Orientation: My Lesson in Patience
I have been doing a great deal of orientations lately due to unforeseen staffing issue. Anyway, it is always interesting when you orienting a new person to see what they really know and what they tell you they know. Somehow they never quite meet. But it gives me a chance to expand my horizons, teach new things, and learn that greatest of skills: patience. (This lesson usually coming after I have had another run-in with my 16-year-old.)
It was on one of those orientation nights when I realized doing a set up for a sleep study and doing it correctly are two different things. I also realized that my need for doing things according to AASM protocol confuses a great many new people. In particular, the need for all my technicians to measure the patients head. It amazes me how so few technicians know how to do this.
And then, even if they do, they do not understand how to put on a lead without pushing on the lead so hard that you think it is going to become a permanent part of the patient's body. To me, this is a basic skill that was learned within the first two weeks of becoming a technician.
Then, there is the middle of the night lead fix. Now, I was taught you want to disturb the patient as little as possible, so if you can wait for an arousal or awakening, great. Do you really want to go knocking on the door, reintroduce yourself, and explain what you are doing to a person at 2:30 in the morning?
I personally think the more unobtrusive you are, the quicker the patient will go back to sleep. I do not even turn the light on. I can usually correct the problem just from the light the hallway gives off. There is always the concern about the patient who will wake up swinging, but those patients usually tell you before lights out not to touch them when you wake them in the morning. Of course, I have had a patient or two over the years take a swing at me, but I have learned how to duck very quickly when necessary.
Lastly, it amazes me how little people document. Of course I am of the belief if you did not write it, it did not happen. (A lesson taught to me at one of the hospitals by their lawyer during orientation.) I think that lesson has stuck with me low this 20 plus years.
I think new techs are afraid to write too much. Me, personally: I am afraid of writing too little. I tell all new techs that they should pretend they are the reading doctor and they have received the study the next day but they have no video. Write to me so that I know why what I am seeing looks the way it does.
If that does not work, I use the lawsuit scenario. Its five years from now, you just received a request to show up at court about a sleep study you did eight years ago. How are you going to know what you did? What was going on? Write it out and it will never be a problem. That usually scares people to my way of thinking.
I know that orientation is important and needs a great deal of attention, but I really hope that they will get easier over time. I really believe that as our field gets more regulated and licensed, we will all be working on the same page to create the best sleep studies possible.