Guide:
Supervision

According to the standard, this is the only instance where supervising someone that you are close with may be acceptable.

Supervising someone you have a close personal relationship with is generally not recommended, because it can make it harder to stay impartial, provide honest feedback, or address performance concerns. When issues within the supervisory relationship arise (for example, hesitating to correct mistakes or avoiding difficult feedback), they can also indirectly affect patient care by influencing clinical decision-making or the quality of care provided.

If you work in a small or close-knit community with limited supervision options, it may be possible to supervise someone you know, but only as a last resort when no reasonable alternatives are available. In this situation, you must take extra care to make sure the supervision dynamic does not negatively impact patient care. Some helpful strategies might include:

• Clearly defining and documenting the supervision arrangement, including roles, responsibilities, and expectations.
• Being transparent with patients, colleagues, and the supervisee about the supervision relationship, as appropriate.
• Using structured supervision processes, such as regular check-ins, documented feedback, and clear performance expectations.
• Staying alert to situations where personal relationships may influence professional judgement, and taking action if concerns arise.
• Reassigning supervision if an alternative becomes available or if objectivity can no longer be maintained.

A strong, professional supervisory relationship helps ensure not only that the supervisee develops their skills effectively, but also that patients consistently receive safe, effective, and high-quality care.

You must ensure patients understand who is involved in their care and each person’s role. You must explain, in clear and plain language, when a supervisee may be involved in their care, and what their involvement will be.

To make sure the patient understands who will be involved in their care, you may introduce the supervisee by name, explain their role and the level of supervision you will be providing, and confirm that you are ultimately responsible for the patient’s care. To further encourage patient transparency and trust, you can also invite questions and give the patient a genuine opportunity to decide whether they are comfortable with a supervisee being involved.

Remember that regardless of how you choose to introduce a supervisee to your patient, patients must provide informed consent before services are delivered by a supervisee, and consent must be revisited if the supervisee’s role changes. For example, if a student moves from an observer role to providing care under indirect supervision where the physiotherapist is available for consultation, the patient must consent to this change.

Supervisees must only provide services when appropriate supervision is available. If you are unavailable or cannot provide a level of supervision that supports safe and competent care, services delivered by supervisees must be discontinued.

Be sure to plan for situations where supervision may be interrupted, such as planned absences or schedule changes. This includes arranging for an alternate supervisor when appropriate and clearly communicating expectations to supervisees about when services must stop.

If you leave your position and end your supervisory role, clearly communicate the decision, rationale, and effective date to the supervisee. In accordance with the Duty of Care Standard, patients must be informed that you will no longer be involved in care, and you must also arrange to adjust or reassign their care.

Be sure to notify your employer or clinic owner of your departure and explain what the implications are for your role as a supervisor. Under the Supervision Standard, treatment provided by supervisees can only continue under appropriate supervision, which would require another physiotherapist to assume the supervisory role. If no replacement supervisor is arranged, supervisees must stop providing services until supervision is re-established.

Physiotherapists are accountable for the physiotherapy services they assign to physiotherapist assistants under their supervision. Remember that regardless of job title or organizational terminology, anyone assigned physiotherapy care by a physiotherapist is considered a PTA and the same professional obligations apply.

However, a PTA may be performing tasks under the supervision of others that do not constitute physiotherapy care. In these situations, the physiotherapist would not be accountable for that care. For example, a nurse asks the PTA to walk a patient to maintain general mobility. Here, even if the assistant’s organizational job title is “PTA,” they are not acting as a physiotherapist assistant. They are working under the nurse’s supervision, scope, and assignment, and assisting with nurse’s care. This activity would not be considered physiotherapy care, and the physiotherapist is not accountable.Later, if a physiotherapist assigns gait-related interventions from a treatment plan, the same PTA is providing physiotherapy care under the physiotherapist’s supervision. This shows that a PTA can move between roles depending on who assigns the care.

In team-based settings, PTAs may be hired with assumed competencies or receive direction from multiple team members. While your organization may assist with competency assessment, you as the supervisor remain responsible for confirming competence when assigning physiotherapy care and for maintaining appropriate supervision.

Tasks may be assigned to a pool of PTAs rather than to a specific PTA if all of the PTAs are determined to be competent to perform the task. The patient must be informed and consent to this care.

Always maintain documentation that accurately reflects what tasks you have assigned and to whom, and which PTA(s) ultimately delivered the care.

No. PTAs cannot be assigned anything that requires independent clinical reasoning. The physiotherapist is responsible for conducting the initial assessment, all reassessments, developing a plan of care, and modifying the treatment plan. PTAs must not perform any of those activities independently.

PTAs may be assigned to gather data on their own, such as documenting the results of a sit-to-stand test, and can offer their insights around decision-making. You can use the observations or data collected by a PTA when reassessing a patient, but you are still required to perform regular reassessments. Only the physiotherapist has the authority to interpret the PTA’s findings or change the treatment plan based on the data they collected.

The PTA needs to get in contact with their supervising physiotherapist whenever clinical judgement, patient safety, or the established plan of care may be affected. This includes, but is not limited to, situations where:

• A patient becomes medically unstable or experiences an unexpected change in their condition.
• A patient’s response to treatment changes and may require reassessment by a physiotherapist, such as deterioration, plateau, or substantial improvement.
• The PTA has questions or concerns about the treatment, their role, or the plan of care.
• A patient or their substitute decision-maker asks to speak with the physiotherapist.

It must be easy for PTAs to contact their supervisor. If you are supervising remotely or off-site, it is recommended that you use a clear and reliable form of contact that you check regularly.

According to the standard, a PTA’s name and job title must appear on invoices whenever the PTA provides all of the treatment (without a physiotherapist present), and in situations where the PTA provides some of the treatment (perhaps in conjunction with the physiotherapist).

If someone other than the physiotherapist provides treatment to a patient, that person’s name and job title must be included on the invoice that the patient receives.

To determine whether the activity performed by the PTA is considered “treatment,” ask yourself if the activity was part of your treatment plan, for example applying modalities, exercises, gait training, etc.

Things like tidying the treatment area, removing an ice pack, or escorting patients to and from the treatment area would likely not be considered treatment.

This expectation exists so patients always know the name and role of everyone involved in their treatment.

In rare circumstances, it may be difficult to determine which PTA provided care to a patient, which makes it difficult to accurately list them on the invoice. In these situations, the expectation may be met by documenting on the invoice a list of PTAs who reasonably could have been involved in the patient’s care on the day of the visit. However, since the intent of this requirement is to allow patients to know who provided their care, the list must be relevant and limited. Providing an overly broad or lengthy list would not meet this expectation.

You can delegate oxygen (O2) titration (also known as the controlled act of administering a substance by inhalation), tracheal suctioning, and wound care to a PTA. No other controlled acts can be delegated to a PTA.

Remember, when delegating a controlled act to another person, you must:

• Make sure that you are rostered to perform the activity.
• Make sure the person performing the act has the knowledge, skills, and judgement to do so safely, competently, and ethically.
• Explain the circumstances in which the person can perform the controlled act, including the patient (or class of patients) the person can treat and any other limitations.
• Ensure that the person knows how to deal with possible adverse events and has a written plan for doing so.
• Confirm that the person understands that they cannotdelegate this act to anyone else.

On weekends, the weekday physiotherapist who assigned the care may be off duty or not scheduled to work, in which case they cannot continue supervising physiotherapy care delivered by PTAs.

If the weekday physiotherapist is unavailable, supervision shifts to the weekend physiotherapist even if they haven’t previously been involved in the patient’s care.

The weekend physiotherapist does not automatically need to assess or see every patient. Instead, they step in when something comes up that requires physiotherapy clinical judgement (for example, if the PTA reports a change in the patient’s condition, there are safety concerns, or the plan of care needs to be clarified).

While the initial treatment plan may have been created by a weekday physiotherapist, once the weekend physiotherapist gives clinical direction or makes decisions about care, they are accountable for those decisions until care is transferred back to the weekday physiotherapist. 

Here are some additional tips for meeting your responsibilities on weekends you are off duty:

• Plan ahead: Identify which patients will need care on weekends and confirm who will supervise PTAs. 
• Designate an alternate physiotherapist: If you cannot be reached, ensure the weekend PT is ready to assume responsibility. 
• Review communication protocols: Make sure PTAs know exactly how to reach the supervising physiotherapist quickly. 
• Assess patient risk: Consider patient needs, PTA skills, and treatment complexity when deciding if remote supervision is appropriate. 

• Document transfer of accountability clearly: When responsibility shifts to the weekend physiotherapist or back to the weekday physiotherapist, record this in the patient’s clinical record. 
• Prioritize patient records: Make sure the weekend PT and PTA have access to all critical patient details, including contraindications, risk factors, and safety precautions before care begins. 

Remember that all standards and expectations continue to apply for a weekend physiotherapist.

For a PTA to continue providing patient care when the primary physiotherapist is on vacation, the covering physiotherapist must do more than act as a contact – they must accept full supervisory responsibility of the PTA.

If you are not easily reachable, care must be transferred to another physiotherapist, and this transfer must be documented in the patient’s clinical record. Once an alternate physiotherapist is contacted, they become the treating PT and take full responsibility for the patient’s care until transferred back. All related billing must then be under the alternate physiotherapist’s name and registration number.

When transferring the PTA to a physiotherapist at another site, keep in mind that they can only supervise a PTA if they have explicitly agreed to do so, are available to provide guidance when needed, can assume responsibility for the care being delivered, and have appropriate access to the patient’s clinical record. If these conditions can’t be met, patient care must be transferred to another PT or paused. 

You may also pause treatment until you return, if this is appropriate for the patient’s care. 

Direct supervision is when you are physically beside the student to observe their performance. It is required when the student is learning a new skill or performing a controlled act. You must directly observe the student’s performance of the new skill or controlled act to assess their knowledge, skills, and judgement and determine the appropriate level of supervision going forward.

Direct supervision must continue until the student demonstrates a consistent level of competence within the limits of the standard and clinical context. If there are concerns about the student’s performance at any point, you must return to direct supervision and complete a student evaluation as appropriate.

Supervising physiotherapists are expected to regularly reassess the student’s competence and adjust the level of supervision to ensure patient safety and quality of care.

Remember, you are responsible for all care delivered by a PT student during their clinical placements while you are their supervisor.