Scope of Practice, Supervision, and Delegation
Scope of Practice
Physical therapists in Florida are authorized to examine, evaluate, and treat patients with impairments, functional limitations, and disabilities. The scope includes musculoskeletal, neuromuscular, cardiovascular/pulmonary, and integumentary systems. PTs may perform electroneuromyographic (EMG) examinations under specific statutory conditions (e.g., certification and supervision requirements). Wound care may be performed by PTs, but debridement is limited. PTs may also provide prevention and wellness services. The key is that PTs practice autonomously within their scope, but must refer patients to other providers when the condition is outside PT scope or requires medical diagnosis.
Supervision of PTAs and Aides
PTAs must work under the supervision of a PT. The level of supervision depends on the setting: direct supervision (PT on premises and immediately available) is required in most settings, including outpatient, acute care, and home health (with some exceptions). General supervision may be allowed in certain settings such as school-based practice or in specified circumstances. Physical therapy aides (unlicensed personnel) may assist with non-skilled tasks but cannot perform skilled interventions. The supervising PT is responsible for the plan of care, delegation, and ensuring competence.
Delegation and the Plan of Care
Delegation to a PTA requires a written plan of care and ongoing communication. The PT must evaluate the patient, establish the plan, and reassess at least every 30 days (or more frequently as needed). The PTA implements the plan and reports changes. Traps: Questions often test whether a task can be delegated to a PTA (e.g., initial evaluation, discharge summary, or adjusting the plan) or whether an aide can perform a modality. Initial evaluation, diagnosis, and modification of the plan are non-delegable to PTAs. Aides cannot perform skilled therapy.
Worked Example
A PT asks a PTA to perform an initial evaluation for a new patient with low back pain. Is this permissible? No-the initial evaluation and development of the plan of care are within the PT's exclusive scope and cannot be delegated. The PTA may implement the plan after the PT completes the evaluation. Rule of thumb: if the task requires clinical judgment that shapes the plan of care, it stays with the PT.