Real World NP

A patient comes in after a head injury. They're having headaches, dizziness, brain fog, or nausea—but how do you know whether this is a concussion you can manage in primary care or something more serious? Head injuries can feel especially intimidating as a newer nurse practitioner. You want to make sure you're not missing an intracranial injury, but you also need to know which patients act...

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...

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...

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...

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 t...

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...

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 wha...

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 whe...

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 brea...

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,...

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 tha...

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 epis...

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. S...

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 clea...

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 em...

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...

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...

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...

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 ca...

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 re...

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...

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...

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...

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 cl...

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...