Senior rehab tech training increases employee skills

Competency standards define role

A senior rehab technician training program at St. Thomas Hospital in Nashville, TN, has relieved therapists’ fears about using nonlicensed staff, encouraged delegation of tasks, and reserved licensed staff for higher skilled activities.

The first rehab techs at St. Thomas have just finished a six-month regime to become senior rehabilitation technicians. The techs attended 15 training sessions and had to pass a written test as well as demonstrate their competency to two different therapists.

Drawing up competency standards for the new senior rehab tech position has helped clarify the role of the nonlicensed staff at a time when rehab providers are being pressured to maximize the use of the higher-paid licensed staff, says Denise Siroky, MS, CCC, SLP, rehabilitation specialist, who spearheaded the rehab tech competency program.

"We are being asked to do more and more with less and less licensed staff," Siroky says. "The therapists like the idea of knowing what they can expect of a tech, what the parameters are, and a concrete definition of what techs can and can’t do."

The 55-member rehabilitation staff at St. Thomas provide therapy for patients in the 571-bed acute care hospital and the 30-bed subacute unit.

Management at St. Thomas proposed setting up the senior rehab tech training and competency program in mid-1996 when they realized there was a lot of inconsistency in what the techs were doing and how therapists were using them, says Donna Helmers, MEd, CCC, SLP, director of rehabilitation.

"We wanted to ensure that all patients receive a standard level of care regardless of what therapist or what tech is treating them," Helmers says. "We had competencies for therapists but had nothing for techs."

The senior rehab tech competency program allows the hospital to utilize the techs more efficiently and makes the therapists feel comfortable with what they are asking the techs to do, Helmers says.

In the past, some therapists had been reluctant to give newly hired techs difficult tasks until they had worked with them awhile and were confident of their abilities, Siroky says. Now, they know that the techs are competent to perform all the duties they are assigned.

The senior rehab tech program guidelines follow the state practice acts for physical therapy and occupational therapy which mandate that rehab techs work under direct supervision of a licensed therapist or therapy assistant.

Therapists have responded positively to the idea of senior rehab tech position, Siroky says.

"It helps the flow, and it helps interpersonal communication for everyone to know what is expected," she explains.

In the first step in the process, the entire rehabilitation staff held a brainstorming session during which therapists from all disciplines compiled a list of all the tasks required of rehab technicians.

A smaller multidisciplinary task force refined the initial list and defined what tasks the entry level techs and senior rehab techs would perform. The task force came up with a list of 15 courses that senior rehab techs would be expected to attend and a list of competencies they should be able to pass. (See charts, p. 76 and above.)

Staff level therapists in each discipline were asked to work on a training program for the senior rehab techs. They developed a training manual, wrote a lecture on each subject, and developed a test for each area.

The rehab techs receive written materials to study, attend a 30-minute lecture, and must pass a written test in each of the 15 areas of study.

For the first group of participants, the lectures were held once a week during lunch hour. The lectures have been videotaped which will give future participants the opportunity to watch the tapes at their convenience before taking the test.

A ‘blind checkoff’

The techs must pass a competency checkoff by at least two therapists. The tech is responsible for setting up the first competency check off with a therapist. The second competency, a blind checkoff, is done by a second therapist when the tech is not expecting it.

"We wanted to make sure they were carrying out the procedures correctly when they weren’t aware they were being checked," Helmers says.

The technicians must make sure they get a therapist to do the checkoffs. (For examples of the checkoffs, see pp. 78-79.)

"They have to be checked off on more than 20 items, and this takes some time," Siroky says. "The techs have to be persistent and keep up with it in order to complete it within a six-month period."

Applicants for St. Thomas’ rehab tech program must have a high school degree, but many of the applicants are in college.

Techs with no background are hired as a basic tech and have six months to complete the senior rehab tech program. Those who are already enrolled in physical therapy, occupation therapy, or speech therapy programs do not have to pass the senior tech program.

"We debated adding some kind of post-high school training to our requirements, but we decided not to do it," Helmers says. "We have four techs here that have never been to college for therapy prerequisites but, nevertheless, are excellent techs."

In fact, the first tech to complete the program had no college training.

When a tech completes the senior rehab tech training, he or she receives a 10% salary increase.

The expectation is that newly hired technicians will learn the entry-level technician responsibilities within their first three months. Then, they have six additional months to meet the requirements of the senior rehabilitation tech position.

Helmers anticipates that some experienced techs may be able to complete the senior tech program in as little as two or three months.

The hospital employs 10 to 12 techs but not all are full-time. Even the part-time techs have to complete the senior tech training. Rehab techs rotate through the hospital’s units on a six-month basis but are expected, however, to flex between areas when the need occurs.

"We hope to promote cross-training and to make sure the techs can cover for each other," Helmers says.

At St. Thomas, therapists see the patients at least every other day. Technicians treat the medically stable patients, following the treatment plan created by the licensed therapists.

Therapists have the discretion to decide which patients are appropriate for treatment by technicians.

For instance, if a patient is not medically stable or has unique medical issues, the therapist may treat the patients instead of using a tech.

[For more information on the senior rehab tech program, call Denise Siroky at (615) 222-6671.]