Pediatric NP Interview
Watch
Show notes:
In this week’s video, I’m chatting with Ashley Sayles (Ashley the NP on Instagram) to answer the Real World NP community’s questions for a pediatric provider!
Interview with a Pediatric NP
Topics and questions we discussed include:
Advice for pediatric NP students
Vaccination talking with parents about them, especially when they’re reluctant
How to build rapport with adolescents/teens
Handling disagreements between parents who are divorced in the care of the patient
When to do hernia checks for male pediatric patients
When to refer for allergy testing
How to broach the topic of childhood weight and obesity status
Also, apologies for my audio quality -- I had a microphone malfunction while recording and it’s as optimized as possible, I know the quality isn’t great.
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well hey there it's liz rohr from real world np and you're watching mp practice made simple the weekly videos to help
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save you time frustration and help you learn faster so you can take the best care of your patients
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so one of my absolute favorite things to do is to talk about clinical topics
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with other clinicians so talking shop is like my favorite talking shop quote unquote is my like favorite pastime uh basically
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ever so in this week's video i'm actually uh it's a recorded interview that i did with ashley the np
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you may have seen her already on instagram she is a pediatric nurse practitioner and what i did was i reached out to the
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people on my email list and asked them what questions they'd like to ask a pediatric provider and it
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was a really great conversation very juicy lots of difficult conversation type of topics
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tons of pearls of practice i really really hope that you enjoy it and if you haven't grabbed your copy of
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the ultimate resource guide for the new np already head over to realworldnp.comguide
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you'll get all these videos sent straight to your inbox every week with notes from me patient stories and bonus content that i really just don't share
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anywhere else including the opportunity to submit questions for upcoming videos so without further ado though i
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would love to share this interview with you thank you so much for watching thank you so much ashley for being here
About Ashley
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um i would love to have you start by just sharing whatever you feel like sharing um a little about
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yourself what kind of practice you're in the stuff you're up to that kind of stuff all right so
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i'm ashley i'm a pediatric nurse practitioner primary care based in baltimore maryland
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i've been a nurse practitioner for uh just shy of three years i've been working in the practice that
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i'm in for about a year and a half it's a small tiny primary care practice
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tiny and that's only two providers but very busy got a lot of patience so
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it keeps me busy i really like it my background in nursing is in the pediatric icu so it's a little
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different um but similar in the sense of being busy and kind of always having to
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be on your toes um aside from that i teach nursing students as a clinical
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instructor i own a resume business a resume and
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kind of nursing career service business a renegade resume
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and a couple other projects but yeah that's pretty much me that's
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awesome oh thank you so much um so so these uh questions we can just jump
Advice for a new NP
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right in so the first question that i got was about uh was from somebody uh saying i just
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got accepted to primary care pnp today i'm so stoked but also very
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nervous so hype me up give me some advice as i embarked on this new journey and thank you so much
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what what advice what advice do you have as long as advice uh advice for a new
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um pnp i'm again i'm assuming that accepted to the a program yeah um yeah so yeah
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i think just really one um being teachable
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i think going back to school um after being in rn or you know working as an rn
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you can sometimes have an idea of what you think things are or how things look or
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something that you've seen you feel like that's the only way it presents and um you know sometimes you become a
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little unteachable because you're kind of stuck on what you've seen um so just making sure that you are
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always keeping your mind open in terms of like new
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ways of looking at things in medicine that's number one um two on the kind of the flip side of
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that is also respecting what you do know you know there are things that your experience
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and um you know past educational endeavors i guess um have taught you and that you're only
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going to enhance that in a pediatric np program so um anyone i i assume that's going for
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pediatric npe um usually has some type of history and pediatrics um to go for such a specialized np
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route so um you kind of know your stuff already you know what you're dealing with and you kind of
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just are looking at it a little different way now and you're going to use a lot of the
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skills that you learned and you know fine-tuned as a nurse
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in your np program absolutely and i love i love you i love what you said about
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being teachable because like i think that like so many nurse practitioners
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like i don't know i think we're so in generally speaking we're intuitive people and it's like yeah yeah it's like hard
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not to like follow that path of like the things that you know especially if you have a lot of nursing experience
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yeah that's a different paradigm and it's it requires so much like humility yeah
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training and then also in the real world practice of humility for sure it definitely does it's
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it's a whole different ball game so yeah did you choose to do um
Did you choose pediatrics
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so you did the picu you said before as a nurse you always know that you were going to do pediatric np or always do pediatrics
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or did you kind of just like find yourself there no yeah it was always pediatrics for me i've that was never
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uh there was a brief stint i thought maybe i'd like labor and delivery but i noticed once the baby was born that's
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kind of the only person i cared about after so i said you know what i think
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pediatrics is for me so yeah i i can't relate to the oh trying to
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decide on a specialty or something that's just not something i ever had to deal with i've kind of
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always known from before nursing school it was going to be kids though and i can
pediatrics forever
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like how much you love the kids that you take care of like in your instagram stories it's just like
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yeah like i can feel that you're like pediatrics forever yeah i there was never like there were a
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couple of moments like in job searching times where i was hardly finding pediatric np
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jobs but there were a lot of family np jobs available and i was just like oh my gosh like should i have just done family or
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whatever and then i remembered like no you you literally cannot stand working with adults like you hate it
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so it's like why would you even do that knowing that you absolutely would never be happy
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taking care of adults like it would always be some type of compromise for me so
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um yeah it was just it's always been peds for me and i think
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um i think it's like i don't think it always has to be someone who knows they like want to be in peds but i think
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it's someone who definitely needs to like understand that like peace is a completely different world
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um and it's not it's not easier by any stretch of the imagination
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i always feel like pediatrics always sounds like it's an easier thing or like it's like kind of not as
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serious and i'm like
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i mean they're cute they're very cute yeah they're cute and we make things fun and we dress up and you know we we
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do make things fun but i've definitely you know done compressions and had an
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emergent intubation in a christmas onesie before so we're so we're still working
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it's so true and i think that that sometimes was like overlooked i think it i don't know what it is it
pediatrics is fun
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maybe it's just because it is fun and because it's yeah but i was i i so i worked one-on-one with some mentees
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and we've had conversations about pediatrics and i'm like trying to distill a lot of information and i i feel like we were just talking
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about even respiratory illnesses and little little babies i don't know oh wow this is like i'm i'm talking for a
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really hard time there's like a lot to know it's like not that it's yeah it's just
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like it's it's like yeah it's just a different world it's simple and we did it at the same
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time in some ways yeah absolutely it's like you have to master
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i have to know how to treat adult things too because by the time my patients hit 12 they're basically
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adult-sized and you know like um adult issues and like
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i had i had to take acls because i was like i need to know how to like deal with adult things not just
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pediatric things you know and emergencies and stuff when i have like my 18 19 year old patients
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are and they're like you know so it's like i i have to know you know when their first teeth are
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supposed to come in and like you know what to how to handle a pregnancy like all of those things fall under my
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scope oh yeah and they're not adults it's like completely different medicine there's
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different exactly totally different yeah yeah those things medications you can
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give when you can start giving them like its treatment plans completely changed
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so yeah it's special so i think a lot of
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people who get into it should really know how special is it
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well um we have a couple we have a couple questions from the audience from the people um so uh the next
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question we uh how this there are so many juicy questions in here i should say
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a lot of these are like very conversation and clinical judgment type of questions and yeah you share our own perspectives
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of course and the evidence absolutely evidence but there's so much absolutely yeah
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so this question is a little tricky one i don't have a ton of experience with this so i would love to i mean
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everything you have to share uh about it right how do you how do you approach parents that are choosing not to vaccinate
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what is your personal yeah so um very touchy topic um
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it's it is very touchy so first things first um
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i am again this is my personal view based on the evidence that i believe to
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be fact based on what i was taught in terms of validating evidence um
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you know this is what i think that's my disclaimer that's all we do have in medicine so we
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have to just go based on the way that we've been doing things and what we've decided is the way to do things
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so um i'm definitely 100 pro vaccination i um i'm
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i'm just pro vaccination i see no no downside to vaccinating
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children i only see upsides um you know in in 99.9 cases except
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there are those few that for whatever reason they cannot have vaccinations for what you know their own medical reasons but
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if you are well and able i feel like you should so um something that's huge for me when
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job searching i i had i only looked at practices that mandated
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the cdc recommended vaccines and on their schedule oh my god
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advice first for you so yeah so for me i think if that's something
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that you feel strongly about you should definitely be putting that on your list of things to be looking for in addition to you know
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vacation time and are you paying for all of my like credentialing because um
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it's huge and it can really impact the way that you do your work when i was in school i had the
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opportunity to spend a really long time in this one practice that does not mandate vaccines and
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they're few and far between in baltimore mainly because of baltimore's
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the population here is highly dependent on medicaid for their health insurance
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like state-funded health insurance and the state-funded health insurance says mandate that
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the kids who use them get vaccinated according to the cdc
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vaccine schedule yeah so that's one of the stipulations to using um to getting medicaid in
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the state of maryland so a lot of the practices here take medicaid and with that they're kind
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of just like you know what everyone has to then regardless of what insurance you have so there are a few practices though that
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don't a few you know maybe a handful that would be like okay you don't have to so
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you know word gets out and they kind of all flock to these places so i was in one of them and it was just a
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very bizarre world for me um i i was always taught in school like
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if someone is refusing vaccinations you're always supposed to kind of have a conversation with them you know educate them
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um to be like you know first ask them why you know try to see if you can debunk any myths that they believe about
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vaccines educate them about vaccines whatever the case is not to be pushy but just to make
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sure they know everything that they should know and that the information that they're basing their decision on
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is actually fact so um that's what i did i went into a
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patient's room um it was like a baby's like four-month visit and you know they would have been due for
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vaccines so i'm going through my little checklist i'm a student so i'm just like you know i'm just making sure i'm doing everything so i
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can go back to my instructor and make her super proud that i thought of everything and um i went and i was like okay so
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she'd be dude for this this is this backseat like i'm looking at my little printed out vaccine schedule everything and she's like oh yeah no we're not
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doing vaccines and i was like oh i was like well may i ask why
vaccine controversy
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um like what what's your reason and um she's just like oh we just don't believe
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in them like we're um you know holistic we don't do any kind of like medication or vaccines
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and i was like oh well i was like do you know that like the the um illnesses that they protect
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against are like you know can be really life-threatening and you know whatever so i'm just trying to like
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educate her a little bit nothing you know nothing to be like you're a bad mom or you know anything like that just like
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making sure she's aware of everything yeah um and you know she's like yeah no i know we're just like really not into
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it i was like oh okay well you know just want to make sure i let you know everything but of course it's always
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your decision um and i walk out of the room and the next thing you know
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my instructor comes back and she's like oh yeah you know that mom was like really upset um and said that you were like
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pressuring her to vaccinate her kids and we don't really you know do that here if they say they
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don't want to vaccinate we just make sure they sign the you know form indicating that they're refusing them and we kind of just don't address
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it anymore and i was like oh um you know that's that's just not what i was taught but
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now that i know your culture here i'll be sure not to say anything um i didn't know in advance that she was
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refusing vaccines you know so i was just under the assumption that she was getting vaccines so
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you know i there was no harm done i thought on my part but i had offended and that was what made me
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realize that i couldn't work in a practice where i would be ridiculed for trying to educate my patients
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and their families about like anything um the practice where i work in now
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um it is one where you know educating is promoted it's pushed it's like you want
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to and if you are deciding not to vaccinate your child um you know with the state mandated
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vaccines then we're just going to ask you to find another practice
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so yeah i as far as approaching it to answer the
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actual question um i i just go in with the facts
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i say look this is what it's always going i always go in with the vaccine information sheet the little two pager
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that has all the info about it i say this is what you're getting these are you know the diseases that
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protect against these are the symptoms or this is what happens if someone were to come down with these diseases this is what has
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happened with outbreaks in the past we're finding that the more people decide not to vaccinate the more likely
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that we um will have an outbreak and if there is one your child won't be protected
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um you know i even right now i've even been kind of using kovis to my advantage to
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be like you know even with everything else that's going on it's good to know that there's at least a few things that your child is not liable to catch
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so i mean you know even if you're looking at it just that way um
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i can usually get parents to be on board um but if they if they aren't um it's kind of like a
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sorry you can't you can't come here anymore yeah yeah oh yeah i've seen that a lot where
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there's there's at least some kind of policy in place like
systemic issues
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hopefully your your office has developed that and if they haven't been there
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on a systemic level oh absolutely yeah we have one they're posted in all the exam rooms um
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you know they're told when they make the first appointment but a lot of them still feel like they can try to skate through and we won't know this we're just like
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oh no no no i know where every one of my patients are on the vaccine schedule and
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um yeah that's just one thing i cannot tolerate we do have some immunocompromised patients that come
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through um we have some like we have a ton of sickle cell patients who are just in that diagnosis amino
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compromise and i can't risk you know us allowing people mixing immediately even
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now with kovid but before then mixing and mingling in a waiting room with people who could be carrying
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you know vaccine for mental illnesses it just doesn't make sense to me and i respect everyone's wishes i don't
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i 100 do but um i can't choose i can't choose to work in an environment where
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that's okay yeah so yeah i have a kind of a similar
immunizations
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experience um we don't have the requirements um qualified health center where it has a lot of
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medicaid um and um i think for the most part um our schools
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are pretty intense about them about getting them and a lot of my clients are from recently came to the country so i think
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that there isn't it tends to i would i when i see people coming with the objections to the immunizations it
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tends to come with like a kind of a cultural paradigm of like yeah we don't do vaccines you know like
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that like what you were talking about with the holistic right i don't see it as much in terms of the clients and the patients that i'm
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seeing don't necessarily have that same kind of cultural belief about vaccinations
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that often but it's come up a handful of times and for me i know that it's similar to me as like
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things like diabetes or any kind of chronic care it's really like developing that rapport and like as a solution to have a
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conversation and if they're open to it and if they're not you know and like you've done your due diligence of like
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me i you know yeah you got this may i tell you about this again no or like you tell them about the site you
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you educate them right and at the bottom at the end of the day you've done your complete job and then you did they
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just have to sign paperwork you know it's but it's right it's really because it is behavior changes behavior change and belief
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change and that is unless it's because they're coming in without knowing something that's really
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tough to change it is 100 is their mind is usually so made up before you even get started
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that yeah but i still try either way but oh absolutely absolutely there's some
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people you can just kind of sense their body language like you're you're talking just to talk
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yeah which is fine yeah and i think that i've seen like when when it comes to like beliefs and
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and behavior change like i've definitely seen like some people like i had a nurse practitioner that i worked with who was
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there for 10 years and after 10 years somebody had been declining to do some sort of screening test i can't remember what it was
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and then just like after 10 years decided right because like right like yeah yeah yeah
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before and maybe maybe they will change their mind you know but yeah we just yeah the best we can with
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the back vaccine um i have another juicy question um do you have a favorite population to
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work with or like age group to work with like babies or adolescents or school-age kids like do you have a
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personal favorite um i do uh my absolute favorite age is four
favorite age
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oh yeah i love four they are really cute at four
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um i love talking to them i like talking to kids that's like one of my favorite
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things to do um which is why i guess like working pediatrics is so good because it's like
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they are just so honest and they will just chat your ear off and at four
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they are like their vocabulary like explodes and they are so excited about
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all the words they know that they want to share them with you and i just let them go and it is like
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just asking about their day and they you know ask them about school and their teacher
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and they just go on and on and on and i'm just like i just love it love a good four-year-old
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sometimes my absolute favorite um you think of like i'm talking with with kids do you have
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any strategies for building rapport with your adolescents and teams i superse
building rapport
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it's always it's always um i it's a case by case it's still case by case because
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like um some of them are definitely very angsty and i'm just like oh my gosh i can't
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believe i used to behave like this because i remember it um and they're just like just like
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i don't want to enroll in their eyes and just in their phones and i'm like oh my god like this is so
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something i'm not ready for um i can usually get them to um
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to open up just kind of like just talking to them really just like asking about school
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or something like even if they don't know if i'm like what are you doing in that phone they always start like giggling and will get off or something
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i'm just like are you on instagram or like are you a tick tocker like what do you do and they always start like laughing like
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why do you know about that and i'm just like oh i'm hip like i know what's up you know um and they like kind of just like
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be a little relatable the teenage boys i can't really seem to break that
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um there's a couple who are just like yeah i like to chat with you they're
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others they're just like oh my god girl and i'm like okay and it's like i'm
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younger and i get it like yeah girl but also provider you know but they're like
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um i i can't like i've had a couple of my male patients switch over to my boss
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because he's male you know like yeah like i'm i'm not i i don't want to force it
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it's awkward for everyone involved really so
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a lot of them i'm closer in age to them than their parents so it's like even
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like my 18 year olds i'm like i'm definitely closer in age to you we could be siblings really
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i know so i have that um approach of like that some some some kind of connection
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you know a nurse practitioner that i know that works in the school setting
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she was talking about how she kind of like starts as like that on the outside of the circle is like the um
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the school and then there's friends and then there's family and then there's the relationships because it can be hard to
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kind of get to the kind of deeper questions with with kids um yeah another thing which i i haven't been
25:18
implementing but i definitely will will kind of more consciously do that and i feel like the other thing
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that i find really helpful in our clinic is that one of the clinicians that i worked with nurse practitioners um developed this um you know like the
25:31
craft like the screening tools um she she amended that i don't know if they just came up with it based on the
25:37
questions that they wanted to ask but they basically just ask a lot of questions about like who they live with
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who their friends are um all of the different like alcohol and sexual health questions
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and and i'm shocked every time they fill it out they fill it out completely and very honestly
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so it's like kind of nice to have that in addition to those conversations because you can kind of get like how much
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like how much caffeine are you having and how's your diet and like it asks a lot of questions you know so in particular is working really well
26:05
for me personally because like it's drawing those questions out is like challenging sometimes exactly now it
26:12
really is yeah and i also like make sure that like there's i don't know what the the laws are in um baltimore but like in
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massachusetts where i live um uh they're the there are laws to protect
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people um talking about sexual health history such that they have on their own and
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maybe that's national maybe i'm just obvious to that but um people can come in and talk about sexual health related topics on their
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own but additionally we have like a policy quote-unquote policy i don't actually know if it's a real policy but i say that it's a wrong way
26:43
where the parents have to step out of the room and like that can sort of be helpful my kids yeah yeah i
26:49
do that too yeah it's hard to get an answer out of them still but at least
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yeah you've given them the opportunity and again rapport over time like if you've said like i say explicitly to
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them like listen especially talking about sexual health there's a lot of things to be concerned about with adolescents but that's
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definitely like a big one and so yeah at least like over time like i've explicitly said to them listen
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i have no judgment about any of the stuff i'm here to help you i can't tell your parents legally speaking you know um and i just hope that that makes a
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difference you know yeah that's the same same same same
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yeah and then when it comes so more juicy questions i haven't experienced this personal
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personally the situation but uh i would love to hear your uh experiences of how you handle when
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parents uh divorced or separated disagree on the care of a patient this sounds
27:44
so painful yeah um and it happens a lot because um
court documentation
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yeah and sometimes it gets to the point where like
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we kind of just like if if it's gonna be like this we need some type of official court documentation as to who has
28:04
medical decision making because it it it just becomes a game of like
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cat and mouse with us like being man in the middle like and it's it's too much
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like um you try to be like reasonable and see if you can get them on the same
28:21
page but if they're like really at war um which sometimes they
28:26
are you know and are really oblivious to how that affects their child um
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then we would we can make like a referral for them for someone to decide critical decision
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making um on between the two because
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it is absolutely absurd sometimes dealing with them like holly and said oh well i wanted i i said
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i was making her appointment i was bringing her on this day and we're supposed to be doing this and this medication works better no this one
29:00
works better and you're just like come on like this is you know we're talking about asthma at this point not like you
29:07
guys being upset with each other yeah yeah and i think i think i'm i'm so glad you brought that
direct conversations
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up about those court documentations because like the court documentation because i think one of the this is this strikes me
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as like a situation that like no so many nurses new nurse practitioners
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i think like struggle with those direct like i'm in charge conversations and like that yes
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to be here is like listen like in a career right of course kindly but like this is
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the situ mom and dad here's the situation you know and just writing it all out very clearly and like if we cannot come
29:41
to a resolution like we are not like this is how it will proceed because right definitely see like myself like
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just looking backwards when i was brand new like getting pulled into those conversations like over and over and
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like just not having that confidence to just like put my foot down and be like direct and honest and just like
29:59
uncomfortable a little bit you know not in an abrasive way but just right correct way um but that's what that's
30:05
really hard and it's nice to know that at the very least there is like what is what is the what is the kind of not like last resort but like that's
30:12
kind of the last resort is like getting the court documentation involved right because exactly solve it this way or we're gonna
30:19
solve it this way like here you're right please choose and i'm here to support you and take the best care of your child
30:26
you know right but that is so that is so hard it is i will say most of the time that
30:32
you do see it though like where parents are uh the dad usually kind of concedes um
30:40
usually as they like dad is like okay fine whatever but um but yeah there
30:49
are a few cases where they're really both kind of fighting and you're just like wow
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this is really so sad that this kid is like monkey in the middle oh my god totally um
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so more more more kind of juicy questions yeah so um i
31:09
i i'm not entirely sure about this question but this is how i'm interpreting it so some providers do
31:15
male hernia checks so i'm not i'm not sure of when to do it
31:21
and so when do you suggest it what ages every wall child check or only
31:26
sports physicals and i imagine what they're talking about is inguinal hernias but i think it applies to testicular
31:32
exams in general or like right a pelvic exam or like you know genital exams for
31:37
kids and do you have a policy on that do you have um not really a policy i kind of just
31:44
like so i'm i'm happy this actually came up
31:50
because my thing is i actually don't know what the recommendation is everything that i do i try to do it
31:56
based on the like recommendation from the american academy of pediatrics like i try to and i'm not 100
32:03
sure like what the policy is what i do
32:10
um i always check um both you know gender genitalia
32:18
um up until maybe about age like four um and then i usually don't
32:26
unless there is a complaint or concern um now i
32:32
i try my biggest thing is i don't i don't want to normalize anyone being there for no reason yeah um
32:40
i think by the time they get to four or five is when we really start getting into you know making sure this
32:46
is our safe space no one touches us here only you know um you know
32:52
the doctor's office even like when i'm doing it i always say like you know no one's supposed to be down here
32:57
um this is only okay at the doctor's office when i'm looking at something to make sure that you're healthy
33:03
um and your parents are here and things like that but otherwise you make sure you tell your parents or someone
33:09
if someone else is down here you know i always confirm that before i go and like i i really don't want to
33:15
normalize um genital exams for just like no reason there's literally
33:21
no reason i need to check your genitals regularly when you get to a certain
33:27
point like i may do like i do a brief like pee just to check like tanner stage make
33:32
sure you're growing like pubic hair and stuff the way but like as far as like an in-depth like
33:38
in between your business forever i'm not there like that my pcp doesn't do that like i
33:44
i don't i don't think that it's necessary um there's definitely times where young ladies will get like ingrown hairs or
33:51
something that's where they have like genital warts and i have to like talk about the ledge and i explain to them what's going on
33:57
or like the boys who swear something's going on and also probably of your ingrown hair
34:03
but like um aside from that i try not to make it a habit of
34:09
looking down there um i totally don't know yeah ap
moral of the story
34:18
like i actually don't know aap guidelines off the top of my head either as it relates to questions but i think like the moral of
34:24
the story and like the bottom line is that like i totally agree with you and i i feel like let's not like
34:30
traumatize kids you know yeah and like yeah like the the point that i guess
34:36
like the what our kind of takeaway is and we talk about this at our clinic like there's kind of a discourse about it of like when is it
34:42
appropriate to do and for how long and i think the challenge that i have is that we get kids all the time that are brand
34:47
new patients especially like new people yeah and so that's like a tricky question but like what you're trying to look for is
34:54
like undescended testes which causes right right so if they've had it done before and consistently when they were
35:00
little and like there's no problems then like like right um and then just asking and having
35:06
those conversations and i love that you brought that up too about like i always have those conversations too
35:11
with little kids especially by age three or four that like
35:17
and here are the words to use and like also just kind of like some kids get real some kids get really
35:23
scared so i brought this up with kids and sometimes they'll tell me that something has happened whether it's
35:28
curious or or who knows like that's usually the scenario that i that that comes up and then the parents
35:34
will be like you never told me that so i kind of like i i've added into my counseling of like you know no one's allowed to touch and
35:40
no one's allowed to ask and so like usually sometimes kids can freeze and they can feel scared and not know what to do in that picture but
35:47
like here are the next steps like here's what might happen and like hear the next things like always tell and it's really it's a really hard
35:54
conversation right it is it happens with people that that are close right and maybe that's an entirely
35:59
different conversation to go off on but right it's it's important to at least talk about
36:05
and i remember as a new grad like all of these things i feel like are easy for you and i know like when you're
36:10
a new grad that might be very young yeah say those direct kind of confrontational things but like
36:16
that is that who knows what that impact is going to have on that kid forever you know in terms of like
36:21
they're armed with that knowledge you know because bad things still happen in the world you know but
36:26
yeah and that's that's really what it is like um i think as a new np
selfbelief
36:34
the number one thing that you have to get used to is just like believing in yourself as a provider like
36:40
you're there you're here to do the job you have all of the the check marks and
36:45
letters next to your name that prove that you can do your job now it's up to you to believe it too you
36:51
know i think we're usually the last people to believe it and because of that we're
36:56
like oh my god what are we saying it's like you know what to say you just need to say it you know
37:01
um you know exactly what to do yeah and you're going to probably feel stupid right because it's not going to
37:06
extremely polished right but like you you have a base in that like yeah like that self
37:12
trust of like you you have what it takes you know what you know like exactly absolutely and it's like
37:18
you may just like you said you may fumble but even like i think you practicing and like sounding a little bit dumb in
37:24
the beginning is what helps you strengthen you're just like oh my god i know exactly what to say next time because that was not it
37:30
you know like that's what that's what gets you out of the gate and like you know start
37:37
buffing off those rough edges so yeah and i actually encourage a lot of my mp students
precepting
37:42
i do a lot of precepting of students and i definitely have to like do things not like i'm not trying
37:48
to make them uncomfortable and like put them on the spot but i always tell them like it's better to feel and like slash look like an idiot and
37:54
i'm doing using air quotes here because you don't actually have an idiot but it's better than that when you're in training then you're on
38:00
the job you know and it's still gonna happen on the job and it's better to just get it over with you know and like yeah get used to the
38:08
feeling yeah most people don't notice and they don't care and it's probably not as worried about it you know
38:14
absolutely so i want to check on time um how are you feeling with time do you want to do
38:19
a couple more questions do you want to look at the list and see what you think yeah we could probably do let's do maybe
38:25
like two more and then he goes out yeah do you do you have a preference
38:30
there's one about allergy testing um oh algae testing that's a good one
38:36
for right now that comes up a lot and um another one about um practice for uh respiratory illnesses
38:44
for like kids who can't take um uh can't take any medications i don't
38:49
know if you want to do that or if you want to do the pediatric ear exams or pediatric cases or it's up to you
38:56
we can do let's see allergy and let me see
39:06
i think childhood oh okay oh childhood obesity i can um oh okay we
39:11
actually let's talk about that because i get into that comes up a ton so yeah let's do yeah allergy and obesity
39:18
for sure okay so um okay so next question when do you refer
Allergies
39:24
for allergy testing and when do you just provide reassurance because nearly every parent comes in
39:30
concerned that their kid has allergies and is requesting a referral and so what does your conversation sound
39:36
like if you don't refer i love this one oh goodness so this one comes up a ton
39:41
um and like it uh oh my gosh it comes up so much so
39:48
this is my thing um so one they're like out like true allergies like and then
39:56
there are sensitivities that's one and two there are allergies that we
40:01
can do something about and they're allergies that we can't in terms of avoidance give it to you i
40:10
that's how i look at it i'm just like okay so a parent there are usually two scenarios one the most common
40:16
scenario is my kid is sneezing itchy watery eyes scratchy throat x y and z dry cough
40:24
um you know i don't know what's going on i'm just like okay um you know let's do some like claritin
40:32
or zyrtec whatever you know something like that let's make sure we have a humidifier let's make sure we've changed our filter in the house
40:38
um let's make sure you know there are no little dust bunnies and everything like that use some saline sprays rinse off our
40:44
sinuses stuff like that you know they'll come back and say oh you know they still have
40:50
allergy symptoms have you done any of the things that i told you to do no i'm like okay
40:56
well you know oh well we just want to go to the allergist i'm like okay and i honestly like i'm kind of some of
41:03
the parents like me for this some of them don't but i kind of look at them and i'm like okay and what exactly do you feel like dialysis is going to do
41:09
i ask them what they what are they looking for from the allergist yeah um and they're just like well because you know we just wanna know what he's
41:15
allergic to and i'm like okay so he's allergic to something environmental he's allergic to trees what are you going to do about that
41:21
[Music] you know and they're just i'm like we can't cut down all the trees now can we
41:26
well no i'm like okay so you found out he's going to treat his then what but you know we're going to give him the
41:33
algae mess i'm like okay so we're going to do the same things i tell you to do regardless you know so like i kind of i
41:40
i reason things out with parents like i i'm not afraid to reason things out with them because a lot of times it's a lack
41:46
of understanding a lot of times like parents will think that oh i'm going to a specialist and i
41:51
walk into that office and i'm going to walk out completely cured i'm like that is not what's going
41:57
to happen you're going to walk into an allergist and they're going to say yeah he's alerted to like bahama grass and ragweed
42:04
and this or that and you're like oh okay and then he's going to hand you a prescription for clarison
42:09
like that that's what's going to happen and they don't they don't really get that same thing with the dermatologist and
42:15
acne same thing with like the pulmonologist and asthma i'm like everything that i'm telling you to do
42:20
you're going to go to a specialist and you're going to be really upset to find out that it's the exact same regimen
42:27
and i just tell them like hey you're taking off work to go these specialists some of you are paying co-pays
42:32
specialists for them to tell you the exact same thing i only recommend these specialists where
42:38
you know my step one step two step three you know options have all failed and i'm like
42:45
okay you know what at this point i think we need a specialist to help us because i've kind of used all the tricks up my sleeves that's
42:52
when i refer to a specialist i'm always a part i'm like team
42:57
let's keep it primary care as much as we can let's leave the specialist appointments
43:04
open for people who actually need them let's keep our parents at work and not having to take off work every five
43:09
seconds to take their kids to the doctor when they don't need to like if i give them the tools like you know they need
43:16
to take care of their own kids so yeah i kind of go through that
Food allergies
43:24
yeah and i'm curious about um uh if it comes up with food allergies for you
43:29
if do you have a lot of conversations so yeah one with living in baltimore
43:34
you know the seafood allergy comes up quite a bit um and so another thing is i'm i'm
43:41
all about like avoidance and like you know kind of preventative care which
43:46
i think is like the np way i always think that like nps are always about like like we can treat things but we'd much
43:52
rather prevent it and we'd much rather spend time preventing things whereas i think like mv's are always just trying to
43:58
figure out ways to treat things and i'm like i think it's great i think both are necessary
44:04
but i kind of like our approach and i think like what i do one with all of my infants at
44:10
six months i always recommend that they um start peanut butter um i guess
44:16
i recommend that they try it so that we can kind of lessen their chances of being um you know having a peanut allergy also
44:23
you know helping parents kind of reintroducing things like lactose and stuff that babies have sensitivities to we work on that um
44:31
if something does come up like you know there's some odd reaction or something i usually will refer to the allergist
44:37
because i find the allergy blood testing isn't as sensitive as the skin protesting
44:42
um so if it's really a food allergy that i'm thinking i'm gonna need to give an epipen for then i usually like to get a
44:47
confirmation from an allergist um but sometimes it'll be
44:53
kind of like random things where like a kid um like bit his lip or something
45:00
but it got all big and red and mom is not like oh my god a crab leg and it's like no he kind of like bit his lip
45:05
on a crab leg you know things like that um trying to kind of i'm like if your kid has had crabs you
45:11
know like every every birthday his whole life now he's 17 all of a sudden he's breaking out hives it's very
45:17
unlikely um that it's crab but um you know it's kind of
45:25
stuff like that i i try to do the advances of course there's some food allergy things you can't avoiding just
45:30
it just is what it is but um some of them like peanut and stuff like the earlier you start to
45:36
introduce and diversify their diet the less likely that you'll bump into
45:42
these algae later on yeah totally and i love that you brought up the lab test because i think that question comes up a lot
45:48
um of like should i do blood tests and i never do because they're just not not as helpful
45:54
as the skin they're not sensitive exactly it'll tell you're allergic to things that you ate this morning and
46:00
you're just like oh wow like i have a level five allergic to eggs and i eat eggs every day that's crazy
46:06
and i think that one of the other things and i'm not like i'm not an allergy expert by any stretch but i think the things
Sensitivity vs true allergies
46:11
that i've like seen is that typically the recommendations are like for it to be a true allergy
46:18
like you're talking about sensitivity versus true allergies yeah someone to have like an upset stomach is
46:23
different than if they have like like there's different like actually types of like that i think yeah
46:28
your ig is it ige media or not right so do they have anaphylaxis do
46:34
they have hives do they have a rash yeah is there some type of systemic response yeah
46:40
and like blood in the stool like i think that like and that's that's like a probably entirely different conversation but i think that like that's
46:46
when it comes to allergies i feel like some pearls of take away are like you know um doing a full assessment of
46:52
like what the symptoms are what potential could be not ordering the
46:57
serum test again doing your own you know your own thing if that's if that's that's your own thing are
47:03
your and i you know philosophically you do that but if that is your thing you can do that but then
47:09
after that is like doing the most you can in primary care and then sending her testing and further treatment if we
47:15
need to um and that's and that's really like my big pearl i think with not even just
47:22
that with anything like any of the a lot of chronic illnesses and chronic things
47:28
can be managed in primary care like they really can be um sometimes like i'll even use
47:36
i'll use um a specialist kind of to like drive my point home or i'm just like i don't
47:41
think they're getting it i think maybe if they heard it from someone else you know maybe you know two messengers
47:47
same message might get there a little faster but um
47:52
but yeah i i'm completely down with the going to one provider and seeing a specialist when you need them
47:58
and if i feel like if everyone sticks with their regular schedule like checkups with all their regular
48:04
providers you know then says gyn everyone like well we can lead the
48:10
specialists to the people they really need to focus on which are the people who really are like seriously battling you know
48:17
something within their specialty like i there are people who have horrible allergies i have to get out you know weekly allergy injections and
48:23
things like that like you don't need to go to now just to let them tell you that you're just a grass there's literally nothing you can do but
48:29
there's nothing that can be done you know so yeah
48:36
um so uh the our last question we uh is another really juicy one we
48:42
could probably talk all night about this but um the question is any tips or advice for broaching the subject of
48:48
overweight or obese kids have you ever referred to a pediatric weight management clinic and this particular person was
48:54
asking saying that her patient population is in the south bronx and most are on public assistance
48:59
and don't have great access to healthy food choices and any tips that you and i have about
49:04
counseling these families yeah yeah so that is something that
49:10
has um since i've been in my price so my practice is a pretty similar demographic to um
49:17
the one that this person who this question asker
49:23
works with so um like of course low income um low
49:30
access to like kind of healthy affordable foods um is kind of my deal too and covid has
49:38
not helped my situation at all it has it has been really really insane i'm
49:46
seeing a lot of my patients now in the past like couple months since kovid how much weight they've gained um how
49:53
sedentary they've been um athletes who were playing on you know
49:58
teams like out of state are like literally not getting off the couch for like days
50:03
um it is it has been it has been quite a scene um i have referred so many
50:10
people so to answer the question yes i have absolutely referred to weight management clinic um
50:16
my thing with obesity there's a couple things so one um i think childhood childhood obesity
50:22
is it's a huge huge huge issue like this is known this is this is fact i don't think anyone's arguing that this
50:29
is not true um there i can't tell you how many of my patients are like
50:35
heavier than me um like significantly i have patients who are over two times my
50:41
weight um we had to recently purchase a new scale because our previous scale only went up
50:48
to 350 pounds and we have patients who are over 350
50:53
pounds and we could not accurately document their weight so we had to get one that goes up to 650 pounds
51:00
so um it's an issue it's definitely an
51:05
issue um i think what we need to talk about is addressing it early so when we have
51:12
our little chunky two and three-year-olds that are also cute i think we need to start addressing
51:18
their relationship with food from from then um i think we
51:23
let it kind of be swept under the rug for way too long um in fear of hurting kids feelings
51:31
and you know seeming mean or treating them differently or something
51:37
that we allow their health to deteriorate um and it shouldn't be so um
51:44
i think we as adults also need to change our relationship with food and our like
51:51
viewpoint of food um i think we need to stop looking at healthy food as a punishment
51:57
i think it needs to be like more of a celebration it needs to be something that's celebrated being you know eating
52:04
healthy being on a diet you know and i use air quotes with that um
52:09
you know shouldn't be this like oh my gosh like why am i being forced to do this like
52:14
i i don't have kids yet but i want my kids and maybe this is me sensationalizing like
52:20
parenthood but i just i want my kids to be like happy that they're eating healthy things like
52:25
i'm i'm gonna be i need to figure out a way to be that parent like i want to be so excited about vegetables that my kids
52:30
are gonna be those weird kids like oh my god yes carrots like that that is what i want um because you know
52:37
we we always like celebrate around food we always celebrate around treats um you
52:43
know i want to normalize celebrating with an activity i want to normalize celebrating with something
52:49
that is not going out to eat and i think maybe covet is helping us figure out other ways to do things like that other
52:56
than being you know eating um also making sure like being active is
53:02
a part of our lifestyle too we have a lot of screens we have a lot of ways to like get away from being active we don't
53:08
have to walk anywhere anymore we don't have to do anything anymore now you know it's hashtag unsafe to go outside
53:14
so it's like we even have more excuse to be sedentary and um you know i've been telling my
53:21
patients i'm like you need to hop on youtube and get into some of these 30-minute workouts they have
53:26
that you can do at home because you you know they're like oh it's unsafe outside um you know baltimore is a lot of crime
53:33
oh it's unsafe there's covet i'm like okay you can do it in your living room you know i'm like that youtube that we
53:39
can't seem to get you off of it has workout videos on there too and they'll be like you know i tell them
53:46
things they can do at home one i i um i always have a really long talk with my obese kids like in their
53:52
families usually it's not just them usually the parents are also obese um and it's like you know the parents
54:00
will be like oh yeah he needs to lose weight and i'm like mom you you are like no shy for 400 pounds
54:05
like you also need to lose weight you know and it's like everyone needs to
54:10
kind of change their viewpoint um i definitely do refer to a weight management clinic that we have
54:16
here i really love it um they have a gi doc uh a psychiatrist a dietitian
54:25
and a nutritionist on a team that manages like these obese kids
54:31
and i think it's really important to have all of their vantage points as a part of the treatment plan i think
54:37
psychiatry is so huge because a lot of these kids have like underlying like depression and
54:44
anxiety and things that kind of drive them to overeating um that if we address that then we may
54:51
even be able to address um you know the bigger issue at hand which is their you know physical health
54:58
so um yeah it's huge it's my biggest advice i'd say or something i
55:05
take away is don't be afraid to address it like i address it with every obese patient that walks in my door if i
55:12
see them i have to bring it up i have to say something i always make it a point i'm not afraid
55:17
i always say in front of the child i always i want everyone to hear what i'm saying um no matter the age i've had tears i've
55:24
had you know parents cry kids cry both cry um which i mean and it's like i always
55:32
tell them like this is coming from a place of love it's not coming from a place of judgment or anything like
55:37
that i would be i would be wrong if i knew i had ways i could help you and i didn't say
55:43
something um and it's always very well received always you know
55:49
i think it's like sometimes they're just like i'm so happy someone said it because like i knew something was up but
55:55
i didn't know how to say it um so yeah you can be that person that can
56:01
really like finally bring an issue out into the light so that it can be addressed
56:06
yeah yeah and i love that like it just again like just being explicit you know
How to talk about obesity with your family
56:11
and a very kind way and like yeah absolutely
56:16
yeah i might when i talk about it with my kids and my families it's it is like such a family thing right um
56:24
because it's not like one a couple i guess couple things um that have been helpful for me is like one of the things is like
56:30
um just like like you had said like involving the family in the conversation and like asking like what are your
56:36
like do you do you have you noticed this or do you have any thoughts about this in my languaging i'm still working on making sure that it's the most like
56:42
sensitive but also right no but like at the same time like you um like what are your thoughts about
56:49
this or what do you think is contributing because they can kind of give you the answers sometimes like you know what i think it's because he eats really healthy food it's just
56:56
a lot of it or yeah that's right something like that or like he's not exercising as much because of povid
57:01
like that kind of thing and then i also talk about it in terms of the growth chart um i imagine you do the same thing with
57:07
like if we're looking at the right we're always looking at the growth chart at all their physicals all their checkups right of like
57:13
you know how tall are they and what is their weight and when i write people don't show them and maybe this is
57:18
just i am very visual but like it seems like it's it tends to go well where i'm just like
57:23
okay so like this is what we're thinking about in terms of this trajectory that we would expect for weight over time and we want to make
57:29
sure it doesn't go too far up and too far down and so as you can see for this you know for this kid or whatever one
57:35
we're talking to is like you know i'm noticing a trend of it going up and this just increases
57:40
um the risk of you know certain health conditions yeah maybe we can kind of start getting in there and i and i definitely i'm really
57:46
big on permission too especially with touchy topics like is it okay yeah is it okay if we talk about right
57:53
um and a lot of times they're like fine with that but even just like practicing in nurse practitioner school
57:59
we did this exercise with somebody like talking about lab results and they and they and i was like the patient and they were
58:04
like can we talk to you about your labs which is such like a silly kind of like silly question of like of course i want
58:09
to know about my labs you know but like just that extra extra level of like involvement and permission and connection with patients
58:15
like i think makes a big difference too um but i don't also refer to a weight management clinic and we have
58:21
we had a program called fitness in the city where you um it was like a i think associated with our grant
58:28
funding and also maybe the medicaid insurance where they can um you know come and exercise and stuff like that um do like fun
58:34
types of exercise right right it's really tough yeah it is tough and
58:41
i just think like i one i would i would hate to address something if i didn't feel like
58:46
i had something to offer in terms of helping you know like i i address it because i want to help
58:53
it's like i think addressing it just to talk is like mean you know it's like if you don't have something to offer and
59:01
like some pearls or some way to help if you're gonna bring up but you know bring something up like
59:06
it just sounds cruel so i would say like look i'm coming with help i'm coming from a space of love it's coming it's
59:13
coming from caring i even sometimes like majority of my um
59:18
my patient demographic is you know also black and i always say like look like these are things that affect
59:24
us more you know and like i'm here to make sure that i'm looking out for all of us and making
59:30
sure that we are being as healthy as we can be like we know that you know i'm like i know for a
59:36
fact that you know there's someone in your family that has high blood pressure diabetes and they always say yes you know and i'm
59:41
just like same here so it's like we need to make sure that we're protecting the kids like it starts
59:46
from a lot earlier than we think and usually when i even bring it to them like that they're just like you're right
59:52
you know like let's let's see what we can do what do i gotta do what number do i gotta call i'm like all right let's do
59:57
it you know like let's work on it so i even like i've even bargained with
1:00:03
kids like hey look i'm gonna get you like a personalized cell phone case like if we can drop ten pounds in six months and
1:00:10
they're like oh yeah i'm gonna do it i'm gonna do it i want that case i'm like all right so i'm gonna order you the case but you gotta make sure you drop
1:00:16
them pounds they're like all right and then it becomes like a little like little challenge and they're like super
1:00:21
motivated so i try you know like anything that i think will help motivate them and
1:00:28
get them moving i'll do it but um it's all talk it all starts with talking
1:00:33
if you don't talk about it then none of that is ever going to happen yeah and i love that like i think another alternative too is if you don't
1:00:40
have that resource of like a weight loss pediatric weight loss mm-hmm is that like you can do your own care plans
1:00:46
right like you yeah you can just make a plan with them of like here's my concern like what are some goals we can set and
1:00:52
also like instilling her and like i love having those like counseling specific visits where it's
1:00:57
like you're not necessarily doing a medical diagnosis and intervention i mean your counseling is the intervention but like
1:01:03
right follow-up appointments of like having those visits having those conversations all out business just like checking in
1:01:09
yeah i'm like how's it going yeah and like here's how we're tracking we're making progress i believe in you like i'm supporting you
1:01:15
and also just like getting their buy-in you know and customizing that kind of follow-up plan um it's not easy right especially if we
1:01:23
it is possible and i think that it's so important to bring all of our passion towards it you know
1:01:30
yeah for sure absolutely well thank you so much for hanging out and
1:01:37
talking with me uh where can they where can the people find you i
1:01:44
am really mainly on instagram ashley dnp that's me um catch me there
1:01:52
i my business is the renegade resume at the renegade resume um all one word
1:02:00
and yeah custom resume stuff or resume templates or what kind of stuff
1:02:05
yeah we do we have templates resume templates cover letter templates
1:02:10
um interview prep guides i have an np credentialing guide actually that will probably be really good for the
1:02:15
listeners this um of this podcast it um helps new graduate nurse practitioners
1:02:22
navigate becoming like a licensed and certified nurse practitioner which is not an easy process
1:02:28
um and i don't think it is discussed enough um it's a lot of kind of like asking
1:02:35
people that you know graduated before you or preceptors like hey so what do what do i have to do how do i get this
1:02:40
and like what order do i do it in and all of that um so i created a nice
1:02:46
it's a nine-page guide that is like pretty inclusive for of everything um that you need to do of
1:02:53
course there will be some things that will be state-specific but even those things are identified and so like what you need to do to find out if you
1:03:00
need to do this for your state and how to do it so um that'll be a really good gem
1:03:06
for the listeners here um also we do resume cover letter personal
1:03:13
statement services so we'll do editing and creation of resumes
1:03:19
um cover letter editing personal statement editing um mock interviews about a personal
1:03:26
statement so hopefully they're listening yeah yeah so yeah that's a that's
1:03:31
something that's been coming up a lot lately a lot of people are thinking about going back to school we've been getting a ton of personal statement edit requests so
1:03:39
um take advantage of that we've definitely been helping people really fine-tune their personal
1:03:46
statements to say exactly what they want admissions officers to know about
1:03:52
them so yeah it's we have a lot the renegaderesume.com
1:03:59
awesome well thank you so so much of course thank you for having me this
1:04:05
is fun
1:04:21
you
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