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PTA Blog Talk

Narrow Scope of Practice

Published May 18, 2011 7:56 PM by Jason Marketti

If I assist nursing with a transfer and the patient has not been evaluated by the PT, am I practicing outside of the practice act? What if I only use the hand crank on the lift device and do not touch the patient? Or what if I prevent a fall from occurring and actually touch the patient, who has not been seen by a PT? Should I turn a blind eye to the patient who is a fall risk and trying to self-transfer even though that person has not been evaluated yet? Or the Alzheimer's patient who has eloped and is crossing a busy intersection - do I ignore the obvious danger only because that person has not been evaluated by the PT before I attempt to intervene?

Some PTs may even report me for changing the oil and brakes on my car because I am not ASE-certified or report me for impersonating an officer because I have laid flares out on a road and direct traffic around an accident. How about reporting me because I have recommended a certain toothpaste to my family and friends due to sensitive teeth even though I am not a practicing dentist?

If I purchase crutches and then teach my daughter how to use them, will someone call the state board and report me because she has not been seen by a PT first? And heaven forbid I do any wound care on myself because a primary provider has not seen me before I clean my own wound.

Maybe I should consult a podiatrist, CPO and the PT before I suggest to a patient with ill-fitting shoes to get some that actually fit without falling off when we walk. And if I perform CPR on someone, even though I am a certified instructor, will someone suggest I should not be doing that since I'm not an EMT/paramedic?

Common sense should prevail in certain cases; however, our scope of practice may prevent us from actually assisting patients from harming themselves and others. And some regulations only bog us down from doing the right thing at the right time with the information we have. I'm sure some would agree when looking for direct access to patient care.

10 comments

Jeanne,

I hope you read this - I'm not sure where else I could put this where you'd stand a better chance of seeing it.

I received a comment on a recent blog that made me realize I owed you an apology.  Feel free to read my August 3 blog post to get a wordier rundown of my thought process, but basically I allowed my previous experiences - both personal and professional - to color my perspective of your comment.  With limited intel, I arrogantly made assumptions and accusations that I had no right to make.

I ask your forgiveness.

Jane Goude July 2, 2011 4:05 PM

I know I'm a bit late into the conversation, but I thought I'd add my two cents...or whatever it's worth.

  I actually love Jason's articles and their candid nature.  I even printed this one and it will be hanging in my office.  I don't find his editorials bitter at all.  I tend to tell people that I stay optimistic when I can, but realistic when I can't.  The reality of the PT/PTA situation is that despite our experiences as PTA's (albeit not all are created equally), we are still treated in the eyes of many practice acts and Medicare laws as nothing more than a high paid aide.  I'm surprised they still let us bill for services.  

  We work hard to improve our patient's quality of life, to investigate and solve problems preventing them from doing so, and yet when it comes to being allowed to critically think and to put 2 and 2 together, we are told it just might be outside our scope of practice.

  It is very frustrating.  I find it more frustrating when I'm working with a new grad PT who doesn't respect where I've been and my experiences.  Fortunately I work in a facility that gives me freedom (where allowed by law) and I choose to work in a state where the laws are more liberal than others.  It's still frustrating however when I go back and read ridiculous laws in some states that state a PTA (no matter experience or CEU's) cannot complete wound care, but a new grad PT that spent a week or two covering the subject with little to no practical experience can.  And some ask why we're frustrated?

  I don't know when it became this way.  Maybe it was the lobbyists, maybe the litigous society that we're in, maybe even PT's worried that we, the lowly PTA's, were taking over.  

 To all who say we're frustrated about our jobs, that couldn't be farther from the truth.  The reality is that our healthcare system has slowly moved farther and farther away from a being a patient advocate and closer and closer to an advocate for the payer systems.  If that's not frustrating, I don't know what is.

  In the end, as many states have precluded PTA's from recommending proper shoe wear (perhaps in spirit and not in letter), the patient's have lost one more person that might be an advocate in the health care debate.

David, Physical Therapy - PTA, Large Hospital System June 30, 2011 8:08 AM
Savannah GA

I'm not going to stand by and do nothing and watch an elderly person fall. Period.

I'm not letting fear of any board, or any one, suck the humanity right out of my heart.

Things are getting ridiculous.

Andy , PTA June 10, 2011 9:42 PM

Thank you all for the comments.  If some health professionals allow for variances in our practice acts when do we put a limit on it?  Perhaps bringing to light that some practice acts are flawed when followed to the letter will allow changes to occur.  

@Jeanne, perhaps you have not read enough of my blogs.  Please go back and read them closely.  

Jason Marketti May 24, 2011 8:33 PM

  Jane.....  that's an interesting perspective ...although far from my meaning.  Thanks for your comment though.   Jason,   The blogs written by you repeatedly indicate a person frustrated in his career.  Since it is what it is, I merely suggest you find whatever gives you peace. If your job/career do not provide that, then it just may be time to move on. State practice acts are naturally very detailed and many times cumbersome. Some states have much more advanced and proactive acts than others. Good luck is sincerely wished in trying to bring around that change and finding peace in the day to day.

Jeanne May 24, 2011 7:38 AM

Jason,

Good topic with good thoughts to ponder.  I think most of us have wrestled with similar questions.  Unfortunate our legal climate has our radar so finely tuned.  It is my understanding that the heart of your question would fall under the Good Samaritan act.

I am saddened that you chose to take the PTA/PT road on this one.  The core of this blog is a universal healthcare provider issue.  There was no need to bring the discipline chip into it.  That brought in a separate issue and made you look bitter, which I believe is what Jeanne was responding to.  This is a great forum to get input on those issues also, but I think you will get more honest and helpful discussions if you address them head on.  

Jeanne, not that you'll read this, but your remark was sorely lacking in professionalism.  I respect healthy discussion, but not low blows thinly disguised with a duplicitous "good luck and peace" at the end.

Jane Goude May 23, 2011 10:42 PM

First and foremost, do no harm. To me that includes the prevention of harm. If someone brings you up to a state board because you intervened to prevent harm, I'm sure that any sensible board would dismiss that claim as ridiculous.

If any PT were to bring such a claim, they would fit in well in the NHS (that's not a compliment!)

Dean

Dean Metz May 22, 2011 9:21 PM

Most states will prohibit a PTA from hands on care until the PT has evaluated.  This is a grey area because if you do stop a fall (hands on the pateint) and then report an assessment of it you will most likely be in violation of the practice act.  If you allow the fall to occur you can say you are following the rules the PT's have given you and will be blameless however, the patient may very well be harmed.  

Ask the state board for clarification on this.    

Karen May 22, 2011 12:40 PM

Jeanne, thanks for the comment.  It is easy to dismiss the questions by suggesting I should move on and change careers.

If I ask too many questions I can be labeled meddlesome, when I ask appropriate questions which allows me a better understanding of state practice acts you call me frustrated.  

Jason Marketti May 22, 2011 3:19 AM

Jason,   Seems like you're a bit frustrated in your life and career. Are you sure it isn't time to move on to another job/career? Such frustration and resentment aren't good qualities in a rehab. director, are they?!   Good luck and peace.

Jeanne May 20, 2011 8:39 AM

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    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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