Rules and Regulations

It's always a pleasure to exchange ideas with others.  You do keep me thinking, thank you.

PT's and PTA's should follow the most stringent supervision whether it is state law, company handbook, or medicare regulations.  It keeps everyone out of trouble.  

Jason,

Thanks for the clarification.  

I thought about the personality issue, also.  That gets sticky.  If there is only 1 PT and 1 PTA, then what?  If there are multiple PTs to supervise the PTAs then I think that is wise - to pair up well suited personalities.  But if it is a 1:1 ratio, I do not think the PT should have the right to decline supervising the PTA.  Sometimes you have to tackle unpleasant tasks for the sake of the patient.  This would be one of them.  That is part of being a professional.  You can agree to disagree on some details as long as the regs are being followed...at least until a more desireable situation comes along.

It is hard to comment on your last statement without seeing the regs.  My point was that I doubt they were indicating that supervising PTAs was a reg.  They were not regulating whether or not supervision took place.  I think a more likely scenario is that they were laying out regs for HOW the supervision should take place in the event it occurred.  In other words, a PT does NOT HAVE to supervise a PTA.  BUT IF a PT supervises a PTA, these are the rules that MUST be followed.  Hope that makes sense.

Thanks for the dialogue!

Janey,

Thanks for the response.  Difference between assessment and evaluation:  Evaluation is done by the PT and this sets up the POC, etc.  Assessments are an ongoing process done by licensed people to deremine if any changes have occured or if there were events during the course of treatment that were different or what part of the treatment was successful.  Hence the old SOAP format when writing notes.

Another senerio for PT's not supervising a PTA is when they do not get along.  It would not be fair for either one.

The point of this blog was to demonstrate some state  laws/rules/regulations that PT boards put out are not being followed.  Obviously if there is no one to supervise you are unable to fulfill that portion.  So, should the PT's change the regs if they cannot follow them?        

Jason,

Thanks for asking these thought provoking questions.  Before I comment on this post, I want to ask for a clarification.  What distinction to you draw between an assessment and an evaluation?

I don't have the state rules and regs in front of me to which you refer, so I can't speak to the specific terminology.  But I would think supervising PTAs would not fall in the same category as CEUs.  If you are in a rural area with no PTAs, you still have to fulfill the CEU requirements.  However, if you are in that same rural area with no PTAs, you are not in danger of license suspension/revocation for not supervising a PTA when one is not available.  If they were truly equal, you would have to apply the same discipline for failure to meet either "requirement".

I think a more appropriate comparison would be the number of CEUs to following the regulations of supervision IF you have a PTA you are supervising.  Both of those have to be adhered to with the possibility of license suspension/revocation if you fail to fulfill either of those obligations.

The CEUs that have to be taken are a mandate. The specifics of HOW a PT supervises a PTA are mandated.  Both of those are different from the privilege to supervise being conferred on PTs once they are licensed, which is not a mandate.

Lynda provides a good example when a therapist would be within their scope to decline a supervisory role.  If a PTA did not have the skill set/experience to provide care in a home health setting, it would be irresponsible for the PT to accept supervisory duties if they knew that PTA would be put in an unsafe position.

Outside of that, I can't think of a scenario where a PT should decline supervising a PTA.  Lynda refers to different PTAs requiring different levels of supervision.  And this may even differ with the same PTA depending on which skill is being utilized.  A PTA may be independent with neuro patients but require more direct supervision in burn care.  

A PT who is unwilling to supervise a PTA is a red flag.  Either the PT does not have enough confidence in his/her own abilities to supervise a PTA, or that PT is not a team player.

Lynda,

By refusing to supervise a PTA would you be in violation of your state practice act?  What if you refused to do the 30 hours of CEU's, would you be in violation then? Do we now pick and chose which regs to follow.

PTA's can do assessments and I know Toni would not let a PTA do an eval.  Some PT's will hand over the patient before the ink dries on the eval because they know the competency level of their coworkers and they trust them to make the right decisions.  

Toni are you saying the PTA is performing the initial eval and you just sign off on it ??? I hope not because you are at great risk of losing your license. No PTA no matter how good you think they are is educated or licensed to perform any evalulation/assessment

period. If you think they are than what separates your education and license from theirs?

As far as the supervision of PTAs is concerned the PT must feel confident in the PTA's abilities (experience, skill set, sound practical judgment) before she/he can turn the treatment of any pt. over to the PTA. Always remember that ultimately the responsibility for your pts. rest with you from admission through discharge.

As with any profession there are strong and weak PTA practioners. And the PT is permitted to decide who to supervise and what level of supervision is appropriate based on the ability of an individual PTA. Just because a PT is licensed in a particular state does not mean foreiture of her/his rights and responsibility to make sound pt. care decisions.

As a Senior PT I have supervised PTAs that were very skilled and some who were not. It is my practice to provide true guidance/ supervison through teaching moments, instructional conversation and demonstration as appropriate. I have also declined the supervision of a PTA who I believed required more formal instruction before working in an Home Care environment that is less structured than an onsite situation.

The supervision of PTAs cannot be taken lightly, we as PTs are responsible for the well-being of our patients and the license you save.. just may be your own.

Lynda Maxwell

I think that PT just didn't want to be bothered.  I've been the supervising therapist for countless PTAs.  It never occurred to me that doing so was a potential problem in the making.  PTAs are licensed to practice.  That license implies a level of competency.  Obviously some PTA are better than others at what they do. That doesn't mean they aren't providing the best care they are capable of.

I think PTAs are underrated and under-appreciated in many instances.  The only guidance I provide the ones I work with is my electronic signature on an intial evaluation.  They know are knowledgeable and don't need me to tell them what to do or how to do it.  That is pretty much true of all the PTAs I've "supervised"