Real World NP

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

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 programFor a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/mentorship-programs______________________________© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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

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

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

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 the importance of medication-assisted treatment (MAT) for opioid use disorder, while emphasizing the effectiveness of methadone and buprenorphine in reducing the risk of overdose and mortality. Liz and Shelby explore the process of induction and the importance of assessing withdrawal symptoms, ongoing monitoring and support for patients on MAT, including addressing cravings and harm reduction strategies. Key takeaways: Exploring the stigma around addiction, and the importance of supporting patients with opiate use disorder.Addiction medicine is a beautiful and impactful field that can be accessible in primary care.Naltrexone and buprenorphine are two treatment options for opiate use disorder.Open conversations with patients and providing support and resources are crucial in primary care.Methadone may be necessary for some patients with extreme cases of opiate use disorder. Medication-assisted treatment (MAT) with methadone and buprenorphine is highly effective in reducing the risk of overdose and mortality in individuals with opioid use disorder.Assessing withdrawal symptoms is crucial before starting buprenorphine to avoid precipitated withdrawal.Ongoing monitoring and support are essential for patients on MAT, including addressing cravings and providing harm reduction strategies.Tapering off medication should be done slowly and on an individualized basis, considering the patient's stability and goals.Individualized care and empathetic communication are key in building trust and supporting patients on their recovery journey.For a full transcript and conversation chapters, visit the blog: https://www.realworldnp.com/blog/opiate-use-disorder. ______________________________© 2024 Real World NP. For educational and informational purposes only, see https://realworldnp.com/disclaimer for full details.