Latest Comments by juan de la cruz

juan de la cruz, MSN, RN, NP Guide 49,112 Views

Joined Nov 14, '06. Posts: 3,543 (47% Liked) Likes: 4,304

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  • 0

    You could ask the program directors in the schools you are interested to attend. As far as I know, ED or ICU experience is not required in AGACNP programs. I have spoken to a new AGACNP and she worked in a step down unit when she was an RN. She did end up working in a high acuity specialty that involves rounding in the ICU. She will have a steep learning curve but hopefully, she has adequate orientation.

  • 2
    ButterflyEffect06 and elkpark like this.

    It's hard to give you advice not knowing your job market. Where are you in the US? I'm in Northern California and there isn't a discrimination towards Master's prepared entry level RN's here from what I could tell. There is, however, discrimination towards new grads in general as employers can easily find experienced nurses from elsewhere (out of state) coming into the state highly qualified for the positions posted. The high RN salaries attract RN's to the area.

    There is a need for APRN's in some areas (Psych, Family Practice outside of the big cities and in underserved communities within cities) and some direct entry NP graduates could get those jobs. So if you lived here, you would actually have a better chance of working in an NP role directly than finding a job as an RN. The salaries between RN's and NP's are close and in some instances, RN's can make more.

  • 3
    traumaRUs, Dodongo, and ksisemo like this.

    This has been a long standing debate because the national boards, the Consensus Model, and the state boards have not been very specific about the rules. Having said that, it's best to be smart about it and stick to the level of training you received in your program and the competencies described in your national certification as a risk management strategy.

    1. Depends on your definition of clinic. There are appropriate clinic settings for AGACNP's and many of us had that exposure in our program. Examples are Adult Cardiology, surgical specialty, Pulmonary practices that involve both in-patient rounding and hours spent in the clinic following established patients. Strict primary care provider practices would not be appropriate for AGACNP's as these are not well covered in the program.

    2. Some schools allow students to switch tracks while already admitted into a specific program. Bring it up with prospective schools.

    3. I was well prepared for various in-patient specialties as an ACNP. My rotations were 70% in-patient with the 30% spent in Cardiology clinic , Pulmonary Medicine clinic, and Adult Urgent Care. These were my choices and the school accommodated them.

  • 1
    traumaRUs likes this.

    Currently, I work with one attending each day I am scheduled. I'm in the ICU, so it's just the intensivist and myself. I previously worked in a CTICU where we rounded with 3 Cardiac Surgeons on all their patients so in theory, we were collaborating with all 3 at one given time. However, weekends were covered by just one surgeon who is on call for all the patients. Would an on-call attending model work for your weekends?

  • 6
    elkpark, kmd1005, Dodongo, and 3 others like this.

    I'm just not impressed with CCNE accreditation at all. It's important, I get that, because all the national NP certification boards require schools to be CCNE accredited for their grads to sit for the certification exam. To me, it seem like any school offering baccalaureate to DNP programs sends in a check, an on-site inspection happens (whatever that entails), and the CCNE "badge of honor" is granted.

    It also baffles me how CCNE accreditation only states the degrees that are accredited and not specific NP tracks. For instance, Walden is accredited for its baccalaureate, master's, and DNP programs. That designation does not specify which particular tracks passed the standards, did CCNE specifically look into the FNP program and decided it met standards? I have to trust that this is the case when they were last accredited in April 2010 and was given up to the year 2020 for when their next inspection is up. However, how can they now offer a brand new PMHNP track? and their AGACNP track started after 2010?

    Were these new NP tracks evaluated before they start admitting students? It seems to me (unless someone else can clarify), that schools can skirt CCNE accreditation rules so easily. We really do not have a specific accreditation entity specific to NP programs just like CRNA's and CNM's - that to me, is a big issue!

  • 4

    I've worked with a handful direct entry ACNP's from a number of well known programs (UCSF, Yale, Columbia, Case Western Reserve U). Some of the programs required students to take a break after the BSN portion and seek acute care employment as an RN for at least a year and then return for the NP portion later. The other programs didn't require this so the graduates never worked as an RN in the acute care setting at all. To be honest, I've not heard any complaints about their competence as an NP.

  • 1
    SummitRN likes this.

    Quote from Mark Hill BSN
    Juan, after all these years, are you still hating on Walden for no reason? Really...? Sad...Well I'm a proud Walden graduate, and I have done just fine without a "real" education. And to think people even let me provide their healthcare for them with no real education or training....weird.
    Me hating? no, just not buying the whole predatory marketing and not making sure students have preceptors which I believe should be the school's responsibility. Of course you got an education that led to you getting licensed or certified whatever the case may be.

    Nothing weird about that at all. You breezed through your program on your own terms while some others who struggled because they couldn't get clinical placements on their own were delayed.

    Also, the point of my previous post was just to express disappointment in how easy it is to set up a PMHNP program with faculty who write online didactic material and not have to recruit experienced and practicing PMHNP's who will work with students on the field.

  • 8

    I still stand by my opinion that for-profit institutions offering NP programs operate unethically with their predatory marketing and admission tactics and shortchange students by not taking responsibility in providing a complete education by making students work on finding their own clinical placement despite charging for full tuition. I have never said in any of my previous posts that graduates of such programs will never get a job nor make top NP salaries.

  • 1
    ICUman likes this.

    I heard similar experiences as Jules. Here in Northern California, Kaiser offers one of the top tier incomes for NP's.

  • 2
    diprifan and chare like this.

    National certification from either ANCC or AACN is just one step in being able to practice. Both certification credentials are similar in that they are the first step a new graduate would do to start a practicing. They are also both widely accepted across all 50 states. The next step is usually obtaining state licensure as an NP. Each state has their own practice scope and that really determines what NP's could and could not do.

    In order to get paid for our services, there is also insurance credentialing which in most cases involve getting an NPI number, CMS application, and approval from a number of private insurances. As ACNP's, many of us practice in hospital setting that also require application for hospital privileges.

  • 0

    Graduates of Adult Gerontology ACNP programs have two options for national board certification examination. These two credentials basically correspond to the specific board exam the NP took and passed. ACNPC-AG is a credential awarded by the American Association of Critical Care Nurses. AGACNP-BC is a credential awarded by the American Nurses Credentialing Center.

  • 2
    elkpark and BCgradnurse like this.

    I would look at it this way, what would you like to achieve with a PhD focusing on health policy? Certainly an interesting field to learn about and possibly a nice field to transition to from a clinical role such as FNP. If all you want is to learn about health policy...read lectures about health care financing, legislation lobbying, and such, then maybe Walden is fine.

    If you want a degree in health care policy and make a career in this field, then you likely won't be taken seriously by peers who had degrees from more reputable institutions with established public policy programs. Your degree might also get overlooked if you are seeking fellowships and research opportunities in public policy in the future because that school is not well-connected to experts who are likely affiliated with the well known institutions.

  • 1
    Jules A likes this.

    California...paid per hour with night shift differential at 16% of hourly rate, approved holidays are time and a half. We have a call structure where an NP is scheduled to be on stand-by call in case additional staff is needed to come in for work...if the NP is on call, they get 1/2 of hourly rate for being on call, if asked to come in to work, time and half starts as soon as the NP walks in the hospital door.

  • 1
    ICUman likes this.

    ICU positions with privileges to do procedures isn't that uncommon anymore. I've heard of positions all over on both coasts and in between. Personally, I worked at a 900-bed hospital in the Midwest in a CVICU as an ACNP where we placed central and arterial lines (even PA catheters), and chest tubes. I'm on the West Coast now and work at a university medical center where we also place lines and intubate but do not place chest tubes in all the adult ICU's.

  • 1
    traumaRUs likes this.

    Agree with the previous posters. DEA certificate is just one step in having the ability to prescribe controlled substances in California. Your NP furnishing license must state that you can prescribe schedule drugs and that requires approval from the BRN. Since you already mailed the CEU certificate, I would just wait to see what the board's final decision is and make sure your employer knows your situation.


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