Real World NP

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 overview02:16 - Pathway into neuro gastroenterology and training background05:06 - What is IBS? Symptoms, diagnosis, and underlying mechanisms07:36 - Factors contributing to IBS: trauma, antibiotics, triggers09:21 - Differential diagnosis: celiac, SIBO, bile acid malabsorption11:54 - When to consider endoscopy and testing strategies14:35 - History-taking tips for primary care clinicians17:54 - Managing expectations in chronic GI conditions20:12 - Overuse of endoscopy and its limited findings22:08 - Understanding what endoscopy can actually reveal24:23 - Communicating with patients who have “all tests normal”27:40 - The multitude of IBS treatment approaches: diet, psychological, medication32:12 - Role of diet and FODMAP in symptom management35:10 - Pharmacological options for IBSC and IBSD39:06 - Medications overview: Linzess, Amitiza, Viberzi, and others44:04 - The role and limitations of probiotics and fiber45:08 - Tips on managing patient expectations and chronicity46:54 - Setting goals and tracking progress with patients48:16 - Final advice: empower patients with knowledge, manage expectations, and tailor treatmentsFor a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/ibs______________________________© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.

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

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 www.realworldnp.com/blog/how-to-negotiate-a-raise/. ______________________________© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.

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

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

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

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 clinical teaching, but overall practices inside the company. One of the core reasons behind the company is not just to make the transition to practice for nurse practitioners easier, but also make an impact on the healthcare and education industries. We want to do continuing education for nurse practitioners differently than the status quo.Some real talk: I feel like I repeat myself a lot, and part of me is like “they know this already.” They know that it’s important to be a whole human, and that they get to do that in their personal and work lives. That they’re not just a machine in the cog of healthcare, and things are starting to change. That they deserve to be supported and held in safe spaces while they learn this extremely important and difficult field of medicine. It’s old news.But I’m reminded of the number of times I’ve counseled patients on their medications - at LENGTH and REPEATEDLY - and they still need to hear it again.Like the time my patient with new-onset afib needing anticoagulation still ended up in the ER for overdosing his meds. Or after three visits for my patient with diabetes, they still did not understand their diagnosis and what it meant.I truly, truly believe that even when things feel daunting and overwhelming, whether it’s the clinic day ahead, the severity of illness of the patient in front of you, or the state of the healthcare industry, individual actions make a big difference.I’d love for you to be a part of the movement of change to make healthcare and education better — listen in to this episode to get a sense of where we’re going and what you can expect from us going forward. It’s also a helpful introduction to the backstory behind the company if you’re new here!More from Louiza “Weeze” Doran:https://www.instagram.com/accordingtoweeze/?hl=enhttps://louizadoran.com/https://louizadoran.com/podcast-----------------------Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guideSign up for the Lab Interpretation Crash Course: https://www.realworldnp.com/labs Grab your copy of the Digital NP Binder: https://www.realworldnp.com/binderFor the full transcript, and for this conversation’s topic chapters, see the blog. Hosted on Acast. See acast.com/privacy for more information.

In this week's episode, I'm thrilled to share my conversation with Lauryn Williams, an extraordinary individual who has not only achieved greatness on the athletic track but also in the realm of financial planning. Lauryn's story is a powerful example of how discipline, dedication, and a willingness to learn can lead to success in multiple arenas of life. Her transition from an Olympic athlete to a certified financial planner is not just inspiring; it's a lesson in reinventing oneself and finding purpose beyond one's initial calling.Lauryn opens up about her journey, revealing the pivotal moments that led her from winning medals to advising clients on financial health. We explore the mindset shifts required to excel in two vastly different fields and the common threads of discipline and perseverance that link them. Lauryn's candidness about the challenges and triumphs along her path offers invaluable lessons on adapting to life's changes and seizing new opportunities with courage and enthusiasm.One of the most enlightening parts of our discussion revolves around Lauryn's passion for financial literacy. She shares her vision of a world where financial knowledge is accessible to everyone, empowering individuals to make informed decisions about their money. Through her work, Lauryn is breaking down the complex world of finance into understandable and actionable advice, showing that it's possible to achieve financial wellness with the right guidance and mindset.Lauryn provides listeners with practical strategies for managing their finances, from budgeting and saving to investing and planning for the future. Her advice is for anyone looking to improve their financial situation and build a more secure future.Lauryn also discusses how her experiences have fueled her desire to give back and make a difference in the lives of others. Whether it's through her financial planning practice or her involvement in community initiatives, Lauryn is committed to contributing to a better, more financially savvy world.Don't miss this incredible episode filled with lessons sure to support you on your financial journey.In today’s episode, we talk about:Lauryn's seamless transition from an Olympic athlete to a certified financial planner, and the motivations behind her career change.How Lauryn is making financial planning accessible and empowering for everyone, regardless of their background.Practical financial advice from Lauryn, including strategies for debt management, savings, and investment.Understanding the value and impact a certified financial planner can have on your financial health and long-term goals.Lauryn's personal and professional growth, and how she uses her platform to advocate for financial literacy and freedom.Read the blog post here._______________________________© 2023 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.

In this episode, I had the pleasure of sitting down with Brooke Nielsen to explore a topic that is both fascinating and incredibly relevant to our work as healthcare professionals—the Drama Triangle. We've all seen it, whether we recognized it at the time or not. Those moments when interactions with colleagues or patients suddenly feel like a scene straight out of a play, with clear roles of victim, rescuer, and persecutor taking shape.Brooke and I explored how these roles influence our work environment, especially for nurse practitioners. We shared stories, insights, and, most importantly, practical strategies for stepping out of these roles. The goal? To foster a more supportive, healthy work environment where we can all thrive, professionally and personally.Understanding the Drama Triangle isn't just academic; it's about making real changes in how we interact every day. From recognizing when we're slipping into one of these roles to setting boundaries that protect our well-being and the quality of care we provide, this conversation is a stepping stone to more effective, fulfilling professional relationships.Tune in to find out how you can start recognizing and changing these dynamics in your own clinical setting. It's an episode packed with insights for nurse practitioners and anyone keen on creating a healthier workplace culture.In today’s episode, we talk about:Understanding the Drama TriangleImpact of the Drama Triangle in clinical settingsStrategies for recognizing and changing dysfunctional dynamicsThe importance of boundary management for healthcare professionalsRead the blog post here._______________________________© 2023 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.

Are you a nurse practitioner feeling lost, uncertain, or unfulfilled in your career? This raw, honest, and needed conversation with Amanda Guarniere, the founder of Resume RX, explores:The career challenges NPs are facingAlternative career paths many NPs are consideringChanging power dynamics between employers and employeesHow to think about career changes and honor YOURSELF in the processWe dive into the growing concerns among NPs regarding stagnant wages, shifting power dynamics between employers and employees, and the desire for personal fulfillment beyond traditional clinical settings.We chat about the rise of entrepreneurship, side hustles, and non-clinical roles that allow NPs to leverage their expertise and pursue their passions.We encourage NPs to challenge societal expectations and professional scripts that may stop them from doing what they love.If you liked this post, also check out:New Nurse Practitioner Survival Guide New NP: Q&A - Is This Normal?Primary Care Nurse Practitioner Roundtable: How Are We Doing After Covid?Timestamps:00:00 - Introduction02:45 - Practical Strategies on Navigating NP Clinical and Job Search03:55 - Are Nurse Practitioners Okay?05:25 - Dissatisfaction and Desperation Among NPs07:55 - How Can ResumeRX and Real World NP Support NPs12:39 - Personal Reflection on the Impact of COVID13:29 - Challenges Faced By Nurse Practitioners17:04 - Evolving Career Landscape for NPs25:29 - NP Burnout28:36 - Self-Judgment and Criticism 34:35 - What’s The Next Best ThingRead the blog post here._______________________________© 2023 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.

I am thrilled to introduce you to Midge Bowers.Not only is Midge a Clinical Professor and Director of the cardiovascular specialty at Duke University School of Nursing, she practices as a nurse practitioner in a Heart Failure Access Clinic.She’s an expert in cardiology, a seasoned healthcare educator, and shares so much incredible knowledge in this jam-packed episode.In this episode, we covered:The importance of looking beyond creatinine levelsHow to focus on practical aspects of echosDemystifying anticoagulation choicesPractical tips on adjusting Warfarin dosagesReversal agents and safety measuresThis barely scratches the surface of the wealth of information Midge provides.0:00 - 3:35 - Introduction and Overview3:36 - 8:39 - Importance of Monitoring Creatinine and GFR8:40 - 15:06 - Impact of New Medications on Kidney Function15:07 - 20:30 - Understanding Echo Results: Akinesia, Hypokinesia, and EF20:31 - 25:01 - Interpreting Trends in Echo Reports25:02 - 31:17 - Anticoagulation Choices: Warfarin vs. DOACs31:18 - 38:15 - Adjusting Warfarin Dosages and INR Monitoring38:16 - 42:42 - Assessing Bleeding Risks with CHADS-VASc and HAS-BLED42:43 - 46:03 - Reversal Agents and Safety in Anticoagulation46:04 - 53:41 - Managing DOACs in Different Clinical ScenariosRead the full blog here.______________________________Please note: This episode is intended only for medical providers and students learning to be medical providers. Hosted on Acast. See acast.com/privacy for more information.

Whether you're a recent NP graduate or someone transitioning between specialties, this video will help ease that overwhelming feeling and help you discover your unique approach to practice.If you liked this post, also check out:Pillars of NP PracticeLeukocytosis Case StudyTimestamps:00:00 - Introduction01:22 - Purpose of the Episode02:35 - Understanding Philosophies of Practice04:23 - Evolution of Practice08:21 - Navigating the TransitionRead the blog post here._______________________________© 2023 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.

Welcome to our brand new podcast season! We're absolutely pumped to bring you a fresh wave of episodes that will be a game-changer for Nurse Practitioners (NPs) on their journey. Whether you're a seasoned pro or just starting out, we've got you covered.In this season, we're introducing some exciting changes behind the scenes to make your listening experience even more rewarding. Expect enhanced content, engaging interviews with healthcare experts, and an interactive community that fosters connection and learning.Timestamps:00:00 - Intro00:47 - Seasons01:42 - Life of A Nurse Practitioner02:58 - Specialist InterviewsRead the blog post here._______________________________© 2022 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.