The New OTA Who Wants to Evaluate and Discharge

No. In Nevada, an OTA is a licensed practitioner who implements occupational therapy services under the supervision of an OT; the OTA does not independently perform the initial evaluation, interpret the referral, establish or substantially revise the plan of care, set goals, or make the discharge decision. Those are OT responsibilities because they require clinical interpretation and professional judgment. The OTA may gather data, carry out delegated interventions, and report Mr. L's performance, but 'did well in the gym' is not the same as a validated transfer assessment or a discharge evaluation. Changing the goal to independent without the OT's reassessment would exceed the OTA's scope and could place Mr. L at fall risk after hip replacement. The OTA's license does not authorize independent practice. The supervising OT remains responsible for the plan and for ensuring the OTA is competent for assigned tasks. The physician's unsigned discharge order is a separate constraint: discharge planning must follow facility policy and physician orders.

You must personally complete the initial evaluation or reassessment before the plan can be changed. Review the OTA's data, observe or directly assess the transfer, confirm weight-bearing and hip precautions with the physician's orders, and document your findings and revised goals. Nevada supervision is not merely a title on a chart: the OT must be available to the OTA, provide oversight appropriate to the patient's condition and the OTA's competence, and review treatment and documentation as required. Because this OTA is 11 days into the job, supervision should be closer, not looser. If you cannot leave the wound clinic, arrange for another qualified OT to cover the evaluation and discharge decision, or reschedule the evaluation; do not authorize the OTA to proceed alone. Tell the OTA in writing or by text to continue only delegated, already-approved interventions and to hold the goal change and discharge. Document the OTA's report, your instructions, and the plan for OT reassessment. If the facility expects OTA notes to be co-signed, follow that policy.

Options: ask the charge nurse or therapy director to have another OT cover the unit; schedule Mr. L for an OT evaluation when you return and keep him on the existing approved plan in the meantime; reassign the patient if the OTA is not competent for a delegated task; and escalate to your supervisor if staffing prevents required supervision. Tell the OTA: 'Do not perform the initial evaluation, change the goal to independent, or discharge Mr. L. Continue only the interventions already delegated and within your competence, and document what you did. I will arrange OT reassessment before any change.' This protects the patient and the OTA. It is not abandonment to decline to delegate outside scope; it is abandonment to leave a patient without needed services, so you must arrange coverage. Document the coverage plan and the OTA's instructions. If the OTA nevertheless performs the evaluation or discharges the patient, report the incident through facility channels and consult the Nevada Board because out-of-scope practice may require board review.