Real World NP

As nurse practitioners, we primarily learn the clinical aspects of practice. For good reason-- we’re taking care of real patients’ lives. But there’s a whole lot more to learn on the job, from delegation and leadership, to navigating day-to-day challenges in the ecosystem of a clinic.

I was SO focused on learning the clinical parts as a new NP, that I was caught by surprise at my first job. I didn’t realize how primary care offices work-- the business of running a clinic -- and the role I now played.

Understanding how primary care offices work from a business perspective can help you in SO many aspects of your job as a nurse practitioner-- from asking the right questions during a clinic interview, to negotiating salary, to making improvements in clinic workflow or requesting more support.

In this week’s episode, I’m covering the foundations of how primary care clinics work from a business perspective, your role, and it will serve for the basis of a few upcoming videos where I address the “ideal world” and the “real world” of primary care offices, and how to navigate the common issues that come up.

Read the blog post here.

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One of the struggles for new nurse practitioners in primary care is managing women’s health topics, and knowing if and when to refer to an OBGYN specialist. We want to do things the right way and use resources we can trust.

In this week’s episode, I’m interviewing Monica Carter, who is a family nurse practitioner who has practiced in the women’s health setting for the last 13 years. She dropped SO many pearls and pitfalls of practice, and is truly a gem of a human. We answered questions from the community for a women’s health provider, including:

• Tips for finding cervixes on pap smears, when to do a pap post-hysterecomy, and how to assess the variable appearances of cervixes on exam
• Tips and resources for managing menopausal symptoms, abnormal pap results, choosing contraceptives (such great insights!) and medications in pregnancy
• Getting into GYN as a family nurse practitioner
• When to refer to maternal fetal medicine
• Initial workup for infertility and pearls of practice

Check out the resources she mentioned inside the video here:

Menopausal symptoms

ACOG green journal (need an ACOG membership or you can purchase)

https://journals.lww.com/greenjournal/Abstract/2014/01000/Practice_Bulletin_No__141__Management_of.37.aspx

Menopro

https://www.contemporaryobgyn.net/view/nams-launches-free-mobile-menopause-app 

Choosing birth control & best resources - Contraceptive technologies - book and conference

http://www.contraceptivetechnology.org/

ASCCP app

https://www.asccp.org/mobile-app

Reprotox app

https://reprotox.org/

Read the blog post here.

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There’s SO much to manage as a new nurse practitioner, on top of developing your clinical knowledge, making a thousand decisions a day and becoming a leader in the healthcare space. The better your time management, the more time to get your work done and ACTUALLY rest at the end of the day.

In this episode, I’m covering the rest of what we do in a day in the life as nurse practitioners-- inbox management and the time management strategies to make it all easier.

I go over:

✅ The types of documents and tasks we need to manage when we’re not seeing patients

✅How to prioritize them, and how to use your EHR to support YOU

✅What to look for, what to ask for, and how to bring suggestions to your team if it’s not going well

As always, if you want help with your lab interpretation, join us inside the Lab Crash Course! It comes with 8.7 hours of continuing education, it’s self-paced and you get lifetime access. Learn more: https://www.realworldnp.com/labs

Read the blog post here.

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So often in primary care, patients come in asking for testing for herpes, whether they have symptoms or not. Sometimes it’s because they “want to be tested for everything,” or are concerned about an exposure from a partner. As a new nurse practitioner, I wasn’t always confident about the best approach.

In this week’s episode, I’m covering:

✅ When to consider HSV, and the unlikely ways it can present

✅ What the difference between primary, non-primary initial and recurrent infections are, and what it means for the patient

✅ The top differential diagnoses to consider

✅ How to test for HSV, what the gold standard tests are and what NOT to use

Read the blog post here.

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Billing and coding clinic office visits are probably not the first thing nurse practitioners think of when they graduate. It's probably more like:

1. Phew! I’m so so so glad that's over.
2. What comes next?! 
3. How am I going to find a job?
4. I’m not going to worry about that right now because...
5. ...I'm finally done with NP school! 👩‍⚕️🦄💪

But unfortunately, the skill set of medical billing and coding is one of the first major frustrations that new nurse practitioners encounter on the job.

And doing it right makes a big difference -- there are serious consequences with chronically under or over-billing!

It tends to feel really hard for new grads at first, but once you get the hang of it, it's much simpler than you think.

We did our first episode on Billing and Coding for Nurse Practitioners last time. I refer to it a few times in this episode, so definitely go and check it out first, if you aren't familiar with how it works.

In both episodes, I'm talking about the bread and butter of coding -- new and established office visits, E&M codes. I don't get into procedures or coding for physical exams or coding modifiers. If you're interested, I'd totally be into hosting a Billing and Coding workshop to get more into those!

Once you've listened to that episode, I need you to head straight back here because we’ve got some good news — The 2021 CMS updates for billing and coding just made life a LOT simpler for nurse practitioners.

They've streamlined it quite a lot — it's still relevant to know the more "complicated" billing and coding method (from the previous episode) since it can help you more accurately code and get reimbursed for all your hard work. But hopefully, this will overall give you back some time in your day.

In this episode, we chat about:

✅ Main branch points for determining strategies for billing and coding in-office visits

✅ Choosing the appropriate documentation to support coding

✅ Options for billing based on levels of decision making OR time spent with a patient 

✅ And other significant updates!

Also! Get your Billing and Coding Cheat Sheet here: https://www.realworldnp.com/026-opt-in

Read the blog post here.

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Billing and coding your office visits for for your office visits can feel overwhelming, tedious and too-hard-to-learn. But, one under-charge here and there may not seem like much, but when you add them all up...

In this week's episode, though, I'm breaking it down SUPER simply (with a cheat sheet!)

Plug the data in and out pops the right E&M code to use.

You'll learn:

✅ How to accurately bill for new and established office visits (primary care only!)

✅ The key differences between level 3&4 (and the most common pitfall I see!)

✅ A few patient examples to apply it to (and a walk-through of the plug-and-go cheat sheet)

Download the cheat sheet here: https://www.realworldnp.com/026-opt-in

Read the blog post here.

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I recently got the question from a new nurse practitioner, “what do you do when you want to give up as a nurse practitioner?”

I’ve definitely been there before myself, and with the stress of this last year and a half, I know a lot of other new nurse practitioners and NP students are feeling that way, too.

In this week’s episode, I’m covering what to do when you feel like this, including:

• The most important questions to ask yourself to help sort through your feelings and get to the root of feeling like yourself again
• Real life contexts of what this may look like for you, and the options to consider
• A few personal stories about how I experienced burnout and what I’ve done to cope with it

Read the blog post here.

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Patients coming into primary care with a chief complaint of hair loss can be so stressful as a new nurse practitioner.

First, let’s normalize this. It’s a broad differential and can be tricky to parse out. It can also feel really stressful and emotional for your patient presenting for care, which adds even more pressure.

In this week’s episode, I’m covering how to approach hair loss in primary care, the differential diagnoses, history, physical exam and testing highlights for new nurse practitioners in primary care.

Read the blog post here.

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So many new grads are most worried about building their clinical knowledge base-- for good reason!

But it’s one thing to prepare for clinical topics-- researching algorithms, choosing the best practice based on the evidence-- but an entirely different experience trying to apply them to the “real world.”

Through Real World NP, I have the awesome privilege to work with new grad nurse practitioners on-on-one in mentorship calls.

Some of mentorship is reassuring new grad NPs about their clinical judgment decisions, and it also involves discussing the most up to date guidelines.

But there’s another level to mentorship and “real world” practice that you just can’t get in school.

This week, I want to share with you some of the “behind the scenes” of what our mentoring conversations are like. I’m covering an example patient case with complex diabetes and medical conditions that I reviewed with a real-life new grad nurse practitioner during a mentoring conversation.

Full disclosure: I hope to someday record a call with a new grad NP (with consent and voice-masking, of course), but for now, it’s just me talking, reviewing what we talked about and the variety of ways we approached the situation.

Hopefully this helps you apply these lines of thinking to your own patient cases!

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

Sign up for the Lab Interpretation Crash Course: https://www.realworldnp.com/labs 

Grab your copy of the Digital NP Binder: https://www.realworldnp.com/binder

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This has been on my heart this week - between working 1 on 1 with mentees and seeing the landscape online of new grad nurse practitioners, I see this ALL the time.

Feeling like you're the only one feeling this way. Feeling behind, not knowing enough, and then beating yourself up for it.

If this sounds like you, take a listen-- sometimes just naming and acknowledging what's ACTUALLY going on makes a difference in how you're feeling about it.

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

More Resources:

Lab Interpretation Crash Course: https://www.realworldnp.com/labs

Digital NP Binder: https://www.realworldnp.com/binder

Diabetes Medication Workshop: https://www.realworldnp.com/diabetes

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