Advertise on podcast: Real World NP

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 causes of worsening respiratory symptoms, assess exacerbation severity, decide when a patient needs a higher level of care, and choose appropriate treatment—including bronchodilators, prednisone, and antibiotics. TIMESTAMPS: 00:00 COPD exacerbations: 2025–2026 update 01:30 Confirming COPD + the patient's baseline 02:19 COPD exacerbation or something else? 04:26 Assessing severity + when to escalate care 07:20 COPD exacerbation treatment: inhalers + prednisone 08:00 When do you need antibiotics? 10:45 Follow-up + reassessing long-term COPD treatment For a full transcript, resources mentioned in this episode, and conversation chapters, visit the blog: www.realworldnp.com/blog/copd-exacerbation-new-nurse-practitioner ______________________________ © 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.

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 the ABE assessment, and how the mMRC and CAT scores fit into your assessment. We’ll also talk about alpha-1 antitrypsin deficiency testing, blood eosinophils and inhaled corticosteroids, initial inhaler therapy, and what to monitor at follow-up. I also walk through the pieces of COPD management beyond medications—including smoking cessation, vaccinations, exercise and nutrition, pulmonary rehabilitation, and management of comorbidities. In this episode: 00:00 – Introduction + COPD guideline updates 01:03 – Approaching COPD management in primary care 01:53 – Confirming COPD with spirometry and FEV1/FVC 03:01 – Pre-COPD and PRISm 03:53 – GOLD 1–4 and the ABE assessment 05:12 – Using the mMRC and CAT scores 06:23 – What to assess at a COPD follow-up visit 07:50 – Alpha-1 antitrypsin deficiency testing 08:26 – Blood eosinophils and inhaled corticosteroids 09:37 – COPD management beyond inhalers 11:15 – Pulmonary rehabilitation and comorbidities 11:37 – SABA, SAMA, LABA, LAMA, and ICS 12:21 – Initial COPD treatment by GOLD ABE group 13:50 – Initial treatment for Groups A and B 14:35 – COPD follow-up and spirometry 15:04 – Chest imaging and lung cancer screening 15:46 – When to refer to pulmonology COPD cheat sheet + Digital NP Binder: realworldnp.com/binder For a full transcript and conversation chapters, visit the blog: https://www.realworldnp.com/blog/copd-management ______________________________ © 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.

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 H. pylori testing and treatment, GERD and PPI trials, evaluating abnormal liver tests, celiac testing, chronic constipation, SIBO and intestinal methanogen overgrowth (IMO), and how primary care can make GI referrals more useful for both the specialist and the patient. We also talk about something that comes up constantly for newer NPs: How much of this am I actually supposed to manage myself, and when is it time to ask a specialist for help? In this episode, we cover: H. pylori testing, treatment, and common pitfallsGERD management and when to consider EGDElevated liver enzymes and what to do before referringCeliac testing and the importance of testing before going gluten-freeChronic constipation, red flags, and initial managementSIBO and intestinal methanogen overgrowth (IMO)How to make GI referrals more useful—and when they’re truly urgentTimestamps: 00:00 – Introduction 02:19 – Meet GI specialist Paige Sosebee, FNP 04:31 – H. pylori testing, treatment & referrals 13:20 – GERD, PPIs & when to consider endoscopy 20:06 – Alginate therapy for GERD 22:31 – Elevated liver tests & GI referrals 24:51 – Elevated alkaline phosphatase & imaging 30:00 – Celiac disease testing 41:10 – Chronic constipation 46:00 – SIBO & intestinal methanogen overgrowth (IMO) 52:50 – When to refer to a GI specialist 56:00 – Clinical resources for primary care NPs For a full transcript and conversation chapters, visit the blog: http://www.realworldnp.com/blog/gi-specialist ______________________________ © 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.

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 what we can actually do to slow CKD progression. We also talk about the Kidney Failure Risk Equation, cystatin C, kidney-protective medications, preparing patients for dialysis and transplant, caring for patients already on dialysis, and a practical approach to hyponatremia. Want to feel more confident managing CKD in primary care? The Chronic Kidney Disease Management Course walks you through CKD diagnosis, monitoring, treatment, slowing disease progression, and when to refer to nephrology. CKD Management Course: https://www.realworldnp.com/ckd  Or get the CKD course as part of the Chronic Care Bundle, which also includes diabetes, hypertension, and kidney lab interpretation. Chronic Care Bundle: https://www.realworldnp.com/chronic-care-series-bundle  For a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/nephrologist ______________________________ © 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.

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 when an echocardiogram is appropriate, and understand what happens after a patient is referred to a structural heart program. They also discuss modern transcatheter valve procedures—including TAVR and TEER—and how these minimally invasive treatments have changed outcomes for patients with aortic stenosis and other valvular diseases. Timestamps 00:00 Meet Christy Cantey, NP 02:02 What Is Structural Heart Disease? 03:22 Understanding Modern Valve Procedures 06:05 Symptoms That Should Raise Concern 07:28 Two Questions That Reveal Functional Decline 08:51 Why Patients Often Don't Realize How Sick They Feel 09:47 The Challenge of Detecting Heart Murmurs 11:09 When to Order an Echocardiogram 12:07 Why Early Referral Matters 15:35 Working With Structural Heart Programs 18:15 What TAVR and Valve Procedures Are Really Like 20:56 Primary Care Follow-Up After Valve Intervention 23:19 Long-Term Monitoring and Annual Echocardiograms 26:17 How to Counsel Patients Who Are Hesitant About Treatment 32:32 Clinical Pearls and Resources for Learning More For a full transcript and conversation chapters, visit the blog http://www.realworldnp.com/blog/valve-disease-primary-care ______________________________ © 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.

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 breaks down what the PREVENT calculator is, how to use it in clinical practice, and why it's becoming an increasingly important part of cardiovascular risk assessment in primary care. Timestamps: 00:00 - Overview of the Prevent Risk Calculator and its significance in cardiovascular risk assessment 00:26 - How the calculator improves risk estimation over previous tools 01:16 - Key inputs needed for the calculator and optional risk-enhancing factors 01:41 - Incorporating additional data like zip code, A1C, and urine albumin 02:07 - Interpreting 10- and 30-year risk results for ASCVD and heart failure 03:02 - Thresholds for hypertension (≥7.5%) and hyperlipidemia risk categories 03:38 - Practical tips for clinicians on using and interpreting the tool 04:06 - Importance of risk-enhancing factors and patient-specific decision-making 04:55 - Limitations of population-based risks and underestimation in young adults 05:52 - Avoiding over-reliance on the calculator and considering the full clinical picture 06:46 - Summary: integrating the Prevent calculator into patient conversations and management pathways  For a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/prevent-calculator-aha ______________________________ © 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.

Hypertension Guidelines Updates: Practical Pearls for Primary Care with Dr. Jordy CohenWhat 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, to break down the updates that matter most for primary care. Rather than reviewing every recommendation, this conversation focuses on the clinical decisions that can make the biggest difference in practice. Dr. Cohen shares practical guidance on medication selection, single-pill combination therapy, resistant hypertension, screening for primary aldosteronism, and evaluating younger patients with elevated blood pressure. The discussion also covers the PREVENT risk calculator, home blood pressure monitoring, white coat hypertension, and common treatment mistakes that can be avoided in everyday clinical practice. Whether you're learning hypertension management for the first time or updating your approach based on the latest evidence, this episode offers practical strategies you can apply immediately in primary care. Timestamps00:00 – Meet Dr. Jordy Cohen and the new hypertension guidelines 02:27 – Biggest changes in the updated guidelines 04:00 – The PREVENT risk calculator explained 07:30 – Managing hypertension in younger adults 11:40 – Secondary hypertension workup and screening pearls 15:20 – Resistant hypertension: What specialists wish primary care would do first 19:20 – When to start one medication vs. combination therapy 22:10 – Choosing first-line antihypertensive medications 25:40 – Hydrochlorothiazide vs. chlorthalidone vs. indapamide 29:45 – Primary aldosteronism: Who should be screened? 36:00 – Why PRN clonidine should be avoided in severe asymptomatic hypertension 41:10 – Home blood pressure monitoring, white coat hypertension, and validated cuffs 49:40 – Microalbuminuria and practical pearls for primary care If you found this episode helpful, be sure to subscribe to the Real World NP Podcast and share it with a colleague. Real World NP provides practical, evidence-based continuing education designed specifically for nurse practitioners to bridge the gap between graduate education and real-world practice. For a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/HTN-updates-2026.  ______________________________ © 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.

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 that every primary care nurse practitioner should know. Whether you're a new graduate or an experienced NP looking for a refresher, this episode will help you better understand what the test measures, when to order it, and how to avoid some of the most common interpretation pitfalls. Chapters: 00:00 Introduction to Microalbuminuria 01:38 Understanding Urine Microalbumin Testing 06:44 Clinical Significance of Microalbumin Levels 10:38 Conclusion and Course Invitation 11:40 Introduction to Real WorldNP Podcast 11:40 Exploring Resources for New NPs The Renal Lab Interpretation course takes a deeper, case-based approach to urine albumin, creatinine, eGFR, electrolyte abnormalities, and common kidney disorders seen in primary care. We’re doing a LIVE round of the Lab Interpretation Series (which includes the Renal Lab Interpretation Course) starting in August with Live Q&As, learn more https://www.realworldnp.com/live For a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/microalbuminuria-2026-updates  ______________________________ © 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.

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 overview 02:16 - Pathway into neuro gastroenterology and training background 05:06 - What is IBS? Symptoms, diagnosis, and underlying mechanisms 07:36 - Factors contributing to IBS: trauma, antibiotics, triggers 09:21 - Differential diagnosis: celiac, SIBO, bile acid malabsorption 11:54 - When to consider endoscopy and testing strategies 14:35 - History-taking tips for primary care clinicians 17:54 - Managing expectations in chronic GI conditions 20:12 - Overuse of endoscopy and its limited findings 22:08 - Understanding what endoscopy can actually reveal 24:23 - Communicating with patients who have “all tests normal” 27:40 - The multitude of IBS treatment approaches: diet, psychological, medication 32:12 - Role of diet and FODMAP in symptom management 35:10 - Pharmacological options for IBSC and IBSD 39:06 - Medications overview: Linzess, Amitiza, Viberzi, and others 44:04 - The role and limitations of probiotics and fiber 45:08 - Tips on managing patient expectations and chronicity 46:54 - Setting goals and tracking progress with patients 48:16 - Final advice: empower patients with knowledge, manage expectations, and tailor treatments For 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.

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. Stay informed of upcoming content by subscribing to our email list at www.realworldnp.com/guide. Apply to become a blog post writer here! For a full transcript and conversation chapters, visit the blog http://www.realworldnp.com/blog/podcast-break 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.

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 emphasizes the value of emotions as sources of information and intuition. The path from disillusionment to fulfillment involves sitting with emotions, seeking support from professionals, and making small changes within the system. In this conversation, Rebecca and Liz discuss the path to overcoming disillusionment in the medical field. They explore the importance of addressing emotions, internal mechanisms, and finding opportunities for wins. They also discuss the role of grief and the need for self-compassion. Rebecca shares examples of clients who have transformed their experiences and found fulfillment in their work. They also discuss Rebecca's book, 'The Rooted Renegade,' which offers practical tools and strategies for navigating disillusionment and finding alignment in life and work. Takeaways Addressing and processing emotions is crucial in combating disillusionment and burnout.Expanding the window of tolerance through practices like meditation and mindfulness can help handle emotions.Emotions provide valuable information and intuition that should not be ignored.Seeking support from professionals is important, especially when dealing with trauma or intense emotions.Making small changes within the system can contribute to a sense of fulfillment and well-being. Addressing emotions and internal mechanisms is crucial in overcoming disillusionment in the medical field.Finding opportunities for wins and recognizing moments of success can help combat feelings of disillusionment.Grief is a common experience in the medical field, and it's important to acknowledge and process it.Self-compassion and self-care are essential in navigating disillusionment and finding fulfillment.Rebecca's book, 'The Rooted Renegade,' offers practical tools and strategies for overcoming disillusionment and finding alignment in life and work. For a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/burnout-in-nursing.  ______________________________ © 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 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. 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 program For 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.