Real World NP

You're seeing a patient for a preoperative evaluation before an upcoming surgery. The surgeon has requested some testing and documentation—but how do you determine what your patient actually needs before their procedure?

Which patients need additional cardiovascular evaluation? When should you use RCRI or DASI? Do you need to order an ECG, chest X-ray, or routine labs? And how do you document your assessment without saying the patient is "cleared" for surgery?

In this updated episode of Real World NP, we're walking through a practical approach to the preoperative evaluation for noncardiac surgery in primary care, including updated cardiovascular risk assessment recommendations and how to apply them during an actual patient visit.

What You'll Learn:

• What your role is during a preoperative evaluation
• How to assess surgical risk and identify reasons to pause before surgery
• Using RCRI, ACS NSQIP, and DASI to assess cardiovascular risk and functional capacity
• What to include in the preoperative history and physical exam
• Assessing chronic conditions and pulmonary risk before surgery
• When preoperative labs, ECGs, and imaging are indicated
• Medication considerations before surgery, including anticoagulants, diabetes medications, and SGLT2 inhibitors
• What to document and communicate to the surgical and anesthesia teams

Timestamps

00:00 – Introduction

01:32 – Your role in the preoperative evaluation

02:13 – Assessing surgical risk

03:04 – Reasons to pause before surgery

03:58 – Cardiovascular risk assessment: RCRI and ACS NSQIP

04:45 – Functional capacity and DASI

05:24 – Preoperative history and chronic conditions

06:56 – Pulmonary risk assessment

07:25 – Physical exam and selective testing

08:25 – Perioperative medication considerations

09:37 – Documenting the preoperative evaluation

Resources Mentioned:

Preoperative Evaluation Cheat Sheet: A quick-reference guide to surgical risk, cardiovascular assessment, functional capacity, testing, and documentation. Get your copy at www.realworldnp.com/binder

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

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© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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Starting insulin in type 2 diabetes can feel intimidating—especially when you're a new NP seeing a patient with an A1C of 13% or 14% and wondering: Does this patient need insulin? Can I safely manage them outpatient? And how much insulin should I actually start?

In this episode, I walk through a practical approach to starting basal insulin in adults with type 2 diabetes, including updates from the 2026 ADA and AACE guidelines.

We'll cover when insulin is appropriate, how to calculate a starting dose, how to titrate using fasting blood glucose, and what to do when fasting glucose is at goal but A1C remains elevated.

We'll also talk about CGM, preventing hypoglycemia, and making insulin initiation manageable for patients—because you don't have to solve everything in one visit, but you do need to make sure your patient can safely manage their treatment at home.

For a full transcript and conversation chapters, visit the blog: www.realworldnp.com/blog/starting-insulin-type-2-diabetes

Need a Quick Insulin Reference?

The Digital NP Binder includes an updated Starting Insulin in Type 2 Diabetes cheat sheet with dosing, titration, monitoring, and treatment considerations for primary care. https://www.realworldnp.com/binder

Want More Support with Diabetes Management?

The Diabetes Management in Primary Care course covers medication selection, treatment adjustments, insulin therapy, diabetes monitoring, and more. https://www.realworldnp.com/diabetes

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© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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A patient with COPD comes in with worsening cough, sputum, and shortness of breath. Is this actually a COPD exacerbation? Can you safely treat them outpatient? And do they need antibiotics?

In this episode, I walk through a practical approach to evaluating and treating COPD exacerbations in primary care, including updates from the 2025–2026 GOLD guidelines.

We’ll talk through how to rule out other causes of worsening respiratory symptoms, assess exacerbation severity, decide when a patient needs a higher level of care, and choose appropriate treatment—including bronchodilators, prednisone, and antibiotics.

TIMESTAMPS:

00:00 COPD exacerbations: 2025–2026 update

01:30 Confirming COPD + the patient's baseline

02:19 COPD exacerbation or something else?

04:26 Assessing severity + when to escalate care

07:20 COPD exacerbation treatment: inhalers + prednisone

08:00 When do you need antibiotics?

10:45 Follow-up + reassessing long-term COPD treatment

For a full transcript, resources mentioned in this episode, and conversation chapters, visit the blog: http://www.realworldnp.com/blog/copd-exacerbation-new-nurse-practitioner

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© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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COPD guidelines have changed—and if you’re managing COPD in primary care, there are a few updates worth knowing.

In this episode, I walk through how to approach a patient with COPD at a routine visit, especially when you’re seeing them for the first time or inheriting their care from another provider.

We’ll cover how to confirm the diagnosis with spirometry, how to think about GOLD 1–4 alongside the ABE assessment, and how the mMRC and CAT scores fit into your assessment. We’ll also talk about alpha-1 antitrypsin deficiency testing, blood eosinophils and inhaled corticosteroids, initial inhaler therapy, and what to monitor at follow-up.

I also walk through the pieces of COPD management beyond medications—including smoking cessation, vaccinations, exercise and nutrition, pulmonary rehabilitation, and management of comorbidities.

In this episode:

00:00 – Introduction + COPD guideline updates

01:03 – Approaching COPD management in primary care

01:53 – Confirming COPD with spirometry and FEV1/FVC

03:01 – Pre-COPD and PRISm

03:53 – GOLD 1–4 and the ABE assessment

05:12 – Using the mMRC and CAT scores

06:23 – What to assess at a COPD follow-up visit

07:50 – Alpha-1 antitrypsin deficiency testing

08:26 – Blood eosinophils and inhaled corticosteroids

09:37 – COPD management beyond inhalers

11:15 – Pulmonary rehabilitation and comorbidities

11:37 – SABA, SAMA, LABA, LAMA, and ICS

12:21 – Initial COPD treatment by GOLD ABE group

13:50 – Initial treatment for Groups A and B

14:35 – COPD follow-up and spirometry

15:04 – Chest imaging and lung cancer screening

15:46 – When to refer to pulmonology

COPD cheat sheet + Digital NP Binder: realworldnp.com/binder

For a full transcript and conversation chapters, visit the blog: https://www.realworldnp.com/blog/copd-management

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© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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What does a GI specialist wish primary care providers knew before sending a referral?

In this episode, I’m joined by family nurse practitioner Paige Sosebee, who has worked in gastroenterology since 2019 at a large academic medical center. We talk through some of the most common GI concerns we see in primary care—and what happens on the other side of the referral.

Paige shares practical pearls on H. pylori testing and treatment, GERD and PPI trials, evaluating abnormal liver tests, celiac testing, chronic constipation, SIBO and intestinal methanogen overgrowth (IMO), and how primary care can make GI referrals more useful for both the specialist and the patient.

We also talk about something that comes up constantly for newer NPs: How much of this am I actually supposed to manage myself, and when is it time to ask a specialist for help?

In this episode, we cover:

• H. pylori testing, treatment, and common pitfalls
• GERD management and when to consider EGD
• Elevated liver enzymes and what to do before referring
• Celiac testing and the importance of testing before going gluten-free
• Chronic constipation, red flags, and initial management
• SIBO and intestinal methanogen overgrowth (IMO)
• How to make GI referrals more useful—and when they’re truly urgent

Timestamps:

00:00 – Introduction

02:19 – Meet GI specialist Paige Sosebee, FNP

04:31 – H. pylori testing, treatment & referrals

13:20 – GERD, PPIs & when to consider endoscopy

20:06 – Alginate therapy for GERD

22:31 – Elevated liver tests & GI referrals

24:51 – Elevated alkaline phosphatase & imaging

30:00 – Celiac disease testing

41:10 – Chronic constipation

46:00 – SIBO & intestinal methanogen overgrowth (IMO)

52:50 – When to refer to a GI specialist

56:00 – Clinical resources for primary care NPs

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

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© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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When should you refer a patient with CKD to nephrology—and what should you do before they get there?

In this episode, I’m joined by nephrologist and medical educator Dr. Rachel Hilburg to talk through the questions that come up all the time in primary care: interpreting proteinuria and hematuria, deciding when a nephrology referral is urgent, what labs and imaging to order before referral, and what we can actually do to slow CKD progression.

We also talk about the Kidney Failure Risk Equation, cystatin C, kidney-protective medications, preparing patients for dialysis and transplant, caring for patients already on dialysis, and a practical approach to hyponatremia.

Want to feel more confident managing CKD in primary care?

The Chronic Kidney Disease Management Course walks you through CKD diagnosis, monitoring, treatment, slowing disease progression, and when to refer to nephrology.

CKD Management Course: https://www.realworldnp.com/ckd

Or get the CKD course as part of the Chronic Care Bundle, which also includes diabetes, hypertension, and kidney lab interpretation.

Chronic Care Bundle: https://www.realworldnp.com/chronic-care-series-bundle

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

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© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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Valvular heart disease often presents gradually— often slowly becoming more fatigued, less active, or more short of breath over time— making it easy for symptoms to be attributed to aging or deconditioning. In this episode, Liz Rohr sits down with structural heart nurse practitioner Christy Cantey, FNP, to discuss how primary care clinicians can recognize subtle symptoms of valve disease, know when an echocardiogram is appropriate, and understand what happens after a patient is referred to a structural heart program.

They also discuss modern transcatheter valve procedures—including TAVR and TEER—and how these minimally invasive treatments have changed outcomes for patients with aortic stenosis and other valvular diseases.

Timestamps

00:00 Meet Christy Cantey, NP

02:02 What Is Structural Heart Disease?

03:22 Understanding Modern Valve Procedures

06:05 Symptoms That Should Raise Concern

07:28 Two Questions That Reveal Functional Decline

08:51 Why Patients Often Don't Realize How Sick They Feel

09:47 The Challenge of Detecting Heart Murmurs

11:09 When to Order an Echocardiogram

12:07 Why Early Referral Matters

15:35 Working With Structural Heart Programs

18:15 What TAVR and Valve Procedures Are Really Like

20:56 Primary Care Follow-Up After Valve Intervention

23:19 Long-Term Monitoring and Annual Echocardiograms

26:17 How to Counsel Patients Who Are Hesitant About Treatment

32:32 Clinical Pearls and Resources for Learning More

For a full transcript and conversation chapters, visit the blog http://www.realworldnp.com/blog/valve-disease-primary-care

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© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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The PREVENT Risk Calculator is a newer cardiovascular risk assessment tool developed by the American College of Cardiology (ACC) and American Heart Association (AHA). Designed to replace older pooled cohort equations, it provides a more comprehensive estimate of cardiovascular risk, including both atherosclerotic cardiovascular disease (ASCVD) and heart failure risk.

In this episode, Liz Rohr breaks down what the PREVENT calculator is, how to use it in clinical practice, and why it's becoming an increasingly important part of cardiovascular risk assessment in primary care.

Timestamps:

00:00 - Overview of the Prevent Risk Calculator and its significance in cardiovascular risk assessment

00:26 - How the calculator improves risk estimation over previous tools

01:16 - Key inputs needed for the calculator and optional risk-enhancing factors

01:41 - Incorporating additional data like zip code, A1C, and urine albumin

02:07 - Interpreting 10- and 30-year risk results for ASCVD and heart failure

03:02 - Thresholds for hypertension (≥7.5%) and hyperlipidemia risk categories

03:38 - Practical tips for clinicians on using and interpreting the tool

04:06 - Importance of risk-enhancing factors and patient-specific decision-making

04:55 - Limitations of population-based risks and underestimation in young adults

05:52 - Avoiding over-reliance on the calculator and considering the full clinical picture

06:46 - Summary: integrating the Prevent calculator into patient conversations and management pathways

For a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/prevent-calculator-aha

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© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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Hypertension Guidelines Updates: Practical Pearls for Primary Care with Dr. Jordy Cohen

What actually changed in the newest hypertension guidelines—and what should nurse practitioners be doing differently in clinic?

In this episode, Liz Rohr, MSN, FNP-BC, sits down with Dr. Jordy Cohen, nephrologist, hypertension specialist, researcher, and member of the hypertension guideline writing committee, to break down the updates that matter most for primary care.

Rather than reviewing every recommendation, this conversation focuses on the clinical decisions that can make the biggest difference in practice. Dr. Cohen shares practical guidance on medication selection, single-pill combination therapy, resistant hypertension, screening for primary aldosteronism, and evaluating younger patients with elevated blood pressure. The discussion also covers the PREVENT risk calculator, home blood pressure monitoring, white coat hypertension, and common treatment mistakes that can be avoided in everyday clinical practice.

Whether you're learning hypertension management for the first time or updating your approach based on the latest evidence, this episode offers practical strategies you can apply immediately in primary care.

Timestamps

00:00 – Meet Dr. Jordy Cohen and the new hypertension guidelines

02:27 – Biggest changes in the updated guidelines

04:00 – The PREVENT risk calculator explained

07:30 – Managing hypertension in younger adults

11:40 – Secondary hypertension workup and screening pearls

15:20 – Resistant hypertension: What specialists wish primary care would do first

19:20 – When to start one medication vs. combination therapy

22:10 – Choosing first-line antihypertensive medications

25:40 – Hydrochlorothiazide vs. chlorthalidone vs. indapamide

29:45 – Primary aldosteronism: Who should be screened?

36:00 – Why PRN clonidine should be avoided in severe asymptomatic hypertension

41:10 – Home blood pressure monitoring, white coat hypertension, and validated cuffs

49:40 – Microalbuminuria and practical pearls for primary care

If you found this episode helpful, be sure to subscribe to the Real World NP Podcast and share it with a colleague.

Real World NP provides practical, evidence-based continuing education designed specifically for nurse practitioners to bridge the gap between graduate education and real-world practice.

For a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/HTN-updates-2026.

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© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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Urine microalbumin is one of the earliest indicators of kidney damage, but the terminology—and the recommendations—have changed over the past several years.

In this episode, Liz reviews the 2026 updates to urine microalbumin interpretation, including the transition to albuminuria and the urine albumin-to-creatinine ratio (UACR), new hypertension screening recommendations, and practical pearls that every primary care nurse practitioner should know.

Whether you're a new graduate or an experienced NP looking for a refresher, this episode will help you better understand what the test measures, when to order it, and how to avoid some of the most common interpretation pitfalls.

Chapters:

00:00 Introduction to Microalbuminuria

01:38 Understanding Urine Microalbumin Testing

06:44 Clinical Significance of Microalbumin Levels

10:38 Conclusion and Course Invitation

11:40 Introduction to Real WorldNP Podcast

11:40 Exploring Resources for New NPs

The Renal Lab Interpretation course takes a deeper, case-based approach to urine albumin, creatinine, eGFR, electrolyte abnormalities, and common kidney disorders seen in primary care.

We’re doing a LIVE round of the Lab Interpretation Series (which includes the Renal Lab Interpretation Course) starting in August with Live Q&As, learn more https://www.realworldnp.com/live

For a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/microalbuminuria-2026-updates

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© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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Irritable bowel syndrome (IBS) is one of the most common—and often frustrating—conditions seen in primary care. Patients may come in with chronic abdominal pain, diarrhea, constipation, bloating, or a mix of symptoms, and many have already been told that their testing is “normal.” So how do you confidently evaluate IBS, rule out more serious conditions, and help patients move forward?

In this episode, Liz talks with neurogastroenterologist Dr. Zach Spiritos about the real-world approach to IBS, including the underlying pathophysiology, common diagnostic pitfalls, practical workup strategies, and treatment options that go far beyond medication alone.

Whether you're a new NP or an experienced clinician, this episode offers practical strategies to help you approach IBS with greater confidence and compassion.

Timestamps:

00:00 - Introduction to Dr. Zach Spiritos and episode overview

02:16 - Pathway into neuro gastroenterology and training background

05:06 - What is IBS? Symptoms, diagnosis, and underlying mechanisms

07:36 - Factors contributing to IBS: trauma, antibiotics, triggers

09:21 - Differential diagnosis: celiac, SIBO, bile acid malabsorption

11:54 - When to consider endoscopy and testing strategies

14:35 - History-taking tips for primary care clinicians

17:54 - Managing expectations in chronic GI conditions

20:12 - Overuse of endoscopy and its limited findings

22:08 - Understanding what endoscopy can actually reveal

24:23 - Communicating with patients who have “all tests normal”

27:40 - The multitude of IBS treatment approaches: diet, psychological, medication

32:12 - Role of diet and FODMAP in symptom management

35:10 - Pharmacological options for IBSC and IBSD

39:06 - Medications overview: Linzess, Amitiza, Viberzi, and others

44:04 - The role and limitations of probiotics and fiber

45:08 - Tips on managing patient expectations and chronicity

46:54 - Setting goals and tracking progress with patients

48:16 - Final advice: empower patients with knowledge, manage expectations, and tailor treatments

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

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© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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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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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

© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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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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© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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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 http://www.realworldnp.com/blog/how-to-negotiate-a-raise/.

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© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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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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© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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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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© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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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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© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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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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© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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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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© 2024 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details.

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