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juan de la cruz MSN, RN, NP

APRN, Adult Critical Care
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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


juan de la cruz's Latest Activity

  1. juan de la cruz


    Could it be that you were set up for failure having attended an FNP program and made to work in an "intensive inpatient provider role" with inadequate mentoring? Did you have in-patient rotations in your program? If not, it's definitely not ideal to start learning the in-patient provider role as you go without a mentor. Can you be more upfront and emphasize your deficiencies to your superiors so that they could address it appropriately?
  2. juan de la cruz

    Stepdown or PACU for pre-ACNP school experience

    Well, just based on the hospital where I work, I have a bias against PACU because although that area is considered "critical care", I feel like a lot of critical care really happens in the ICU. PACU nurses are good at managing post-anesthesia complications or recovery, if you will, in patients who are slated to transfer to non-ICU settings after surgery They are good at monitoring airway, managing pain, and post-op nausea. They may titrate a vasopressor or see a freshly extubated patient who is still quite drowsy but these are consequences of the patient's anesthesia rather than a true multi-organ dysfunction that is managed in the ICU. Step down, to me, will offer you a more well rounded idea of how non-ICU patient's are managed on a day to day basis. You may actually interact with Hospitalists in this setting and have a better sense of their thought process in managing their patients. It might be tough though since you're only going to pick up Per Diem hours. It is also a busier unit and depending on where you work, some step-down patients in certain hospitals are considered ICU patients in another.
  3. juan de la cruz

    A friend bought her degree from the Philippines.

    As already mentioned, foreign educated nurses typically have more hoops to jump in gaining US licensure. If she's applying for a Florida license, her education must be evaluated by a third party entity such as CGFNS before getting her ATT. These companies know how to comb through fraudulent degrees. The California cases other posters alluded to occurred because California does not rely on those third party credentials evaluation services and was in effect "double crossed" by a minority of applicants, not in a grand scale as it might have been publicized.
  4. juan de la cruz

    NP job wants my Medicare number, but I have only worked as RN.

    For an NP, there is a separate application for a Medicare number that the hiring organization should be doing for you in the first place since you just graduated. It is tied to your NPI number but the paper form must be signed by you and sent by the sponsoring organization to CMS. RN's don't bill Medicare and don't have a Medicare number. ETA: I guess there is an online application as well: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/downloads/Suppliers.pdf
  5. juan de la cruz

    What do you call a SICU NP? ICU/Critical Care/Surgical NP?

    As already mentioned, this is going to vary based on the specific hospital. Typically, NP's who are hired in by a surgical subspecialty will be asked to function within the spectrum of settings the surgeon sees his or her patients - that can include seeing preop patients in the clinic, assisting in the surgery itself (for some), following up on the patient in the PACU or SICU, all the way to transfer to floor, discharge, and clinic follow-up. That would be an ideal role but again there would variations in that pattern. You may be referred to as the NP for General Surgery or Colorectal Surgery or Hepato-biliary Surgery, etc depending on the subspecialty you work under. SICU's are not all the same. In Trauma Centers, you may see a great deal of traumas on top of the bread and butter ACS (Acute Care Surgery) patients who had abdominal surgeries. In hospitals with a high cancer population, you will see Gyn-Onc, Surg-Onc, ENT cases in the SICU. Transplant centers have post solid organ transplants in their SICU's (mainly livers). The SICU is typically the purview of the intensivist and in many places that intensivist is not always a surgeon (in ours, they are a combo of surgeons and anesthesiologists with Critical Care training). The NP's who work with these physicians only work in the SICU and are mostly referred to as Critical Care NP's.
  6. juan de la cruz

    It's Driving Me Crazy

    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.
  7. juan de la cruz

    Medication order correct or no

    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.
  8. juan de la cruz

    International Graduate BSN-DNP question?

    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).
  9. juan de la cruz

    Anyone attend Drexel University from California?

    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.
  10. juan de la cruz

    Adv. Health Assessment

    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.
  11. juan de la cruz

    Two jobs, one has to go

    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.
  12. 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!

  13. juan de la cruz

    Question about NP License transfer to CA

    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?
  14. juan de la cruz

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

    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.
  15. 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.
  16. 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.