Adventures in Sleep : Leadership

Continuing Education: Keeping Your Credentials vs. Pushing to A New Level

Amy Reavis — Thu, 04 Oct 2012 17:41:00 GMT

You know I believe in education: I nearly shout it from the rooftops. However, sometimes being educated on the same subject over and over really does not move you forward. Recently, I found a resource that has pushed me out of my comfort zone to a new level of education.

Coursera.com allows you to take college classes for free on many different subjects. I am taking a class on bioelectricity, online lesson planning and the brain and personality. All of them are given my major universities and are run like a college class. You may not get college credit or CEUs for it, but the knowledge itself should be amazing.

You might ask why I would do something that will give me no immediate tangible benefit. It is simple: I believe that to be a great professional I need to learn as much about my chosen field. When I entered sleep I taught myself how to score by using the R&K manual. I was not required to learn it but I did. Even though I do not work in respiratory therapy anymore I still keep up on all the new knowledge and ideas in the field. I learned about management from the articles, blogs and boards I read. Now that I am in education and writing, I want to learn as much as possible to be to perform optimally.

There is one more part to this: The more knowledgeable I am the more I am able to share. I believe that the goal is to create a strong work force and that those of us who have experience are responsible for sharing with those who are still young in the field. I believe that we need to create more college programs and more conferences that are affordable.

Okay, off my soapbox. Do you believe that online courses and CEUs are of benefit or do you just take what you need to keep your credentials?

The AAST Strategic Plan: On Target or Missing the Mark?

Amy Reavis — Thu, 20 Sep 2012 14:51:00 GMT

The AAST is aware of the changes in the field and the concern that some technologists have about its relationship with the AASM. To this end, the organization's board has updated its strategic plan to help increase its effectiveness at creating a strong, cohesive community. In some ways, this strategic plan is strong; in others, it misses the mark.

I personally believe the AAST has hit the mark when they talk about the educational offerings they hope to create and their desire to increase communication with the membership. We as a community need to have the updated education as our field continues to develop. This is especially true with private insurances mandating HST and CPAP titrations. Those patients are going to need more support than ever and we are in the best position to give them that support. We can give them the education that they will need and monitor them when they're titrated using autoPAP therapy.

The AAST strategic also addressed the biggest problem that I believe that the organization has had as long as I have been a member: communication with membership. In the past, I had even tried to be on a committee to help but I really did not see a change in the organization. This plan came up with specific ways that they are going to try to increase communication. I hope the AAST implements them soon.

I also like the proposal to evaluate the board and committees. This should have happened a long time ago. People need to be held accountable and there should be tools in place to show the membership how different people and committees are successful and how they need to improve. Hopefully these reports will be available to the membership so board and committee members will not just be accountable to each other but to us as well.

The strategic plan also discussed how the AAST needs to be the force that helps facilitate communications between all associations that affect our field-but they did not address it completely. When they talked about updating education, they talked about the A-STEP but not those programs accredited by the BRPT. We need to get past this AASM/BRPT animosity and create a cohesive community or there will continue to be walls in place that prevent our profession from growing.

We as a community should look at this strategic plan and hold the board to it. We are the AAST and the board members are in place to serve us. If we do not take an active role in our organization then we have no right to expect them to represent us to the best of their ability.

The Future of Sleep Medicine: Questions Asked To Its Leaders, part III

Amy Reavis — Fri, 01 Jun 2012 15:14:00 GMT

Editors Note: This is the third in a series of blogs where Amy Korn Reavis, RPSGT, asks her mentors, role models, and people she admires about the field of sleep, how they got here, and what the future might hold.

Sheri Ruth, RRT, RPSGT is one of the people I had the opportunity of meeting in North Carolina. She is an amazing woman with a wealth of knowledge and organizational skills that I envy. She ran her state's conference with confidence and was able to have fun with everyone in the evening. I hope I get to see her and spend more time with her in the future.

Joe Anderson, RPSGT, RPFT, CRT-NPS, RCP, is someone I have known and admired for many years. He has been a driving force in education in sleep. He understands where the field is heading in this country and around the world. He volunteers for multiple organizations, has started a scholarship and a medical supply company to help sleep labs work together to get better pricing. He also helps people to understand the business behind the field of sleep.

How did you get into the field?

Sheri Ruth (SR): I was just graduating from college with my Associate in Respiratory Therapy. I was looking for a job in respiratory in a local hospital that I did some of my clinicals in. At that time, there were no openings, but the director of respiratory therapy pulled me aside and said, "I have a suggestion. They are building a sleep lab here, but it will be under the neurology department instead of respiratory. I understand they are seeking a respiratory therapist to operate it, so why don't you apply? It will be a foot in the door, and when we get an opening in respiratory, you can transfer to us." I followed his suggestion, but instead of transferring to respiratory therapy, I found that I loved my new career in sleep so much that I wanted to stay right where I was at.

Joe Anderson (JA): I was a neo-natal respiratory therapist and also owned my own DME company doing sleep screenings in the Caribbean.

Why did you decide to go into the leadership role?

(SR): I was one of the original founding members of CSS who sat around the board meeting table at Spartanburg Region Medical Center back in 1991. Over the years, I watched as the CSS got larger, but with its increased population came increased conflict among those leading the group. Over time, I was observing sleep professionals become discouraged with the CSS; they didn't care if they ever attended another meeting again. It concerned me that the organization that I helped create had begun to be a disappointment rather than a support system to myself and other sleep professionals. With the encouragement of several friends and colleagues, I decided it was time to take the lead and bring the CSS back to the way it was supposed to be run.

(JA): I have been an educator since 1984 and it is a passion for me. Taking the leadership role at Priority Health Education is a dream job for me and helps me further the education programs I started years ago with Sleepmate called Professional Training Services. The Sleep Professionals Association (SPA) is a pathway for sleep professionals to unite to further the profession through education and information.

What is the most important lesson that you have learned while working in the field of sleep?

(SR): That nobody can fix everybody with CPAP all of the time. There are going to be people that you just can't fix. It doesn't mean you are not a good sleep technologist. I tell new technologists that those are the patients that keep our skills sharp, the ones who challenge our skills and sometimes our creativity. Sometimes, the ones we can't fix are the ones who help shape us into becoming even better at our profession.

(JA): That every tech and every sleep center's needs are different. However, one goal is very common in our industry: improving our patients ' lives.

What is the funniest thing that has ever happened to you while working?

(SR): As I mentioned in question # 1, the sleep lab where I worked was part of the Neurology Department. This meant we had to be crossed trained in EEG technology as well. One weekend I was "on-call" for EEG. My pager went off summoning me to the hospital for an EEG. Of course all the way back to hospital I was grumbling about why the beeper had to go off just when I was in the middle of my Saturday afternoon. Upon arrival, I find that the name of my patient is Clyde Burroughs, and I was to go to his room and do the test portable instead of having him coming down to the lab, which would have been easier. So I started up to the floor with my EEG machine in tow, thinking about the name Clyde Burroughs, and asking myself where I had heard that name before. As I reached the patient room, I was greeted by a room full of people. The patient in the bed, of course, and all the others running about chattering about the NASCAR races, sporting hands-free phones, walkie-talkies, and carrying clip boards. Not really paying all the bystanders much attention, I set up the EEG machine and got behind the patient's head as I applied his lead wires. After listening to some of the dialogue between the patient and his visitors, I asked him a question just for the mere purpose of "small-talk." I said, "So, Mr. Burroughs, you must have something to do with the NASCAR races. What, do you work at the Darlington Racetrack? Or are you part of someone's pit-crew?" A look of amusement came over everyone that was in the room and the patient himself spoke up, "I am Dale Earnhart. Clyde Burroughs is just an alias. You ever heard of ‘Bonnie and Clyde?' Needless to say I was quite embarrassed. The only thing I could think to say at that moment was, "Pleased to meet you Mr. Earnhart...I guess you've figured out by now that I don't get out too much." We all laughed.

(JA): Listening to one of my patients actually saying "knock-knock" jokes in his sleep.

What do you see for the future of sleep and of sleep technicians?

(SR): Well, I feel that sleep medicine has become a payer-driven practice. Reimbursement for health care shapes so much of how we have to do things anymore. I feel that sleep diagnostics will probably shift towards the home sleep testing arena. It is more cost effective for the providers. Compliance for positive pressure therapy has been tracked at only being "fair" at best. Providers are asking themselves why they should pay out all this money when the compliance is not where it should be. At the same time, I see a shift in the field for sleep technicians on the horizon. We may not need as many nocturnal PSG techs in the future, but we will need skilled sleep technologists taking on the newly defined roles of "sleep counselors and compliance coaches. " We are looking at why patient compliance for sleep therapy is low. Is it poor quality diagnostics? Probably not. It's because our patients need a continuance of care once they walk out of the DME company with their new CPAP machine. This is where the new role of our technologist offering our patients post follow- up care, counseling, and support comes in. This is where sleep medicine in the past has been weakest, but with our realization of this fact, we can work towards overcoming our weakness and provide complete diagnostic, therapeutic, and follow-up care that our patients deserve.

(JA): Continuing education and specialization. With the almost daily changes we see in sleep technology, center ownership, licensure, and credentials I believe that the desired tech of tomorrow will be a highly specialized CLINICIAN with specialty credentials. These credentials will most likely be in Scoring, Pediatrics, and other Emerging Technologies.

See answers from AAST President Melinda Trimble RPSGT, RST, and James Krainson MD, FCCP FAASM, RPSGT, here.

Henry Johns, BS, RPSGT, CRT, CPFT, and Anglee Leviner, RPSGT, answer the questions here.

Learn more about the new clinical sleep educator certificate program from the BRPT by clicking here.

Getting to Know our Leaders in the Sleep Field

Amy Reavis — Wed, 04 Apr 2012 19:36:00 GMT

Editors Note: This is the second in a series of blogs where Amy Korn Reavis asks her mentors, role models, and people she admires about the field of sleep. View part I here.

The next two people who answered my questions are people who I have learned a great deal from. Henry Johns is one of the original leaders in the sleep field. When I worked in Kansas City, he was the man you wanted to learn from. He is one of the original sleep techs who helped shape our field. Anglee Leviner has no problem expressing herself. She recently was recognized with an AAST award for her writing. She shares her knowledge with those who are new to the field. She will be part of the future of sleep medicine.

How did you get into the field?

Henry Johns (HJ): I was a respiratory therapist working in an ICU in 1988, when a pulmonologist handed me an article in CHEST about apnea and cyclic desaturation. He asked me if we could start doing sleep studies and I said "Yes." I had no clue what I was talking about, but soon found myself sitting with a Grass Model 6 & Omedia oximeter. Within a year, we had a Vitalog system and were doing home testing.

Anglee Leviner (AL): There's nothing grand or glamorous about how I started in sleep. Like many people in my generation, I lacked direction after high school and some college. Being unsure what the life plan was, I went on an adventure on the west coast to find myself. There was no plan to ever come back, but months in, I was bored with doing nothing. My mother called me one day and said "Anglee, there's an opportunity to start a profession I know you'll enjoy, get your behind home!" As much as I dislike admitting it -- she was right. My mother trained me, on the job, and the rest is history!

Why did you decide to go into the leadership role?

HJ: I have never thought of myself as a leader as much as a guy who can't say no. I was never a leader in HS or College. I volunteered for the AAST (APT) in order to give something back to the field. I served on the program committee and was appointed vice chair and then chair. At the same time, I became a site visitor for the CoA PST, was appointed to the board of directors, and am now president elect.

AL: Through online networking, I became aware of the issue born of the new exam the American Board of Sleep Medicine (ABSM) had announced. Based on the information I was receiving, I became involved in finding solutions and ways to arm my fellow sleep technologists against what I was told was a threat. As anyone who knows me in any capacity will quickly confirm, I'm fond of playing devil's advocate in order to strengthen my own and other's viewpoints. Doing this allows one to prepare for debate with the other side when it arises, and to not be caught without a response to their points. During my research and discussion of the new exam, I uncovered numerous inconsistencies and exaggerations. I felt as though I was suddenly standing in the eye of a hurricane, calmly able to see all the lies and strife. The online community of networking sleep professionals isn't large or connected enough to spread the information, so I decided I needed to write an informative article. After that, it became clear to me just how much writing impacted the field. Writing is something that has always come very easy for me. And where I come from, using our time and talents to help the community is just what people do.

What is the most important lesson you have learned while working in the field of sleep?

HJ: That everyone brings something to the table in this profession and that is what makes it such a dynamic field. As I said, I was (still am) an RT, that body of knowledge is what I bring. I have worked with R. EEG. T.'s who taught me volumes in exchange for what I offered.

AL: Pick your battles. I've passed this advice on many times to professionals frustrated with their management or medical direction. When a mistake in treatment, reporting, ordering, the whole process is just a matter of pride, I've found it's best to let it go. If a mistake in those matters endangers the patient, compliance, or appropriate treatment -- stand up for the patient's best interest.

What is the funniest thing that has ever happened to you while working?

HJ: There have been a lot of moments over the past 24 years. One of the best was a quiet night with two seemingly normal patients. I was nodding off and getting that 3 a.m. whiplash when the female patient began to scream at the top of her lungs and wave her arms. It startled me so that the chair rolled out from under me, I almost hit the floor, jumped up, grabbed a flash light, ran to her room only to find her quietly sleeping. I sat for a long time trying to figure out what happened, rewound the video tape to see if it really happened or not. It was my first case of night terrors.

AL: I was working in a new lab, and new equipment can take some acclimation time. I could not for the life of me figure out why the PTAF signal was not coming through. All wires were plugged in the appropriate spots, switches flipped on. So I called support and explained how everything was where it needed to be. "Did you check the batteries?" he asked. I didn't realize it took 9V batteries! How embarrassing.

What do you see for the future of sleep and of sleep technicians?

HJ: I think the future of sleep is going to be as exciting and dynamic as the first 40 or so years have been. There is still so much to learn and discover about human sleep. New fads come and go, new technology, new practice models, but the challenge is still there. Every night.

AL: In the future of sleep, I see innovation, variety, and genius. The sleep technicians who do their job, and leave it behind at work will give in to the idea that home sleep testing is replacing us. They will give in, and move on to a new field. The genius within the field will conceive of a new role. This concept is very exciting; I'm sure I'm not the only one who sees redundancy in the NPSG-PAP model of work. Once in a while we have the opportunity to get excited about a rare or complicated case, but not often. The Thornton Adjustable Positioner (TAP) does not have an auto adjusting capacity yet. The bridge between the dental sleep medicine world and our polysomnography world is coming together. Sleep technicians will be needed across that bridge. The variety of tasks that we, as sleep technicians, will be able to apply our knowledge and education to is staggering. And I, for one, cannot wait to jump in and experience it all!

Educating Future Sleep Managers

Amy Reavis — Mon, 08 Nov 2010 21:18:00 GMT

The other day I had to work part of a night shift with two of my technicians. We had a patient that may have needed a little extra care, and I felt that another person might help to run the study better. When I got home, I posted on Facebook how impressed I was with the technicians I worked with. They really understand that they're on the frontlines of our business and that patient care and a little extra time can make the sleep experience comfortable for patients.

The response I received on Facebook surprised me. Someone said they had rarely seen a manager be so supportive of their technicians. This made me think. Where do managers come from and why are they not more supportive of the technicians that work with them. I believe the problem is that we do not educate our leaders in leadership.

Most managers have moved up from being a technician to a manager. Others do not necessarily have a sleep background; they have a management background. So where do we learn the skills we need to become strong managers? Many new managers do not have the time or energy to go back to college, and even if they did, the classes may not offer the information they need to be the best leader.

I would like to see a mentoring program. I know if I had access to one when I first started, I would take advantage of it.

If there are any new managers out there who would like assistance with the transition from technician to manager, I would be more than happy to help. I would like to help those who feel overwhelmed with the new role and are not sure where to start to create a strong plan to move forward. I would love to see more sleep and respiratory departments grow and thrive. I cannot tell you I am the best manager, but I do know that sometimes a little outside support and education can go a long way.

Celebrate Sleep Tech Appreciation Week

Amy Reavis — Thu, 30 Sep 2010 11:27:00 GMT

The best time of the year for teaching sleep is Sleep Tech Appreciation Week, Oct. 4-10. My goal is to inform doctors and the community that walking around tired all the time is not normal.

The AAST has a page dedicated to Sleep Tech Appreciation Week. On it you will see how others have celebrated, activities such as a crossword and word search, a sample calendar of activities, and a list of songs about sleep and dreaming. Also, on ADVANCE you can read about more ways to celebrate and download a customizable certificate of appreciation to recognize techs.

If you want to have CEUs for your techs, you can approach manufacturers. Many have websites with CEUs you can take online. You also might want to write a CEU class. I'm writing one on CPAP titration to give to my technicians. I am also doing a case study for all of us to review on an unusual patient who ultimately was diagnosed with delayed sleep onset and sleep apnea.

In addition, I'm hosting an open house to show the new CPAP masks available to existing PAP patients. And this might be an excellent time to start a support group or newsletter for patients.

Whatever you do, make sure that you express to your technicians how much you appreciate them and the excellent care they give your patients. They're the reason for the lab's success.

Work-Life Balance Is a Tricky Business

Amy Reavis — Tue, 29 Jun 2010 17:03:00 GMT

Growing up, I was taught you always want to act like you run the business you work for. You want it to be successful, profitable, and have a great reputation. I always have taken that to heart. Yet now as I am getting close to another birthday, I wonder if this belief, which I have shared with my children, is truly worth some of the things I have missed.

I always have been the breadwinner of the family. I have worked hard and taken on extra work and time when needed. For instance, in my lab I had scheduled a day study and my marketing rep called and informed me that he had a physician who wanted to come in for a night study the same day. The physician specifically asked for me to perform the study. I told him I could not do the whole night because I don't do well working 36 hours straight, but I would stay and set up this doctor and start the study. Now, it happens this same day my daughter, who lives in the Midwest, was down for a long weekend. I lost a whole day of my visit with her so I could help my company grow the lab.

My medical director and reading physician also have this strong work ethic. Both men are wonderful. They usually read the sleep studies between 11 p.m. and 3 a.m. depending on when they finish hospital rounds. They do not like to leave patients waiting for results and they know there will probably not be any more extra time tomorrow. So they sit up and read the studies, reviewing each epoch, writing out results, signing scripts, and faxing them back to me if necessary at these odd hours.

I can even give you a third example. I have two technicians that have the same belief I do. They have come in on very short notice, on days they thought they would have off and have stayed late when a patient's ride does not show. They never complain. In fact, they always respond the same way, "It's my pleasure to help make this lab a success."

The fact is that all of us have our lives a little out of balance. My goal for the rest of the year is to try and create more balance. I will always feel like this is my business even if I am just an employee. I also will be working harder to respect my employee's free time. It is summer here and they need to enjoy the weather, go on a picnic, and pursue their dreams. And maybe I will even take a little time for myself.

Working Together to Improve Respiratory and Sleep Medicine

Amy Reavis — Thu, 17 Jun 2010 12:32:00 GMT

I have mentioned before that I want to get involved with sleep and respiratory on a larger scale. Well, the opportunity hit me a couple of weeks ago when I was asked to attend the tri-county school board meeting. In attendance were representatives from the two community colleges, the area university, the local hospitals, a community member, students from the respiratory programs, and two private sleep labs. All in all, about 25 people were present.

This group was not about competition or figuring out who can one up the other. We came together to create a strong working environment for education of new respiratory therapists and sleep techs. We discussed what will happen to our BS in cardiopulmonary services now that the local university has closed it down. It appears the two community colleges will work together to keep the program going. This would create a strong funnel for the program to be filled by the current students. We also talked about how this program will work to create advanced practitioners for a field that is changing with the new needs in medicine.

The meeting also covered employment for new students. Although the field has slowed down, everyone is working to help students find a place where they fit.

In addition, we talked about some issues between respiratory and sleep. In the end, there was an agreement to join sleep with the respiratory program and perhaps eventually make it an independent program.

This meeting shows how well the community here is interlocked. It is really amazing to see such a large group of people work so well together to improve our field and the care in the area. It was a great way to get started working toward making the fields of sleep and respiratory care strong in central Florida.

AAST Needs Our Support

Amy Reavis — Wed, 17 Feb 2010 15:11:00 GMT

This is the time of year when the AAST asks for people to volunteer. They need committee members as well as a new secretary and two members-at-large for the board.

I applied to committees for education (I teach sleep at a local community college) and membership (I'm truly passionate about growing this field and the organization). Both these causes are so important to the profession.

We must create a respected educational and testing system so we don't have to worry about other fields trying to create their own testing program. Also, the profession would be stronger if people understood the importance of joining AAST as soon as they enter the field. This includes those who work with DME companies and students in sleep programs.

However, I must note, the one thing I find disappointing is that AAST has never responded to my applications over the years. An autoresponder or form letter just so I know they received my application would be encouraging. I understand they don't need everyone who applies, but I'm sure I'm not alone in wondering if my application actually went through.