Monday, July 4, 2011

PSW Scope of Practice: Mission Creep

Ontario has unregulated, untrained personal support workers (PSW) delivering the most intimate of care, including nursing care, without accreditation, training standards, or monitoring to ensure that they know their Scope of Practice, what they can do and what they should not do.

PSWs belong to one of two groups in Ontario: OPSWA and PSNO. Both groups are totally voluntary, both offer workshops. PSWs need not belong to either one. OPSWA has been lobbying for training standards, to ensure that we have truly accredited workers to provide the most intimate of care.

Yes, a PSW can go from cleaning a toilet, to administering medications, if they are trained by a nurse. This is not always the case, however. We know how much physicians rebel against checklists, which improves the delivery of healthcare.

One percent of doctors account for nearly 20 per cent of patient complaints, a University of Melbourne study has shown. Complaint-prone doctors were more likely to be male, surgeons or psychiatrists, and to have been in practice for at least 30 years.

Researchers recommend that intervening with these complaint-prone doctors may help improve patient
satisfaction and public confidence in health services.
‎(Medical Journal of Australia) Prevalence and characteristics of complaint-prone doctors in private practice in Victoria

Study: A Simple Surgery Checklist Saves Lives,8599,1871759,00.html
14 Jan 2009 – A new report finds that when surgical teams followed a straightforward surgical-safety checklist, patient death rates fell by half... 

The same is true for PSWs, some of whom know about proper handwashing techniques, some of whom (not all in all facilities) have access to gloves, and understand sanitary practices, sterile conditions.

Scope of Practice

From a PSW:
Wow, is this ever an issue for me right now. I just interviewed with a lady that is needing help in her home.

She would require me to flush her catheter, administer a suppository and measure and administer her insulin injection. I have never been trained to do this. She had me come in and observe her current caregiver so I could see what the job entailed. The only time I saw the caregiver put on a glove is when she gave the suppository.

My dear friend, Michelle in LTC
Where'd she get her training? I am feeling that I should not take this job. I have assisted in medication, given enema's and even was trained in wound care while doing private home care but I had supervision from the hospice nurses and home care nurses. I found this ladies help wanted ad through Unemployment Ontario website, and did home care for year without training, but now I am a PSW graduate and certainly need to stay within my "Scope of Practice".

By nature, caregivers are nurturing people who put other's needs before their own. But how can you set limits without feeling guilty? Where do you draw a line and say "I can do this much and no more"?

Mission Creep - where you are asked to do a little more, and a little more, until you are outside you Scope of Practice because your employer asks you to do so.

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