Case Study: Implementing an Apprentice Program at the Sleep Lab

This article previously ran in the Q1 2023 issue of A₂Zzz.

Back in the fall of 2005, I was new to the sleep medicine field. After spending 10 years working for police and fire departments, I was searching for an avenue into nursing within emergency medicine. Through this avenue, I found my way into a loosely formed apprentice program at a local sleep laboratory.

My thinking at the time was that a lab technologist in sleep medicine would be a stepping stone. In those days, the sleep lab coordinator, who worked collecting studies in the sleep lab, was tasked with training the apprentices. There were no training outlines, no syllabus and no online courses or guides to be followed. We studied the R&K Manual, “Principles of Polysomnography” by Spriggs and “Atlas of Clinical Polysomnography” by Butkov. The sleep lab coordinator would demonstrate the tasks to be learned and we would follow his instructions. Through a hands-on approach, we learned how to set up and conduct the ordered sleep studies. We also learned through trial and error how to fix any challenges that occurred during the night.

In those early years, I struggled to get my two assigned patients set up for their ordered sleep studies. Measuring for the international 10/20 system and applying the electroencephalogram (EEG) sensors were challenging enough, add to that electrocardiogram (EKG) sensors, leg leads, respiratory inductive plethysmography (RIP) belts, cannulas and the pulse oximeter. And who can forget impedance values, needing to have those down to the company prescribed levels. If a positive airway pressure (PAP) device was to be added for either a titration or a split, there was yet another stressor on the two hours of available time allotted to set up the patients.

With the passing of time, opportunities have arisen availing me to slowly transition into a position that regularly trains apprentices in polysomnography. The once fledgling program at my lab has now grown into what would be expected from an apprentice program.

You may be asking yourself a few questions by now. What does an apprentice program actually look like? Isn't that something that the trade unions do? Doesn’t Mike Rowe talk about them on the television show Dirty Jobs? The answer is yes, Mike Rowe does talk about apprenticeships and that trades have used apprentice programs successfully for years. Looking to the website cefcolorado.org:

• “Apprenticeship programs are designed to teach skills that are required for a particular trade.
• Employers sponsor their entry-level employees and an apprenticeship after they complete an introductory phase to determine if the employee wants to continue their career in the industry.
• Apprentices typically work for their employer at the jobsite during the day and attend classes in the evenings. The apprentice will participate in classroom sessions as well as work alongside a skilled tradesperson on their way to earning a certificate of completion or a license in their chosen skilled trade.”

One challenging observation my sleep lab colleagues at NorthStar Medical Specialties and I have come to realize, however, is that the future needs of our sleep lab staffing will not be met through formal college programs. If anything, we've learned that college-credentialed technologists may have the educational background, yet they come to the workplace needing additional training in the skills required in the sleep laboratory. This startling observation was confirmed while I was discussing the observation with a lab technologist in another state. He has been working in a sleep lab witnessing the same challenge also. It is my opinion that the future staffing needs in sleep labs will be regularly met with those trained through apprentice programs.

An Overview of Our Program

Typically, NorthStar's program brings on two apprentices at a time that work as a team with the sleep lab coordinator. The first three months comprise of the following:

• Learning to set up the associated sensors for a polysomnogram
• Operating the software for the collection of the assigned study
• Continuous positive airway pressure (CPAP) equipment selection, application and operation
• Scoring of sleep studies

We utilize the American Academy of Sleep Medicine (AASM)'s A-Step program, along with assigned readings from numerous sources. Benchmarks for training have been established, the first and most challenging would be the apprentices successfully setting up and implementing two sleep studies within two and a half hours. Two benchmarks are more predictable. The apprentices will be able to earn their certification and registration according to the requirements of the Board of Registered Polysomnographic Technologists (BRPT).

What We’ve Seen

Over the years, we have found training our apprentices has benefitted our sleep lab greatly. By the time an apprentice earns their certification in polysomnography, the relationship with the apprentice has changed to that of mentor/mentee. Each individual apprentice shows areas of strength, which benefits overall sleep lab operations.

We also find our scoring to be more consistent with our doctor of sleep medicine’s scoring. When the time comes for the apprentice, who has earned their necessary credentials, to move on to another lab, future networking is established, benefitting both labs.

Challenges

Our biggest challenge in conducting the apprenticeship program is simply the hours of operation. Permanently working 12-hour night shifts is not a simple task for someone used to daytime hours. The isolation from daytime operation has presented challenges where the new employee does not feel as if they are a part of the company.

Although improvements have been made, recruitment process continues to be a challenge. We keep close ties with our human resources director to maintain open communication about the selection of personnel. This has eliminated the pressure to fill positions. Our mentality changed from filling a vacant slot to finding the right person for the program. This new mindset provides better opportunities for the successful completion of the program.

Moving forward, we have future growth plans for our apprentice program. The successful training of future technicians will not only benefit our sleep lab but the sleep labs of other entities.