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AU Blog Pillar Page / August 24, 2023

Scope of Practice

Scope of Practice

Displaying professionalism is an expectation across many disciplines, and typically included in some workplace Codes of Conduct. Some say that this is not often displayed in the ‘younger generation’ and having supervised a number of students I must admit I find it hard at times to argue against this! We however are more than just expected to ‘be professional’, as our we are also known as Allied Health Professionals. About one year post graduation I returned to my university to speak to the final year OT students and offer some words of encouragement about the real world of OT. There was one part of this that is ingrained in my memory: I remember saying to them how they are now Occupational Therapists – this produced a few smiles but no concern. I then said ‘you are Allied Health Professionals’ – that brought on nervous looks and whispers! We are though, whether OTs or PTs, however being an allied health professional doesn’t mean we know everything, our fields are too vast and ever-developing.

The Australian Occupational Therapy competency standard has ‘Professionalism’ as its first standard, and standard 1.10 states “[An occupational therapist] practices within limits of their own level of competence and expertise”. The Physiotherapy practice standards in Australia and Aotearoa New Zealand lists in key competency 4.5 being to “recognise situations that are outside their scope of expertise or competence and take appropriate and timely action”.

I have often heard the team ‘within scope’, referring to whether someone’s skills align with their practice. For Australian therapists however, there are no additional credentials required to prescribe complex wheelchairs, unless as specific insurance body have specified this. Considering this, although complex wheelchair prescription falls in their ‘scope of practice’ in a technical sense, their skills may result in a lack of ‘clinical competence’ for a specific referral, potentially such as a New Graduate prescribing a customised seating solution or scripted wheelchair. Perhaps ‘clinical competency’ should be discussed in this manner rather than ‘scope of practice’ in Australia.

In New Zealand however, there are two levels of accreditation required to prescribe ‘complex’ equipment, such as a power wheelchair with multiple power seat functions, or laterals on a backrest. It is clearer therefore whether a therapist is working within their ‘scope of practice’, as their accreditation level determines this. There is however still the need to consider one’s ‘clinical competency’ for new or challenging situations in these areas.

Is there then a link between recognising one’s clinical competency and demonstrating professionalism in our field? What does that mean in practice? Does this then mean we shouldn’t expand our skills or challenge ourselves? Of course not, but it may mean seeking the latest evidence on the subject, receiving supervision from another who is competent in that area, or seeking high quality training in that area – or a combination of the three! This is how we build on our clinical competency whilst ensuring those we work with are receiving the standard of care they expect and deserve to receive.

The AHPRA OT board states “Scope of practice is the professional role and services that an individual health practitioner is trained, qualified and competent to perform.” (Emphasis added). Competent to perform. This is complicated as ‘competency’ can be perceived differently to many people, and what actually makes one competent? Is it confidence, knowledge, collaboration, understanding, problem solving, or something else entirely? I remember the first time I looked up pressure cushions online as a new graduate OT and felt completely out of my depth. What material? What size? What design? What profile? What is the cost? Are they even necessary? These were all questions dancing around my head, and those I worked with were relying on me to provide the best outcome. I was not competent as new grad in pressure cushion prescription despite my qualifications, so I reached out to respected leaders in the field and attended training events. There were so many opportunities for professional development and I attended as much as I possibly could! This is not to say there are not outcomes looking back I may now have done differently, but I made sure I didn’t go about these clients alone if I was not ‘clinically competent’ in this area.

Too often though I have spoken with a therapist or dealer and heard ‘the client wants to trial a wheelchair’ or ‘they have a pressure injury so need a new cushion’ with no additional information provided in regard to the individual needs, sizing, location of use or parameters needed for this equipment. As a profession, we can do so much better for our users. If you’re currently reflecting on your own clinical competence and considering this for your caseload, a key question to ask yourself regarding your recommendations is ‘why?’. Why is that your intervention/ recommendation? Being able to explain the ‘why’ is part of our clinical reasoning, however, if the answer to that is ‘someone told me that was best’ or ‘I have no idea’ or ‘it’s what everyone does’, perhaps it is worth setting some time aside and updating your professional development plan! If you are new to an area of practice and don’t have the supervision or time required to develop your skills, perhaps it is in your and your user’s best interests to uphold your own professionalism and decline that referral or hand it over to someone in that field of practice. Let us keep our disciplines recognised as the professional and highly respected disciples we have trained and deserve to be, by delivering high quality services and outcomes.

If you’re not sure where to start to build your clinical competence, talk to your supervisor for suggestions for ways you can develop the most relevant for you. Many associations offer mentoring (see some below), and there are multiple organisations running various levels of training. You could always reach out to the provider to ensure it will cater to your learning needs, or reach out to our team at 

Australia: Education.AU@permobil.com
New Zealand: Education.NZ@permobil.com
Other Countries: Education.APAC@permobil.com

Other suggestions:









Rosie profile img 200x200

Roseanna Tegel, BHthSc/ MOT

Clinical Services Specialist

Roseanna Tegel joined Permobil in May 2023 as a Clinical Services Specialist. She graduated from Western Sydney University in 2016 with a Bachelor of Health Science/Master of Occupational Therapy and received the Prize in Undergraduate Occupational Therapy for Overall Achievement and the Cerebral Palsy Alliance scholarship. Roseanna began working at residential aged care facilities where her understanding of the need for suitable, person-centred equipment commenced. From there, she transitioned to work in community disability and quickly developed an interest for complex seating and mobility outcomes to benefit both the end user and wider network. She then stepped into a Team Leader role due to her passion for learning and best practice; supporting the Occupational Therapists with their own clinical needs and outcomes, and progressed to also provide external supervision to Occupational Therapists. Roseanna is motivated to support clinicians with their confidence and clinical reasoning allowing them to provide the best outcome for each individual user. Outside of work, Roseanna enjoys time with her dog, playing the 'cello, horse riding and aerial sports.


Categories: Complex Rehab, Therapists, Therapist, Clinician

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