Hey! I'm Liz. I’m a primary care family nurse practitioner, and I made this because:
- I wish I had it as a new grad myself. - There’s no “real world” curriculum in school- it's painful seeing new nurse practitioners struggle with the same issues again and again. - After a brush with burnout earlier this year, I reconnected with what lights me up: teaching and helping others succeed. - I'm obsessed with learning and fascinated by medicine.
Since 2015, I've been a PCP with my own panel (1200+ when I was full-time). Today, I work part-time in an FQHC clinic in Boston, MA.
DISCLAIMER: for educational, information, and entertainment purposes only. Topics discussed should not be used to diagnose, treat, or prevent any diseases or conditions. The views expressed on this channel are solely my own and should not be interpreted as official policy or position of my employer or affiliates if there are any. Always do your own homework. Full details at: www.realworldnp.com/disclaimer
I would love to see your ideas come to fruition. As a new NP myself, your courses have been very helpful to me and I too often struggle with trying to figure out how to manage conditions for other specialties, how much tests to carry out before referring, and more. So, personally I would definitely appreciate this. Thank you for all you do and how hard you work to help fellow nurse practitioners. You’re awesome!
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US based primarily! I always recommend double checking what the guidelines are outside the US - a lot of guidelines we follow here are also international guidelines but I haven't practiced outside the US so I can't speak to practice specifically in the UK/elsewhere
You know I haven't seen that myself and I don't see anything on my resources that suggest that varicocele can cause hematuria. That would be something to look into futher!
Thank you so much I’m so glad I found you because you have been so helpful I was getting so discouraged I’m in my seventh month of practice and it has been a huge challenge thank you so much for all your encouraging videos and all your education
This video is too late for me. After 4 years and a lot of burn out I decided to quit as FNP and return to be a nurse. Im currently working as a Public Health Nurse and hapier than ever. As a NP I had too much responsibility, few support and worked as crazy. Sad but true. A vacation didn't fix anything.
I'm so glad to hear that you are happier than ever! I'm sorry you didn't receive the support you deserved as an FNP. I hope your journey continues to be a happy one. ❤️
The NUMBER ONE time suck for me is the technology. I spend more time rebooting the computer, waiting for the server to come back on, logging in, verifying my identity..on the phone with IT Support....at least an hour and a half just this morning...drives me nuts!!!
It's SO tough - that used to happen to me at my first job all the time. Usually when it comes to systematic change (tech upgrades, etc) I usually recommend collaborating with colleagues and making a written case (like "paper trail" with emails) to management to let them know how big of a challenge it is, so there's more impetus to change where they can/make it a priority
Everyone is different - I think there's a trial and error/practice that needs to happen for everyone. I tend to structure my days with coming in a bit early to look at who's on the schedule, reviewing labs/documents/phone notes/refills that need addressing, then only checking back in at lunch time and the end of the day so I can stay focused on visits/charting. For me it's about finding a rhythm, and trying to stay as focused as I can and not get pulled in a million directions (not always possible). Any other things that have helped you so far?
How do you know what measure requirements are due?..mine always show up at rhe end after I've seen the patient, then i have to backtrack...any pointers to prevent the backtracking??
It's nice when EHRs let us know ahead of time - it may be helpful to have a quick text reminder for yourself to check the metrics/measurements needed to chart at the start of the visit, and/or letting your management/IT people know that that would be a helpful adjustment of the EHR to get those prompts at the beginning. Some offices, the medical assistants are trained to ask those sorts of questions - PHQ2, tobacco use, etc.
@@RealWorldNP thank you for that suggestion. Practicing at the nursing home, I am my own staff. Your tips are valuable. This transition has been ..... difficult to say the least.
It's so tough - a lot of it is practice over time. I love quick texts to help with common chief complaints. It looks like you saw the time management video, hopefully that one helped! Her book is also great if you want to check that one out
This is tricky - if it's something that has a plan that's substantial and needs to be followed up on, it should be charted. But some things are conversations and you have to use your judgment there, because not all things like "quick questions" need addressing each visit. I definitely struggled with that at the beginning but I think over time you develop that clinical judgment to discern what needs comprehensive addressing versus is sort of just a conversation
Overall it correlates with the amount of blood present in the sample but it's dependent on a few factors! Tricky to answer in the comments here, but we definitely go into depth with interpretation inside the Lab Crash Course if that's something you'd like support with! www.realworldnp.com/labs
No neurological causes that I'm familiar with - typically renal, urologic, or "mimics" from structures in the area (perineum, anus, etc) or medications/foods/false +
Hey! We don't have a community as it stands right now, but definitely check out the mentorship waitlist page as we investigate options to support NPs- www.realworldnp.com/mentoring
Hi, Liz - I came across this insightful video after a search on hyponatremia. I have a question about when to go to the E.R. If someone receives a sodium value of less than 130 in an outpatient PCP setting, is it always required to go to the E.R. for a recheck (as you discuss at the 7-min:30-sec mark)? Would rechecking via non-E.R. means ever be appropriate (such as returning to the PCP)?
Thanks so much for watching. Unfortunately for safety and liability reasons, I can't answer specific cases here, but it's a complicated answer. I'm familar with VERY rare cases that can be assessed closely outpatient but this has been under strict guidance of a nephrologist and due to a known diagnosis, managed by renal and in a collaboration with a nephrologist & PCP. We talk more about specific patient cases inside the Lab Crash Course, though, if you want to join us there and ask inside the community (www.realworldnp.com/labs).
