Advice for New Grads Interested in Urgent Care with Michelle Lew, NP
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If you’re interested in becoming an urgent care nurse practitioner, this podcast episode is for you.
This week’s episode is another beautiful interview with Urgent Care nurse practitioner Michelle Lew.
You may have seen her on Instagram making reels that make us smile and laugh, or if not, you definitely should follow her. 🙂
She’s been a nurse practitioner for a decade and has worked in both primary AND urgent care. She tried both locations a few different times to try to find the right fit.
I love this interview because not only do we talk about how to bridge the gap between primary care nurse practitioners and urgent care providers, she got to share her journey with discerning what feels best and right in her career and for her life.
She struggled with burnout as so many of us do, and thought about leaving the NP profession altogether (like so many of us also do!).
But she made the brave choices to explore what she wanted and needed and is now absolutely thrilled with her work and her life (it’s so inspiring to hear).
We covered:
The conundrum of when to send someone to urgent care instead of the ER, or vice versa
The pet peeves of urgent care and primary care providers when working together, and how we can work better together
Pearls of wisdom for entering into an urgent care job, and what resources she recommends for both new and experienced NPs!
Resources mentioned in this episode:
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Michelle Lew 00:00
With urgent care. I mean, it's kind of like the bridge between primary care and the emergency room. And let's be honest, nowadays, patients are having a really hard time getting in to see their primary care where they need to, when they need to get seen. And then a lot of times, people are either using like telehealth, or they're calling, like, their insurance nurse hotline, and these people are getting the recommendation of like, hey, you need to be seen. Please go to an urgent care Well,
Liz Rohr 00:26
hey there. It's Liz Rohr from real world. NP, and you are watching the real world NP, YouTube channel, we make weekly episodes to help save you time frustration and help you take the best care of your patients. Hey there. So this episode is an interview with Michelle Liu, who is a nurse practitioner in urgent care. I love specialist interviews, because what I really want, what I really hope for the healthcare profession and for nurse practitioners who are practicing in it, is that we are better connected between the silos of primary care and all the different specialties, so we understand what they do, they understand what we do, and how do we communicate and connect better so that we're taking the best care of our patients. So in this interview, I talked with Michelle. She actually had the unique perspective of working first in primary care then transferring to urgent care and actually going back to primary care because she wasn't sure if that was right for her. And now she's back in urgent care, which is beautiful. So in this interview, we talked about what she loves about it, what her kind of day to day is like, what she wishes primary care providers knew, especially from that perspective of practicing herself in primary care. And we talked about when, when nurse practitioners or clinicians would like to get into urgent care. What are some of the things to consider whether you're a new grad or you're an experienced provider, and you're thinking about that career change? We talked about general kind of pearls of practice and wisdom to share from an experienced urgent care provider to whether you're a new grad or again, considering going back into urgent care or going to urgent care for the first time. So I hope you enjoy this interview. I had a really fun time recording it. So without further ado, here is my little chat here with Michelle. Liu, oh gosh, thank you so much for being here. Can you introduce yourself to the people?
Michelle Lew 02:17
Yeah, well, first off, Liz, thank you so much for having me on here. My name is Michelle, and I am a board certified family nurse practitioner. I graduated from Gonzaga University with my Master's back in 2014 so I've been practicing now for almost 10 years, and the majority of the time has been in urgent care prior to becoming a nurse practitioner, I was a perioperative nurse. I started out in esthetics and plastic surgery, and then moved to ortho and general surgery, and then I also did a small stint as a contract nurse in the GI Lab, which was really fun as a nurse practitioner. I started out in community health, and then I went to urgent care. I thought I missed primary care while I was in urgent care, I think I just missed managing the chronic conditions and really developing these relationships with my patient. So I actually went back into primary care for a couple of years and realized that I I actually enjoy urgent care a lot more. So I went back, and I've been back ever since. On a more Yeah, on a more personal note, I am also a mom to three amazing young kids. They're three, six and nine, so they keep me quite busy. I don't really have any hobbies because of that, but I do like naps, so whenever possible, how to sneak in
Liz Rohr 03:37
a nap my ultimate hobby, right?
Michelle Lew 03:38
Yum. I love food. I'm a big boba fan. Yeah, I, you know, I grew up internalizing a lot of, like, the struggles that I was going through when I was in nursing school, grad school, as a new grad, and all of that stuff. And so I have an Instagram account where I share a lot of it. I think, you know, back then, that ideology that I had where if I shared any of my weaknesses, it made me less of a person. And now that I'm older, I realize how faulty that thinking was on my part, and so I really encourage people just to, kind of like, talk about what they're going through, because I can almost guarantee whatever you're feeling right now, whatever you're going through, someone has gone through it, or someone else is going through it, and just being able to make that connection and talk about it is such it's game changing. I love
Liz Rohr 04:32
that, and that's how I found that's how I connected with you. Is through Instagram, I feel like you're just so relatable, and it's awesome. So thank you so much for sharing all of that, and thank you for sharing your your story and your story and your background. Because I think that it's really permission giving for people to hear the different journeys that people have. I think, I think especially in my work with newer grads, they people go through school and have this conception of what they think that they want. I think we all kind of do whenever whatever, whether it's nurse practitioner or another profession. And then once you kind of get out there, it's like figuring out what i. Like and what I don't like, and giving yourself that permission of, like, you know what? I missed primary care. Oh, wait, no, I don't. I'm actually really happy in urgent care. Like, that's just so wonderful to hear.
Michelle Lew 05:08
Yeah, I mean, I think I'm pretty indecisive. I like to have options. I don't necessarily think I will go with those options, but I find that, you know, the more options that I have, like, the more I'm gonna thrive, because I know I can do it if I if I want to, absolutely,
Liz Rohr 05:27
and it's just, I love, I think, especially, I don't know if this is post covid, but that's what it feels like a quote, unquote post covid. Like, people just kind of, there's this conception of, like, you have to, you know, you went to school for this thing, and you have to do this thing, and you have to do this thing, and you have to do it this way. It's like, No, we don't. We don't have to do that anymore. We don't have to. We can change
Michelle Lew 05:46
our mind. You're allowed to change your and especially when it comes to, like, nursing, like, it's so flexible. And I always knew nursing was flexible. But I mean, the more that I you know, like, the more that I stay in this career, like, the longer I see, like, just how really, really flexible it is. And I think I never quite grasped that concept when I was younger.
Liz Rohr 06:08
I love that. So one of the things I want to, I want to touch on next, is when we were chatting before we recorded when we first chatted, I just felt like you really lit up when you were talking about how much you like your job. So can you tell us, like, can you tell the people like, that light and that magic and that joy, I think is so important to share when things get especially in this profession, when things can feel really heavy. So like, what is it that you what is your job, and what do you love about it?
Michelle Lew 06:31
Yeah, so I work in urgent care, and I love urgent care so much, and I think it fits my personality. Again, it goes back to like, you know, I have all this option because I see so many things. I see a variety of conditions. I get to do procedures. Every day is a little bit different. You never know what comes through the door. And there are some days where, you know, it's not as busy. And then there are days when I am just like, I'm running around like crazy and and to me, it's fun. It makes the day go by faster, and the impact that I have on my patients, I know for the most part, it's usually a positive one, and it's, for me, it's such a rewarding experience. So the particular urgent care area that I work in, I feel like it's a little bit different than your traditional urgent care, where people walk in, you know, they they're like, Okay, you're number three in line, and you might have to wait 20 minutes. You might have to wait two hours. Yeah, my current practice right now, we have kind of like this newer model, where it's appointment based, so even if you walk in, we'll give you the next available appointment. And for me, I think it's such a great model, because people know exactly how long they're going to have to wait until they're seen, as opposed to just sitting there and not really knowing, like when you're actually going to be seen. And then I also like that approach, because as a nurse practitioner, I know what my schedule is going to look like. I know that I don't have 10 people out there in the waiting room. For me, I get anxiety when I know that people are waiting for me. Yeah, the more people that
Liz Rohr 08:15
are waiting. It just like, keeps piling up, and you're like, oh
Michelle Lew 08:18
my gosh, yeah. I love this a lot. I also love the organization that I work with right now. They very much care about us. They make sure that, you know, we get our breaks. They make sure that if we're seeing a whole bunch of patients, we have the appropriate resources that we need to provide safe and effective patient care, and also just my work life balance in general is amazing. I work three and a half days, and on the days that I'm not working, I'm not thinking about work, I I can, I can do whatever I want and not have to worry that there's something going on with a patient that I saw you know, during my last shift that I need to follow up with right away. Otherwise, I'm going to miss something important,
Liz Rohr 09:05
absolutely, absolutely and I want to in our in our time. I want to talk about, how do we connect? How do we better? How do we better connect, or best connect urgent care and primary care, like, I feel like there's definitely, like, a lack of understanding between the different. It's just so siloed. So I want to get to that, but first I can hear the people asking, there are so many people I think, that are interested in getting into urgent care, and they're really intimidated. And so I can just hear the questions of, like, what kind of training did you like if you're in primary care? How long did you wait in primary care before going to urgent care? Just your experience, not that that's the gold standard, necessarily, right, but how much experience and like, what were the things that you did to get there? Like, did you do any special trainings? Like, how did you know you would be ready to do urgent care?
Michelle Lew 09:52
Yeah, yeah. You know, I think, I think anyone can start out in urgent care. I think Urgent Care is fine for new graduates. Ads, there are definitely certain criterias that I think you should look out for if you are a new grad to make sure that you'll actually succeed in new grad and urgent care. With urgent care, I mean, it's kind of like the bridge between primary care and the emergency room, and let's be honest, nowadays, patients are having a really hard time getting in to see their primary care, where they need to, when they need to get seen. And then a lot of times, people are either using like telehealth, or they're calling like, their insurance nurse hotline. And these people are getting the recommendation of like, hey, you need to be seen. Please go to an urgent care. And so in terms of, you know, addressing your first question, kind of like the disconnect between urgent care and primary care, and what I would like primary care to know, and I guess maybe a little bit for patients to know too, is that we don't always necessarily know or have access to your medical records.
Liz Rohr 10:58
Yeah, I was gonna say, but before you get further into that, I think one of the frustrations that, I mean, you know this, because you're in, you were in primary care as well. But I think a lot of people are just like, oh, urgent care. Like, why did they do that thing? So I think that this, like this, so continue on. I just want to, like, like, name that there's that thought there sometimes for primary care. So I'd love to make to bridge this gap here. So go ahead.
Michelle Lew 11:18
Yeah. I mean, I wear in, like, a standalone Urgent Care Clinic, and so we're not affiliated with any, you know, major healthcare organization around my area, and we also don't have access to their health records. And so a lot of times I get patients who come in and they're like, Oh, can you just look it up on my chart, you know? And it's like, it's spending that 30 seconds and educating them like, you know what? Unfortunately, we don't have, like, a universal electronic medical record at this time. So I don't, I can't. And, you know, patients, sometimes I don't think, are as aware of, like, how detailed their medical records are. Yeah. So even when I go through a history and I'll ask a patient, hey, do you have any medical conditions that I should be aware of, right they'll say no, but then I go to like, their medication session, and I'm like, Are you currently taking any medications right now? And they're like, I'm taking low start, I'm taking Lipitor, I'm taking Metformin. And then I asked them, like, Oh, are you taking these questions, or are you taking these medications because you have high blood pressure? And they're like, yes, but they failed to mention that when I asked them, so I definitely think there's that disconnect. And so yeah, in urgent care, you know, we don't have the same access as primary care do, and so what we're doing in that short amount of time that we have is really to, like, the best of our abilities. I also think sometimes Urgent Care gets a really bad rep of just dispensing antibiotics and steroids, like it's handy, but again, you know, that's not that's not necessarily the case. I think in urgent care, we do see a higher volume of people who may need antibiotics because they're just able to get into see us sooner. So, you know, I think we may dispense more, but I don't necessarily think it's like inappropriate in how we dispense it, and so I think we get that kind of a bad rep, but I want to say it's not true.
Liz Rohr 13:22
Yeah, absolutely. And I think, I guess, I guess, to focus on on this for a second. Like, when people, I think one of the things with primary care that feels like a mystery, like I know that I struggle with this because I haven't worked in urgent care or the ER and like they're especially like having a couple of years of experience at this point, I know which ones need to go to the ER specifically, right? But I think sometimes there's a little bit of a gray lot, like, a gray area of like, Is this appropriate for urgent care or not? And I think I would just love to hear your thoughts about that. I think acknowledging that there are different kinds of urgent care with different types of facilities and equipment, like, I had to bring a family member a couple weeks back, and I was like, I don't know if they have, if they're going to do IV fluids, I don't know if they have X ray there. Like, we're just going to have to see on a personal side, but on the clinician referral side, I would love to hear your thoughts about that. Like, are there things that you're like, yes, urgent care, or absolutely stop sending these to urgent care, because we don't have capacity for that. I don't know. What are your thoughts on that? No,
Michelle Lew 14:21
I totally agree with you that every Urgent Care is also very, very different, and there's different acuities to them, like some urgent cares, they have CT in them, they have X ray, they have EKG, they have CT. These urgent cares are usually ones that are associated with, like bigger Health Organization, and I think usually they're the ones that are, like, right across from their emergency department. So they have a lot of resources, and then you have, like, some smaller standalone urgent cares where, you know, they don't have EKGs, they, Oh, wow, might not have X ray and so. There's such a range in them and, you know, and I think one thing that a patient can do is they can always call and ask that way, you're not wasting your time going there and then being redirected to somewhere else. I think when someone comes into my urgent care and we don't have that resource, you know, we let them know, and then we do recommend close by areas who are able to provide that service for them. But it's, it's really hard, and I think, as the clinician, unless you you know this urgent care, you know what they have, you don't really know, yeah, you know, you don't really know the resources that these urgent care have, or you don't really know the resources that these urgent cares will have to, kind of like, serve for patients totally
Liz Rohr 15:48
in general, though, I guess are there? Are there specific diagnoses that you're like, I don't, I don't know if there's any hard and fast rules, but there are any, any specific either chief complaints or situations where you kind of like, have to refer over and over again, actually refer them to the ER instead. Like, I'm so sorry you came here to urgent care, but I actually need to go to the ER. Like, are there any of those kind of scenarios for you? Yeah,
Michelle Lew 16:08
um, there. There are, um, my the way that I practice is a little bit different. I mean, if someone is acutely ill looking, if they are just pale and they're, you know, just, you know, humped over and you know, they're just throwing up non stop, those people, just because their acuity, like their symptoms, are so severe, urgent care most likely won't have the resources to help them stabilize at that moment, even if their condition isn't, you know, like a medical emergency, because they look and they sound so bad, like we're very limited on what we can do and what we can offer at the same time. You know, people present with different conditions very, very differently. You know, a medical emergency that I think everyone knows is, like appendicitis, for example. So I think you're more, I wouldn't say traditional, but I think, you know, if a patient comes over, yeah, if they're hunched over, you know, they're hugging their lower abdomen, they're they're pale, and they're like, so nauseated, you think, yeah, that's append. That's the look of appendicitis, right there. But I've also had patients who come in and, you know, they walk into the clinic perfectly fine, you know, and they're like, Yeah, I have a little bit of nausea, but I think I just ate something from the food truck last night that's causing me to have this symptom. And then when you go do the physical exam, you're like, oh my gosh, you have rebound tenderness. You're a tenure at Bernie's point. You know your tachycardic I'm actually really worried that this could be appendicitis. And so I think if you ask people, they might say something, they might have a different opinion. But for me, I think if there's a patient that sounds acutely ill, the emergency room is kind of, like their best resources, because there's, again, not that much that we can do in urgent care to really, like, stabilize them at that moment. But for me, in practice, anyways, like, I, like, I'll see anyone, and usually within like, the first five to 10 minutes or so, like, I'll know if they need to go to a higher level of care or not? Yeah,
Liz Rohr 18:21
definitely. Yeah. And I think I'm primarily, like thinking about it sounds it's hard to say, like, I think there are people that get referred to urgent care from the clinic, but also like telemedicine, like, if you have a telemedicine visit, or, like, an on call call, type of thing, that's helpful to know. And I think it sounds like it's also the patients who need ongoing monitoring, like, if you're worried about them further destabilizing, you probably don't have the staff to, like, monitor them and make sure that they're not getting worse in that kind of way. So hopefully, hopefully that can help people. And you
Michelle Lew 18:50
know, I think if you asked me this question, like, five years ago, I would tell you, anyone with chest pain, like, like, you know, anyone with like, right, lower right, lower abdominal pain, send them to an emergency room. But everyone just presents so differently that, you know, unless they're acutely ill, it's kind of hard to tell, until you actually get in there and you talk to them and you do an assessment.
Liz Rohr 19:14
Yeah, totally. Um, so are there? Are there other things that you'd love to share with primary care, aside from like, kind of a little bit of grace on the like steroids and antibiotics and needing to prescribe without any history kind of thing, without any, like, medical records, any other things that would be helpful for them to hear about how to bet, how to best work together.
Michelle Lew 19:36
Yeah, you know, I think one of the hopes that I have in the future for urgent care and primary care is that we find a way that we, we find a way to, I guess, almost have, like a better partnership. Because absolutely, you know, again, it's, it's so hard for patients to come in to their primary care provider when they have an acute illness. Um. And even if I see them in urgent care and I'm like, okay, you know, let's say you have pneumonia, I would like for you to follow up with your primary care provider in a week just to make sure everything is okay, because you always want to make sure you close that gap in terms of like, patient care. But the honest truth is, they there's a really good chance they probably won't be able to get in to see their primary care in a week, and so most likely, they're going to come back and see me. And so I, I, I wish we can have, like, a partnership, or like something where, where we can, where we can, almost, like, go hand in hand with patient care, because I feel like the future of medicine is like you have your primary care provider who's going to manage, you know, your chronic conditions that are relatively stable. Ish, I think primary care providers are really great at, you know, at preventative medication, or preventative medicine, making sure that you stay healthy. But just with how healthcare is going. I I don't see how it's going to be possible for patients to get in to see their primary care provider when they're sick. And so I'm hoping to have, like, some, some kind of, like, a better partnership,
Liz Rohr 21:15
totally, totally. And I feel like I think a lot about the healthcare system, and like how we can do this better, and like how there's individuals, and then there's systems, and it's so hard sometimes being an individual in a system that needs work. But I think one thing that occurs to me as you're saying that is like, and I actually talked about this on another interview recently, is cold calls or something that I was introduced to. I don't know if that's an actual name that other people know, but that's what we call it. Is like when you do a cold call to a specialist, and it's like you develop a relationship with that specialist, so that when you refer to them, it's like you can ask a quick question about a patient that you mutually see. It almost feels like that might be a good way for people to think about urgent care as well. Like, what are the urgent cares that are available in this area? And it's almost like, could you consider to having that conversation with your patient in primary care. Of like, what is your clinical urgent care home? And could you try to use that one, right? People travel and stuff, but it's like, that would be really nice. But then the other thing you said about the fact that you don't have medical records, it reminds me of like when the power used to go out, or the system the HR used to go down in primary care. And one of the clinics I worked at, and then you'd see patients and they it would be dependent on what they knew, because you didn't have records, and it's like, oh, wow, that's really hard, and there's so much to address in primary care, but just putting a kind of like a bug in the ear of people thinking about that of like, what would it be like if you were to conduct a visit without records? You know, like, does your patient understand what their medicines are, why they're there in the first place? They're like, I don't know. I'm just following up. I'm like, Okay, well, I'm glad you're here and I want to take care of you, but I don't have any information.
Michelle Lew 22:46
So, yeah, exactly, yeah, that's, that's exactly, right? Yeah. I mean, even when our, even though we don't have a lot of access to patients medical records, but I'm when our medical record system goes down. It's like the apocalypse. Yeah,
Liz Rohr 23:02
it's really hard. It's really hard. So I'd love to, I'd love to hear from you, I guess, a couple of things so I can, again, hear the people wanting to who are interested in urgent care. What are some of the things that you see in a day? I mean, I know that's kind of hard to recall. Probably, I don't know if it's like, like, sometimes when I leave clinic, I'm just like, What did I do today? I don't remember any. But Could you, could you give some examples of things? Because I think it's really intimidating for people, like, how different is it from primary care in terms of the patients that you see and the procedures that you see and
Michelle Lew 23:29
things like that? Yeah. I mean, having experience in primary care, honestly, it's not that different with urgent care. We are seeing more acute stuff. So the bread and butter of urgent care is really your ear, nose, throat, respiratory infection, so your strep throat, your ear infection, sinusitis, you know, bronchitis, cold, flus, things like that. We also see a lot of like UTIs, for example, a lot of muscle skeletal injury. So someone is playing soccer and they twisted their ankle, or someone bent over and sprained their back. We also do a lot of, like workers comp too, in my Urgent Care in particular, and then I do procedures like laceration repairs. I do I drink abscesses. Sometimes we'll do like a skin biopsy or removal. So it's a really good mixture of seeing patients and then getting to do procedures. And I will say, when I was in primary care, I hardly had any opportunities to do any procedures at all whatsoever. And coming from a perioperative background like I love procedures. I love doing things. They're so fun. And so, yeah, so it's really fun. I think my favorite procedure to do is just like suturing. Like I love suturing, but, yeah, but, and then I mean a typical day in urgent care, again, it's kind of hard to say, because every day is so different. We do have I think. Think just kind of like primary care, we have, like waves of things, so in the fall and early winter, that's kind of like our peak respiratory season, so we'll see a lot more colds and flus than anything else. In the summertime, typically, we see more muscle skeletal injuries, because people are out and about doing things outdoor, and then they can get hurt, and then you see them. And then, I think, like, right before school starts, we see a lot of, like, sports physicals, for example. And then the first couple of months of the year, I think it's, it's a little bit more relaxed compared to the rest of the year. And I, I think that's kind of like a normal trend in, like, all specialties across healthcare, where the new year, it's a little bit more relaxed totally.
Liz Rohr 25:43
And
Michelle Lew 25:44
then for my urgent care, I mean, I think on average, I probably about 18 to 20 patients a day. I get really relaxed days where I see like maybe 12, and then I can have really busy days where I'm seeing like 20 patients.
Liz Rohr 25:59
I'm sorry I cut up for a second the busy days. You say, usually 20 patients, 2828 okay. And so how does your schedule work? Like, how did and when you went into, like, an interview and stuff like, is it 15 minute visits? Is it Do you have a set kind of schedule bracket? Do you get longer for procedures? Like,
Michelle Lew 26:15
how does that work? Yeah. So, because my Urgent Care is appointment based, most of our appointments are 15 minutes base. We do have certain appointments where we'll try to make it a 30 minute if possible. So for example, if I'm going, if I think I'll have to do like a pelvic exam, for example, for example, that would be a 30 minute visit if I have something that might be a little bit more involved. We do have that option of changing it to a 30 minute appointment, and that does include all procedures as well. When I first joined this company, I they made all of their appointments 15 minutes regardless. Yeah. But a lot of us, you know, voice our concern like, hey, we we actually don't have enough time. And with the particular organization that I work with, they really want to emphasize on, like, their timeliness and making sure that patients get seen when they're scheduled to be seen. So they kind of took that into consideration. And so now we are allowed, like, 30 minute appointments on certain,
Liz Rohr 27:18
uncertain concerns. Oh, that's great. And then when you have those 28 day 28 patient days, it's just kind of like a by discretion, over book type of thing. Or how does that work?
Michelle Lew 27:27
Pretty much, it's pretty much, you know, you're just, we're just lamb and, you know, I we're there to help people, right? And so we do what we can to try to, like, squeeze the people that we're able to see in, yeah. And how did
Liz Rohr 27:41
you learn the procedures that you learned, like suturing and things like that, like, did you do learn it on the job? Did you do like, trainings or anything like that?
Michelle Lew 27:47
Yeah. So in terms of, like suturing, again, because I was a perioperative nurse when I worked in esthetics and plastic surgery as an RN, I worked under an amazing surgeon, and she taught me how to suture. I was assist. Oh, my gosh. That was like, Oh, wonderful wealth of knowledge that I'm so incredibly grateful for. And then when I transitioned to primary care, and then I did some of these other procedures that I wasn't too familiar with, like, for example, splinting, yeah, a lot of like flinting, my job offered like, a hands on skill lab every couple of times throughout the year. And so anything that we felt deficient in, we can just go to the skills lab and kind of just brush up on our skills. So it was training that my current workplace
Liz Rohr 28:36
offered that's awesome. And then you mentioned that you did orthopedics as a nurse as well. Yes, I think that people really struggle with musculoskeletal, ortho things. So I think that's just like, I'm hearing that question too. Any thought, any like, how did you get more comfortable with that topic?
Michelle Lew 28:48
So when I said ortho, I did more like ortho surgery as a Oh, I see ortho clinic. I see, I see, yeah, but again, it really, it's just more like exposure, because even in primary care, especially when you're first starting out and you don't have that huge patient panel, you kind of are like a walk in clinic, and so you start seeing people more for like this, and so that exposure and just experience
Liz Rohr 29:13
awesome, beautiful, cool. Well, thank you so much. Are there other kind of, like, pearls of practice or pieces of wisdom you want to impart to the primary care
Michelle Lew 29:23
people? Yeah. Well, I don't know if this is specifically just for primary care. I totally like for everyone. I think one of the things that I would, you know, recommend or, or say, take to heart, is like number one, if you're really interested in urgent care, go for it. You know, go for it. Whether you're a new grad or if you are in a different specialty and you or even in primary care and you want to go to urgent care, everything that you've learned, everything that you've experienced, will help you in urgent care, because we see so many things. Things we see so many varieties. You're going to see it. You're going to use that knowledge in urgent care. So don't ever go into something saying, like, I'm just wasting time here until I can get into urgent care, because that's not true. Whatever you learn is going to be so valuable. And then the other thing too is like, if you are a new grad and you are interested in urgent care, I really recommend looking at the places where you want to work make sure that you're working with another provider. And I think that's one of, like, the biggest recommendation and advice that I have for new grad who wants to work in urgent care is you have to work with someone urgent care is very face, or urgent care is very fast paced. And, you know, I remember, like, as a new grad, like, I was scared, I was so overwhelmed. I had like, you know, imposter syndrome, and I and working in urgent care where you're by yourself and you're having all these patients, it's very overwhelming. You know, you're not setting yourself up for success, you're going to get burned out, so work with another provider that way. If you have any questions, you can just ask them. They're right there in the clinic for you. And then number two, make sure that you talk to them about having a ramp up program and get it in writing. I think one of the things that sometimes people can encounter in urgent care is that, you know, their employer will say, yeah, you'll, you'll get a train. You'll, you'll train with someone for like, four weeks, you know, before we have you go solo. But really you're only training with someone for two weeks, you know. And then, let's say they're short staffed, and they have to pull this other person, and then you're kind of just there all by yourself, and it's a very much sink or swim situation, and it's just it's not the best environment, and I don't recommend that at all. So get it in writing. Make sure you have proper training, you know, make sure you get a mentor, if possible. I think having a mentor is such an important component to being successful in your career. Absolutely,
Liz Rohr 32:08
I cannot emphasize everything that you just said so much. I guess I'm wondering two different things. One is like so if you're interviewing either a new grad or somebody who is transferring from another specialty. What are the, what are the things that you're looking for? Like, what are the, I don't know if you participate in interviews, but like, what are the things that you've noticed about candidates that it's like, oh, that's not a great that's not a great match, or that is a great match, yeah, especially somebody who doesn't have experience. Yeah.
Michelle Lew 32:35
So one of the most important skills to have in urgent care is being able to tell if a patient is sick or not sick. And basically what that means is, is this patient stable enough to have outpatient management, or do you need to escalate this person to a higher level of care? And usually that's the emergency room. Usually with interviews, you're going to get case scenarios. And you know, we want to see what your thought process is like. And so, you know, if you get a patient who comes in and let's say they have really abnormal vital signs, but they look stable, you know, what do you do? Again, everyone presents so differently. So really learning, you know, just red flags, like major overall red flags. So watch out for I think that's that's a really important skill, and I think that can definitely set you apart from other candidates that are applying, because you have this amazing skill of being able to tell, is this person sick? Are they not sick? And I can't emphasize how important that is
Liz Rohr 33:39
absolutely and I love, I love what you said about we want to know what your thought process is. Because I think when I've talked to new grads and even experienced people looking for a new job, it's like they're, they're so focused on what the quote, unquote right answer is. And actually, like, there there are, there are safe answers and there are unsafe answers, right when, even with patient care, but it's in that interview process, it's like, we don't know what you know. And that's a way to, like, walk through, like, Oh no, okay, I see where, I see where they're going with this. It's like, they're going on the safety track, they're going on the red flags track. Like, I can see, versus like, I think I would just ask somebody, which is great. Like, you can ask people, but like, you also have to think through the process, and, like, demonstrate what the process is. And it's nerve wracking in interviews, but it's nice to share that, yeah,
Michelle Lew 34:19
for sure. And you know, to your the comment, if you know, if someone were to say, I would ask somebody. I think that's perfectly fine too. I know interviews are very scary, and even when I go on interviews now, I get very, very nervous, totally. But it's really just, we want to know what you're thinking. And one of, I think, a big strength that a person can have is knowing what you don't know. Yeah, to say I don't really know, you know, I would go ask somebody, and if you know, maybe it came back this way, then I would do this, and it was this way, then I would do this. And then I also think too, I. So the way that we practice is very dependent on our environment. So if you come from an area where you know you have, you don't have a lot of resources, let's say you don't have like on site labs, your answer may change. You may say, you know, I would send this person because I don't have access to it. Whereas, if you worked in an area where you had so many resources, and you're like, Yeah, I would order a troponin. I would order a D dimer, right there, yeah? The fact. And I think just verbalizing like, oh, you know, hey, I come from a clinic where I don't have this, so that's why I would send them for this exact purpose, yeah. So just giving a lot of information, talking about your thought process, there isn't necessarily, like, a wrong answer, per se, which is, really wants to get to know you and how you Yeah, totally.
Liz Rohr 35:47
I love that. And then my last, I think my last question is, what are some Do you have any urgent care resources that you recommend that either you enjoy or your colleagues enjoy, especially for somebody who's like, I still want to prepare more before I go into urgent care? Like, what? Urgent Care. Like, what are the, you know, sites or books or podcasts or anything like that?
Michelle Lew 36:06
Yeah, for sure. So there's a couple on the top of my head, hippo education, urgent care boot camp that I absolutely love. It's very detailed, it's very comprehensive. And the style, too is very relaxed. It's kind of like you're having a conversation like a lecture. So I think they present it very, very well. And so hippo Ed has an amazing course, so I usually recommend that I also have, like, small little resources for other stuff too. Like, for example, in urgent care, sometimes we have to order, you know, advanced imaging, whether it's like an ultrasound, CT, MRI, depending on a certain area. And I have a link to this PDF. It's in my Urgent Care Resources on my Instagram. Oh, beautiful, but it's an amazing resource where you know, you can look up what is going on, and then they'll tell you exactly which imaging, what type of and that has saved me so many times. Because, I'll be honest, sometimes I don't really understand the difference between ordering something with contrast and without contrast, totally, totally and yeah, and then EKG cardiology made easy.
Liz Rohr 37:23
Oh yes, I have to have her on the podcast. Absolutely Go ahead.
Michelle Lew 37:28
Jen is amazing. She again, I love, like I I'm a simpleton, and so I love it when I, you know, read something or I'm learning something, and they break it down really simple. So I'm like, oh, yeah, that makes so much sense, because EKGs are very, very intimidating to me. Oh, absolutely, yeah. And then the way that Jen breaks it down is just amazing. So that's another resource that I have. And if anyone who's listening to this and are interested in learning a little bit about EKG, she does have, like, free classes that you can do every once in a while. And I did that first, and again, it was still a lot of information that I learned just from those free classes. So that's another resource that I would recommend, beautiful,
Liz Rohr 38:15
and I'll make sure that these are all in the show notes, and I'll definitely link to your urgent care resources on your Instagram? Yeah. And so where can people find you, and do you want to share a little bit about something else you're working on?
Michelle Lew 38:27
Yes, for sure. So like I mentioned, if anyone is wanting to connect, or if anyone has any questions about urgent care, you can definitely find me on Instagram. At my handle is the dot, NPA, dot, Mom, I love being a nurse practitioner, and I'm very passionate about this career. And one of my latest project is that I wrote a children's book introducing little kids to nurse practitioners that I'm very, very proud of. I'm so excited. I I love our profession so much, and I wish more people would know our profession and know what really nurse practitioners are. And so I figured with this children's book, hopefully we can educate the next generation, and who knows, maybe educate their adults in the process of what our profession is. So if anyone is interested, you can find my book on Amazon. It's called my mom helps people feel better.
Liz Rohr 39:23
Oh my God, I didn't know that was the title. That's so sweet. And
Michelle Lew 39:28
it the story is told by my oldest daughter's point of view. And there's and there's a photo of like my other kids, and like my husband in it, and my kids are so proud of the book, and it's just, it's so amazing. It's such a great project. I
Liz Rohr 39:45
love that. I love that we'll be sure to share that too. That's awesome. Congratulations. Book writing is not easy, so acknowledgements for that.
Michelle Lew 39:52
Thank you. Well,
Liz Rohr 39:53
thank you so much for being here. This is really, really special, and I think people are going to get so much out of it. So thank you
Michelle Lew 39:58
also, thank you. So much again. Liz, of course.
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