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juan de la cruz MSN, RN, NP

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

BSN, 1991

MSN/ACNP, 2003

CCRN-CSC

juan de la cruz's Latest Activity

  1. juan de la cruz

    It's Driving Me Crazy

    juan de la cruz replied to AlmostThere19's topic in Nurses

    Well, when I was a bedside nurse the assignments are usually up 30 mins before shift change and this was Med-Surg, ER, and ICU. When I was starting out, I would come early, get my assignment and try to get report from the nurse early. After giving me report, that nurse can hang around and finish some of the left over work but I can start looking up my patient's data. These were hospitals where we never punched in and out and hours are based on an honor system.
  2. juan de la cruz

    Medication order correct or no

    juan de la cruz replied to Mqnurse13's topic in Nurses

    That medication may not be available as either a 500 mg or 1000 mg tablet. There are missing elements in that prescription though. The rule for prescription writing (which still applies with current EMR systems) should read: Drug Name 500 mg tablet, take 2 tablets by mouth twice a day. or Drug Name 250 mg tablet, take 2 tablets by mouth twice a day. Those specifics should appear in medication bottles the Pharmacy prints out.
  3. juan de la cruz

    International Graduate BSN-DNP question?

    juan de la cruz replied to Gill88's topic in Nurses

    Different universities have different requirements for graduates of a BSN in another country. I wouldn't give up just because one university said no. Be aware that not all universities with a DNP program offer a BSN to DNP yet as some are offering the DNP degree as a post-Master's option only. That said, your pool of university options is going to be smaller knowing that there are schools that do not accept students in the BSN to DNP program whose BSN was obtained outside the US. Where in the US are you? for instance both Columbia and NYU do not specifically state in their admission requirements that the BSN must be obtained in a program that is CCNE or ACEN accredited. I suggest you call each individual schools so that you know what their specific requirements are. I've seen a range of requirements for international grads from having any of the third party credentials evaluation services confirm that your BSN is equivalent to having you also pass an English exam (such as TOEFL). You are not considered an International Student since you are a US citizen and will not require a Student Visa to enroll. However, you are classified as an Internationally Educated Nurse (IEN).
  4. juan de la cruz

    Anyone attend Drexel University from California?

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

    I'm not a Drexel grad but California does not really have restrictions for NP certification if you graduated from an out-of-state program online or not. Out-of-state grads must pass a national certification exam (ANCC or AANP) in order to be certified as an NP while those who attended a California-approved NP program in-state do not. To be absolutely sure, you can call the BRN.
  5. juan de la cruz

    Adv. Health Assessment

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

    It depends on the program and the school itself. I did an on-campus program back when ANP and ACNP programs existed (they're now AGNP and AGACNP). The ANP and ACNP students attended the same Advanced Health Assessment didactic sessions and simulation lab together. However, for us ACNP students, we had a separate in-patient clinical rotation of 80 hours doing H&P's with a preceptor which the ANP students were not required to do by their program.
  6. juan de la cruz

    Two jobs, one has to go

    juan de la cruz replied to aerorunner80's topic in NP

    As someone who pretty much always had a side gig as a breadwinner, I can relate to the "tiredness" you feel right now. However, I always make it a point that any side gig I accept is not more stressful than my full time job. I have done mostly similar specialty (Critical Care) as a Per Diem NP on top of my full time Critical Care NP job but they are in mostly smaller community settings with less acuity and less stress in a more manageable schedule (i.e., no shift rotation). I currently do a really easy Interventional Cardiology side gig that is chill (H&P's, pt teaching, admission orders, Med Recs, discharges or transfer back to referring service, no cath lab or EP lab involvement). I have no problem with 12 hour shifts and commuting (I will take public transportation if feasible and use that time to relax). That's my secret to staying sane in my world where I like the ability to add an extra source of income. I would not stay in that crappy UC job if I were you but I also don't know the rest of your circumstances.
  7. jessieCCRN

    hi juan! I saw your comment years ago about AV epicardial Pacing wires. I wonder what if there are only one AV wires? I'm hoping you could teach me how to use it after CABG. Thank you!

    1. juan de la cruz

      juan de la cruz, MSN, RN, NP

      this would summarize it better: https://www.ctsnet.org/article/ctsnet-step-step-series-pacing-wires

  8. juan de la cruz

    Question about NP License transfer to CA

    juan de la cruz replied to jdarby2's topic in NP

    I did that over 10 years ago and there are other posters who endorsed more recently in other threads who are saying that you could send the RN, NP, and NPF applications all at once. Does the online application allow you to proceed if you leave the CA RN license answer blank?
  9. juan de la cruz

    Best States for RN's and NP's both in terms of pay and practice?

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

    It doesn't include differential. That's base pay. Travelers would get cancelled first before regular staff in any hospital in Northern California but I can see how Kaiser would play aggressive about it given that their regular nurses have strong CNA representation.
  10. juan de la cruz
    See, I don't think RV is not consciously aware that her acts could put her patient in harms way. I think what happened is that her "inner voice" signal didn't fire effectively and tell her to stop in her tracks and say to herself she should check the name on the vial since it seemed odd that she shouldn't have to reconstitute midazolam. She was performing "at risk" behaviors and ignoring the "inner voice" to tell her to take a pause. Any nurse knows that you have to check the 5 rights and any nurse knows that when you are giving a medication intended for an immediate response (such as whether anxiety was relieved in Charlene's case), you hang around assess. She willfully ignored those voices and now Charlene is dead. She displayed multiple "at risk" behaviors which were the only elements required for a criminal charge of Reckless Homicide in Tennessee. I certainly don't need to have the last word on this but I have firmly believed this after looking at all angles and removing my own emotional reaction to the case. You certainly can have your opinion.
  11. juan de la cruz
    I'm looking at it from two ends of vastly different approaches. Yes, safety improvements are necessary and we must continue to strive to make healthcare as safe as humanly possible. I advocate for them in my practice all the time and fortunately for my practice, as long as there is not a true emergency situation, I take my time and not take shortcuts. I'm also fortunate that my environment doesn't interfere with that. We once admitted a patient from another hospital where a nocturnal intensivist inadvertently placed a central venous catheter to the patient's common carotid artery instead of the internal jugular vein. From his note, it said he used ultrasound guidance. However, he missed an important next step...either the fluid column test or guidewire visualization. He may have visualized the needle enter through the jugular but made the mistake of going through and through that vessel and hitting the artery lying just beneath the vein. Just missing that important next step could have saved him from making the error. Unfortunately, the safety community is only one part. There is the law enforcement and judicial system that exist alongside as well. They're not always at odds with the safety community but RV's sentinel event is so full of egregious omissions that I can't blame the TBI, subsequent DA charges, the gran jury deliberations, and the upcoming criminal trial from happening. Oh I'm aware of that. I'm just saying (and I think you agree), that a mistake this monumental is not something easily hidden. However, I am going as far as to not give RV credit for reporting it.
  12. juan de la cruz
    This should be the focus of error prevention and safety...getting to the bottom of why nurses make short cuts and set themselves up for risks of harm to their patients. That shouldn't be a pipe dream.
  13. juan de la cruz
    I agree with your statement. My question was to open the discussion up for my opinion that an error of this magnitude is not something that can be easily hidden. Even if the primary nurse did not discover the vial and RV disposed of it, there is still a way to trace her name to the vial of vecuronium from the ADC override. Errors of this magnitude are not underreported is what I'm trying to drive at but that's an opinion...not based on actual data.
  14. juan de la cruz
    Well, that ISMP article is an opinion piece...a Position Statement. All posters here in this thread are also giving their own opinions including you and I. Since you asked, I have a few opinions on that ISMP piece based on their bullet points in numeric order: 1. Describing RV as "well-liked, respected, and competent" is not only an assumption...it's almost a "a stretch" if you will to call her that. Using emotionally charged language takes away from to the overall objectivity of the case and the impartiality we are seeking from a jury who would decide her fate. 2. I understand a statement saying that ISMP does not believe that criminal charges are justified in nursing errors. I initially struggled with the same opinion myself. But this case stand out to me and focusing on the ADC override alone totally misses the point because a series of omissions made by RV directly caused the unjust and senseless death of a human being. How egregious does a series of acts have to be for us to say we should console the nurse who made the error? 3. Yes I agree that criminal action will not result in improved patient safety. Let me ask you this? Did RV voluntarily report her med error or was she forced to report it because she was caught? Remember that the primary nurse found the vial of vecuronium, not RV. 4. I totally agree that leaders should be accountable for safe system design. Something Vanderbilt should have had in place. 5. I already stated an opinion on severity bias in a previous post.
  15. juan de la cruz
    It was kind of a weak example on my part I have to say. But again, if you think about it, there aren't a lot of other details in my example and it's not completely inconceivable. An Uber driver hit a child and caused death in the busy streets of San Francisco a few years ago...driving a little over the speed limit. Many years back, a tech executive riding his bicycle downhill ignored a stop sign (as many bicyclers do in the city does) and hit an elderly man killing him. These are accidents that can happen when we minimize the role safety precautions have in preventing them. The courts in Tennessee agreed (via a grand jury) that RV deserve a trial to disprove the charges. I can not disagree with that decision as it's based on how the law is written in that jurisdiction.
  16. juan de la cruz
    I agree about how speed is incentivized and praised as an asset. Perhaps that was RV's downfall. Given that she even had a new nurse she was training, was she modeling her self notion of speed and "efficiency" while at the same time risking accuracy and safety? Unfortunately all these conjectures does not take from the fact that RV did a series of unsafe actions on her own volition that led to the death a human being.
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