In my last blog I discussed the serious issue of changes in our field -- changes that could affect job availability and job descriptions.  I never bring up a topic without trying to provide a solution.  My solutions may not be the best for you, but at least I want to give people some ideas and I hope you will share your feedback as well.

My first idea is that as a field we should not just rely on the AASM to protect the field.  We technicians have our own association that is more than willing to represent us, but it needs your involvement.  We have the AAST and ASET as recognized national associations, there are also regional and state associations who have hard working volunteers to represent us. The NBRC also represents our field as a profession as far as testing is concerned.  They are not designed to be an advocate, but they do make sure that the community does know that we are well-educated professionals who perform to best practices.

The next important issue is to consider licensure.  I know there are many who say licensure is just an expense, but it does have its place and will protect our field and assure professional best practices within each state.  We need more advocates in this area.

Education is the next big thing.  I have returned to school to get my MBA in healthcare administration.  I know it is hard for many, but education is an important part of creating a strong field.  We need more college programs across the country and in order for that to happen we need more professionals with bachelor degrees and master's degrees to run these programs.  We also need to hold ourselves to higher standards and obtain more continuing education. 

It's Nurses Week and I felt it appropriate to honor some of the special people  I've known throughout my career in health care. I must say that I have worked with some of the best nurses on the face of the earth. No, they have not received an extraordinary reward other the gratitude of those they cared for, and they are deserving of our admiration and love.

First are the girls (since we all started our careers together, they will forever be "girls" in my mind), who are now passed on, beautiful souls who dedicated much of their lives to nursing. They were smart and strong and could make you laugh until you cried. They possessed wit  that seemingly could come out at the most inappropriate times. They had no problem calling docs wrong when they were, and at the same time making them better physicians. My wonderful friends, true angels of mercy -- Judy, Keri, Charlotte, Amy, Muriel, Beverly, Runnell, and the guys, no less beautiful to me, Allen and Bobby. I miss you all.

Nurses are usually the first and the last person patients see. They check you in and check you out. They know who has family and who does not, they hold your hand when you're alone and scared, or  on your way to the OR. They stand by the beds of those on their way out of this world when there is no one else. They are there when a woman makes the transition to mother. They witness miracles every day. 

Sometimes I think we miss it. We get so caught up in the other stuff (meds, IVs, charts, orders, treatments, computer problems, emesis, bedpans, blood, spit, stat this and stat that), that we don't notice the daily miracles.

And I do think nurses are underestimated and still undervalued much of the time. We ALL still struggle for better hours and benefits and hope for someone to come and give us a potty break please. We are our own worst enemies, too, at times. But our passion to help and compassion for others drives us on day after day. 

And no, it's not the money. I have always been of the opinion that there are two kinds of nurses.  Those who were "called" and those who were not. You know them, I'm sure. Those who were "called" will tell you they always wanted to be a nurse, never wanted to be anything else. They seem to identify heavily with their patients. They are awesome nurses and will see their units through anything. They stick with it. Those who are not called, will not. They complain more, are better at setting personal limits where the job is concerned, and will tell you they don't have to take this or that from a patient and can have a cold bedside manner. They are different. I am not saying "bad," mind you, just different. I will say too, that if you got into nursing for the money, you may be disillusioned. It's probably not going to be enough to make it worth it to you to you to endure the hours, the attitudes, the demands -- not to mention, the vomit, blood and exposure to other bodily fluids that is the "meat and potatoes" of nursing. Yuck. Did I actually say that?

Care Centrix is the company that does the authorizations for sleep studies for Cigna insurance. They recently bought a home sleep company. They now not only get to make the decision on who gets a sleep study, they then order the study, send out either an HST machine or more often an autopap machine with instructions and basically tell the patient "best of luck."

When did insurance companies get in the business of practicing medicine?  Where is the care for the patient? Who is going to do the follow-up for these patients who may not have been diagnosed properly and who are definitely not being educated?

This is when we, as a field, need to make our voices heard. We are too quiet. We do not toot our own horns loudly enough. We need to prove that our time and education changes outcomes. We need to prove that it is not all about just obstructive sleep apnea but about the myriad of different disorders we help to discover. How many cardiac issues have we found? How many nocturnal asthma patients have we helped? Even the AASM thinks Cigna has gone too far. 

This is a call to action! Write the company and your representative. Write the insurance administration. We need to change this.

I was thinking about our insurance plan last night just before drifting off to sleep.

This year we have some new incentives for trying to live healthier lifestyles.

For example, if we keep up with our preventive visits or attend the gym 6 times a month then we are awarded extra funds loaded on our HSA card.  I think that's a pretty good deal, not so sure I can make it 6 times a month to the gym though. I am trying. I am encouraged.

And so I was wondering what if we incentivized CPAP users  too?  Instead of threatening to take away the equipment if usage falls below the set amount of time, why don't we award users for the total time used?  I mean, the goal is to get people acclimated to and using CPAP or whatever the therapy is. It seems to me this approach would foster goodwill on the patient's behalf since the first encounter would include instructions for how to obtain the "reward" instead of the threat of losing the equipment if not compliant. Rewards, however small, are still rewards. I am not saying we should "break the bank" for the system to work. But why set them up to fail? I am definitely in favor of positive reinforcement. Over and over studies have shown it works well. So link the desired outcome with a small reward. 

Yet our go-to response is usually the negative choice. It seems all we hear are negatives from the insurance industry, Medicare and Medicaid. Cuts and losses of coverage, things covered last year are no longer covered this year. And then there's the new rule about patient education and loss of payments if a patient is readmitted for an illness and it's determined they were not educated about their illnesses, meds, treatments, etc.  WHAT?? Good grief. I am a nurse and can't count the amount of time I have spent with patient's "educating" them, hoping they would take their meds and check their blood sugars and keep those dressings changed.  Was the benefit of good outcomes incentive enough for them?

And sometimes, a lot of the time, you can tell even as you're speaking that what you're saying is not going to happen at home, like good sleep hygiene or even a set bedtime for children. And now it seems I am backed into a corner because the reward of good health is not enough, but neither is the threat of removing equipment.  And at what level should a reward system be implemented?

I have been a respiratory therapist since 1986 and have loved the field with all my heart. I started on sleep in the late 1990s and have a passion for sleep that is just as strong, if not stronger, than my passion for respiratory therapy. I can tell you that the people in both of these fields are motivated by the same drive for education of their patients, caring for their patients and changing the world one person at a time.

I entered the neuro world this past year when I took my current position as program director of a college NDT program. The one thing I can tell you is that neuro people and sleep people do not understand each other. They do not understand what motivates the other, what drives the other and really how they view their job and their interactions with patients.

I really noticed the difference when I was attending a conference last year and I see it more the further I dive into the field of EEG. When I meet with groups of sleep techs we talk about growing the field of sleep, educating our patients, doing studied and therapy follow up, and learning more about how we can serve our patients.

When I attended the neuro conferences, they talked about bringing sleep into their fold and, since we already worked nights, hpw we would be excellent for performing long-term monitoring on the night shift. When I was in one class they were talking about how patients were not educated on some aspects of epilepsy, and I asked why they did not do that themselves? I was informed that it was the physician's job and we were not supposed to talk about conditions with the patient.

The idea of not being able to generally educate a patient about the disorder they are being tested for would seem wrong to most sleep technologists I know. They want that interaction with their patients. They want to do more than just perform a test.

The other issue I find very different pertains to the conferences and the CEUs we need to obtain. EEG techs and other neurology techs are required to do some live CEUs. They also tend to go to bigger conferences because there are fewer of them than sleep techs. Sleep techs, on the other hand, can gain all their CEUs online or through free and low-cost education provided by equipment companies such as RESMED and Respironics. This usually happens in smaller groups and if we do go to bigger conferences it is because they have something on the program we can get nowhere else, such as the Sleep Educators course.

I believe sleep and neuro can work together but there would have to be understanding and acceptance of the two different places we come from. The approach would be to educate each other rather than say your role would be only this, or you should do only that. It would be tough, but it can be done and I think it would help improve both fields for the techs.

It's been a long week. Springtime in Augusta means allergens go on the attack. (My garden city is on the list for poorest air quality.)

I had been doing well with Claritin for the past several years. But last week I succumbed to the barrage of pollen and bad air. I am breathing better now thanks to the addition of Alegra, Flonase and Sudafed. 

But allergies are not the only problem, there has been a bad stomach thing going around. We had three cancellations this week and two techs out due to the virus. I've had an MSLT every day and again in the a.m. I am so tired. I just want to sleep past 05:30. I can't wait for Saturday!   

There is a silver lining though. The lab will be closed over Easter weekend. It will be nice to be off and not on call. I am supposed to be off Good Friday, too, but am thinking of working for a few hours to take care of some loose ends and close the lab down. 

Meanwhile, tonight is A.W.A.K.E  night. I am anticipating a nice sized group. It means I will be at work from 07:00 to 9:30pm, so Friday may end up a "no go".  Anywho, I hope you all have had a productive week and that you get some time off to rest and enjoy friends and family over the Easter weekend.

What keeps you going? Are you a glass half empty or full kind of girl/guy? My hospital has a wellness center of which I am a fair weather attender. I have the best intentions at the start of every day. I plan to go workout today and by the end of said day I have all but abandoned my plan.

I mentioned the wellness center because they have a plan to keep us going. They send little motivational emails about once a month. The one from today was particularly interesting. It talked about a study that was done which asked the question about happiness -- glass half empty or half full? Turns out that you may be less likely to have a heart attack if you are happy. Not really new news I know, but still worth repeating. Researchers had the participants rate their satisfaction within key areas of their life: job, family, self, lifestyle,love. Those who consistently rated these areas above average percent run less risk of developing heart disease, heart attacks and angina.

It's not quite clear how feeling good helps your heart and further research will be conducted I am sure.  But we have long known about the toxic effects of stress on our bodies. Most of us won't have to look far to find real life examples of that toxic principle in action. It intrigues me though. How come some of us have that positive happy bent? I am an optimist. I tend to start over each day with a clean slate and not drag yesterday's baggage along if I can avoid it. But I have a co-worker who can't let go of anything. And I swear I can see that pile of baggage she carries. She is sickly and has frequent headaches, not surprisingly. I wonder what her life theme song is. I will have to ask in the morning.

Anyway, so what do you think of that research? Valid?? Interesting?? What's your life theme song? "Don't Worry, Be Happy" or "I Can't Get No Satisfaction"?  Thanks Patsy Donath, for motivating us and for being my source for the blog. Patsy's source was realage.com.

I recently attended the WSET conference in San Francisco.  One of the most interesting talks given was on the importance of long term EEG monitoring in the ICU.  We have many concerns about the future of sleep testing.  Although I see the field changing and the work of technologists becoming more of a doctor-extender, there are other options for those interested in expanding their knowledge.  Long term ICU EEG monitoring appears to be one such growing area. 

The field of long term monitoring is young and the care of the patient is needed.  It  appears there are not enough technologists to perform and monitor these patients.  Although the job is not the same as sleep, there is a good baseline in our field to help us expand our knowledge. 

The EEG field is actually quite different in responsibility and language, however they are still learning new terminology in the long term monitoring field as well.  We come from a field where change happened quite frequently and this long term monitoring is also changing -- so we are already used to a sharp learning curve.  To get involved we would have to learn additional 10/20 set up.  We would also need to learn their montages and identification of waveforms.  There is a great deal of details we would be required to learn.  We do have the advantage of knowing ECG already which many EEG technologists do not know.  So there is a balance.

The issue is where to learn EEG.  There are still very few schools nationally teaching EEG.  There are some online schools that can be accessed.  Most EEG technologists were trained as OJTs, however the registry exams require more formal education as EEG technologists look to become a licensed profession. 

I believe our role as sleep techs is not one of just running a clean study but is also one of educating.  We tend to talk to patients when we are setting them up and in the morning. We also tread a slim line between what we can and cannot share. One of the issues I see us assisting with is the use of complimentary therapy to help a patient who may have compliance issues.

Oral appliances have received a bad rap and many physicians believe they do not work. This is not the case for many patients. It may not fix their apnea but it could assist them in a decrease in pressure; especially when the patient needs a high pressure or if the therapy did not eliminate the respiratory events. It is also good therapy for those who just snore, as studies are tying snoring alone to heart disease. If we become educated about oral appliance and also work with our ordering physicians about suggesting this therapy for their non-compliant patients, we increase our role in patient care. We can also help the dentists who are well-educated about dental appliances to grow their practices. They in turn can help grow the field of sleep since they can identify patients with a high likelihood of sleep apnea for your referring physicians. 

Being part of the marketing of our labs and our physicians' practices should be in the thoughts of sleep techs who want to stay in the field. We need not limit ourselves to being techs, but rather should consider ourselves part of the patient's team. 

It is the end of February and we are on the cusp of a new month. Let's not dwell on how fast were aging at this point. It could become depressing. 

I was reading an interesting article online that discusses the link between insomnia and suicide. The author Dr. W. Vaughn McCall, is chair of the department of psychiatry at Georgia Regents University, home to the hospital I work in. 

McCall says that insomnia can lead to a specific type of hopelessness and that hopelessness by itself is a powerful predictor of suicide. He goes on to say that this shows the importance of examining sleep habits and the attitudes toward sleep of people who are depressed.

Most of us have probably had a bout or two with insomnia and know how frustrating it is not to be able to fall asleep. I am very grumpy when I don't sleep. I have a lower tolerance and very little patience. It's not pretty.

I can only imagine how those symptoms must be amplified in someone also battling depression. How do you change someone's attitudes toward sleep?  We see it all the time -- poor sleep hygiene. People who think they are too busy to sleep and will sleep "when I'm dead" or people who have "junky" sleep:  sleeping with the television on and cell phone under the pillow -- or worse, clutched in their hand -- and laptop right by their sides. 

I am interested to know, really, what are the general public's attitudes toward sleep? What I see daily in my lab is pretty concerning. About 50 percent of pediatric patients do not have a sleep routine at all, let alone a regular bedtime. There seems to be no thought given to sleep. It just happens when it happens, as though we have no control over that part of life.

Here is the link to the article from the Huffington Post.  ( http://news.gru.edu/archives/7837 ). It's good food for thought.

I was at a conference and I have to say that I did not expect to experience HIPAA issues. It did not have to do with the presentation. It was members from a specific company who started to discuss patients because they do not get together very often. Although the conference was limited to health care workers, we were all from different companies and I do not think they were aware that anyone but themselves was able to hear them.

The idea of talking about care in general allows us as professionals to lower our guard. We believe that we are in a safe environment. With so much social media available and goings-on recorded, what we say should be guarded more than ever.  Stop to think about the possibility that you could be talking about a specific patient with specific details and someone nearby could be videotaping -- that conversation could end up on the internet. 

Even worse, would you like it if someone was talking about you and your life in public? I believe we should treat all our patients as we do our family. Privacy is essential for creating trust and once you lose that trust it is terribly hard to get it back. We need trust to help the patient accept an invasion of their privacy at a time when they are vulnerable. We also need them to trust us as a tool to help accept therapy. 

We need to protect ourselves and our careers. Even when we are among ourselves as a group, we need to keep in mind that HIPAA laws always pertain to us. I never want to see anyone a their job or credentials because of something  that could have been prevented.

Weary am I.  "And why is that?" you may ask.

Well, my elation over the hiring of new staff was short-lived by the realization that I would need to go to night shift to complete the training and orientation process. I haven't worked nights in 3 or 4 years, since I became the day tech, and man-oh-man are they kicking my butt. 

I have no problem staying awake or keeping up with the workload, but my body is in a state of revolt. It is not cooperating with me at all. My feet hurt, my stomach is upset and my eyes don't want to stay open. I can't sleep. That is to say I sleep fine at night and after a night shift, but I wake up no later than 08:00 and then I'm unable to fall asleep when I need to take a nap. I'm walking around squinting like a possum and my inner man's attitude is not much better. There's a name for what I am experiencing and no, it's not torture as much as it feels that way. What is that name?  Oh yes, shift work syndrome.  Did I mention that I'm having memory issues too?    

There's nothing like an instant dose of night shift to jerk you back and remind you of what our patients are going through on a daily basis. The good news is that my tour on nights will be over at the end of the  month. The bad news is that it will take me that long to get re-acclimated and then I'll have to regroup.

It's a short lived inconvenience for me. But for many it's the norm. Lack of sleep is accepted as a necessary evil, even among those who know better. Between work and responsibilities at home, burning the candle at both ends -- and the middle -- is all in day's work. We have to work and we have to get kids to school and do homework and take grandma to the doctor and stop by the store and pick kids up from school and do homework and fix dinner and then go to work again and again and again and......  I have one friend who always jokes that he will sleep when he's dead. Scary thought. And it's not as though we are out gagging the lollies when we should be sleeping. These are important things we have to do. But where does it stop? It has to stop at some point because as I am sure you all know, that sleep bill will come due eventually and when we are least prepared to deal with it.  

So do what we must, but try to get sleep nearer to the top of that list. Turn the phones off and put in the ear plugs. Turn the TV off an hour earlier and just stop.  Put yourself in a timeout and go to bed.

It's still early in the year, and things move a bit slower. I find this is the best time for me to look over what worked and did not work over the last year and to plan a course of action moving forward. This year is particularly important as the economy has changed how we do business.

As I look at the changes in the environment I have to take into account the fact that competitive bid has moved forward and the new requirements for the follow-up of these patients have increased while the reimbursement has gone down for the DME companies. My choices of where to send an order have decreased and service by those companies -- as well as how that company is structured -- is more important. 

I have also had to reevaluate how we operate as we have increased business by about 40% during the last 5 months. This change has profound effects on how everything is done from scheduling to CPAP follow-ups. 

So how am I going to go about creating a new plan for my department?  I happen to like doing a SWOT analysis. It looks at four quadrants: strengths, weaknesses, opportunities and threats. If I put all this on paper it is a great tool for creating a stronger department. My biggest problem in creating a SWOT graph is that I tend to focus on problems and I forget it is just as important to look at the positives. It is also helpful if I have input from others both in my department and those we have to interact with. 

Since our department is small we will work together on the SWOT analysis (for an excellent sample and free template clock here), and then our one-year plan. I believe this will help the staff be part of the growth and see how their growth as technicians will play into the growth of the department.   

I am also going to focus on how best to market and help those with minimal or no insurance. This is becoming a larger population as the unemployment rate reached 12% in our part of the country.  The problem is that people have to deal with their health whether they have insurance or not. But we need to find a way to help these people that is affordable. This is where I think home sleep testing has the opportunity to grow and expand if the doctors do a good job of screening. With the right tools I am sure we may be able to help more patients to be treated in spite of the insurance issues.

I look forward to our growth over the next year and I am sure that with the changes that are going on in healthcare, this year will be as exciting as the last year was.

I have an infusion of a lot of "new" things in my life lately. New clothes and books from Christmas that are still unused. New challenges at work.  New techs to train.  New AASM scoring rule.  New equipment to buy. New projects to coordinate (because my boss likes to do that). New insurance plan and deductible. New supply chain.  UGH!! GIVE ME A BREAK!! Does anyone else know how I feel?

I remember when "new" had a certain, crisp smell to it and when "new" was shiny and exciting.  But this "new" has a sort of staleness to it.  A certain been-there-done-that aura about it.  I also remember when I tried to meet every challenge with a new "go get'em girl" kind of energy.  Lately that energy is missing and I feel more like I am stuck in traffic with no exit lanes.  After a while the newness of "new" wares off and the work required in learning  how to deal with the "new" begins to take its toll.  It's hard to face every day with a new attitude, but I try.  I try to let go of the icky stuff and keep what's good and needed and move on.  Don't we all?  But sometimes I get overwhelmed.  Sometimes it hurts my head!  It seems like right now I am in a tornado of "new" and I am afraid something may spin out on to me if I am not careful.

For instance, the AASM os going back to the 3% percent rule. How are we adjusting our practice to accommodate the payers who insist on 4% desats? And what about new sleep equipment that is written on old software? New doesn't necessarily mean better, buyer beware... 

I guess sometimes we just have to accept that it's all in a day's work and that most of the time, things will work out. I mean really is there anything new under the sun? It sort of is same story, next line.  I guess what makes it difficult is that not all knowledge gained in the previous story line applies and it tests our ability to adapt and change.  And it's that living, breathing, changing quality of life that really is new in some fashion every day.

It's that "new" that keeps us moving when we just want to stop. Like me, now. After having shared my list of new things with you, I can now move on, to something else new.

The creation of the certification credential was initiated by the AASM, however they are not the ones who decide what will be covered by the test.This test was created to allow new technicians to work in states with licensure while continuing their education. This is not a test that is an end state, but instead it allows people who are very new in the field to work while they continue to learn and advance. It gives a person three years to take and pass their RPSGT -- the credential that demonstrates basic competency in the field of sleep. 

Think of the CPSGT as an entrance exam into the world of sleep. The test covers just the basics and we discussed what the basics were during the JTA. We discussed what would be expected of a CPSGT vs. an RPSGT. We discussed how a CPSGT would handle things above their education level. It became heated sometimes; it was difficult because when you have been an RPSGT you forget what it is like to just be learning in the field. 

Ultimately what was decided was that for many issues, it is the job of a CPSGT is to ask a RPSGT to correct or deal with the problem. A CPSGT will need to know how to set up a patient for a PSG, but not for an extended montage. They would need to know how to set the filters for a basic montage, but not how to change them. They would need to know how to read a chart, but not how to evaluate the information. And they would need to know basic staging and respiratory events including oxygen saturations so they can make decisions about split night studies. They would not be able to do any troubleshooting other than identify a medical emergency and would need to get assistance from the RPSGT on duty. The idea is that these are basically students learning the field and can do the basics but really do not have the theory they need to make informed decisions.

The idea of advanced credentials actually has many in the field excited. The movement toward the Educator's exam has really started to move forward. Although our job was not to make any decisions about this move, the board members who did attend understand the desire and the need for these types of credentials. There were discussions for the type of advance credentials besides an educator, and there were discussions about jobs that might be available based on the advanced credential. 

The only thing we did not discuss, which I believe could have a great deal of influence, is how formal education programs, degree granting programs, would play into this advanced credential. Would it be available to those who went and got their AS degree in polysomnography or neurodiagnostics?  Would the curriculum for the class be made available to the programs so they can add them to their curriculum?  These are questions I have.

The JTA is an important part of creating a test because it takes the input from the whole credentialed technologist community and uses it to create a test that covers the job responsibilities. It looks at some of the demographics of the field as well, so we know who is going into the field and sitting for the exam. Most importantly it allows the test to change as the field evolves, which makes it relevant year after year.