Adventures in Sleep : Professionalism

New Equipment Brings New Anxiety

Penny Mehaffey — Thu, 23 May 2013 14:09:00 GMT

Finally we were able to purchase new equipment for the lab that I have been dreaming about! I am expecting installation to begin next week and training the week after.

The prep work on our end -- checking the existing cabling and wiring connections for compatibility with the new system -- has been going on for a couple of weeks now. And about half of it will need to be replaced since our current system is, don't tell anybody, fairly old.

I have butterflies of anticipation. I am excited to have all new equipment ... and I am terrified to have all new equipment. Gone is the thrill of the hunt and purchase and it's been replaced with te occassional buyer's remorse and, "Oh no, what have I done?"

What if we hate the new stuff and what if it's not as user-friendly as I thought, and nobody can work it? That's the stuff nightmares are made of. I have been going to bed with visions of cable clutter in my head, and counting all the "what if's" that could go wrong. You'd think I would know better than that, and I do, but I just can't help myself. Try as I might, I can't summon those lovely little friends of mine that usually help me fall asleep. I look for sheep and get cable snakes instead.

On a happier, more personal note, my son is coming home on leave from the Air Force this week. He will be home today and here for about 30 days. Yay! I had scheduled vacation for the first week of June, but the delays associated with the new equipment have intruded. Originally the plans were for the installation to take place mid-May, so I have given up the first half of the week to the install, and will take the remainder in another week or so after installation is completed.

So, to answer the million dollar question as to whether things are settling down, nope! And probably not anytime soon. Maybe by the Fourth of July...

I miss my sheep.

What is Your Five Year Plan?

Amy Reavis — Thu, 16 May 2013 20:10:00 GMT

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.

Finally, we should each know where we are going in the next five years. A five-year plan is like a roadmap. If you do not have it you will never arrive at your destination. While wondering what to do for a time is fine, in the grand scheme of things it does not help make your life better. That is what I want for all my readers and friends -- a better life.

A Salute to Nurse Friends

Penny Mehaffey — Thu, 09 May 2013 12:59:00 GMT

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?

So to all my friends, who were born to be nurses, happy Nurses Week! I salute you.

A Case for Learning EEG

Amy Reavis — Thu, 14 Mar 2013 13:39:00 GMT

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.

In truth the language and the need to be much more detailed is necessary for this profession. It also removes the tech from the role of an educator, something many in the sleep field love. It is, however, a growing field with a large need and a strong future in the changing healthcare landscape.

Role of Techs Includes Guiding Patients to Other Therapies

Amy Reavis — Thu, 07 Mar 2013 14:44:00 GMT

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.

We can also recommend other products to help patients be successful. A technologist and lab manager in my area, Kristina St. Peter-Weaver, is fantastic at being a patient advocate and support system. Her AWAKE support group is a thriving community and she is constantly bringing new information and equipment ideas to her patients. She also has the support of her local physicians because she understands the necessity of being part of a team. She is truly a role model for the new sleep lab. She manages to integrate home sleep testing, lab testing, compliance and education into one very strong department in a smaller community.

The Best Time to Plan Is Now

Amy Reavis — Thu, 07 Feb 2013 13:54:00 GMT

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.

Routines!

Penny Mehaffey — Thu, 17 Jan 2013 12:15:00 GMT

I, for one, am glad to be settling back into my work routine, post the holiday crazies. Another routine I am settling into is the daily barrage of denials for in-lab sleep testing. Oh, and let's not forget the routine of doing more with less, and less ... and less.

If I sound a little disgruntled, I apologize. I just keep wondering when so much of this stuff will begin to make sense. I was hoping the distance of the Christmas and New Year's holidays would somehow provide some clarity when I returned. And by clarity, I guess I mean I was hoping Santa would leave us a clean slate and all the approvals we needed to carry on the day-to-day business of sleep. But what I got is more like a bundle from the Grinch. For it seems the business of sleep is changing daily now and it's a challenge to keep up. Sometimes I feel as though I'm trapped in a vicious game of badminton and I'm swatting away at the birdies but the birdies keep multiplying.

We are getting our feet wet with out-of-center sleep testing and it's proving more challenging than anticipated. I am curious as to what's going on elsewhere. So far I've conducted 10 HSTs. It's been strange. Several have failed due to patient errors, one took it off at 2 a.m. and said he couldn't tolerate it. And another has complained twice now that he just couldn't sleep "a wink." Sound familiar? Our device is a simple, easy-to-use unit that I all but sleep in for the patients! They are testing in the comfort of their homes, on their chosen schedules and still we have these mishaps. What's the answer?

Despite that, I continue to really enjoy my job. We have to take the challenges in stride and keep batting away the birdies. It's a difficult, transitional time for us all in healthcare. One thing I know for sure is that the answer is not to give up. I still love sleep and what I do. I am rewarded every time I get it right with mask fits or a perfect test comes back or I witness a patient have an "a ha!" moment. I just hope we are able to navigate our way through the mire and not get bogged down.

The Problem with Being an OJT

Amy Reavis — Wed, 26 Dec 2012 21:29:00 GMT

I believe there is a place for someone being trained on the job, but medicine is not that place. I am sure this statement will make many of my readers unhappy with me. But there are too many issues that cannot be taught while you are working and too many theories that need to be taught in a learning environment. We are dealing with people’s lives; if we want to be a respected career, then we need to embrace education as part of it.

I know that the A-STEP and STAR programs exist, but they are very minimal and do not quantify that the students learned what they really need to know. Many people rush through the A-STEP and take the test several times until they pass. They do not really absorb the information and they have no one to turn to when they have questions. This does not create an interactive learning environment. Unless the person is really motivated, they learn the very

basics and that is it.

The reason I bring this up has to do with several incidents where technicians missed critical arrhythmias during studies. One person was registered and the others were not. What they all had in common was that they were trained “on the job.” Did they get taught about arrhythmias? Maybe, but if they did it was from someone who may or may not have had a strong ECG background. They may have read a book or used a poster to identify the arrhythmia at hand.

I am not saying a school is a “be all and end all.” I do believe, as I have said before, in continuing education. I know that school would be more systematic and would include more time to learn. This is essential to creating a top-of-the-line technician.

We are an advanced field where we are expected to educate and treat patients. In order to do so, we need a strong, structured education program that is well respected by those in and outside our field. We need to move forward.

Time for a Change in Work Scheduling

Penny Mehaffey — Wed, 21 Nov 2012 13:27:00 GMT

NURSES BURN OUT ON LONG SHIFTS!!

Well surprise, surprise, surprise, and to quote one of my favorite malcontent Disney characters, Diego, "I am not surprised, I am so not surprised, I think I am going to die from not surprise!"

This article under this headline laments the long 12-hour shifts nurses must work and how dissatisfied they become with the job, how patient care and satisfaction suffer. How many more of these studies do we need before someone takes the high road and stops demanding the workforce comply with whatever crazy schedule the company imposes?

Doctors, police officers, firefighters, and paramedics work long shifts too. In our area it's common for some to work 24 hours on shift. Let's not forget those who do true shift work, and by that I mean swing shifts--a week or two of days, then evenings, then nights, then only a day or two in which to "turn around." How many reports of horrible mishaps by air traffic controllers have we heard about? Tragic trucking accidents where the driver fell asleep? And what about the train engineers? How many more before those long shifts are regulated?

And why is this dilemma going on so long? It's not that we are unaware of the problem. Is the workforce really shrinking that much, the nursing shortage that bad? Not enough new people are entering the work force so we must maximize the time the current staff spends working? All things being relative, I live in a city with five major hospitals and three nursing schools. You would think a nurse could leave one job today and have another tomorrow and that the hospitals would have a new pool of nurse graduates to pick from every year. And while, in theory, that may be true, is it possible the shortage is created by the hospitals' budgets and not the number of available nurses in our workforce? Hiring freezes are in effect at all most every institution and demands to do more with less are our mottos.

Who would not be happy with an 8-hour shift? I remember, back in the day, when three 8-hour shifts per day were the norm. Lunch and 15-minute breaks were mandatory, and you did not skip those under strict penalty. Now, 12-plus hour shifts are the norm and what is a lunch break? I mean you can eat but if your patient calls, you go take care of it. I think that is jokingly called the "working lunch." Those 8-hour shifts sound like a vacation to me. Sign me up!

I know my comments sound ludicrous. But so do these surveys that continue to fall on deaf ears. I am sure the data are true. Surely there is a solution to this problem, but does anyone really care? Are we powerless to control our destiny?

Where Do We Find Quality Teachers?

Amy Reavis — Fri, 16 Nov 2012 00:16:00 GMT

I can tell you I learned sleep due to people sharing their knowledge in books and at conferences. I took advantage of my manufacturers' representatives. I will forever be grateful to those who helped me to become a sleep tech. Now I have moved to a place where I can help shape the next generation of technologists, who will be well educated because we can create classes and degree programs to help them.

But where are the people to help create these programs? As techs, we need to expand not just our sleep knowledge, but also our general knowledge. Many people who enter this field do not wish to get a formal education. They do not understand that those who have gotten a formal education not only have passed the RPSGT exam more easily but are also will be the educators, leaders and managers in the future. As well, at the school where I teach, there has been a challenge in finding qualified teachers because instructors need to have a degree.

My degrees are in respiratory therapy and organizational management. I chose to advance my education because I knew that learning about management would help me in the future. I also understand that I will continue to need to advance my education, and I plan on getting an MBA in health care administration. I believe it is important to understand the laws and business involved in creating a successful business. I also will have the knowledge to run a lab more successfully if I choose to go back to the lab. If I do not go back to the lab, I might be able to share my knowledge with the next manager of a successful lab. Either way this education is going to be used to change the field.

So where do we find the quality teachers? If RPSGTs are not willing to get an education, then we will have to look to other fields, such as EEG, to find out instructors. I believe in the people in this field and know there are some great teachers out there who want to help create our next generation. I hope to see you step up, and maybe we can even have a breakout for educators in sleep and NDT at the next BRPT or Sleep conference. We can help create curriculum and lesson plans together. We can share what we have learned during our teaching.

According to the BRPT website, in this country there are 24 NDT programs, 40 PSG programs and 11 RT programs with sleep add-ons. This is not even close to enough programs to supply the need, and it is our generation that needs to step up to help the next one.

In the Middle of Patient And Referral Source Disagreements

Amy Reavis — Thu, 14 Jun 2012 13:53:00 GMT

I received a phone call the other day from a patient who wanted a new CPAP machine. His was 10-years-old and knew he needed a new one. I told him to talk to his primary care doctor. The patient called me back and said that his doctor sent him to a pulmonologist who he did not want to see. He asked if my medical director could follow him instead.

I love being helpful to my patients but you run a thin line when you deal with going over a doctor's head. We have to keep our referral sources happy but also need to help our patients. I did make arrangements for this patient because I knew the primary care would not mind. However, there are some doctors that would not have been happy with this patient's choice.

As a technician or a manager or a patient advocate, we sometimes get put in the middle of hard decisions. The one thing that will always be in our favor is that the patient has a choice on who he or she sees. Just like they have a choice of which sleep lab they go to. If we work as a community we can make sure all the patients are well cared for. It is not all about competition; it is about good medical care and patient satisfaction.

How Do Sleep Labs Handle Bad Publicity?

Amy Reavis — Wed, 02 May 2012 13:48:00 GMT

In the news this week, a pediatric sleep tech was accused of inappropriate contact with two underage children. The news channels jumped all over his role as a night-time tech who sets up children for studies, even though the alleged contact did not happen at work and he had no criminal record when he was hired five years ago.

Whether the person is guilty or innocent, the accusation will make people worry that something bad can happen at a sleep lab. This makes it essential that as a lab we develop a plan to help patients feel safe and secure. This is especially true when there are male techs and female patients or one tech and one patient at the facility. We need to plan for these scenarios and to work with our marketing people to make sure they can handle any questions that come up.

The biggest scare, however, is how we help to protect our profession. It only takes the misinterpretation of a move like putting on belts to ruin a life. We have to practice defensive medicine to protect ourselves and our futures. We need to make sure we are videotaping everything. We need to remember that it just takes one person who may not have the best interests to ruin a career or a facility.

Time to Review Your Sleep Policies and Procedures

Amy Reavis — Fri, 06 Jan 2012 00:16:00 GMT

Once a year I try to do two things. I review and update our policy and procedure manual to meet the new needs of our facility and I do technician evaluations so if there is any new education that needs to be done I can plan for the education during our monthly meetings.

Policies and procedures are essential for any good sleep lab. These are the backbone of every good facility, not just a piece of paper the accreditation companies require us to have. As we change we should update these. I had a friend who is adding HST to her facility and so I shared my P&P with her. If she sees anything that she thinks may need changing I am open to new or better ways to do something.

I also need to change how we do our quality assurance and so that policy should be changed to keep up with these changes for the year. I am fortunate that one of the speakers at the FAST conference gave such great reference material to use for it.

It is also fortunate that this is the slow season so I can take the time needed to rework what must be done. I can come in at night and observe my technicians and see their techniques. I have learned so much from watching others and sometime I may have an idea or two for them to be more efficient.

This is the beginning of the year. Take the time to take a fresh look at your policies, please share any good ideas you might have. That is how we can become the strong field we need to be.

What I Know for Sure ... About Sleep

Amy Reavis — Thu, 22 Dec 2011 13:11:00 GMT

I am borrowing a line from Oprah and her magazine. Each month she writes what she learned from the issue. I am going to take the time to tell you what I have learned this year being a sleep technician.

I have learned that keeping your staff motivated is a challenge. If you need them to take a test, you have to give them a reason and an absolute deadline, and then they are more likely to do it. But they will still give you multiple reasons why they cannot meet that goal.

I have learned that not everyone wants to excel. Some people are happy with middle of the road. I have to learn to accept that.

Patients will always amaze you if you are open to it. You can learn something from each patient whether it is a lesson in patience or learning how to do something new, such as scoring seizure activity. The generosity and curiosity of patients, as well as their belief that anything posted on the internet is true, really can make you think about the amount of misinformation circulated.

Whether a person wants to be sick or well is truly a mindset thing. I have 80-year-old patients who are active, sharp, and young and I have had 40-year-old little old ladies who have more health issues than you can imagine.

ADD is the new IT problem. People want reasons and easy cures and will latch onto anything, and right now the surge is toward ADD. The question is how many of these people really have sleep disorders that are not being treated? How many prefer to pop a pill rather allowing a doctor to send them for a sleep study?

Depression and Sleep Apnea have similar symptoms and again people are taking pills rather than have a sleep study.

HST is not the end of sleep labs. We should not be afraid of new technology, but rather should embrace it and work it into our labs. We can guide the future or we can stick our heads in the sand. The choice is ours.

Credentials and recertification is here to stay. This drama around the change in credentials should be put to rest because the future is about proving we are professionals -- not trying to live in the past. Proving you have taken CEUs just proves you are a professional. If you want to fight something, then fight for our profession and education programs.

This year has had drama and controversy and more changes in our profession than ever. Next year promises more of the same. We need to band together and be the professionals we are. We need to help educate each other and help the field to grow and take on more responsibilities. This much I know for sure.

Give Yourself the Gift of Good Sleep

Penny Mehaffey — Thu, 01 Dec 2011 15:31:00 GMT

Well, it's been a year now since I started blogging for ADVANCE. I have to say I have enjoyed it very much and I really can't believe how fast the time has passed.

This is typically the time of year when many things can sabotage our best efforts to get adequate sleep. I know for instance, that since my husband's gifts have appeared under our Christmas tree, I will not be sleeping much tonight. He shakes and rattles every gift. He cannot stand the suspense. Even as I write this, I can hear the beep, beep, beep of the metal detector in the living room. Seriously, he's using the metal detector to see if he has any gold ore. His hobby is prospecting.

Then, there's the extra financial strains that come with the season and -- if you're lucky -- the opportunities for overtime to rob you of your sugar-plumb visions. The holiday parties and social events and extra cooking and shopping and wrapping and cleaning.... all crammed into the same 24 hours as the rest of the year comes to a quick close. It all leaves us little time for sleep. A big sleep stealer for me are all those Christmas specials and the Lifetime channel. Must see TV for me.

Whatever it is that interferes with your good night's rest, try and minimize it. One of the best gifts we can give ourselves is a peaceful slumber. Brace yourself, only 24 days left 'til Christmas.