PTA Direction/Supervision Advice

[Thrifty]

Hello! I've searched the forum and haven't found anything with this discussion, but please correct me if I'm wrong!

I work in a small rural clinic privately owned by one individual. With this being such a small clinic, rules are pretty lax and PTAs do have quite a bit more independence than I've experienced at other clinics, which is overall not a bad thing. I'm a new grad and have been practicing for about 6 months now. I'm having difficulty with my plan of care being followed by one of the PTAs. My clinical director picked up early on of this being somewhat of an issue on their own, however very little change and enforcement of rules has come from the director and the comment, "Well that's just how that PTA is" has been thrown around. Schedules are getting switched around by the PTA so she can see the patients she likes, specific manual interventions are not being performed, and focus of treatment is getting lost in PTA's own assessment of what they think is important (i.e. working on strength only when balance is the main issue).

I've been consistent about making my goals for patient care known, as well as specific conversation with the PTA about what I've assessed as necessary and important interventions for treatment, however I still have instances in which this PTA ignores my direction. I do think multiple patients have attended therapy for longer than they should have because of this.

Is there another way I can approach this directly to improve my work environment and ensure my patients are getting proper treatment? Any other new grads have a similar issue?

Thanks!

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[truthseeker]

Hello! I've searched the forum and haven't found anything with this discussion, but please correct me if I'm wrong!

I work in a small rural clinic privately owned by one individual. With this being such a small clinic, rules are pretty lax and PTAs do have quite a bit more independence than I've experienced at other clinics, which is overall not a bad thing. I'm a new grad and have been practicing for about 6 months now. I'm having difficulty with my plan of care being followed by one of the PTAs. My clinical director picked up early on of this being somewhat of an issue on their own, however very little change and enforcement of rules has come from the director and the comment, "Well that's just how that PTA is" has been thrown around. Schedules are getting switched around by the PTA so she can see the patients she likes, specific manual interventions are not being performed, and focus of treatment is getting lost in PTA's own assessment of what they think is important (i.e. working on strength only when balance is the main issue).

I've been consistent about making my goals for patient care known, as well as specific conversation with the PTA about what I've assessed as necessary and important interventions for treatment, however I still have instances in which this PTA ignores my direction. I do think multiple patients have attended therapy for longer than they should have because of this.

Is there another way I can approach this directly to improve my work environment and ensure my patients are getting proper treatment? Any other new grads have a similar issue?

Thanks!

I would talk to the owner again and say that you are ultimately responsible for the plan of care and its implementation and if the PTA can't/won't follow your plan then leave. Maybe have the meeting with the PTA in the room so everyone hears the same thing at the same time.

 

[Fiveoboy11]

Hello! I've searched the forum and haven't found anything with this discussion, but please correct me if I'm wrong!

I work in a small rural clinic privately owned by one individual. With this being such a small clinic, rules are pretty lax and PTAs do have quite a bit more independence than I've experienced at other clinics, which is overall not a bad thing. I'm a new grad and have been practicing for about 6 months now. I'm having difficulty with my plan of care being followed by one of the PTAs. My clinical director picked up early on of this being somewhat of an issue on their own, however very little change and enforcement of rules has come from the director and the comment, "Well that's just how that PTA is" has been thrown around. Schedules are getting switched around by the PTA so she can see the patients she likes, specific manual interventions are not being performed, and focus of treatment is getting lost in PTA's own assessment of what they think is important (i.e. working on strength only when balance is the main issue).

I've been consistent about making my goals for patient care known, as well as specific conversation with the PTA about what I've assessed as necessary and important interventions for treatment, however I still have instances in which this PTA ignores my direction. I do think multiple patients have attended therapy for longer than they should have because of this.

Is there another way I can approach this directly to improve my work environment and ensure my patients are getting proper treatment? Any other new grads have a similar issue?

Thanks!

You should be a bit more confident that what this PTA is doing in these instances is not indicated or is less indicated than something else. Be critical of your own assessments and why you want what you want. If you still feel the same you should consider having a joint meeting between you and the owner. You really need to be critical of your own work though first I think. Be objective, clinical, and calm. Not opinionated, subjective, and emotional. Good luck.

 

[ya1]

I had to cosign all treatments done by PTAs when I was working in outpatient clinic. Not sure if your clinic does that. But I respectfully refused cosign treatments that I did not order (let's say PTA by mistake would use ice on patient whereas ice was not in POC). If the owner-PT wants to take responsibility for PTA's treatments (and cosign them) that supervising PT did not order, it's their choice. But you do not have to take responsibility for treatments you did not order or do not agree with.
If you write SOAP, put your orders for future treatments under Plan. PTA must follow them by law.
All this should be discussed in respectful and professional manner of course like previous posts suggested. If there is no agreement, you can also refuse to be a supervising PT for this PTA for obvious reasons.

 

[deleted797640]

is that not negligence?

 

[truthseeker]

I think its more of a violation of the PTAs practice act (if there is one in that state) that is being enabled by the owner/boss person

 

[Azimuthal]

Is this in the SF Bay Area, by chance?

 

[PTAwesome]

PTA with a mere 6mo experience chiming in. I would agree with Fiveoboy and suggest that perhaps you need to address the inconsistencies you perceive between your PoC and the PTA's interventions directly with the PTA. Make sure your PoC and communication are conveying what you want for sure. And ask her directly, for example, why she implements the strengthening stuff she chooses over balance stuff if your PoC clearly denotes needing to focus on balance. You can approach it with her from a place of genuine curiosity and lack of experience in order to reduce the potential for coming of as though you're making an accusation. And in this way, you can get a direct and full answer, and address any issues in communication or adherence you guys are having.
My PTs frequently include strengthening of the LE in their balance patient PoC at the hospital and SNF settings I work at, and sometimes I can get creative and do things like heel raises on an Airex pad and bill for balance while also nailing some strengthening or vice versa. Your PTA might have a justifiable reason for doing what she does, or interpreting your PoC as she does. Of course, if it's more a case of her just going rouge on the PoC, that's unacceptable, and needs to be addressed with your boss or the APTA.
Also, IDK how your notation system is set up, but at the hospital I work at, their notes are via a custom "shell" that provides fields for details on gait training, transfers, therapeutic exercises, etc, and each one includes a line that reads: Plan: in which the PT always fills in a general summary of the PoC. This line always carries over to each new note. It's like a quick reference for everyone, so that we don't have to scroll back through the evaluation every time we see a pt; it and keeps us all on track for what is and isn't appropriate to use as an intervention. Example:
Plan: LLE strengthening, LLE patellar mobs, standing balance, gait training, bed mobility, HEP education
or
Plan: strengthening for general conditioning, lateral transfers, bed mobility, gait training when appropriate, NO SLR, SAQ, KNEE ROM LLE
The eval is always available and this line is not meant to replace it as a reference, but it's handy.
Could something like that be of use to your clinic?