Hi, I’m Liz Rohr: family nurse practitioner, wife, parent, and founder of Real World NP, a continuing education company for new nurse practitioners in primary care. I’m on a mission to equip and guide new nurse practitioners so they can feel confident and capable through comprehensive, concise, an
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,…
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…
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…
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…
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…
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…
Hypertension Guidelines Updates: Practical Pearls for Primary Care with Dr. Jordy Cohen 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…
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,…
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,…
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…
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…
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…
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…
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…
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…
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…
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…
In this conversation, Liz Rohr and Shelby Pope discuss the importance of taking a comprehensive history of substance use, and how to assess and treat stimulant use disorder. They cover the challenges healthcare providers face in asking the right questions, and emphasize the need for open conversations and non-judgmental approaches. They cover screening for addiction, how to elicit a substance use history, including types and routes of substance use. Shelby covers the mechanism of action of cocaine and methamphetamine in the brain, the withdrawal symptoms associated with stimulant use…
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…
We’re expanding our course catalog at Real World NP! This time, we’re collaborating with specialists, making courses tailored for primary care providers. Our goal is to provide comprehensive and practical courses for nurse practitioners and PAs, and to bridge the gap between primary care and specialty care. We want NPs to have the knowledge and resources to provide the best care within their scope of practice. Share your input about what courses you want to see first! Head over to realworldnp.com/blog/courses-nurse-practitioner to share your thoughts For a full transcript, check out the…
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…
On this week’s episode I want to give you some permission if you feel like you need it— To be a whole human with needs, feelings, desires, and cares. To do what feels authentically right to you. We’re plopped into a healthcare system that is specifically NOT set up for humans to be humans, and is designed for us to operate like machines. And it takes a LOT of courage to stay true to ourselves and what we want and need when we’re also trying to stay safe— financially, emotionally, physically. Sometimes it’s helpful to see and hear from others doing the same so we can see what’s possible for…
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…
Welcome to our latest podcast episode, where I had the immense pleasure of sitting down with the incredible Dr. Omolara Uwemedimo. Today's conversation is a testament to the power of resilience, innovation, and community in healthcare. Dr. Omolara shares her journey from being a pediatrician to founding two revolutionary organizations aimed at transforming healthcare for under-resourced communities. Through Strong Children Wellness and Melanin and Medicine, she is not just treating patients but also addressing systemic barriers to access and sustainability in healthcare for BIPOC…
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,…
In this episode, I explore a crucial topic shaping healthcare today - caretaker fatigue. Join me as I delve into an enlightening conversation with my dear friend and Executive Coach, Catherine Wood. Cat shares invaluable insights about balancing work-life commitments and the importance of recognizing and meeting our personal needs for sustainable career longevity. Even if you feel like you've heard all there is about burnout, I promise this conversation brings fresh perspectives and tangible steps you can incorporate in your daily life. In today’s episode, we talk about: How to caretake…
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 facing Alternative career paths many NPs are considering Changing power dynamics between employers and employees How to think about career changes and honor YOURSELF in the process We 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…
In this video, I sit down with two incredible NP colleagues and friends, Kara and Heather, for a candid conversation about the rollercoaster ride of being a nurse practitioner. We delved deep into our shared experiences, tackling everything from the highs of fulfilling our calling to the challenges that can sometimes leave our compassionate hearts feeling a bit weary. Burnout, boundary setting, and the beautiful power of teamwork — it's all on the table. 💖 Join us for a heart-to-heart chat that's raw, relatable, and peppered with a good dose of humor. Because, let's face it, sometimes…
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 levels How to focus on practical aspects of echos Demystifying anticoagulation choices Practical tips on adjusting Warfarin dosages Reversal agents and…
This week, I have an episode for you that I think is even MORE important than the clinical knowledge that I share — navigating NP burnout. Meet Cait Donovan, an International Keynote Speaker, host of “Fried – The Burnout Podcast,” author of the book "The Bouncebackability Factor", and an acupuncturist with a master’s degree in Chinese medicine. Her creative burnout recovery solutions have been featured on podcasts and online magazines such as “Forbes”, “NPR,” and “The New York Post.” We chat not only about recognizing NP burnout but also about understanding, navigating, and bouncing back…
About Real World NP
Hi, I’m Liz Rohr: family nurse practitioner, wife, parent, and founder of Real World NP, a continuing education company for new nurse practitioners in primary care. I’m on a mission to equip and guide new nurse practitioners so they can feel confident and capable through comprehensive, concise, an
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