Monitoring sleep technologists is a careful balancing act. On one hand, supervisors want to ensure patient safety to the highest degree, sometimes by watching the moves of employees through video cameras and software that requires regular updates. On the other hand, supervisors want staff to feel like they are trusted professionals who don’t need to be monitored. It seems like supervisors can’t have it both ways—trust and close supervision—but a balanced policy can ensure patient safety, trustworthy techs, and satisfied supervisors.

NIGHTMARE EMPLOYEES

It was about 1:15 am when my pager went off and a nervous employee, Linda,* called me saying that her coworker, Jack,* had been on a long break and she was alone with her two patients plus his two. Fortunately, I lived within walking distance of the lab and was able to arrive there in 15 minutes. When I pulled into the facility, I saw Jack in his car accompanied by another individual looking a little more than cozy, shall we say?

I walked past the vehicle to make sure I was noticed and entered the lab. As I reviewed his workstation, the last documentation was at 11:30 pm. Jack came into the building and asked me what I was doing. I turned and asked him to explain why the patient had not been charted on. The color drained from his face as I relieved him of duty and terminated him the following morning when HR was in to complete the paperwork.

Despite the shock of this scenario, a month prior another employee was terminated for running up the lab’s monthly cell phone bill to $6,000, which we had for 911 emergency uses only. Why would I hire such individuals to work in my lab? The answer is easy; I didn’t. At least they didn’t demonstrate those characteristics when I was working nights, so how did we get into this predicament?

The answer involves many factors including ethics, morals, and opportunity. When we monitor our patients, there is a level of trust between the technologist and patients much like that of an airline pilot and his passengers. Lab managers have a responsibility to monitor and protect patients similar to a pilot’s obligation to get passengers to a destination safely and in a timely manner. The lab manager takes the overall responsibility for the staff, patients, customers, and services and needs to have policies and procedures in place to protect all. But to what lengths must supervisors go to ensure similar scenarios do not occur?

DESIGNATING SUPERVISORS

The fewer the staff at a lab, the easier it is to manage, particularly if there is only one location. In the beginning, the lab where I was employed had two sites and about 10 beds, so dropping in to check on staff, give in-services, or do performance reviews was not difficult. As the sites expanded to four, then five, staffing was up to about 35 full-time employees total. What had been a biweekly occurrence now needed to be done nightly or even more to be able to keep in good communication with staff. One solution was to designate a night supervisor who would rotate around the sites and be a resource person as well as supervisory staff. But such employees need paid time off, can’t be at all sites statewide simultaneously, can be hampered by inclement weather, etc. It was a start, but it was not the complete solution.

INSTALLING VIDEO MONITORS

The next step for me was to pursue an educational endeavor with a lab that had facilities in multiple states and multiple institutions, and was running 40+ studies nightly. Being the full-time educational resource, I taught during the day for a few weeks and then followed new hires into the field and worked with them for their first few weeks on the night shift. I would also occasionally rotate to local facilities and fill in for a sick call and in-services. On one such occasion, I walked into the lab around 3 am to find Robert* and Andrea* with their backs to the patient monitors watching a portable DVD movie. Even more surprising, there was no documentation since lights out; the techs would “back-chart” in the morning. When I reviewed the record around 1:30 am, the patient had a 13 beat run of ventricular tachycardia (V-tach). According to the medical director, procedures of this facility required the tech to notify the medical director of any V-tach that went beyond 10 beats. As one might imagine, the physician was less than thrilled and wanted an explanation as to why he was being called in the middle of the night 2 hours after the event occurred.

It was at this point that the company manager installed video cameras in the control room. We had already been utilizing remote server access to help techs troubleshoot or check on quality control during acquisition. We also had instant messenger installed on PCs so techs could communicate together as well as with supervisory staff, but this was not enough.

The backlash from staff was not unexpected. However, when explained to techs who do their job and take pride in their work, they understood the reasoning for it. In order to offer solutions to staff, we utilized photo therapy lights to help the techs manage their shift work.

MORE SOLUTIONS

The above-mentioned techniques are just a few of the options available to managers. Creating a career ladder for techs and giving those with exemplary work ethics a limited supervisory role work very well, but there needs to be loyalty to management and a commitment to quality care. Ultimately, I believe it is up to the individual to hire, evaluate as best as possible, teach, and allow employees the opportunity to prove themselves in the clinical arena. Teaching the basics of professionalism in the hospital starts with HR, moves through orientation, and then is covered through compliance and HIPAA presentations in nearly every health care organization.

I personally don’t think video cameras replace direct observations, but logistics may necessitate such a monitoring system. Installing video cameras does make staff think that they are not trusted. Managers can help minimize this reaction through honest explanation of policy changes.

The lines of communication between management and staff need to be crystal clear. Having a set policy for the above-mentioned offenses sends a signal to staff that illicit or unprofessional behavior in any manner will not be tolerated.

As the numbers of techs continue to grow, managers can be a bit more selective in their new hires. Educating techs on proper sleep hygiene and providing light boxes may help curb the urges to sleep. Stopping in on the night shift occasionally to have a staff meeting, bring in food, and review new procedures acts as positive reinforcement techniques.

I am always a firm believer in treating staff as professionals. Mutual respect can help foster professionalism, but with that respect comes a responsibility to perform high-quality care in a safe environment for patients.

* The names of individuals have been changed to protect their identity.

The above scenarios are the worst examples of employee behavior and represent only a few of the nearly 120+ techs I have had the pleasure to have either trained or worked beside. With firm and clear departmental policies that are enforced, lab managers should be able to elevate quality of care. I hope lab managers never have to deal with situations such as these, but methods need to be in place to deal with such circumstances should they occur. Considering lab resources, logistics, and needs should help inform monitoring policies.


Stephen Tarnoczy, RRT/SDS, RPSGT, is director of clinical education for the Respiratory Care Program at Carrington College, Las Vegas. The author can be reached at [email protected]