Real World NP

Decreased Appetite in Children May 10, 2022

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.

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

Sign up for the Lab Interpretation Crash Course: https://www.realworldnp.com/labs

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, 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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Well Child Check Hacks for Nurse Practitioners May 03, 2022

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

Sign up for the Lab Interpretation Crash Course: https://www.realworldnp.com/labs

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

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

Come follow along for even more tips and inspiration:

Instagram: https://instagram.com/realworldnp

Facebook: https://facebook.com/realworldnp

______________________________

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

While anyone is welcome to 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.

_______________________________

See acast.com/privacy for privacy and opt-out information.

Diagnostic Approach to Fatigue in Primary Care Apr 26, 2022

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.

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Pancreatitis Diagnosis for New Nurse Practitioners Apr 19, 2022

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

See acast.com/privacy for privacy and opt-out information.

Diagnosing Abdominal Pain for New Nurse Practitioners Apr 12, 2022

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.

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Acute Diarrhea Diagnosis for New Nurse Practitioners: Part 2 Apr 07, 2022

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

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Acute Diarrhea Diagnosis for New Nurse Practitioners Apr 05, 2022

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 Mar 29, 2022

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)

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Weight Management Part 2- Medication Management Mar 24, 2022

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.

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Weight Management Part 1- Lifestyle Intervention and Counseling Mar 22, 2022

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

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Pelvic Floor Dysfunction for New Nurse Practitioners Mar 17, 2022

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

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Interview with a Physical Therapist Mar 15, 2022

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

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How to Delegate Effectively as a Nurse Practitioner Mar 10, 2022

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

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How to Navigate Scheduling Issues for Nurse Practitioners Mar 08, 2022

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

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How Primary Care Offices Work for New Nurse Practitioners Mar 03, 2022

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.

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Interview with a Women's Health Nurse Practitioner Mar 01, 2022

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/

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Time Management for Nurse Practitioners: Inbox Feb 24, 2022

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 week’s video, 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

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HSV Diagnosis for Nurse Practitioners Feb 22, 2022

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

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Updated Billing and Coding for Nurse Practitioners Feb 17, 2022

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

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Billing and Coding for Nurse Practitioners Feb 15, 2022

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

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When you Want to Give up as a Nurse Practitioner Feb 08, 2022

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

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Approach to Hair Loss for New Nurse Practitioners Jan 25, 2022

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.

See acast.com/privacy for privacy and opt-out information.

Diabetes Case Study in Mentorship for Nurse Practitioners Jan 18, 2022

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!

Also, speaking of mentorship, we’re expanding our offerings OH. SO. SOON. Jump on the waitlist here to learn more and get first dibs.

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

Sign up for the Lab Interpretation Crash Course: https://www.realworldnp.com/labs

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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New Nurse Practitioner Transition - You're Not Alone Dec 21, 2021

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.

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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 Dec 14, 2021

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 video 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, below this video 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

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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

See acast.com/privacy for privacy and opt-out information.

New Nurse Practitioner Visit Routines Dec 07, 2021

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 video, 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

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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

See acast.com/privacy for privacy and opt-out information.

Chronic Care Conversations Nov 23, 2021

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

**PS our brand new course Managing DIabetes, Hypertension and CKD in Primary Care opens for enrollment next week. The only way to join is by email, so join the waitlist at realworldnp.com/courses.**

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Chronic care visits for new nurse practitioners Nov 16, 2021

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're launching a new chronic care course this fall 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 waitlist at https://www.realworldnp.com/courses.

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Chronic Kidney Disease (CKD) for new nurse practitioners Nov 09, 2021

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!

Looking for more guidance on CKD? Get on the waitlist for our upcoming chronic care course at https://www.realworldnp.com/courses — registration opens this fall!

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Resistant hypertension for new nurse practitioners (Part 2) Nov 02, 2021

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

Looking for more guidance on CKD? Get on the waitlist for our upcoming chronic care course at https://www.realworldnp.com/courses — registration opens this fall!

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Interview with a pharmacist Oct 26, 2021

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

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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) Oct 20, 2021

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

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 Oct 13, 2021

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

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 Oct 06, 2021

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

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 Sep 28, 2021

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

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How to Get a Patient History Sep 21, 2021

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

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 Sep 14, 2021

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

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 Sep 07, 2021

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

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

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What Causes Low Sodium? Hyponatremia Workup Aug 31, 2021

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)

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 Aug 24, 2021

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

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 Aug 17, 2021

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

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 Aug 10, 2021

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

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 Aug 03, 2021

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.

Download FREE Ultimate Resource Guide for the New NP

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High TSH Levels: Lab Interpretation for New Nurse Practitioners Aug 03, 2021

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!

Download FREE Ultimate Resource Guide for the New NP

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New Nurse Practitioner Survival Guide: My Top 3 Tips Aug 03, 2021

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

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Trailer Jul 27, 2021

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.

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