Granting Competency to Therapy Assistants

My province, like many jurisdictions, has a policy that the standard for establishing competency of a TA in a task that may be delegated is for the PT to provide direct supervision of the TA while they perform the task and observe the TA performing the task competently.

While “observations” is definitely one standard for establishing competency (and may be the standard of practice established by your local regulatory body), it is not the only method and obviously has its own weaknesses. Is a new graduate PT as competent in the decision to “grant” competency on a TA via observation as a more experiences PT?

One of the frequent tenants of establishing competency is that it cannot be “granted” but is actually an intrinsic process. Only the individual that wish is establish competency knows if they have mastered the task within education and training they have received. External validation is still necessary in that individuals may not have the breadth of knowledge, skills, or experience to understand the full scope of what “mastery” for the task is. If I complete an external competency process successfully but know that I was simply lucky that certain questions were not asked that I might not have known the answer to or certain skills not tested that I may not have been able to safely perform, I honestly cannot consider myself competent. The first step in establishing competency is for individuals to honestly reflect on whether they have any gaps in knowledge or skills and then implement a plan to address those gaps.

PTWonk

PT to TA Attitude

One significant issue in the optimal use of Therapy Assistants is the perception of the PT being liable for the care provided by the TA. This is not to say that PTs are not liable… most provincial and state laws would clearly indicate that they are… but, it is where this premise leads.

What I have observed is PTs are willing to educate patients, families and caregivers on aspects of rehabilitation, such as chest physiotherapy and assisted ambulation, but are reluctant to delegate the same tasks to therapy assistants. We educate patients on performing dressing changes, but will not allow a Therapy Assistant to perform the same activity.

This has got to improve.

What I recommend is that PTs identify the top 3-5 tasks that they frequently perform and develop a process to proactively ensure that the Therapy Assistants they work will are competent to perform these tasks and that the delegation of these tasks then become routine practice. The process to establish that TAs are competent should be efficient, with all reasonable attempts to avoid situations where one PT that has not recently worked with the TA is unwilling to delegate tasks to the TA until the TA has repeatedly reestablished their competency yet again on a task that is now routine for them.

PTWonk