Real World NP

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 o...

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...

How did your entire visit get eaten up by getting the HPI? What are you supposed to do in a visit with the complicated patients with 17 chronic conditions? I learned many time-management lessons the hard way in my first year of practice, and they're the same patterns I see in my NP students and new grads I've worked with. In this episode you'll learn time-saving tips to help before, during and aft...

Keeping your head on straight while juggling so many moving pieces in a typical day as a nurse practitioner is TOUGH. I heavily rely on structure and routines to make sure I keep it all straight — and I don't miss anything! In this episode, I go over my routines with new patients, annual physicals, follow-up visits and sick visits, so you can stay on track and make sure you've got all the info you...

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 incredibl...

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 car...

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...

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 t...

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 ph...

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...

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 Diagnost...

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 r...

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 arou...

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 dollar...

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 doub...

Urine microalbumin: you need to check it once a year for patients with diabetes. But interpreting the results — and knowing what to do with them! — can be tricky.  In this episode, you’ll learn: When to order urine microalbumin labs How to interpret the results and what to do with them How to treat abnormal levels 4 steps to elevated microalbumin management Read the blog post here. Need more...

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 to...

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...

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 w...

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 n...

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...

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 t...

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 m...

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 provi...