What 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.

00:00 – 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. 

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© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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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 

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© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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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

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© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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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

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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.

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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. 

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

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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/. 

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

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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 

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

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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

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

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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

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

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