Good Practice: Working Responsibly with Support Workers

  •   September 1, 2015
  •  Leanne Loranger, PT, Practice Advisor


Physiotherapy Alberta’s primary responsibility is protection of the public’s interest related to the care they receive from physiotherapists.  This month, as we reveal our revised Supervision Guide, we address a key aspect of physiotherapy practice, the appropriate supervision and integration of support workers into the physiotherapy practice environment.  

One of the biggest challenges in drafting this document was to try to address the needs of a wide variety of practice settings and therapist-support worker relationships. Another challenge is the wide range of qualifications seen among support workers in the Alberta physiotherapy environment, which includes those with four-year post-secondary degrees, two-year diplomas and on the job training. This range of skills, knowledge and competence impacts the support worker’s individual scope of practice and what can and should be assigned to them.

One way to conceptualize scope of practice is to think about what falls under the entire umbrella of physiotherapy from which we draw our own skill set. The group of skills that we are individually competent to perform reflects our personal scope of practice. The same is true for those whom we supervise, regardless of their education or background.

Physiotherapists must take their support worker’s training and competence into consideration when deciding what to assign and how to supervise treatment.1 For this reason, the use of this guide will vary between therapists and practice settings however, some expectations apply to all registered members of Physiotherapy Alberta:

  1. Physiotherapists are responsible to ensure that they, and those they supervise, are providing high quality, effective and safe care.2
  2. The public has the right to expect that if they are receiving physiotherapy, there is a physiotherapist providing, directing or overseeing the care, its appropriateness, effectiveness and progression.1
  3. If bills are being submitted for physiotherapy treatment, a physiotherapist is involved in the treatment session.1,3
  4. Regardless of the who and how of care, the patient is assessed and routinely re-assessed by a physiotherapist to ensure that the care delivered is appropriate and effective for the patient.2


In my career, I have had the opportunity to work with several excellent physical therapist assistants, with varying educational experience, technical and non-technical skills. If I am honest, some were better than others. The simple fact is that regardless of education and experience, both physiotherapists and physiotherapist assistants have unique skills and abilities; areas where they are highly competent in and areas they are (hopefully) working to develop. As a supervising physiotherapist, one of your primary responsibilities is to identify the skills and competence of those whom you supervise to ensure that when you assign tasks, you do so appropriately.2 It can be difficult and at times awkward to undertake direct supervision of a therapist assistant, but it is a critical aspect of supervision to do so.

In fact, it is a requirement of Physiotherapy Alberta that members do so before assigning tasks to others.

Another key requirement of Physiotherapy Alberta is that members are appropriately involved with the care of patients whose treatment has been assigned to support workers.2 The appropriate level of physiotherapist involvement will vary based on patient acuity, rate of change of patient status and patient need. It is conceivable that in some environments a physiotherapist may only re-assess a patient every few weeks, while in other environments the patient should be re-assessed at each treatment session. It is advisable that you and your support worker develop guidelines relevant to your practice area and patient population that establish the frequency of patient reassessment and key indicators that would trigger a non-routine reassessment.

If you’re questioning if you need to be more involved in the care of your patients, you’re probably right.

Patients expect they will receive high-quality care from their physiotherapy team. When people are paying for physiotherapy, it is fair that they receive just that, care from someone who has the credentials to call themselves a physiotherapist. While support workers are often involved in many aspects of patient care, there are some things that only a physiotherapist can do. These tasks include patient assessment, interpretation of the results of the assessment, interpretation of scores from outcome measures, the performance of restricted activities, the performance of any activity that requires continuous clinical judgment and the performance of any task that the physiotherapist determines the support worker is not able to complete safely.4

It is important to remember that the physiotherapist is responsible for the tasks that they assign to the support worker. This means that it is up to each individual physiotherapist to determine what tasks they feel they can safely assign (keeping in mind the support worker skills, physiotherapist, patient and system factors).2 Although from the support worker’s perspective it can be frustrating to have one physiotherapist refuse to assign a task that another routinely assigns, it is the physiotherapist’s authority, responsibility and accountability to make this judgment call.

To provide less than high-quality care undermines the profession and its standing in the eyes of the public.

Much has been made of workforce planning issues arising from our aging population. As the baby boom generation prepares to retire, it appears that physiotherapists and indeed all health care providers, will need to work to their full scope of practice to meet the needs of the public. This affords significant opportunities to physiotherapists however, we need to remain vigilant that as practitioners and as supervisors we clearly know our limits and the limits of those we supervise, both in terms of scope of practice and personal competence.

The revised Supervision Guide provides information about supervision of support workers, as well as physiotherapist students and physiotherapist interns. If your role involves supervision of any provider within the practice environment we recommend you check it out!


References:

  1. Physiotherapy Alberta – College + Association. Supervision Guide. 2015. Available at: http://. Accessed on August, 2015.
  2. Physiotherapy Alberta – College + Association. Practice Standard: Supervision. 2012. Available at: http://www.physiotherapyalberta.ca/physiotherapists/what_you_need_to_know_to_practice_in_alberta/standards_of_practice/supervision. Accessed on July 28, 2015.
  3. Physiotherapy Alberta – College + Association. Practice Standard: Fees and billing. 2012. Available at: http://www.physiotherapyalberta.ca/files/practice_standard_fees_and_billing.pdf. Accessed on July 15, 2015.
  4. Physiotherapy Alberta – College + Association. Practice Standard: Supervision Appendix, Assignment of Services. 2012. Available at: http://www.physiotherapyalberta.ca/physiotherapists/what_you_need_to_know_to_practice_in_alberta/standards_of_practice/supervision_appendix_assignment_of_services. Accessed on July 28, 2015.