Adventures in Sleep : Staff Development

Make Staff Meetings More Productive

Amy Reavis — Wed, 28 Nov 2012 23:11:00 GMT

Every month we need to have a staff meeting. I personally hate them, but I know they are necessary--and I've discovered that you can create meaningful staff meetings and help meet your CEU requirements at the same time. If you create a yearly schedule of educational topics and have a basic outline of topics that need to be covered, you can get meetings over in 60-90 minutes and make them interesting

The first thing to do is create a basic meeting structure allowing for discussion of things like changes in policy, issues that patient surveys uncover and issues that staff may have brought to your attention. A basic agenda should be mailed out one week ahead of time so that any subsequent information that may be needed can be gathered. Topics of discussion should be general in nature. If there is an issue with one person, it should be handled in private. The staff meeting should deal with wider issues, such as the rooms are too cold or dirty equipment has been left for the next shift. There should be some mechanism allowing for an open review of policies and changes in policies, such as a change in the scoring manual.

It is important to allow time for problem solving and discussion but that you keep the discussion controlled so that it does not lead to name-calling or finger-pointing. You also want the business part of the meeting to be short and concise.

The second half of the meeting should be for learning. You can get CEUs by applying to the AAST or BRPT. I like the BRPT because the application, available at http://www.brpt.org/downloads/CSTE/CSTE%20Application%20FINAL.pdf, is simple. Consider offering a topic of the month or case study of the month. I would assign a tech to do this so that you are encouraging leadership and learning throughout the staff. If a staff member has an interesting patient, they can do a case study of that patient and their disorder.

Here is a sample list of topics that could be covered in a year:

January: Staging
February: Respiratory Events
March: Movement Disorders
April: Parasomnias
May: Medication Effects
June: Titrations
July: Report Creation
August: Women
September: Pediatrics
October: Sleep Hygiene
November: ECG
December: Day Studies

If you are a larger lab you also might want to add an incentive program that offers recognition at monthly meetings. You could honor the staff member with the most positive patient survey or create a "catch someone doing something good" program. You can give out prizes or certificates to those who have done an exceptional job. Incentives and rewards will be a help when it is time to do yearly evaluations because staff will know that recognitions will be considered.

Monthly meetings are an important part of running a sleep lab. They do not have to be the boring exchange of information they have been in the past. Take advantage of the tools and people out in the community and in your facility to create a dynamic learning environment for everyone.

What Can't a Sleep Tech Do?

Penny Mehaffey — Thu, 02 Aug 2012 16:42:00 GMT

Hodgepodge is my word for the day, and if you follow synchronicity, then it's the pattern for my life lately. I guess it's a good thing. That post-vacation funk is gone and in its place is the business of the new agenda.

All of the new hires have moved to night shift, which has quieted my space considerably but created a head-banging concert on nights. Still, we are continuing to do more with less there, so that should be music to our ears right?

The A.W.A.K.E. support group is flourishing ... BIG SMILE!!! Finally, it has a steady cast of regulars who have begun submitting suggestions and asking questions and RSVPing. I am excited for the coming year.

We received the OFFICIAL word from the AASM that we are REACCREDITED. WOOOHOOO! The certificate is beautiful.

I recently enrolled in online university to complete my degree. Now, I am having buyer's remorse. But I am committed to completing my education even if it takes me until I retire to do so. Study tips anyone?

Where was I? Oh right, a hodegepodge, defined as: a jumbled mixture, with synonyms like miscellany, muddle, mess...oh, there's one I resemble.

Post-Vacation Blues

Penny Mehaffey — Thu, 19 Jul 2012 13:49:00 GMT

I hope everyone's week is going good. I wish mine was going better...I have been in a weird kind of funk since vacation. I've been back long enough to be back in the swing of things, but it's just not happening.

I guess part of the problem is I took too much time off: 11 days. Someone else filled in for me (Thanks, Joanna!) so I really wasn't behind when I returned. But honestly, after 11 days my body did not want to go back to work mode.

It was almost impossible that first day back. I had two new sleep techs waiting for me to orient them. The orientation lasted about two to three weeks. It's hard for me at times to have all those extra people around. I typically am alone with a few "walk-ins" during the day. That is nothing like having two people following your every step, not to mention all the extra words I had to use.

The first week was the most disruptive because I had those two shadows and a teen volunteer helping me. (I love my teen volunteer, Frances, by the way, and sadly she is gone now.)

With the new techs on nights now and the day schedule back to normal, I should be better. I am keeping up, the pace is the same, but I don't feel the same. I don't feel settled yet. What's up with that??

Co-workers Inspire Praise

Penny Mehaffey — Thu, 06 Oct 2011 13:40:00 GMT

It's sleep tech appreciation week and in that spirit I'd like to dedicate this blog to the wonderful group of sleep techs I work with. They are a mixed bag of personalities like I have come to suspect is the deal at a lot of sleep labs. But a more dedicated group of professionals you'd be hard pressed to find.

These people come in early and stay late and volunteer at support group meetings every fourth Thursday of the month.

For the past six months they have worked at least one shift of overtime per week to cover the lab and why did they do this? For the money or for the glory? Naah ... that's not it. Because it's expected or was mandatory? Nope.

Well then why? I can tell you why. They rallied together to cover shifts when one tech had an extended illness and when another retired suddenly, and when deaths in families occurred and more untimely events beset us. They did it without skipping a beat just because we asked them to. Really. That's how they are -- one of the most caring, giving groups of people I've worked with.

I am very proud of my co-workers and believe there is no better set of sleep techs anywhere. And in the face of all that, plus budget cuts, downsizing and layoffs, they still show up with their shiny faces to staff meetings and shifts heavy laden with 2 year olds, ready to do whatever it takes to get the study done.

So to Beverly, Joanna, Keneshia, Jordan and Jeri, thank you. YOU GO GIRLS! YOU ROCK!

Becoming a Multicenter Sleep Lab: The Challenges

Amy Reavis — Thu, 30 Jun 2011 13:15:00 GMT

Growth is hard. Our lab is planning its first offspring. It is exciting but a little distressing. I am learning that when you work with people who like to have control, you have to stand up for what you want. In the end, you will get what is best for the patient. (It has taken me a while to learn this.)

I have not been allowed to go out and see the building. I have no control over what it will look like. So I have had to let that go.

I do have control over what equipment we will buy and who will be working at that lab. I can insist on a clean and a dirty utility room and on a washer and dryer. I have even insisted on good sheets and blankets and pictures for the walls.

So why do I say growth is hard? Well, there is a certain amount of balance that you get when you have been running a lab for 3-plus years. Adding new beds and new doctors to the mix means you have to accept that there are going to be changes.

There is the increase in work we will be doing based on sales projections (which we all know are basically a guess). There are staffing issues including who can work on their own and what happens when there are no studies.

Mostly, I'm learning to change my leadership style to give more responsibility to people. I hate to micromanage but I like to know what is going on with all my patients. I will not be able to do this with the new facility. I will need to create higher expectations for some of my technicians. I have some great techs who are go-getters and I have some techs who are excellent techs, but do their job and that is it. They do not study and look to improve. So I keep encouraging the go-getters and I try to help the others find their niche. But as we grow, I will need to not necessarily promote those who have been here the longest but those who have made the most consistent improvements.

All I know is that I need to find the balance of moving from a small one facility lab to the next step: a multi-facility organization challenging. I think I am up for the challenge. I know that it will go smoother if I am aware of my shortcomings and learn from those who came before me about how to make this transition successfully.

Moving to the Next Level

Amy Reavis — Thu, 05 May 2011 12:59:00 GMT

One of my jobs is to help run an ad on sleep program for the local respiratory therapy degree. We are even considering making it part of the BS degree in cardiopulmonary. Which leads me to ask, "Where do I see an advanced practitioner in this field?"

When I put that question out on one of the sleep bulletin boards I got a great deal of feedback that really did not look forward. There were a lot of requests for extra scoring classes and troubleshooting classes. There were requests for electrical theory. There were thoughts about pediatrics.

What I was hoping for was maybe thoughts about what an advanced practitioner might do. Would we need classes in PAP NAP, or understanding billing and coding so we can run a DME program? What about patient follow up? These are all jobs done by respiratory therapists but could probably be done better by a sleep tech with some advance practice classes.

We seem to be focusing on the politics of sleep; but if we want to grow we really need to add more responsibility and education to our jobs. We need to be an integral part of a physician's practice. We need to be involved with running research projects.

Where do you see this field 5 years, 10 years and 25 years down the road?

Another Credential Won't Tell the Whole Story

Penny Mehaffey — Fri, 25 Feb 2011 17:13:00 GMT

So, I have been thinking a lot lately about this situation with the AASM's new credential. My first reaction to the comments by the AASM was "what?" and then OMG! I can't believe they said that! I was insulted to the core of my professional self. Eventually, a few articles later, I became less emotional and tried to look at both sides objectively. And while I am no expert, I certainly do agree with Janice East that what we need is standardized formal training (schools) and not another test.

We all know of those who are great at test taking and pass tests easily with little to no studying, and those who are not test takers but are great at what they do and can tell you all you need to know about the given subject. Given the current state of training for sleep technologists, I can't believe the AASM is surprised that some of those with credentials aren't fully job-ready.

I remember how shocked I was when I first came to sleep. My experiences as an LPN qualified me for the position but I was nowhere near job-ready when I started hook-ups on my own, despite many years in nursing. I had a brief orientation period and was then pushed off on my own. It used to take me 2 hours to get a hook-up done, forget about knowing what all those squiggly lines meant. I did know the EKG though, thank goodness.

It was six months or so before I felt fully comfortable with my practice. It was only then that I was really able to focus my attention on the academics of sleep, so to speak. And my experiences in sleep over and over again have been similar. It is not uncommon in sleep to hear the phrase "just read the manual, it's easy" or "nobody showed me how to and I figured it out." Contrast that to the nursing side of things that I was used to where you did not touch a new monitor until you had been properly inserviced on it by a company rep, demonstrated proficiency before being approved to use new equipment. Talk about a reality shock, or is it culture shock?

Based on my experiences, and conversations I've had with peers, it would seem we have a whole sect of professionals who are largely self taught. I have heard of some labs where the medical director holds classes on a routine basis. This does not appear to be the norm though. The closest thing we have to formal training is ASTEP, a self paced, self guided curriculum that is totally dependent on the student's knowledge base and ability -- no outside input or support from a counselor of any kind.

So in the world of sleep we have only ourselves to learn from and only ourselves to blame. I am very competent in my practice. I was fortunate that my employer actively participated in my education and still does. We were all sent to the Atlanta School of Sleep Medicine for intensive two-week training and within a few months we all sat for the registry exam. I highly recommend a program such as the Atlanta school. The classes I attended there made everything I had been exposed to come together for me. Before then I wasn't really confident in my knowledge and felt that what I was learning was very scattered.

I am very proud to say that our lab was the first in our area to be accredited. Because of this, a certain level of expertise is expected and required of us. Have all of our techs come to us at the level we want? No. But we take them on at whatever level they're at assuming we will have to bring them up to where we need them to be. I would say it is a given. Until there is a formal sleep curriculum that everyone is required to study, I see no reason to expect improvement just because there is another credential to test for.

Sleep Credentials: The Infighting Continues

Amy Reavis — Thu, 27 Jan 2011 19:02:00 GMT

In sleep there seems to be a lot of infighting over control of who will provide credentials for the technicians. With such a young field this does not help out professionalism and it makes our field look undervalued. The latest group to get involved is the American Academy of Sleep Medicine (AASM). They have decided that since the Board of Registered Polysomnographers could not create a test with a high enough pass rate, they should take over the testing of sleep technicians.

This is the group that created the A-Step program, an online educational program for people who have come into the field through on-the-job training. It consists of 18 units that cover the basics of polysomnography. It is not a complete education but in conjunction with a good on-the-job training program it can give people the starting point to become excellent and well=educated sleep technicians.

The reason they feel that they needed to take this step was due to the low pass rate of the BRPT exams. As a manager of a lab with several technicians who work hard, have done the A-Steps and have failed the test, I can tell you it can be frustrating. I personally took the test myself and passed it but I believe my background in respiratory therapy assisted me because I have a background in understanding the respiratory and cardiovascular systems. I did think that some of the questions about such issues as pen deflection and the old paper sleep systems were not as useful as asking me questions about computer-based systems.

What will this mean for the field is unclear. Which tests will end up on top? Will being an RPSGT mean anything? Will all of us be required to take additional tests? Will the NBRC see this as a way to push their credentialing test forward and reopen the discussion about licensure? All these are unanswered questions while people sitting in an office make decisions that effect our field.

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.

How Can You Nurture Sleep Techs With Low Self-Esteem?

Amy Reavis — Mon, 01 Nov 2010 17:29:00 GMT

I believe one of the most important parts of management is to help to create future leaders. I don't think that nurturing new leaders puts your job in danger. It actually encourages people in my department to be better techs and to be more satisfied at their jobs. However, techs with low self-esteem can derail this goal.

For whatever reason, they feel people always judge them. They're afraid of making a mistake and what repercussions might happen. They also may be afraid of failing or succeeding. Regardless of the issue, is it is very hard to nurture these people.

I struggle to teach them, because they get defensive when you try to show them something new or to encourage them to attempt something in a different way. What I find truly troublesome is that it takes a great deal more energy to work with these people.

I can honestly say I was there once, and I sincerely apologize to all those who tried to help me grow. I sometimes think maybe this is a bit of payback. I just wish I had a great phrase or quote or something to help these people realize that feedback is not always bad, that they shouldn't second guess every move, and that they're truly great technicians.

Unfortunately, I have learned I need to keep my professional distance as a manager and that all I can do is help those who want to move forward and hope someday these techs with low self-esteem realize how they're holding themselves back.

How do you work with staff with low self-esteem?

Sleep Techs Need to Understand How Insurance Works

Amy Reavis — Fri, 15 Oct 2010 11:22:00 GMT

Many sleep technicians don't know how insurance works. They don't understand what insurances cover and which insurances need authorizations before giving equipment or performing tests. To them, this is an issue just for the billing office and the scheduling desk. I have found that the more I understand about our field and the way we are paid, the better I am able to help the lab be profitable.

The difference between a job and career is that in a career we understand as much as possible in all aspects of our field. This makes us an important part of the business. We are then able to contribute more to the lab. A person who has a job comes in, does what's required, and goes home at the end of his or her shift. There is a place for both types of people. However, the best way to help our patients is to understand how everything works so we can educate them.

Insurance reimbursement is something most patients do not understand and so they do not see why we can't do a split night study on everyone, why we do not send them home with a machine, and why they may have to pay a separate deductible when they get a piece of sleep equipment. If we have a better understanding in the sleep lab, then we're able to educate them. The more education you give a patient, the more successful you will be when you're selling them on the need to use a PAP device.

I will admit it is hard to keep up with competitive bidding and changes in policies by insurance companies and managed care programs. But if we at least keep up with Medicare reimbursement policies, then we have a basic idea of what patients need to know. We can tell them that they need to make a follow-up appointment 30-60 days after the delivery of their PAP device. And we can explain when they should get new masks and filters for the machine. This information will then be reviewed again when the machine is delivered. The more times people hear something, the more likely they are to remember it. This will help to contribute to compliance, which is the ultimate goal of testing and treating sleep apnea.

A little research goes a long way in helping you to grow the lab. When you have successful patients, your referring physicians will be happy. The more tests ordered, the more beds are filled and the less likely you are to be cancelled. All in all that is a good deal for everyone.

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.

Avoid Taking Shortcuts in the Sleep Lab

Amy Reavis — Fri, 20 Aug 2010 14:22:00 GMT

I've been involved in sleep for the past 10 years, and I can tell you that I still measure every patient's head when I do a setup. My setups take between 45 minutes and an hour. I have never really gotten much faster than that. I think it's because I really believe that if you take your time and measure and clean the sites well, you will get the best results. Unfortunately, many technicians out there would not agree with me.

I have had techs who don't know how to measure a head or tell me they have been doing it so long they don't need to measure anymore. These same technicians also use a great deal of paste on the leads to get low impedances. Although low impedance is important, doing a good job with a setup is an essential part of our job.

Techs take other shortcuts. Some refuse to learn to stage. They feel their job description doesn't include scoring, and if they learn how to do it, then they might be required to score during the night. How do you know when to split a patient or increase the pressure if you don't know how to stage a patient? We need to be expanding what's demanded of us day and night if we want our labs to grow. This means always learning new skills and taking on new tasks.

How do you encourage your staff to perform quality work?

Does On-Demand Testing Come at a Price?

Amy Reavis — Mon, 09 Aug 2010 17:34:00 GMT

The RPSGT and CPSGT exams have gone to on-demand testing. This is a great thing because for the past two tests it took more than three months to get the results. However, this change came with an increase in the test of $100. This price increase along with the cost of the A-STEP is making it financially stressful for many people to take the test.

In many states, there are still no requirements for credentials. There is also the fact that if you have respiratory credentials, you can sit for a specialized test, the SDS credential, for less money. With this competition, no real reason to sit for the test in some areas, and the low pass rate, I wonder if this was the best move by the BRPT.

In my lab, I have a technician who took the A-STEP online, has been working in the field for eight years, and has not passed the test in two attempts. He has very limited study materials because the test keeps changing. The blueprint is vague. And when we looked at why he failed, he did the worse on archiving and patient education.

I believe in the credentials. I sat down with test books and studied myself. I took the APT, now AAST, review course and passed the test with no problem. I'm not sure if being a respiratory therapist helped. I'm not sure what I need to do to help this technician pass the test. I'm not sure if it's better for him to take the CPSGT right now and see if the pass rate changes.

I do know that the credentialing process is important if we are to grow as a strong independent field. But raising the price may discourage some people, even if they can get the results immediately.

What do you think?

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.