juan de la cruz MSN, RN, NP

juan de la cruz has 27 years experience as a MSN, RN, NP and specializes in APRN, Adult Critical Care.

juan de la cruz's Latest Activity

1. 

   Should I take this job at a community college?

   juan de la cruz replied to Skips's topic in Educators

   It doesn't look good nor does it seem appropriate that a faculty member with no experience in a particular clinical setting is being assigned to teach nursing students there. From a legal perspective, you are supervising students and their actions may fall as your responsibility, would you feel safe with that knowing that your license is on the line? Could you ask to be reassigned to L&D rotations?
2. 

   International Nursing program

   juan de la cruz replied to queenDi's topic in Philippines

   I read about their partnership with Alderson Broaddus University (ABU) in West Virginia. The student gets admitted to the program based on ABU's admission requirements, takes the first 3 years of BSN at Arellano in Manila using ABU's curriculum, and then takes the final year of BSN at ABU. The claim is that you graduate with an ABU diploma and can sit for the US NCLEX-RN as a graduate of a US accredited program. Seems like a good idea for US citizens who want to study in the Philippines. I would email ABU's admissions directly and ask about the program and/or connect you to alumni. https://ab.edu/academics/nursing/ - scroll down for the AU-ABU program
3. 

   Holding diuretics, beta-blockers, and nitrate when there are no parameters

   juan de la cruz replied to JJBookman's topic in General Nursing

   @JKL33, agreed. There are nuances to the OP's concern. The setting is a SNF where patients are technically stable enough that they are no longer in an acute care setting but not quite stable to be completely independent at home. The question of do you just hold the medication and chart it on the MAR as such? For a patient with symptomatic hypotension or a 20 point drop in SBP with dizziness? yes, hold the medication and make sure the provider knows about it...that's a status change that warrants further investigation and conversation with a provider. I have remote SNF experience and in some of these places, residents are only seen by providers once a week. You don't always want to wait that long for a provider to notice that meds are being held.
4. 

   Holding diuretics, beta-blockers, and nitrate when there are no parameters

   juan de la cruz replied to JJBookman's topic in General Nursing

   OP, you're in a tough situation and your concern is legitimate. Unfortunately, I think a lot of staff education must happen in your setting. Typically, the residents in your SNF has had at least a 3-day acute care hospital stay where hopefully the medication list for each particular resident were fine tuned and reviewed by a provider in the hospital prior to discharge so that there shouldn't be any reason to hold the medications because they are prescribed at maintenance dosing just like what would happen if the resident was at home recuperating. That said, your patients are in a nurse-monitored setting in terms of vital signs and clinical assessments so it is reasonable for a nurse to question whether to give a medication or not based on assessment findings. That, however, should be communicated to a provider not because the nurse has no independent judgement skill but because the legal scope for acting on whether meds must continue rests on providers not nurses. You're right to say that not all "BP lowering meds" are purely used for BP control. That is where speaking to the provider will help to clarify indications. For medication safety and to advance the quality of care of our elderly in SNF's, I'd say this is a serious issue in your institution and you might want to discuss it with whoever is in charge of staff development or even the DON.
5. 

   Resigning from first NP job...

   juan de la cruz replied to amahucka's topic in Advanced

   Without a contract stating how many weeks notice you give prior to resignation, I would play it in a way that you don't compromise the relationship with this employer by leaving in good terms. You will almost always need some form of recommendation from this employer in the future. To me, a good way to start is to sit down with the manager and state your situation. Given that you are furloughed (and some others), they may not need more than 2 weeks of notice. Pre-COVID, it typically takes a long time to fill an empty provider position and what you don't want happening is cause ill-will with the providers you are leaving behind to take over your patients or workload. That is certainly not the case here.
6. 

   Hospital requiring personal cell phones for patient care

   juan de la cruz replied to krekear's topic in General Nursing

   There are smartphone apps used in healthcare to communicate between clinical staff and providers that are HIPAA-compliant. Our hospital uses Voalte Me which is one example of these apps. However, in our hospital nursing staff are provided older iPhone 6 smartphones that they carry during their shift that have the app pre-loaded. None of the nursing staff (or RT, Pharmacy, PT/OT/SLP) use their own personal smartphones for this. It's a different case for us providers however, some providers are fine using their own smartphone and have the app downloaded on their personal device.
7. 

   Should I Leave?! Help!

   juan de la cruz replied to sunflower28's topic in NP

   I agree but the fact that the ER docs know that there aren't any providers managing the patients on the floor and per your quote, their response ends with "...don't wake me up again" tells me that they don't see serious patient problems being ignored a big deal which is bothersome. But who knows, there might have been a prior history of the ER guys complaining about this very situation to the administrators and nothing was done to address it, hence, their apathy. Either way, it's not a great place to be.
8. 

   Should I Leave?! Help!

   juan de la cruz replied to sunflower28's topic in NP

   #3 would be a deal-breaker for me. That is a clear example of patients being put at risk for harm by providers who are just plain lazy. I would hate to be part of an organization where something like that is the norm and nobody is addressing it. I think it's time to look at other options.
9. 

   NP's how are you these days?

   juan de la cruz replied to juan de la cruz's topic in NP

   That word has been thrown around here as well. As a Critical Care NP, I am obviously essential staff. However, we've had NP's working in other departments volunteer to be cross trained in our department in case we have a surge. Our area fortunately have been spared the surge so far (comparative to other parts of the state and NY, MI, and LA for instance). We've also had CRNA's wanting to help out in the ICU.
10. 

    NP's how are you these days?

    juan de la cruz replied to juan de la cruz's topic in NP

    Shady! bet they are going to stockpile and sell them in the black market. Just kidding.
11. 

    Transferring NP license to California

    juan de la cruz replied to kgrl's topic in NP

    You can apply for both RN and NP license together. You also need an NP Furnishing License (for prescribing) and that can also be sent together with the other two. Leave the space thats asks for a CA RN license blank.
12. 

    NP's how are you these days?

    juan de la cruz replied to juan de la cruz's topic in NP

    Yeah, testing has been challenging even in acute care. It's getting better though and being ramped up at least. Our PUI cases fluctuate between 30-40 a day at first but is actually mellowing down a bit surprisingly. I think the faster turn-around in getting results is responsible for that. ICU cases are relatively low, I'll tell you that. It's affecting hiring though...interviews are being rescheduled, some NP students are getting cancelled in some of the clinical placements.
13. 

    NP's how are you these days?

    juan de la cruz posted a topic in NP

    Just checking in to see how everyone is doing in the NP world amidst this COVID19 pandemic. We in Acute/Critical Care for sure are on high alert...mandated work hours if a surge happens. We've had patients with the disease of course but not to the point of shortages of supplies, equipment or healthcare worker fatigue. The daily emails and updates can be overwhelming though. I'm sure those in primary care are inundated with requests for testing.
14. 

    SURVEY: Nurses, Are You Prepared for an Encounter with COVID-19?

    juan de la cruz replied to tnbutterfly - Mary's topic in Disasters

    I agree...I can't even begin to tell you the public health issue this can bring. Poverty and lack of access has always been independent predictors of poor health outcomes and we will see this with COVID-19.
15. 

    SURVEY: Nurses, Are You Prepared for an Encounter with COVID-19?

    juan de la cruz replied to tnbutterfly - Mary's topic in Disasters

    I think the public should be aware of the symptoms but I also think healthcare workers should be able to screen. I don't think it's necessarily wrong for the public to seek care if they're worried. That's what we're here for, to screen and test if we have a suspicion. There have been admissions for severe ICU cases where the individual did not seek care for 2 weeks and God knows who else they exposed.
16. 

    Applying for a PMHNP license in California

    juan de la cruz replied to PsychRN_CA's topic in Advanced

    From my understanding, the Psychiatric/Mental Health Nurse certification in California is a voluntary program. That tells me it's not a requirement for practice. To practice as a Nurse Practitioner in California, you must have an active RN, NP, and NPF (to prescribe). Since you're already an RN here, you only need to apply for NP and NPF which you can do as soon as your school releases your transcript if you went to a California-approved NP program in-state. Grads of those programs are not required to pass ANCC. It is recommended that you also take the ANCC exam so that if in future, it is required by the state or an employer, you already have it.