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juan de la cruz MSN, RN, NP

allnurses.com Guide

Adult Critical Care Nurse Practitioner


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  1. juan de la cruz

    Nurse Charged With Homicide

    I believe she was terminated after maybe a few days. I still don’t know how she found employment right away unless her references didn’t mention the case.
  2. juan de la cruz

    Nurse Charged With Homicide

    Has anyone checked their Epic? Ours doesn’t even allow ordering any medication as stat or now. The only option is for: drug name 1 mg IV once.
  3. juan de la cruz

    Nurse Charged With Homicide

    And that's the unfortunate reality of this tragedy. I fortunately work for an institution that don't have vecuronium or pancuronium on the formulary. We use rocuronium for intubation, cisatracurium for NMB bolus and drip. If I type VE to order a medication on Epic, all that shows up are VErsed and ProVEntil and that's searching for both generic and brand. I don't know how familiar RV is with vecuronium as a relatively new nurse. Did she think that was Versed under another name? (I know stupid!), was that a particular Pyxis she's never used before because all along she's been overriding Versed and not getting "vec" because "vec" is only stored in a dedicated Pyxis? It doesn't excuse her blatant disregard for safety but it illustrates how easy it is for a distracted and inattentive albeit careless nurse to make that error.
  4. juan de la cruz

    I Hope This is Not the Latest Trend

    TFor me, the bigger picture is the systemic failure of how we provide care to our vulnerable elderly citizens in our long term care system. Unlike many wealthy countries, our system is rigged with unequal care due in part to socio-economic, income and insurance disparities, poor government funding, poor staffing, bureaucracy, and a prevalence of for profit facilities whose CEO's take advantage of the system. Long term care facility patients have one of the highest level of care burden from nursing staff. That's the reason why they are there because either their families are no longer able to provide that care or there are no longer any family members present. In the US, people with financial means can pick the best and most highly rated nursing facility for their loved ones. Those who qualify for Medicaid (which basically means all your liquid assets have been reduced to zero, hence, you qualify), have very little option but to leave their loved ones to places such as the one mentioned in the suit with low standards of care and chronically high staff turn over if they can even retain staff. If you look at their state inspection reports, they have been receiving failing scores for years. It's easy for a nurse like some of us with options for other areas of employment to run away from these places, work in another field, etc. But that doesn't take away the fact that these long term care residents need care. If we all do that, yes, these places will be left with people with past criminal offenses, uncaring and untrustworthy individuals, you get the idea. That's how come a woman who can't even speak for her own rights can get raped and carry a pregnancy unnoticed in these settings. https://projects.propublica.org/nursing-homes/homes/h-365272 https://www.medicare.gov/nursinghomecompare/profile.html#profTab=0&ID=365272 https://assets.aarp.org/rgcenter/il/2007_19_usgerman_ltc.pdf https://www.med.uio.no/helsam/forskning/nettverk/hero/publikasjoner/skriftserie/2010/2010_2.pdf
  5. juan de la cruz

    How Much Should a Collaborating Physician Be Paid?

    Thanks for the article, Karen. I'm not in a position where I would practice independently and hire a physician to meet collaboration requirements. It seems like the "summary" is that whatever the hourly market rate for a physician in the same specialty multiplied by the actual number of hours spent on collaborative activities (phone calls, chart review, etc.) is the rule. I think this is a great moonlighting gig for physicians.
  6. juan de la cruz

    Nurse Charged With Homicide

    The variability in quality of care I do agree on. Maybe what was meant was that there are strong union protections in many hospitals. For instance, nurses can fill out an "Assignment Despite Objection" form as a way to tell the manager that "yes, I'm not going to abandon my patients but you're putting me in an unsafe situation and you can be held liable if something were to happen".
  7. juan de la cruz

    Nurses Call the Governor of Tennessee

    Haha, thanks @mtmkjr, I think I've already said everything. I didn't post most of yesterday because it was Valentine's Day. Also, I have only been posting in the General Nursing forum more recently even though I've been a long time member.
  8. juan de la cruz

    What would you do

    Who orders insulin 50 units to be infused in 10 hours? no titration whatsoever based on glucose levels? it's on you if you even follow that order.
  9. juan de la cruz

    It’s that most wonderful time of the year (catching everything)

    I wash my hands frequently, avoid touching my face, put on a mask if I'm worried about a patient with a URI, disinfect the phones I get after sign out...it has worked so far...but this is more prevention than cure I guess.
  10. On the Bay Area Rapid Transit train to San Francisco and saw a guy wearing a red Make America Great Again hat written in Russian...irony?  maybe just a lot of balls, lol.

  11. I’d add, I guess, to determine early on which of the nurses on the unit inspire you for their knowledge, expertise, work ethic, and allow yourself to be mentored by them by seeking their input especially when faced with challenging situations.
  12. juan de la cruz

    Nurses Call the Governor of Tennessee

    And I do agree because my initial instinct was why is she back at work so soon at another hospital...no second victim syndrome here?
  13. juan de la cruz

    Nurses Call the Governor of Tennessee

    Sorry but I was referred to as a "she". Seriously, I'm sorry if I offended anyone. Perhaps I should go away.
  14. juan de la cruz

    Nurses Call the Governor of Tennessee

    That's just a term used to describe the after-effects of a serious medical error (including medication errors) on the healthcare provider involved. It is well studied and some of these providers do go through traumatic feelings, guilt, depression, etc. That does not minimize the loss that the family of Nurse RV's victim is experiencing.
  15. juan de la cruz

    Nurses Call the Governor of Tennessee

    Stop with the binary pronouns, lol.