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juan de la cruz MSN, RN, NP

APRN, Adult Critical Care, General Cardiology
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juan de la cruz has 29 years experience as a MSN, RN, NP and specializes in APRN, Adult Critical Care, General Cardiology.

BSN, 1991

MSN/ACNP, 2003

CCRN-CSC

juan de la cruz's Latest Activity

  1. juan de la cruz

    Acute Care NPs in California, NEED ADVICE.

    If California BRN told you they have no preference, then neither does ANCC or AACN. It's ultimately up to your school (some even allow MD or DO as preceptor). I am precepting a student from an out-of-state institution in the Fall and was given a specific California BRN form to fill out that was asking for my experience, my credentials, and years service within the practice.
  2. juan de la cruz

    My Instructor Used To Be My Nurse

    Derogatory and mental illness in my mind should always be mutually exclusive. There is a professional way to present a case of mental illness in a classroom without interjecting your own personal bias about it. What I got from what the OP was saying was the instructor did not follow that. Regardless of whether that person is the student or not doesn't make it right. In my job, I take care of a lot of people who have made the wrong choices in their life by their unhealthy habits that brought upon their disease and medical conditions. There is a way to discuss those risks the patients took to harm their health as a teaching point without interjecting my own judgement of the person who did them.
  3. juan de la cruz

    We Must Demolish NP Diploma Mills

    Not to nitpick but the original post said, no "for profit MD program" exists and the link your provided is a DO program. In effect, the original statement is true as there has been no for-profit MD program yet in existence. There has been other for-profit DO programs that have started out with Rocky Vista University in CO being the first when it opened in 2007.
  4. juan de la cruz

    FNP working in Nursing Administration

    I will go against the grain here and say that you should ask yourself what you really want out of your career. As it stands, ANCC will allow you to renew your FNP-BC without practice hours since they simplified their criteria and made practice hours part of the renewal categories. You can actually do CEU's + academic courses, lectures/presentations, etc. and still be eligible. That said, you will likely never ever find a position as an NP unless you actually maintain some clinical practice. Plenty of people in your situation in nursing management have decided that clinical practice is not their thing even if they were trained as NP's and they are just as happy with that.
  5. juan de la cruz

    CA BON- I need some help

    California has very specific educational requirements for pre-licensure/RN education. Many US-educated nurses from other states and international-educated nurses have been told of deficiencies in their nursing program in the past and have been denied RN licensure until the deficiencies are rectified. Did you take any social science undergrad course other than Psychology that can meet the requirement? You may need assistance from your school of nursing to justify or vouch for you that you did have the required courses.
  6. juan de la cruz

    New NP needing advice

    I only work in-patient and Neurology is one of the departments where I see providers still wear lab coats (most others wear sweater/jackets with embroidered logos for their specialty). You could potentially wear the sweater/jackets as some of them do look professional and have large pockets (some brands are actually expensive!). Some of the female Neurology residents walk around with a small version of a messenger bag that contains all their assessment tools. Fanny packs are an option but I personally think they aren't attractive.
  7. juan de la cruz

    Anybody regret going to Kaiser?

    I'm in NorCal too but work as an NP so take my "observation" with a grain of salt. I work full time at an academic medical center and was working per diem at a Kaiser facility. The nurses seem happier in the academic medical center and has more support from management. There is less of nurses having to "stand their ground" in terms of being dumped on with unfair workload. Less "policing" of nurses' independent actions based on their own judgements. More of nurses being part of the decisions that impact patient care. Both are unionized and the pay is very similar actually.
  8. juan de la cruz

    CCRN Audit Anxiety

    I think you'll be fine. I have been audited before by AACN (for my CCRN) and was able to send in all the CERP categories at the last minute. I am active with AACN so audits are random (I have been part of committee with NTI, joined task force for writing of standards of practice, and have volunteered as a test item writer). I find that the best way to keep up with CEU's is to maintain AACN membership and take advantage of their educational offerings online.
  9. juan de la cruz

    First job as a new AGACNP

    I can speak to your questions since I actually worked in PM&R the first year after graduating from an ACNP program. I enjoyed the interview process with the group and the role involved in-patient management (in a free standing acute rehab hospital) and consults in an acute care hospital. I thought what a great group of people and how nice it would be to have a chill specialty that is still hospital-based. Anyway, one year in and I was super bored. The patients were stable medically but when they start to show an indication of instability, they oftentimes no longer qualify for continuation of their rehab plan and are transferred back to the acute care hospital for evaluation. There were plans to transition us to spend time in the out-patient clinic doing pain injections but it wasn't something I was interested in. In the end of that year, I talked to the PM&R chief and was honest to him about how I was wanting a more acute care related specialty and luckily one of my classmates who worked as an ICU NP told me about a position that has opened and I left PM&R to join that team. If I had stayed in PM&R longer, I may not have had that chance.
  10. juan de la cruz

    APRN Education

    Is this a school project? LOL. Well, the historical beginnings of both professions took different turns through the years to what it is now, hence, the structure and training is different. PA's started at Duke in 1965 when a physician there conceived a role that would fill the gap between a physician and a nurse. The PA's of the time were male and were ex-military corpsman who already had some form of advanced medical training. There was a nursing shortage then and the sentiment was that the new role should not take away from the current pool of nurses at the time. NP's started around the same time in 1965 when Loretta Ford, a nurse, and Dr. Silver started a program at the University of Colorado to train nurses for the primary care provider role in pediatrics in underserved urban areas and rural communities. Few years after that, another Peds NP Program began at Boston College. The NP concept kind of already started as a specialty-based training from the beginning. Family NP programs didn't start until the 1970's. ACNP programs became an offshoot of the Adult CNS role and the first ACNP programs came later in the early 1990's. Not sure about PMHNP's and the others but overall, the NP specialties are rather newer. There are pros and cons to generalist training that PA's have that NP's don't. I think this is something that will be an astronomical task to even change much less have a conversation about. I personally am satisfied with the specialized nature that NP's offer but it does need a bit of tweaking to meet real world situations.
  11. juan de la cruz

    We Must Demolish NP Diploma Mills

    I went to a state university. It has a medical school (MD), a Pharm D program, degrees in rehabilitation sciences (PT, OT, SLP), CRNA, CNM, all NP tracks including NNP and PNP-AC, and believe it or not, PA as well. It is surrounded by a medical center campus including a stand-alone children's hospital. There is no difficulty finding preceptors and the school arranges them. Though not a lot of people have heard of it, it does figure well in the upper 25% of programs in the US News rankings not only in the nursing category but also in Medicine. I stayed in the area after graduation and roughly 60% of physicians in the area trained there whether in their MD program or residency/fellowship. That helped me get a network of healthcare professionals recognizing where I attended school. After 5 years, I moved many miles across the opposite coast. I think it was my experience and skills that sold my employers to hire me, not necessarily my education anymore.
  12. juan de la cruz

    We Must Demolish NP Diploma Mills

    I'm somewhat familiar with those schools as a California resident. Sonoma State is part of the Cal State U system. They offer just an FNP program which makes sense given that Sonoma County is considered rural. The program is highly web-based and they don't guarantee preceptors though they will assist in making calls. I think the issuse with web-based or online programs is that some students enrolled can be outside a geographical radius where the school has a network of preceptors. Samuel Merritt started out as a Diploma Nursing school and grew into a private institution affiliated with Summit/Alta Bates Medical Center in Oakland, CA. They have multiple campuses now and offer various health-related programs (RN, NP, PA, PT, Podiatry). I've heard better reviews of their PA program over the NP Program. It is also quite expensive to attend there. It's not lumped in the "for-profit" category in the sense that those schools are defined as "corporation-owned" by a parent entity such as how Walden, Phoenix are structured. However, there are similarities in their recruiting and operational goals.
  13. juan de la cruz

    We Must Demolish NP Diploma Mills

    AANP doesn't have control of the operation of NP programs just as AMA has nothing to do with the accreditation of medical schools. The responsibility for accreditation of all types of nursing degrees including NP programs lies under the American Association of Colleges of Nursing (AACN) with their Commission on Collegiate Nursing Education (CCNE) arm. I do feel like CCNE should not be solely accrediting NP programs because of their larger involvement in all the other nursing degree programs at the college/university level making it seem that they are not focused on the distinct issues and needs of NP education. For CRNA's and CNM's, their leadership don't rely on CCNE accreditation alone. They have COACRNA and ACME respectively that also make sure that educational standards are maintained. I wish we NP's have our own accrediting body for our programs. I feel that this will solve our problems with substandard programs. https://www.aacnnursing.org/CCNE https://www.coacrna.org/ https://www.midwife.org/Accreditation
  14. juan de la cruz

    Four 12s in a row?!?! 😭😭

    Could you try to switch with someone? We work 3 12's a week as well (as NP's) and though I like the consistency of having the same ICU patients in a row, I feel like a 4th 12hr shift in a row would be too much unless I asked for it. No way I would do that on a night shift either but luckily I don't do nights anymore.
  15. juan de la cruz

    ICU nurse to Acute NP

    You can even take the test after you get your ACNP if you really want the credential. In the ICU NP group I worked with, not everyone has CCRN or kept their CCRN certification once they started working as NP's. I see no point in having it if you end up working in Cardiology for instance. I keep my CCRN-CSC since I'm active with AACN and have been on NTI and test question writing committees in the past.
  16. juan de la cruz

    Can you have multiple MSN degrees?

    The Master of Science in Nursing is a degree offered in nursing schools and that is taken once regardless of the specialty focus (NP, administration, education, etc.). You would take a post-Master's certificate to add another specialty focus that is nursing related. However, you could add another Master's degree in another field if you wish such as MPH or MHSA or MBA. Those are degrees that are not exclusive to nursing. Some CRNA programs are not offered as MSN, perhaps in those you will obtain another Master's degree once you finish.