Are there clear lines for what PT aides are allowed to do?

[PathforwardtoDPT]

I'm currently a PT aide in California, so I tried looking at the California PT Board regulations and it's hard to figure out from the verbiage what exactly we are allowed to do. I'm in a typical outpatient ortho "mill" where it's obvious that they're simply trying to see as many patients as possible. Frequent double booking throughout the day etc... This of course means that the aides are relied heavily upon for the clinic to operate well. Some of the things that we are doing on a daily basis or has happened are:

-Apply e-stim pads and also turn them on and adjust intensity (with very little guidance from PTs)
-Reusing e-stim pads for different patients. (Simply tossed into a bin and reused)
-Perform ultrasound for patients
-We let patients do their own laser therapy (holding it up against themselves in specified spots)
-Guide patients through exercises even when PTs aren't around to supervise
-Occasionally PTs ask us to come up with an exercise and they'll tell us if their patients can do it or not. It's odd.

Also, I'm noticing that a few of the PTs seem to just "disappear" during their patient's session because they're so used to having aides take care of everything after their ~15 minutes of treatment. This means we sometimes have to go find them (big facility) to ask them what they want their patients to do. As aides, we're supposed to be on the lookout for patients who seem lost and give them direction, which I feel like the PTs are supposed to do. Because of all this and the double booking nature of our clinic, we're sometimes running around like headless chicken trying to manage everything, sometimes doing heat/ice for patients on treatment tables while supervising up to 3 patients at a time on their exercises. It all just seems nuts. And it's also minimum wage, which I originally didn't care because I was in it for the experience... but now it just seems very little for how much is expected from us. As an aspiring PT, I'm a bit discouraged by all this to be honest.

Sorry this turned out to be a rant. Is there any clear regulations/laws that define what the limitations are for aide responsibilities? Are my fellow aides and I being asked to do anything illegal?

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[Army_DPT]

I'm currently a PT aide in California, so I tried looking at the California PT Board regulations and it's hard to figure out from the verbiage what exactly we are allowed to do. I'm in a typical outpatient ortho "mill" where it's obvious that they're simply trying to see as many patients as possible. Frequent double booking throughout the day etc... This of course means that the aides are relied heavily upon for the clinic to operate well. Some of the things that we are doing on a daily basis or has happened are:

-Apply e-stim pads and also turn them on and adjust intensity (with very little guidance from PTs)
-Reusing e-stim pads for different patients. (Simply tossed into a bin and reused)
-Perform ultrasound for patients
-We let patients do their own laser therapy (holding it up against themselves in specified spots)
-Guide patients through exercises even when PTs aren't around to supervise
-Occasionally PTs ask us to come up with an exercise and they'll tell us if their patients can do it or not. It's odd.

Also, I'm noticing that a few of the PTs seem to just "disappear" during their patient's session because they're so used to having aides take care of everything after their ~15 minutes of treatment. This means we sometimes have to go find them (big facility) to ask them what they want their patients to do. As aides, we're supposed to be on the lookout for patients who seem lost and give them direction, which I feel like the PTs are supposed to do. Because of all this and the double booking nature of our clinic, we're sometimes running around like headless chicken trying to manage everything, sometimes doing heat/ice for patients on treatment tables while supervising up to 3 patients at a time on their exercises. It all just seems nuts. And it's also minimum wage, which I originally didn't care because I was in it for the experience... but now it just seems very little for how much is expected from us. As an aspiring PT, I'm a bit discouraged by all this to be honest.

Sorry this turned out to be a rant. Is there any clear regulations/laws that define what the limitations are for aide responsibilities? Are my fellow aides and I being asked to do anything illegal?

I have been working at an outpatient PT clinic in Florida as a technician/aide for close to 3 years and I experience much of the same. Aides are relied on heavily to keep the clinic functioning and maintain patient flow through the day. Im curious to learn of any limitations/restrictions that might be placed on PT Aides.

 

[DPThopeful1859]

Working as an aide for about 6 years in a few different clinics around Georgia, I was allowed to do some things in clinics versus others. The first clinic I worked in for about 4 years, we were able to assist with exercise, apply heat/ice, take OFF e-stim but not put on, prepare iontophoresis pads, work one on one with the therapist and a patient if they needed more assistance. The second clinic I worked in allowed us to do a bit more. The therapist saw like 6-7 patients per hour everyday and had one aide to assist, so I did basically what I did before but I was allowed to put estim pads on and take them off, adjust exercises according to patient difficulty, set up and take down traction and I also monitored like 3-4 patients at a time, which was more hectic. One clinic I was at for a few weeks, before I found a better position, the therapist actually wanted me to massage the patients, but frankly, I don't feel comfortable doing so. Not that I'm unsure of my skills, but I know it's the therapist's license on the line if something goes wrong. I've heard of some clinics letting their aides do ultrasound or putting on and adjusting estim, but to me...I feel like that's not in the scope of what I'm allowed to do. I'm sure it's different from state to state or clinic to clinic.

 

[NJ DPT HOPEFUL]

All of this is bad.

 

[DPThopeful1859]

All of this is bad.

How so? What are your thoughts?

 

[panzmo]

I also work as an aide in a "mill" type of facility. We have about seven therapists, and my responsibilities are vast but not quite as daunting as yours! I am responsible for bringing patients back to a table or room, setting them up on heat or a machine or with stretches (if double-booked, I take them through exercises first), setting up stim and traction and taking patients off of them, and I often have to work with 3-4 patients on exercises at a time. I don't come up with exercises, but I adjust them based on discomfort. I also help out with taking phone calls, scheduling patients, taking co-pays, and other front desk duties.

The most overwhelming part is having seven therapists yelling my name and giving me a patient to bring back and set up all at once and them expecting me to make all of that happen within five minutes (while also remembering which body part the heat is for blah blah blah). Also, patient juggling is tough. And keeping up with laundry! The therapists can disappear at times but never without clearly asking me what to do first. We have decent communication here, and although the therapists often get lazy and have me do all of the exercises with a patient when they just want to stand around and chat, they never ditch me completely without at least communicating first.

That's not okay to be having an aide massage a patient or adjust the stim or take that much responsibility. I'm not even allowed to turn stim ON, so that's crazy to me. It definitely seems like something is off.

 

[DPThopeful1859]

Yeah, I've never been told to turn on Estim. I've certainly adjusted it for a patient when they asked, which wasn't an issue, but that sounds like a typical day from what I experienced in the past! I'm thankful I work front desk and aide occasionally now. I'm always weary about certain things people, as aides, have told me they have been allowed to do. I guess I'm super cautious when it comes to someone's license being on the line because if it were me, I wouldn't ask my aides to do half the things some people are allowed to do.

 

[ateebo]

I have been working as an aide in California for about 8 mo. My duties usually involve bringing a patient back to a room or table and setting them up on heat. The PT goes in for treatment for about 25 min and then they tell me to either perform Soft tissue work (massage), Ultrasound, e-stim, traction, taping, show exercises, stretches. There is a 1:2 aide to PT ratio so I am not overwhelmed with duties or patient load and we never double book. The patient flow runs smoothly and I don't feel uncomfortable performing any of the modalities.

 

[NJ DPT HOPEFUL]

How so? What are your thoughts?

It's not my thoughts. Having an untrained aide making clinical decisions is not only immoral it's illegal. An aide performing soft tissue work? I can't imagine that's legal in any state.

There is a major difference between a PTA and and aide. Someone using an aide in the ways described in this thread while billing for skilled PT is not only an embarrassment to the profession but in many cases a criminal

 

[DPThopeful1859]

It's not my thoughts. Having an untrained aide making clinical decisions is not only immoral it's illegal. An aide performing soft tissue work? I can't imagine that's legal in any state.

There is a major difference between a PTA and and aide. Someone using an aide in the ways described in this thread while billing for skilled PT is not only an embarrassment to the profession but in many cases a criminal

I agree with what you're saying. When you said it's all bad, you made it seem like everything that was mentioned was looked down upon (assisting with exercise, setting up modalities for the therapists to turn on, etc.).

 

[NJ DPT HOPEFUL]

I have been working as an aide in California for about 8 mo. My duties usually involve bringing a patient back to a room or table and setting them up on heat. The PT goes in for treatment for about 25 min and then they tell me to either perform Soft tissue work (massage), Ultrasound, e-stim, traction, taping, show exercises, stretches. There is a 1:2 aide to PT ratio so I am not overwhelmed with duties or patient load and we never double book. The patient flow runs smoothly and I don't feel uncomfortable performing any of the modalities.

To be blunt. The laws the prohibit you from performing soft tissue work are not for your comfort. They are for the patients safety and to ensure that they get skilled care from a qualified therapist

 

[NJ DPT HOPEFUL]

I agree with what you're saying. When you said it's all bad, you made it seem like everything that was mentioned was looked down upon (assisting with exercise, setting up modalities for the therapists to turn on, etc.).

I think it would depend on how much you're assisting with an exercise. Getting the equipment is one thing. Determining if it should be adapted or assessing how they perform the exercise is another.

 

[DPThopeful1859]

I think it would depend on how much you're assisting with an exercise. Getting the equipment is one thing. Determining if it should be adapted or assessing how they perform the exercise is another.

I think it's safe to say that if the therapist said one thing and the patient is clearly struggling to do it or it's clearly too simple or if they rush through the exercise or use poor form, I would trust an aide to make that call and correct it. Personally serving as an aide, if a patient exhibits any of those issues, I usually will consult the therapist first, but in moments when I am the sole person working with them, as well as 3-4 other patients and I don't have time to consult, my knowledge and background is sufficient enough to know what's appropriate. It's about body language, proper communication and body mechanics to ensure the patient is safe and getting the benefit out of what is given.

 

[NJ DPT HOPEFUL]

I think it's safe to say that if the therapist said one thing and the patient is clearly struggling to do it or it's clearly too simple or if they rush through the exercise or use poor form, I would trust an aide to make that call and correct it. Personally serving as an aide, if a patient exhibits any of those issues, I usually will consult the therapist first, but in moments when I am the sole person working with them, as well as 3-4 other patients and I don't have time to consult, my knowledge and background is sufficient enough to know what's appropriate. It's about body language, proper communication and body mechanics to ensure the patient is safe and getting the benefit out of what is given.

An aide being alone with 3-4 patients is not a position a good Physical Therapist would put you in.

 

[DPThopeful1859]

An aide being alone with 3-4 patients is not a position a good Physical Therapist would put you in.

I agree, but it's also not my call on how they schedule patients. Unfortunately, a lot of clinics are concerned with numbers and sometimes lack on the patient care front. If you have a good team and there is constant supervision from other therapists as well in case the main therapist is busy, I feel like it's different. Its one thing to have one therapist and 7 patients an hour with 1 aide and no supervision. It's another to have 3-4 therapists out in the gym with their own patients, providing supervision and guidance if necessary to the aide.

 

[PathforwardtoDPT]

I also work as an aide in a "mill" type of facility. We have about seven therapists, and my responsibilities are vast but not quite as daunting as yours! I am responsible for bringing patients back to a table or room, setting them up on heat or a machine or with stretches (if double-booked, I take them through exercises first), setting up stim and traction and taking patients off of them, and I often have to work with 3-4 patients on exercises at a time. I don't come up with exercises, but I adjust them based on discomfort. I also help out with taking phone calls, scheduling patients, taking co-pays, and other front desk duties.

The most overwhelming part is having seven therapists yelling my name and giving me a patient to bring back and set up all at once and them expecting me to make all of that happen within five minutes (while also remembering which body part the heat is for blah blah blah). Also, patient juggling is tough. And keeping up with laundry! The therapists can disappear at times but never without clearly asking me what to do first. We have decent communication here, and although the therapists often get lazy and have me do all of the exercises with a patient when they just want to stand around and chat, they never ditch me completely without at least communicating first.

That's not okay to be having an aide massage a patient or adjust the stim or take that much responsibility. I'm not even allowed to turn stim ON, so that's crazy to me. It definitely seems like something is off.

Yea your experiences seem somewhat similar to mine. What state are you in?

 

[PathforwardtoDPT]

I have been working as an aide in California for about 8 mo. My duties usually involve bringing a patient back to a room or table and setting them up on heat. The PT goes in for treatment for about 25 min and then they tell me to either perform Soft tissue work (massage), Ultrasound, e-stim, traction, taping, show exercises, stretches. There is a 1:2 aide to PT ratio so I am not overwhelmed with duties or patient load and we never double book. The patient flow runs smoothly and I don't feel uncomfortable performing any of the modalities.

Wow you guys do soft tissue and taping? Are you talking about kinesio taping?

 

[PathforwardtoDPT]

An aide being alone with 3-4 patients is not a position a good Physical Therapist would put you in.

I wish more therapists would realize this. I think they get complacent end up doing this when nothing has gone wrong with the routine after a while.

 

[Azimuthal]

The regulations in CA stipulate that the PT Aide must be under continuous and immediate supervision by a PT. That means immediately available -- you're not suppose to have to search for them. A PT Aide must be trained and competency recorded for every patient-related and nonpatient-related task that a PT allows them to do. Example 1: If an aide is applying e-stim, the aide must have been previously trained, and competency on application and use of the e-stim system documented. The PT will always dictate the settings. Example 2: Ther-ex. Any exercises prescribed in clinic must be taught to the aide and their competency of monitoring and correcting said exercises must be documented. The PT is required to program the progression, duration, intensity, etc.

The PT is always suppose to assess the patient before delegating to the aide. One of my rotations used to have aides bring patients to the gym for warm-ups, which is okay if you already have the POC in mind, but they should first be assessed for changes, vitals, pain, whatever. The aide can gather all this info for you if training was provided and documented.

https://govt.westlaw.com/calregs/Do...ype=CategoryPageItem&contextData=(sc.Default)

My hospital follows these regulations because I when I was hired, I immediately enforced them. I didn't make this push to discount all the aides who are CSCS, massage therapist, trainers, kinesiology, exercise majors, etc. I did it because there are a lot of untrained career aides out there who have no background in health and fitness, and really have no interest. Our organization needed a set standard (expected knowledge) on aide competency. I did not for my patients.

 

[PathforwardtoDPT]

The regulations in CA stipulate that the PT Aide must be under continuous and immediate supervision by a PT. That means immediately available -- you're not suppose to have to search for them. A PT Aide must be trained and competency recorded for every patient-related and nonpatient-related task that a PT allows them to do. Example 1: If an aide is applying e-stim, the aide must have been previously trained, and competency on application and use of the e-stim system documented. The PT will always dictate the settings. Example 2: Ther-ex. Any exercises prescribed in clinic must be taught to the aide and their competency of monitoring and correcting said exercises must be documented. The PT is required to program the progression, duration, intensity, etc.

The PT is always suppose to assess the patient before delegating to the aide. One of my rotations used to have aides bring patients to the gym for warm-ups, which is okay if you already have the POC in mind, but they should first be assessed for changes, vitals, pain, whatever. The aide can gather all this info for you if training was provided and documented.

https://govt.westlaw.com/calregs/Do...ype=CategoryPageItem&contextData=(sc.Default)

My hospital follows these regulations because I when I was hired, I immediately enforced them. I didn't make this push to discount all the aides who are CSCS, massage therapist, trainers, kinesiology, exercise majors, etc. I did it because there are a lot of untrained career aides out there who have no background in health and fitness, and really have no interest. Our organization needed a set standard (expected knowledge) on aide competency. I did not for my patients.

This is how I imagined working as an aide would be more like. Where I work, it almost feels like they are taking advantage of aides by over-utilizing them.

 

[panzmo]

Yea your experiences seem somewhat similar to mine. What state are you in?

This clinic is in DC, and I've been sent to other locations in the chain that all seem to work in a similar way.

 

[atorres]

I recently left a job as an Exercise Specialist at the largest PT company under a single name with over 500 clinics. The position was designed as a step up from an aide. A bachelors degree + a year of fitness related experience was required. This was different compared to the techs within the company who were mostly undergraduate students. They were relegated to mostly front desk, laundry and taking people off of heat or ice. Generally, most aides were not allowed physical patient contact. Fortunately, I was able to set people up on stim, and take patients through exercises among other things. Due to my past experiences in PT, college strength and conditioning, and general fitness, the PT's were confident in my capabilities to handle multiple patients at once. This clinic also happened to be one of the busiest clinics in the company.


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[PathforwardtoDPT]

I recently left a job as an Exercise Specialist at the largest PT company under a single name with over 500 clinics. The position was designed as a step up from an aide. A bachelors degree + a year of fitness related experience was required. This was different compared to the techs within the company who were mostly undergraduate students. They were relegated to mostly front desk, laundry and taking people off of heat or ice. Generally, most aides were not allowed physical patient contact. Fortunately, I was able to set people up on stim, and take patients through exercises among other things. Due to my past experiences in PT, college strength and conditioning, and general fitness, the PT's were confident in my capabilities to handle multiple patients at once. This clinic also happened to be one of the busiest clinics in the company.


Sent from my iPhone using SDN mobile

Sounds good that they need aides to have experience before doing the more independent tasks.