Kimberly F. Ellis, MSN, APRN, NP-C
Kimberly Ellis is a Certified Family Nurse Practitioner and Nurse Educator with over 12 years of nursing experience across the lifespan. Her primary focus is culturally competent care for disenfranchised populations at risk for Prediabetes and Diabetes Type 2. She currently is a Lead Advanced Practice Clinician with United Health Group servicing the Medicare and Medicaid populations through preventative care and education. Through this role, she has served on numerous committees & pilot research projects to evaluate best practices for the nurse practitioner role in wellness and community health. In addition to her current role, Mrs. Ellis’ company, Ellis Diabetes Education & Consulting, LLC., provides continuing education resources and courses for nurse practitioners to improve patient outcomes in Diabetes Management.
Homework
0:00:03.7 Latrina: Alright, good evening everyone. Hopefully, you all are joining us or will be with us shortly, so I’ll wait a second and let everybody hop on and get comfortable ’cause we are excited tonight. Tonight is the night we are doing our deep dive into our disease processes, and we are starting with diabetes packed full of information for you. So this will be a three-part series, just starting with the first one tonight, so we are really, really excited that our guest has agreed to come on and speak with us and give you guys some education.
0:00:43.1 Latrina: So again, just kind of deep diving into our disease processes, we are starting out with diabetes and our special guest tonight, is Ms. Kimberly Ellis. So Ms. Kimberly Ellis is a Certified Family Nurse Practitioner and nurse educator with over 12 years of nursing experience across the lifespan. Her primary focus is culturally competent care for disenfranchised populations at risk for pre-diabetes and diabetes Type 2. She currently is a Lead Advanced Practice clinician with the United Healthcare Group, that’s right, the insurance company servicing the Medicare and Medicaid populations through preventative care and education. Through this role, she has served on numerous committees and pilot research projects to evaluate best practices for the nurse practitioner role in wellness and community health.
0:01:34.5 Latrina: In addition to her current role, Ms. Ellis’ company, Ellis Diabetes Education & Consulting LLC provides continuing education resources and courses for nurse practitioners to improve patient outcomes in diabetes management. So we are super excited to have her and we are going to bring her on board. So hey, Kimberly, how are you?
0:01:58.2 Ms. Kimberly Ellis: I’m good, how are you?
0:02:00.1 Latrina: Fantastic, fantastic. We are so excited to have you here and have you talking to the students. Diabetes is one of those things where I think when we were in school, we are taught the mechanisms, but we are not really taught how to manage it well. So who better than to teach us how to do that or guide us into that but you, an expert in that field.
0:02:26.9 ME: Well, I will definitely try. It’s a lot of information, but yeah, I’m ready, I’m excited about this. I had a lot of great… I had fun putting together this presentation, so I’m ready.
0:02:41.3 Latrina: Good, fantastic. Alright guys, so we have a lot of… And just so you know, Kimberly, we do have a lot of practicing new NPs, so they will likely, if they are not watching live, they will watch later, and so they will get all of this information as well ’cause as always, guys, the replay is available. So with that being said, what we’re gonna do is I am going to show Kimberly’s screen, so she is up here. I’m gonna fade to the back and I’m gonna let her do her lecture and I hope you guys enjoy it. I will be sitting here listening as well, so take it away.
0:03:15.6 ME: Okay, so am I up? ‘Cause you know, I can’t really see myself.
0:03:20.2 Latrina: Yes, we see everything. We see you.
0:03:24.9 ME: Okay. I can’t see you guys, I know you’re there, I feel your spirits. So anyway, again, my name is Kim and I love this topic. And just to give you, she read all my bio, but let me just bring you up to why and how I got to this space, okay. So like Latrina said, I work in primarily community health, and so I go out and I do a lot of education in the homes of elderly retired populations and really doing a lot of education, and I was noticing that every one of my patients, if they were not diagnosed with diabetes, they at least were… They had pre-diabetes and to be quite honest with you, I was getting a lot of questions about things, new treatments and devices that people were seeing on TV. And really, quite honestly, I couldn’t keep up with it, so I decided myself, not my job or anything like that, I decided to kinda go on a journey to try to tighten up my skills, ’cause at this point I had been an NP for a few years.
0:04:35.1 ME: And so I was like, “You know what, the things that I learned at NP school, they probably have updated, there’s probably some more stuff out there, so let me just try to go about doing that”, and boy, was I overwhelmed because from just that four-year period, there seemed to be at least nine drug classes that had been added to diabetes management, and I found myself having a very hard time getting credible information and also information for the practicing provider. And I really had to do a lot of digging. It took me a lot of time, it took me a lot of money. I bought lots of books that were just good, and I was just like, “This is a waste of time.” And so I created my YouTube channel to kind of like share what I was learning on the journey, and in the process I realized how much I love diabetes management and how much… Pretty much it made me a better nurse practitioner because like I said, pretty much everybody I was seeing was either… They either had diabetes or they were pre-diabetic, so I had lots of information to share.
0:05:43.3 ME: So today, what I’m going to do is kinda give you like a crash course to diabetes management. Now I am assuming… Well, before I say that, I’m gonna be with you guys over the next three months, April, May. And so what I want to do today is really set a foundation, let’s just set our Foundation, so we’re all kind of working from the same place. So I do wanna give a disclaimer that my style of teaching is… I’m really respectful of the fact that you guys are my colleagues. My goal is to help you all feel more comfortable with managing diabetes and that’s to empower and to not cripple. And what I mean by that is that you’re gonna see as we move through this presentation that you’re going to have to develop and stretch that clinical judgment and discernment.
0:06:41.6 ME: And I cannot tell you step by step by step how to treat every patient that is diagnosed with diabetes, I cannot do that. It’s impossible because no one person with diabetes is the same, and there’s always these… It’s very nuanced, there’s many steps, there’s many things that you have to consider with each patient. And so what I would like to do though, is to help you be able to work through and think through certain scenarios when they come your way. And it’s not to be mean, but it’s really just to help you be a better nurse practitioner, because what I find a lot of times, people want definite answers and you really can’t give definite answers, you have to know the whole story behind the patient and everybody is different.
0:07:32.3 ME: And so I received the responses from your surveys and that’s what guided me with what I was going to talk about, and I pulled out the three things that I felt were the more dominant from your responses. And so first, I just wanna lay this foundation, so we’re all on the same playing field, okay?
0:07:53.7 ME: So with that being said, one of the things that I really picked up from your responses is that I could feel the sense of just being kind of overwhelmed with diabetes and where to start, there’s so much… There are so many medicines, there are so many things I can do, there are different types of diabetes and they’re all different and they’re all the same. And my little three-year older is in here, so…
0:08:24.2 Latrina: It looks like she just disconnected. Well, while we wait on her to come back, don’t worry, and I meant to give you that background information, this is real life, guys. So just in case we have children or things pop up, I want you guys to remember we’re mommies first, so kids may pop up into the screen. Don’t worry, we’ll shoo them away and get back into our topic.
0:08:52.0 Latrina: So she’s talking about the ADA standards and while we wait for her, I want to be really clear, these are the things that we have dropped in your binder drop for you. That’s right. So all of this stuff that she’s starting to mention and saying a great place to start is the ADA standards of care, this is all that binder information, and what we’ve done is we’ve gone through those articles and those journals, and we pulled out all of those charts that you will need and we have placed them in your portal so that you can print them out if you need to, I like printed out things, I like to be able to flip through things. I do use my phone, but I like to be able to flip through things. So that is what that is. So please, if you need a binder or a quick start or you’re looking to kind of build your foundation, make sure you pull out those documents because those documents were provided for you for that purpose knowing we were having Kimberly come on to the screen.
0:10:00.8 Latrina: So again, we’re just kind of waiting for her to come back, she just got a little bit disconnected and it’s no worries. It looks like she’s playing with her screen there, so I’ll come back on the screen while we wait for her. Alright, so we’re having a little bit of technical difficulties, real life. While we wait on her to come back, I am gonna do a little thing where I check in with you. So with that being said, hopefully you guys are doing well. I know that you guys have been asking for a few things, and we’ve been in the messages looking for you and looking to help you get the information that you need. We’ve done that.
0:10:45.5 Latrina: So you guys have recently asked me for some updated guidelines and where to find that information and how do we keep track of that. Guess what? So we’re gonna start typing that for you and putting it in your portal so that you can have access to it. If you saw our most recent conversation, we were talking about… I think Hanna had brought it up, talking about annual physical. How do we know what to order, when to order? All of that good stuff. Well, we looked it up for you, of course, like Kimberly was saying, that clinical judgment and kind of knowing, since I’ve been practicing a little bit, knowing what to order, we put it in a nice little chart for you. I just need to edit it, a few things, edit… Just to look at it and clean it up a little bit, but we put it in a nice chart for you.
0:11:40.0 Latrina: And then we added another form that has kind of the explanation of each lab that you would draw. So that’s going to be available for you. We’ve also got a few of the updated guidelines that we are starting to see, and we have nice, clean, straight to the point, put it on a form for you and printed it out. I mean, not printed it, and typed it up so that if you like, if you like, you can print that out as well. So again, trying to get the information that you guys are requesting so that you can have it so that at any time you’re at work and you’re wondering, I wonder if there’s a new guideline for this, or what should I be doing for this, we have that for you. We’re working really hard to get the information that you want and that you need so that you can be good, practicing, strong NPs. So hopefully, you guys will appreciate that, we love the feedback, so please keep that up when we’re asking for that, because that lets us know that we’re serving you the right way.
0:12:52.3 Latrina: The other thing that we are working on is… You might have gotten an email, you might have gotten an email about a fireside chat. So you might have gotten an email about a fireside chat… Kimberly is back with us, so we’ll get started in a second, but you might have gotten an email about a fireside chat, that’s with me. So I want you guys to respond and please make sure that you put in a good time, and we’re just gonna chat about something that’s gonna be nice, cool and casual, and we’re gonna get updated and do a little bit of this mentorship, I’ve got a lot of things up my sleeve, you guys know me. So trying to put you guys in groups so that I can talk to you about certain things. We’re gonna be looking at that, so make sure you check your email so that we can spend some time together, but Kim is back. So we will… And again, y’all remember, real life, technical difficulties happen, it’s not a big deal. And we’ll get started again. Kim, if you wanna bring up your screen, I will go ahead and bring up your… If you wanna bring up your PowerPoint again, we can do that. So here’s Kimberly, Kimberly is back on the screen, you guys.
0:14:10.3 ME: I’m sorry guys, I don’t know what happened, and so I have my husband scrambling around off camera trying to get it where it’s stable and I don’t know. My three-year-old, you know, they come here, they…
0:14:23.5 Latrina: No worries, I have a five-year-old, so they get it.
0:14:28.1 ME: Anyhoo, so I you, a little bit, speak about the ADA standards of care, and I do wanna touch on that a little bit. We’re not gonna go through it, it’s too lengthy of a document for that to happen, but I do wanna say… And this is a clickable link where it’s underlined, so when you get the PowerPoint, you’ll be able to click it and it’ll go right to the table of contents for you, if that’s something that you want as well. But this document comes out every year in January, and it really gives you the recommendations for all practice, when it comes to diabetes care.
0:15:06.7 Latrina: Sorry to interrupt, but we can’t see your screen, Kimberly.
0:15:11.1 ME: Oh, you can’t?
0:15:13.1 Latrina: Share your screen so that they can…
0:15:15.7 ME: Wait a minute.
0:15:16.8 Latrina: So that I can add it up here for them and then I’ll go ahead and fade off.
0:15:20.4 ME: Let’s see. Okay.
0:15:41.3 Latrina: We’re gonna get there guys, don’t worry. There it is. Now, pull up your… There it is, here we go. Perfection. You’re on mute still. You’re muted.
0:16:16.0 ME: Okay, you can hear me now.
0:16:17.8 Latrina: We can hear you now. There you go. Alright, go ahead.
0:16:19.7 ME: It feels like we’ve been doing this for a whole year.
0:16:22.6 Latrina: That’s okay. Well, we’ll go ahead and get back on your lecture and let you go.
0:16:31.3 ME: Okay.
0:16:31.8 Latrina: Okay.
0:16:33.7 ME: Tell me when you see it.
0:16:33.8 Latrina: You’re good, go ahead, I’m gonna fade off.
0:16:36.7 ME: Okay. So the great thing about the standards of care is that though it comes out once a year, they put out the new one in January, they add updates to each section. So as you’re going throughout the year, and let’s say for instance you need to look up something about, I don’t know, classifying a type of diabetes, you can always go to the top and you can check for updates, and if there are any updates, then you’ll know what the new ones are, so it’s very nifty and they provide multiple ways for you to access this. You can go to the website and just read it from the website, they have the PDF, and then you can also purchase the book as well, but it’s one of those things that you wanna keep bookmarked. And this year’s current standards has 16 sections, which is kind of more than last year because they expanded some sections and they broke them into separate sections. So at the beginning, you’ll see who the people are that put this together and then they give you a summary of the revisions, and then you get into the individual sections and it’s very nifty.
0:17:49.9 ME: So these are the 16 sections. I’m not gonna read them all off, but as you take some time and you look at this, look at all the different things that they’re hitting down, this is pretty much everything that you need to know about diabetes management. And it’s very exhaustive, each section is rather long and they have charts and all those things like that, so from your tech, diabetes tech, your Pharmacology approach, how to deal with complications, pediatrics, management of Diabetes in pregnancy, all the things that you would have a question about, they have you covered. And so the ADA does a great thing for this. I absolutely love it. I personally read it every single year, and as you read through it, you’ll understand it a little bit more, so the coming years to come it’ll be easier for you to read through it.
0:18:47.7 ME: Now, something that I do want to pull up here is that even with the standards of care, this is still just your guide and it actually says it in the document that… And even in our algorithms, that we’re gonna go over next time I speak with you guys, they always leave room for you to have clinical judgment, it is your guide, but it’s not your bible.
0:19:13.0 ME: It actually says that, they still want you to use your clinical judgment, so it’s very important that you develop it and that you’re always stretching it because one person is not alike. So what I want to touch on and really spend some time on is prediabetes, and the reason why I want to spend some time on prediabetes is because as providers, I find that we do not really put a lot of heavy lifting here, okay. You have a golden opportunity when you come across a patient that you find in this category to really do some work, so we can just prevent diabetes altogether. Now pre-diabetes has been known by many different terms, borderline diabetes is still considered impaired glucose tolerance. When I was in school, they used to say subclinical diabetes and it wasn’t prediabetes, that may be dating me a little bit, but it was subclinical diabetes. And so you may feel like, yes, we know what prediabetes is, we know what we should be saying. It’s common knowledge, but I really don’t believe that we really believe that because according to the CDC, one-third of Americans fall within this category.
0:20:36.7 ME: And that’s 88 million people. Think about how many people, if we can get in there early and really drill in better lifestyle modifications, how we could just prevent people from having to deal with this debilitating disease altogether, and this is where we should be doing a lot of our heavy lifting. By definition, this is a higher than normal blood sugar that really does not meet the threshold of diabetes in the A1C is 5.7 to 6.4. Now, something that I do want to make note to you as Well, gone are the days where we’re just looking at the A1C to be higher than a seven to actually diagnose someone with diabetes. If you have two separate readings that is in the range of 6.5 or higher, you can diagnose them as a person with diabetes. So that means if you get a 6.5 and the next time you get a 6.8, you can diagnose them with diabetes. And so even with our algorithms, you can start with some of the medications earlier than seven.
0:21:49.8 ME: Now, signs and symptoms of prediabetes. There are no clear signs and symptoms, and this is why it goes undetected for years, but look at those risk factors there guys, that’s pretty much everybody, that’s a lot of your patients right there. Overweight, obese, 45 or older. Something I wanna point out that a lot of people don’t know is that a sedentary lifestyle is if you do not have physical activity less than three times a week, that’s a lot of people. I think sometimes we can lean into the racial groups a lot, but here you go, and you have all these other risk factors. We see a ton of people on a daily basis that have these risk factors, and so it’s not so much of someone coming in with signs and symptoms, it’s you looking at the patient as a whole and making the clinical decision, I’m going to screen them, I’m going to educate them, so we can get that on board earlier.
0:22:52.2 ME: Now, preventing and treating diabetes, there’s the one thing, lifestyle modifications. And we’re gonna talk about lifestyle modifications a little more on the next presentation that I’m going to do, but it is the most powerful thing that you can do for your diabetic patients, it is. It trumps any medication because we know that we can treat prediabetes with metformin, but nothing will bring that A1C down more than good lifestyle modifications. Now, the problem that we run into a lot of the time is that, and I’m guilty of this, I can say this honestly that I’m guilty of this myself, is that we run off the same old spiel about eat good, exercise, and we think that our patients really know what we’re talking about. You really have to break it down for your patients.
0:23:44.7 ME: And next go around, we’re gonna talk a little bit more about what that is and what you should be telling your patients, but when it is implemented correctly and it’s adhered to, nothing is gonna bring that A1C down more than lifestyle modifications. Now, something I do want to talk about and something that I always like to tell people about… This is a great pearl of wisdom, and it kind of blew my mind when I learned about this, but we’re gonna… I’m focusing in on Type 2 diabetes A, because it’s the most common type of diabetes, and in other presentations I’m going to touch on the different types and it’s also the one that is preventable. So with Type 2 diabetes most people go anywhere between seven to 12 years, having elevated blood glucose, prior to them being diagnosed. And so what happens is it’s normally the postprandial glucose, not the fasting hence why it goes undetected ’cause when do we see our patients, they’re typically fasting. So their fasting is normal during this time, it’s the postprandial, and so the pancreas does what the pancreas does. When we eat, it gives off the insulin and it does this overdrive, overkill for all these years.
0:25:05.7 ME: So what happens is the pancreas is trying to compensate because typically your blood sugar should normalise about two hours after you eat, but if you have a person who’s not at normal, they’re not at target, well, then what does that pancreas do? It goes ahead and it spits out more insulin. So it’s constantly working, it’s over-working, and eventually around year nine, it starts to tire out like anything else. And so that is when we start to pick it up clinically because then it’s no longer able to keep it going just the postprandial, it starts spilling over into our fasting blood glucose as well, and then that’s when we start to see it come up and then that’s when we may diagnose someone, but think about all that time, if we are screening and we’re educating, how we can really just cut that out. Okay, that’s nine years, about 7 to 12 years of a pancreas working in overdrive. Now, something that you can do on your own time is, I’ve linked here two videos that I made over on my YouTube channel, Kim E. The Diabetes NP, what insulin resistance is and what’s going on with insulin resistance and then also prediabetes as well. I have two videos there, so when you click it, you’ll be able to go right to those videos, and that’ll tell you a little bit more about what’s going on behind the scenes there.
0:26:39.4 ME: Now, these right here are your… These are your numbers of what is considered diabetes, a fasting blood glucose of 126 or more, a two-hour blood glucose of 200 or more after an oral glucose tolerance test or an A1C of 6.5 or higher, and then bolded at the bottom, it says, in a patient with classic symptoms, so that’s like your three P’s, your Polyuria, your Polydipsia, your Polyphagia, if they have the classic symptoms of Hyperglycemia or hyperglycemic crises and you do a random blood sugar and it’s higher than 200, 200 or higher, you can diagnose diabetes at that point, okay? Now something to also keep in mind is that you do need to confirm your diagnosis. So basically, when we go back here, you can do either one of these top three, but you need to go back and you need to confirm it with one of these three as well. You can do it with the same test, so you can get two A1Cs, you can get two-hour glucoses, you can do a fasting blood glucose, it can be two of the same or it can be two different tests. Now, something I do wanna point out to you as well, let’s say that you do the two, let’s say that you got one and let’s say the A1C was abnormal, but the fasting blood glucose was normal, you still need to go… You need to repeat the test that was abnormal, I hope that makes sense.
0:28:22.7 ME: So let me try to say that again. So two abnormal tests, you need to confirm it, you can confirm it with the same exact test. If you do two separate tests and one is normal, one is abnormal, you need to repeat the one that’s abnormal, and that should tell you what your diagnosis would be and I hope that makes sense. I hope that second time it makes sense. Let’s see here. Also, I want to also bring up some alternative tests here. So right here, you have the C-peptide test. Now, this test you would see… So, diabetes really manifest the same, really no matter which type you get, but you do have those zebras, those are what my teachers used to tell us. Those random people that come in, and you may have a Type 1 that is 40 years old, and sometimes we can misdiagnose them as having Type 2, but they’re really Type 1. So if you’re looking at all of your clinical assessment and then you’re looking at your lab values and you start to think to yourself, “I’m not sure of this person’s Type 2, they may be Type 1.” Or you started them on some type of treatment for Type 2 and they’re not getting better, they’re getting worse.
0:29:47.5 ME: Then if you want to see if this is a Type 1, you can always draw a C-peptide test, and this tells us how the beta cell function is doing. And so what I wanna do is kind of explain to you what this test is and why it’s important because I think the why helps you to understand it a lot better. So in the pancreas there’s a molecule called pro-insulin and before insulin is secreted, it’s a part of a molecule call pro insulin, before it’s secreted, it cleaves down and half of it is insulin and then the other half is C-peptide, connecting peptide. Now, the great thing about this is because it’s the same molecule, they are secreted in equal amounts. So if you get a C-peptide, that tells you what your level of insulin is, so if your C-peptide is low, then that tells you that your insulin is low. And so the question can be, because I know I have this question, “Well, can’t you just pull out an insulin level?” Well, you can, but let me tell you why it’s probably not the best to do that. For one, a C-peptide is inexpensive, it’s easy to do.
0:31:00.0 ME: And then also insulin has a… It’s degraded quicker than C-peptide. So C-peptide lingers a lot longer in the system than insulin does, so it’s a better way of us seeing indirectly what our insulin level is. So that’s a test to keep in your back pocket if you ever have the question. I also wanna talk about the fructosamine test and this is a good test that’s a good option for when the A1C test is unreliable. And typically, the A1C is still the golden standard for diagnosing diabetes, it is, but sometimes you’ll have cases where you can’t rely on the A1C. One of the biggest things is hemoglobinopathies and things like sickle cell, and you see I have a video there that kinda goes over that as well that we’ll talk about, but… An A1C is a hemoglobin A1C… If there is something going on with your hemoglobin, it’s going to skew those results. Now, what you can do is take an alternative test, like fructosamine, and it does basically the same thing that the A1C does, but instead of telling us how the blood sugar has been over past two to three months, it tells us what it’s been over the past two to three weeks. So still not a superior test, but it’s an option.
0:32:27.2 ME: It gives you an alternative. It’s more of a shorter term, and it’s a good test to bring… If you’ve changed up treatments and you’re kind of trying to figure out if something’s working and you don’t wanna wait the full three months, that’s a good test. It’s an option, something to keep in your back pocket. And like I said, speaking about hemoglobinopathies, one of the big hemoglobinopathies that really affects the A1C is sickle cell anemia and sickle cell trait.
0:32:54.4 ME: And at this point, there are options labs, do you have options when you think that the A1C result is not right, they do have some regulation on that, but again, you would wanna make sure that your lab is accommodating for that and that they are aware of that. I believe that the main stream ones are, but that’s just something to understand and to be looking out for. So what is next? So like I have been speaking about that in the future presentations, I’m gonna get more into the types of diabetes. We’re gonna talk more about diabetes self-management education and support, because that’s a whole thing, that’s a whole thing that insurances are really pushing, because they see the studies are giving better patient outcomes. We’re gonna really talk about what lifestyle modifications are, and we’re gonna go over the algorithms to really help us with the medications.
0:33:58.5 ME: Now, in the mean time, what I would like for you to do, if you have time and you’re interested, over on my YouTube channel, I’ve created a whole playlist over each diabetes medication, each little class, each one, I have a video over it, so if you want to just give a quick little, okay, what each one is, I got you covered on my YouTube channel. Also, I created mad cheat sheets. It’s a part of the pre-resource that I created, it’s called The NP Diabetes Starter Pack, so not only will you get cheat sheets, there’s other free printables that are part of that starter pack. And then lastly, I also have a mid-bootcamp course that I have an exclusive code for you guys, if you use NP collective, you’ll get a very hefty discount and so I’m offering it specifically for this group. That’s really all I have, I do have some references and resources here for you guys that… Good articles to read. And that’s all I have.
0:35:13.5 Latrina: Perfect, perfect. I am coming back on screen, Kim E you’re still there with us. So we thank you for that. So this was more of, just kind of an introduction, you guys, so giving you those basics and what we’ll need for you to do is we have to have you do your due diligence, right? So I need you to go back and we’ll have her document so that you’ll be able to click the links and get a little bit more education about that and we’ll do some chatting about it as well, just so that you guys have clear understandings of what those things were. I think one of the things that I definitely want to maybe hone in on and stress, Kim, is, you kind of mention… And not just about diabetes, but it’s one of the first things that you said, and it is that we are going to have to develop and stretch your clinical judgment. And I think this is so important, and I’m not sure… I think as new NPs, many are looking for people to tell us what to do. Tell us the right answer. Tell us what is right and what is wrong.
0:36:23.7 Latrina: And it’s hard to do that. I’ve used that in my lives when they’ve asked me questions, and a lot of times I say it just depends. Because, like you said, every patient is different, and once you get to know your patients, it becomes a much different ball game. It’s not someone who is just on a piece of paper and you can give a right answer, you’ve gotta take everything into account, so you wanna add a little bit more, but it’s so important that you use your clinical judgment.
0:37:00.2 ME: Yeah, that’s a biggie. That is a biggie. And the questions that I get on my platforms and really, like I said, when I reviewed you all’s responses, I could feel the whole room and I’m like, “Calm down, okay.” And the thing is that… The great thing about being where you’re at… One of the things I really wanna impress upon everyone is that you’re gonna have to always be a student, like always. It does not stop. And like I said, when I… I was probably about an NP for about four years and from that time, like nine drug classes had come out. And I remember one of the injectable medication, COP-1s, the only one that was in the class when I was in school was …I’m like, wait a minute, we already know … And it’s okay, it’s okay. Being a part of communities like this, and doing courses, going to conferences, that’s going to help you stay up to-date. And then there’s still gonna be some things that you’re just like, “I don’t know, I’m gonna have to trial it out”, and when you have your standards and you have your algorithm, you know how to be safe, but then on you have to decide, “Okay, I have these… ” Even with it, they give you many options within the algorithm.
0:38:32.0 Latrina: They do.
0:38:35.7 ME: So once you check off, okay their kidney function is good, now I still have four medicines.
0:38:40.4 Latrina: It is, I think… And again, stretching that clinical judgement, it’s so important that you develop that rapport with your patients so that they are honest with you so that when you go to make those judgments, you feel comfortable, like you said, that you are safe and you are making the right judgment for them, and just that. These are guidelines guys. So we are going to give you all of the tools that you need, we are gonna point you in the right direction, but at the end of the day, you’re still the provider and you are the one who is going to make that call. So we are gonna give you everything that you need in order for you to practice safe and we can practice having those conversations with our patients and acting as if we are those patients, and what would you do next? Then thinking things through. But even at the end of the day what we say may be something completely different than another provider would say. As long as we’re staying within those guidelines, and that’s what I really wanna stress, as long as we’re staying within those guidelines, and like Kimberly said, we are staying safe, then there’s no…
0:39:47.1 Latrina: And I hate to be like that, but there’s really no right or wrong answer once you inject that clinical judgment. You all are worried… ‘Cause I saw the same thing in the surveys, ’cause I did see them. You guys are worried, but again, I talk about this, lean into it, you know as a nurse, when you were on the floor and things did not make sense and it wasn’t right, you at least knew it wasn’t right. That’s your judgment. When you know something is wrong and it shouldn’t be this way, you go look it up, you make sure that you’re able to practice in a safe manner and then you make a decision from those guidelines, that’s what you do and that’s how we do it. And all I can do is give it to you and get people in here like Kimberly who are gonna help guide us in that right direction so that you can make those clinical judgments. Okay, so we’re excited. So you guys know I give homework, so you guys have homework, but it’s not… It’s good homework, it’s watching Kimberly, so it’s nice and easy.
0:40:54.0 Latrina: It will be nice and easy for you, there’s no hardships that will be there, but there’s some terms that she put out there. There are some links that I want you to get familiar with it, that you’re able to bookmark in your phone or on your tablet so that you have them so that you know where I’m getting these documents, you know what she’s referencing when she’s speaking because she’s gonna get deeper every time, so every time it’s gonna be a little bit more, and we don’t wanna overwhelm you either. So this is why this was kind of just a basic start. As new NPs, we know you’re overwhelmed, so we’re gonna ease you right into that. Go through those documents that we gave you, those drops that we did for you, go through them, start looking at them, apply them to your current patients that you have. And I know that we have some folks who are in specialties and things like that, you still need to be very much aware, ’cause I know I have a nephrologist in this group, and she is a new NP. This is your wheelhouse.
0:41:56.2 Latrina: This is where you need to be, so you need to understand diabetes inside and out, because again, number one, number two, right? So this is one of those things that affect them tremendously. So go through those things, print them out, have them ready. So Kim, we are so excited to have you back, and we will be asking questions guys, getting feedback. And as she goes, she’s gonna get a little bit deeper so that next one you’re gonna be learning even a little bit more. Alright, so thank you Kimberly, I’m gonna take you back and then I will close up for you guys. So you guys, like I said, you’re gonna have the homework, it’s nice and easy, all you have to do is watch. So I need you to go to those links. Again, know the terminology, know what’s happening, ’cause you know I’m big on the why. If you understand what is happening in that process, then you will understand what she is talking about. Like Kimberly said, she is here to empower you and same thing with me, alright? We’re gonna give you those tools. You will have access not only to the lecture, of course, but you will also get her document which will have the links that you will be able to click on. We’re also going to post the information about the code for her bootcamp that you guys will have. You guys take advantage of these things.
0:43:20.3 Latrina: This is how you learn. We talk about CEUs, this is a CEU situation right here. So we’re gonna have CEUs that will be available for you because we did some learning today, okay. So those two will show up in your portal, whether or not is the replay or not, you will still have access to those CEUs. Go to her links, we will incorporate that and as she comes back, we will incorporate those things as well. But as always, I am protective of your time and like I said a little bit earlier, just to do a little bit of housekeeping, she’ll be back for the next two months. So that is going to take place. We also sent you an email, please be checking your email because we’re looking for feedback, we’ve got some things up our sleeves and some ideas that I have, so I wanna make sure that I am able to incorporate those things for you. In your portal, again, the labs, at least the annual labs will show up this week for you, so you will have an explanation of the labs that you wanna order and the ones that you should order.
0:44:28.6 Latrina: Excuse me. Again, those two, are clinical judgments. I do wanna preference this by saying, with the annual labs, the physical labs, you wanna check with your organisation as well, because a lot of times your individual organisation will have a standard of labs that they want you to order for the physicals every year. Not every organisation does. This is very helpful if you’re at an organisation that does not have those standards, if they’re just like, “Order what you think is necessary”, you have this as your guideline, and we will talk more about that as well. So don’t worry, I’m not just gonna drop it off and leave you hanging, we’ll have a little discussion about it, alright? So, okay guys, protective of your time. If you missed the beginning, go ahead and watch the replay, but this was an example of real life, so I appreciate you joining us and watching, and we will see you in a little bit. Check your email and respond, okay, guys? Alright, I’ll talk to you soon. Bye