tmaca

But apparently some places are still operating in the 1980s. You don't even need a VPN. They could just create the pay statements in PDF format and email them to everybody.

Y'know, last job references, if the person is still working there, can be weird. I remember when I was working for the feds, and everything was civil service. A lot of the time budgets were nasty and you could have a hard time hiring a replacement immediately; the CPO used to like to delay things so they'd save some salary while the position stayed open. So all too often a supervisor would give at best a wishy-washy reference for an employee they didn't want to lose, but give a glowing one for some jerk they wanted to get rid of. So you really had to rely on your interviewing skills more than anything else.

Yes, I was talking to the OP, but all businesses of any kind have access to the internet nowadays, as do all employees, and paystubs (more accurately pay statements if you don't receive a paper check) can easily be sent in PDF form. I do know a lot of places don't do it for no better reason than not wanting to change, even though it'd save them money. And I suppose some state or other might have some law forbidding it, but I haven't actually heard of one yet. Try making a suggestion. Of course, many facilities, of all sizes, outsource their payrolls nowadays, so it might not be up to the hospital, care facility, whatever.

Don't quit without notice, it could bite you in the butt later in your career. Actually, I think you ought to start looking for a new job. You might try to get prospective employers to agree not to call your current workplace unless they've really decided they want to hire you, pending that call. Or maybe your current employer finding out you're job hunting might get them to make some changes. Sounds kinda like they're short on people. You'd probably have a better read than anyone here as to how they'd likely react. And by ther way, is your HR still in the dark ages? Why can't they just email your paystubs?

Don't quit without notice, it could bite you in the butt later in your career. Actually, I think you ought to start looking for a new job. You might try to get prospective employers to agree not to call your current workplace unless they've really decided they want to hire you, pending that call. Or maybe your current employer finding out you're job hunting might get them to make some changes. You'd probably have a decent read on how they'd likely react. And by ther way, is your HR still in the dark ages? Why can't they just email your paystubs?

What I'd do is check requirements. Does your state require a DR's order for OTCs for LTC residents? Does your facility have a written policy, like maybe "no meds administered without a DRs order"? If there's a rule, state or facility, that requires a DR's sign off for OTCs, every time someone administers one without the actual order, relying on a signature from someone later on, he or she is sticking his or her neck out. The sad reality is that shortcuts being SOP at LTC facilities is more the norm than the exception anymore. It seems like the lowest person on the totem pole is always the one who's asked, whether explicitly or in a "this is how we do it" way, to take chances for the convenience of the more "important" staff, often in ways that leave the DRs and the facility and even the RNs in the clear if anything goes wrong. But if you're a CNA or LPN or such and you make a stink about rule breaking, well, you're a dime a dozen and you better be good at job hunting.

Uh, not exactly. It's kind of confusing, really. Yes, heplock is kind of an old term, from when a patient got a semi-permanent IV which wasn't going to have fluid running through it most of the time. For example, if the patient is a difficult stick, for any of a number of possible reasons, but it is known that he will need to have blood drawn or IV meds administered (without a drip) several times in the near future. Or he might get one prior to general anesthitic if it's going to be difficult for the normal person who does it to get an IV in. Or even if he's just going to need meds administered by IV several times over a few days, but is not going to be hooked up to a regular saline drip for some reason. There are lots of reasons for them. All this assumes, of course, that he doesn't meet the criteria for getting a port or a central line. In fact, I've heard a couple people call them junior grade ports. Which, of course, they aren't. But they do serve a similar purpose, just for a shorter period of time. The terminology is the only problem, if you want to call it a problem. As mentioned in other responses, most of the time nowadays (except sometimes in peds) they get flushed with normal saline. However, sometimes heparin is still used. Instiitutions usually have a policy regarding dwell time, often 72 hours for a heplock. But in some cases a longer period is necessary, but a port isn't really needed. Say, for example, a patient has unusually deep veins, an ultrasound is always needed to either draw blood or install an IV, and he has a PET and CT with contrast scheduled on the 1st, an MRI with contrast on the 3rd, and a CT guided biopsy, for which general anesthetic will be used, on the 10th. A heplock that can remain in place for 10 days would obviously save a lot of time and aggravation, as well as wear and tear on his veins, and avoid the more complicated procedure of giving him a port. Some institutions will allow that. However, you'll want to use larger veins, with longer straight stretches so you can insert a longer line. You'd most likely go in 2 - 3 inches above the elbow on the inner arm. And in such a case, you'd probably use a daily bheparin, rather than saline, flush to make sure it stays open. From what I've seen, saline is nowadays the preferred flush, with heparin used when there are some sort of special circumstances (like lengthened dwell time) involved. But most folks still refer to them as heplocks, even when it's saline that's being used.