Real World NP

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

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

The thought of your Nurse Practitioner job not being the right fit can be scary. You’ve invested a lot of time, money, and energy – not to mention all the things that you have sacrificed – to get to this point, and now?   You may have spent a lot of time imagining what it would look like to be working as an NP, and this isn’t it. Whether you are working with a collaborator or on your own, whe...

Wrist pain is a SUPER common chief complaint in primary care. Most of the time, luckily, it’s chronic wrist pain that’s from overuse (versus the more acute, dangerous differential diagnoses with injuries), but it’s still a lot to work through as a new nurse practitioner. In this week’s episode, I’m covering the overview approach to diagnosing wrist pain in primary care for new nurse practitioners:...

When you're a new nurse practitioner, you need to make thousands of decisions a day. (Which usually translates to thousands of questions). I made mistakes as a new grad, and luckily for me, I had a very patient colleague who was there to help guide me. In this video, I'll share: Some of my mistakes (I'm a little embarrassed) Three easy steps to make sure you ask questions the right way (so you get...

Syphilis lab interpretation can be confusing, and it’s a BIG topic, but in this episode, I review the most common scenario that I see in primary care. I cover treponemal and non-treponemal tests, how to interpret them most specifically in the context of slightly abnormal, asymptomatic patients (the most common scenario in primary care), as well as the treatment and follow up, and when to refer to...

When it comes to choosing which oral contraceptive pill to prescribe, there are SO many options. How do you know which one is the right one? As a new nurse practitioner, you’ll usually get different recommendations from different providers. In this video I’ll be covering: The first step to prescribing that’s easy to forget What criteria to consider when choosing The two main routes to follow (and...

It's 2 p.m., the medical assistant comes to your office and lets you know your next patient is ready, and they're here because they "need antibiotics"... ... But do they? Or don't they? They've "had a cold" or "a nasty cough" for over three weeks now. ... they've "tried everything," and "got an antibiotic last time." Are you seeing this every day now, too? 'Tis the season.  This week's case s...

So many things in primary care are deceptively complex. There may be a few genuinely simple things that we treat, but so many things that come into our exam rooms are complex and sometimes downright confusing.   Anticoagulated patients are one of those situations. While the concept itself is pretty simple – medication that thins the blood so that they don’t get clots, got it – the reality of...

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

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

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

You know that moment in the job interview when they ask if you have any questions? Have you ever been totally stumped? Not fun. Even worse is when you get home afterward and think of all the questions that you wish you asked.   If you are on the job hunt, or about to be, we have the questions to ask that will give you lots of information about the job and the workplace, and really help you to...

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

In this Livestream, I share about our newest course Managing Diabetes, Hypertension & CKD over at https://www.realworldnp.com/courses . After lab interpretation, the three main topics that new NPs struggle with managing are DM, HTN & CKD-- so I decided to review the 100+ page guidelines cover to cover, do a deep dive on all the meds, cold-call specialists with my questions and report back...

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

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

Why can’t diabetes management be like we learned in school? That was complicated enough. Now you’re on your own, and there are so many questions with your patients to manage diabetes. Symptoms that don’t necessarily follow a straight line. All of the elements of managing diabetes that are beyond your control – patient’s motivation, cost of medications, how realistic a plan may be, how long until t...

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

For patients and providers, few things are more frustrating than recurrent UTIs. This week, let’s talk about recurrent UTIs and how to get real results for your patients. Gender - and how to approach all patients in an inclusive way The difference between recurrent and relapsing UTI Evidence-based versus anecdotal risk factors Labs to order, what to look for (and how to look) Strategies for manage...

You have a patient who has been coughing for weeks, maybe even a couple of months. You’ve already ruled out COVID; where do you turn next? This week, let’s talk about chronic cough – what it is, how it differs from acute cough, when to refer the patient, and more: ✅ Common causes – things like GERD, asthma, allergies ✅ The special history questions to ask and how they will help with your differe...

What could be causing your patient’s lower limb numbness? And more importantly – how do you figure it out? This week, we’ll talk about some strategies to help narrow down the cause of your patient’s symptoms, share some clinical pearls, some assessment techniques that can point you in the right direction (FAST), and more: ✅ The most essential history questions to ask ✅ Special questions just for...

With the most recent global Monkeypox outbreak in May of this year, there’s been a lot of confusion among patients and providers about treatment options and vaccination. With about 7,000 cases in the United States as of this recording, luckily the treatment options are starting to become more available. As I mentioned in the first episode of this series, thus far the treatments and vaccines have b...

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

**ERROR UPDATE** I mistakenly said that cotton swabs can be used but it's ONLY synthetic swabs for monkeypox testing!! Link for testing instructions here . Monkeypox has been confusing and scary for patients and providers alike, especially on the heels of the Covid pandemic that we’re still facing. The WHO named it a public health emergency and global outbreak, as has the CDC, but that doesn’t nec...