The College of Physiotherapists of Alberta’s primary responsibility is protection of the public’s interest related to the care they receive from physiotherapists. The Supervision Guide and Supervision Standard address a key aspect of physiotherapy practice, the appropriate supervision and integration of physiotherapist support workers into the physiotherapy practice environment.
One of the biggest challenges in drafting the Supervision Guide 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 physiotherapist 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 physiotherapist 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 the physiotherapist support worker’s training and competence into consideration when deciding what to assign and how to supervise treatment. For this reason, the use of physiotherapist support workers will vary between therapists and practice settings however, some expectations apply to all registrants of the College of Physiotherapists of Alberta:
- Physiotherapists are responsible to ensure that they, and those they supervise, are providing high quality, effective and safe care.
- 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.
- The physiotherapist discusses their plan to involve a physiotherapist support worker in the delivery of physiotherapy care and obtains the patient’s consent to do so.
- 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 physiotherapist support workers who possessed 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 support workers have unique skills and abilities; areas where they are highly competent 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 physiotherapist support worker, but it is a critical aspect of supervision to do so.
In fact, it is a requirement of the College of Physiotherapists of Alberta that physiotherapists do so before assigning tasks to others.
Another key requirement of the College of Physiotherapists of Alberta is that registrants are appropriately involved with the care of patients whose treatment has been assigned to physiotherapist 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 physiotherapist support workers 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 receiving physiotherapy, it is expected that their care is provided by someone with the necessary skills and competence to provide safe, effective, quality care. Whether they are a physiotherapist or a physiotherapist support worker the expectation is that services are provided in accordance with the Standards of Practice.
While physiotherapist support workers are often involved in 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 physiotherapist 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 physiotherapist 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 physiotherapist 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.
Providing high quality care is part of our Code of Ethics
Members of the physiotherapy profession have an ethical responsibility to:
- Take responsibility for the client care delegated to students and other members of the health-care team.
- Assess the quality and impact of their services regularly.
We all feel pressure to meet the expectations of our clients whether we are in public or private practice settings. Busy caseloads require us to assign work to physiotherapist support workers and as the population continues to age, we may see a further increase in the demand to do so. It is our responsibility to work with physiotherapist support workers within their capabilities to not succumb to complacency when things are hectic.
The 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!
- Physiotherapy Alberta – College + Association. Supervision Guide. 2015. Available at: http://. Accessed on August, 2015.
- 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.
- 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.
- 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.