov 2021 21:10:42 GMT

Chronic care conditions are a big part of working in primary care, but they’re also complex, time-consuming, and stressful to treat, especially for new nurse practitioners.

So this week, we’re going to do a walkthrough of how you can conduct these visits, but in a way that that feels timely, organized, and safe!

In this video, I touch on the 4 most important steps to take in each chronic care visit:

✅ Reconciling medications

✅ Assessing the status of their condition

✅ Identifying the red flags for the most common chronic care conditions in primary care

✅ Determining the extent of specialist care

Still feeling overwhelmed by chronic care visits? I've got you covered. We have a new chronic care course that helps you get oriented with the most common chronic conditions you see in primary care: diabetes, hypertension, and chronic kidney disease (CKD). Join the course at https://www.realworldnp.com/shop.

Read the blog post here.

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Chronic Kidney Disease (CKD) for new nurse practitioners

Tue, 09 Nov 2021 21:15:04 GMT

When I was a new grad, I thought I’d never master CKD. It was so stressful because, as you probably know very well, unmanaged CKD can lead to kidney failure.

But the more I’ve learned and practiced medicine, the easier it gets. And now? I’m obsessed with CKD — it’s one of my favorite clinical topics to explore these days.

So hopefully in this week’s video, I can share some shortcuts to understanding CKD and making patient assessment and care easier.

✅ The basics of staging CKD

✅ When should you think about referring to nephrology?

✅ Assessment parameters for renal problems that you absolutely need to know

And, of course, more pearls of practice!

Read the blog post here.

Looking for more guidance on CKD? Join the chronic care course at https://www.realworldnp.com/shop

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Resistant hypertension for new nurse practitioners (Part 2)

Tue, 02 Nov 2021 20:00:53 GMT

In Part 2 of our Resistant Hypertension videos, I’m looking at hyperaldosteronism, or high aldosterone levels, as a cause for treatment-resistant hypertension — and an underrecognized one at that.

So what is high aldosterone? Where does it come from? When do you check for it? What causes it? If a patient has high aldosterone, what do you do next?

Let’s dig in!

Note that assessing for this may be out of your practice comfort zone — and that’s totally fine! But it’s still important to know what hyperaldosteronism means for your patients.

In this video, I touch on:

✅ What distinguishes primary and secondary aldosteronism - and why it matters

✅ Symptoms to keep an eye on when looking at the different ideologies for high aldosterone

✅ And how to navigate that always-tricky dance of testing and referral as a nurse practitioner

Read the blog post here.

Looking for more guidance on CKD? Join the DM, HTN, CKD Review Course now: https://www.realworldnp.com/shop

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Interview with a pharmacist

Tue, 26 Oct 2021 20:00:23 GMT

Both pharmacists and nurse practitioners play a critical role in medication management for patients.

But we don’t always understand what we can do for one another, which can lead to confusion, frustration, and missed opportunities. Finding ways to collaborate and build professional bridges, however, can improve outcomes for everyone.

In this week’s video, I talk with Miriam Ahmed, a pharmacist based in Canada who also runs the educational Instagram platform, @rxnotes. We dive into important topics like:

✅ Ways nurse practitioners can increase their comfort level prescribing medications

✅ Tips on mitigating common errors when dealing with medication management

✅ How to navigate medical guidelines for prescription medications

✅ And tons of questions from the audience

Read the blog post here.

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Stressed about labs? Watch our free Top Three Mistakes New NPs Make Interpreting Labs training at realworldnp.com/training

Grab your free Ultimate Resource Guide for the New NP at realworldnp.com/guide

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Resistant Hypertension (Part 1)

Wed, 20 Oct 2021 03:50:48 GMT

Resistant hypertension is a common chief complaint in primary care clinics. But for new nurse practitioners, there’s a lot to sort through.

In this video, I walk through the thought processes and approaches to managing resistant hypertension in primary care.

✅ How to talk about medication adherence with patients

✅ The role of ongoing blood pressure checks — both in clinic and at home

✅ Considerations for current medications and dosing

✅ How to investigate the secondary causes of hypertension

Read the blog post here.

Stressed about labs? Watch our free Top Three Mistakes Even Smart NPs Make Interpreting Labs training at https://realworldnp.com/training

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Diagnostic approach to dizziness

Wed, 13 Oct 2021 00:00:10 GMT

Dizziness alone accounts for about 5% of all primary care office visits in the US.

5%! That's a huge number.

But as a chief complaint, dizziness is somewhat nebulous. The causes of dizziness can run the gamut from annoying-but-benign to yikes-let's-get-you-to-the-ER. So how do you sift through all the possibilities and uncover what’s really going on with your patient?

In Diagnostic Approach to Dizziness, we walk NPs through the basics of assessing patients who are experiencing dizziness. We talk about:

✅ The four buckets of ideologies that your patient’s dizziness might fall into

✅ The critical patient history questions. (And why it's important to drill down on what patients mean when they say they're CONSTANTLY dizzy.)

✅ The diagnostic steps and key physical tests to run (and how to do them in a not-scary way for your patients!)

🚩And the red flags you absolutely need to watch out for

Read the blog post here.

Stressed about labs? Watch our free Top Three Mistakes New NPs Make Interpreting Labs training at realworldnp.com/training

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Diagnostic approach to back pain

Wed, 06 Oct 2021 00:00:11 GMT

Back pain — it’s truly one of the most common issues you come across in primary care. That’s why you need to have your diagnostic approach to it down pat as a nurse practitioner.

And the sooner you get comfortable diagnosing back pain in primary care, the sooner you’ll feel confident helping your patients on their road to recovery.

In this week’s episode, we talk about why you should really take a triage-based approach to back pain — among other chief complaints — plus other hot takes on assessing back pain such as:

✅ Red flags that are critical — if sometimes tricky — to uncover when taking a patient history

✅ Key tests to consider when you're doing a physical exam

✅ Should you order imaging or further testing?

✅ And how to advise patients and set expectations for recovery

Read the blog post here.

Stressed about labs? Watch our free training: 3 Mistakes New NPs Make Interpreting Labs for what to avoid and do instead at realworldnp.com/training

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Interview with an Orthopedic Nurse Practitioner

Tue, 28 Sep 2021 21:29:02 GMT

It’s super common for new NPs — and experienced ones — to get anxious when encountering orthopedic complaints.

It’s a conundrum — on one hand, it seems like it should be simple. After all, you can feel all the musculoskeletal body structures right there.

But at the same time, there are so many (SO MANY!) nuances to each body part. And there’s a lot of ortho lingo to wrap your head around.

That’s why it’s helpful to understand exactly what an orthopedic nurse practitioner does — and what that means for working in primary care.

So sit back and enjoy — this week, orthopedic nurse practitioner, Yessica Salazar, has stopped by to talk ortho with us...and left behind so many great clinical pearls that I just know will help you in your daily practice:

✅ How to order knee X-rays the right way

✅ Her approach to medications for orthopedic complaints

✅ Non-invasive treatment options for patients

Read the blog post here.

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How to Get a Patient History

Tue, 21 Sep 2021 05:00:27 GMT

Do you ever find yourself spending an ENTIRE 20-minute visit just getting a history?

And even with all that time, do you still leave the room feeling like you didn't even get the info you needed?

In this episode, I'm sharing my top tips for not only a FASTER history, but also a more accurate one — so you can take great care of your patients while saving time and, quite honestly, health care dollars.

You'll learn:

My top tip to keep your patient visits moving
Pitfalls of where you could be missing info (and how to ask questions to get the answers you're looking for)
The most important question to ask to save you TONS of time in each visit

Read the blog post here.

Need more support? Check out the Lab Interpretation Crash Course for Nurse Practitioners

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Lower Extremity Edema Causes - A Case Study for New Nurse Practitioners

Tue, 14 Sep 2021 05:00:00 GMT

Seeing "lower leg swelling" as the chief complaint for patients as a new nurse practitioner was incredibly stressful. What’s the best course of action? Should you give diuretics for symptom control? Is this something serious...or something totally ordinary?

I had a super interesting case the other week and knew immediately that I had to share it with you — and it was one that I actually got a double-check from my colleague on!

In this episode, you'll learn:

The top DDXs - most common and red flags
What important history questions to ask
Two clinical pearls of patient histories
Differential diagnoses
How to manage patients in this common scenario - re: testing & treatment

Read the blog post here.

Need more support? Check out the Lab Interpretation Crash Course for Nurse Practitioners

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Microalbuminuria Case Study: Lab Interpretation for Nurse Practitioners

Tue, 07 Sep 2021 05:00:32 GMT

Urine microalbumin: you need to check it once a year for patients with diabetes. But interpreting the results — and knowing what to do with them! — can be tricky.

In this episode, you’ll learn:

When to order urine microalbumin labs
How to interpret the results and what to do with them
How to treat abnormal levels
4 steps to elevated microalbumin management

Read the blog post here.

Need more support? Check out the Lab Interpretation Crash Course for Nurse Practitioners

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What Causes Low Sodium? Hyponatremia Workup

Tue, 31 Aug 2021 05:00:43 GMT

I saw a meme recently that compared hyponatremia to folding a fitted sheet— you can watch a million videos on how to do it, but in the end you'll probably just crumple it up and hope you never have to deal with it again. 🤯

Luckily in primary care low sodium is easier to deal with outpatient, and doesn't have to be super complicated. In this episode, I talk about low sodium, which is one of the top abnormal labs in primary care.

Hyponatremia involves understanding kidney function, but I've broken it down into the simplest, clearest, most digestible way to give you the most helpful insight to take into your practice. I'll bring you through the step-by-step process to implement for the vast majority of patients you'll see, and if you need to go down the rabbit hole of workup further, you'll have the tools to do so!

You'll learn:

How to know when your patient needs to go to the ER, and when you can work them up outpatient
The simplest way to remember low sodium
The #1 lab you should always think of when you see low sodium
How to know if your patient needs IV fluid (or if that'd be the worst possible thing to do for them)

Read the blog post here.

Want more lab goodies? Check out the Lab Interpretation Crash Course for Nurse Practitioners

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How to Know When to Refer to a Specialist: # 1 Tip for New Nurse Practitioners

Tue, 24 Aug 2021 05:00:13 GMT

Feeling uncertain about referring a patient? That’s super common. You might wonder things like:

Are there other tests you could do first?

Should you wait it out?

At what point can you be sure?

In this episode I will answer ALL of these questions. I will also walk you through my 3-step process, the pitfalls and mistakes to avoid (that I learned from experience!). Plus, I’ll give you my NUMBER ONE resource to help you:

Feel more confident with your referrals
Deepen and broaden your knowledge base
Take excellent care of your patients

Read the blog post here.

Need more support? Check out the Lab Interpretation Crash Course for Nurse Practitioners

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Leukocytosis Case Study: Lab Interpretation for Nurse Practitioners

Tue, 17 Aug 2021 05:00:44 GMT

You've seen high WBC counts as a nurse, but what about leukocytosis that's only 13 or 15? And it's chronic? And what about peripheral smears? How do you know if it's urgent?

In this episode we are going to talk about this super interesting case study to give you the step by step approach to interpreting these labs, and teach you how to manage a high WBC count safely and confidently.

Together, we will cover:

Knowing when to order what labs
Three main components of working up a high WBC
The differential and the peripheral smear
Absolute lymphocyte count
The Flow Cytometry Test

Read the blog post here.

Check out the Lab Interpretation Crash Course for Nurse Practitioners

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Elevated Liver Enzymes (LFTs) Case Study: Lab Interpretation for New Nurse Practitioners

Tue, 10 Aug 2021 05:00:54 GMT

There are many facets when it comes to interpreting Elevated Liver Enzymes (LFTs). In this episode we will be going through the most common presentation and primary care so that you will feel confident in knowing what steps to take when you come across these abnormal labs, and as a result, put your mind at ease and keep you from freaking out!

Together, we will cover:

Key anchors of LFTs that you need to remember
Two main factors to know what labs to order and when
Three points to start with during your initial approach to LFTs
Four main questions to ask with every lab
Symptoms, causes, evaluation, and algorithm specifically for mild AST and ALT

Read the blog post here.

Check out the Lab Interpretation Crash Course for Nurse Practitioners

Download FREE Ultimate Resource Guide for the New NP

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How to Deal with Imposter Syndrome as a New Grad NP

Tue, 03 Aug 2021 10:00:56 GMT

It happens to all of us. Those questions and self doubts we get in the back of our minds, “What did I get myself into? Do I even know what I’m doing? Should I even be in this field?”

The list goes on. If you are struggling with these fears, then you need to know a few things. First, you are not alone! And second, you are in the right place, because I’m giving you the strategies I use to deal with imposter syndrome.

Imposter syndrome is especially common among New Grad NPs, but in all honesty imposter syndrome is something that many of us experience whenever we move to take that next step in our career or any time we explore something new. (Yes, even I still experience this!) So even if you are not a New Grad NP, you’ll still want to check out this episode because these tips are beneficial to everyone.

Read the blog post here.

Download FREE Ultimate Resource Guide for the New NP

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High TSH Levels: Lab Interpretation for New Nurse Practitioners

Tue, 03 Aug 2021 09:00:10 GMT

When you’re a new nurse practitioner, there can be a lot of overwhelming, high-stress situations that you may find yourself in.

A big contributing factor are lab interpretation resources — they’re scattered, hard-to-use, and don’t cover enough information. I used to DREAD opening up my lab results, but over time I went from avoiding my inbox to being obsessed with labs.

How did I get there? I found the right tools and techniques to use. In this episode, I’m going to help eliminate the overwhelm as we walk step by step through a case study of a patient with high TSH levels. Together, we’ll:

Go over the three main steps of hypothyroidism assessment and management
Review components of holistic care
Talk about medications that can affect thyroid levels
And share pearls of practice

Get out your pen and paper because this episode is jam-packed with information, and I know you will walk away feeling more confident and prepared for your next high TSH-level patient!

Read the blog post here.

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New Nurse Practitioner Survival Guide: My Top 3 Tips

Tue, 03 Aug 2021 05:00:33 GMT

Welcome to the first episode of the Real World NP Podcast! Let’s dive right into the good stuff.

I’m giving you my top three survival tips to help you get through your first year as a Nurse Practitioner.

As a student, you’re always looking to your preceptor for approval and feedback. You have someone to tell you, “Yes, that was right,” and “No, that was wrong.” This relationship sure makes things easier, but we don’t remain students forever!

There comes a time when we have to take that leap and make the transition from student to professional.

I know that leap can be a scary one filled with anxiety, self doubt, and a lot of questions. That’s why I’m giving you these three tips that I learned from personal experience. I can’t stress enough how important it is to get the adequate support you need from the very beginning so that you can avoid burnout and stay in this career for years to come.

Download FREE Ultimate Resource Guide for the New NP

Read the full blog post here.

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Trailer

Tue, 27 Jul 2021 10:00:07 GMT

Hi, I’m Liz Rohr: family nurse practitioner, wife, mama and founder of Real World NP, a medical education company for new nurse practitioners in primary care.

I’m on a mission to guide and support new nurse practitioners so they can feel confident and capable through comprehensive, concise, and hyper-relevant educational resources, without the fluff.

Real World NP is also here to provide an approachable, supportive community in order to bring about a new generation of healthcare providers who know that they can make an impact and disrupt the healthcare industry.

Each week you’ll hear a mix of clinical pearls and practice tips, guest interviews with specialists and allied health professionals, and guidance on navigating the role transition from RN to NP. Make sure you subscribe and leave a review so you won’t miss an episode. Plus, you’ll find links to all the episodes, plus extra goodies over at realworldnp.com/podcast.

Read the blog post here.

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