shutterstock_419212180-New-700x458 Navigating and Understanding Supervision in Occupational TherapyLike many of us, I’ve been an Occupational Therapy (OT) supervisor, and like all of us, I’ve also been supervised.  The experiences have spanned the spectrum from positive experiences resulting in lifelong professional relationships to nightmare scenarios I’ve learned from, and would rather not rehash. 

A good supervisor often has characteristics that include empathy, wisdom, passion, and deft communication skills.  Yet there’s much more to an effective supervisor/ supervisee relationship than a list of traits. Nuances in the way a supervisor manages the various team personalities, conveys the overall vision or mission of a practice, balances the staffs’ work load, and the manner in which a supervisor handles obstacles or problems that arise all influence whether one flourishes or burns out.

A 2016 Forbes article entitled “8 Bad Mistakes that Make Good Employees Leave” discussed factors that may burn out top performers, stating that people do not leave their jobs, but instead leave their managers. According to the article, the staff most likely to leave would be the top performers or “good” staff members, because they’d be the most likely to quickly find employment elsewhere. [i]  Among the managerial mistakes listed were: treating everyone equally, tolerating poor performance, not recognizing staff accomplishments, and not allowing staff to pursue their passions. Such insights could be relevant to a supervising OT in order to maintain the engagement of top performing staff members, increase the likelihood of boosting overall staff competence and confidence, and thus limiting a high rate of staff turnover.

However, success doesn’t rest solely on the shoulders of a supervisor. Much like any successful relationship, both a supervisor and a supervisee must be held accountable for the success of a working relationship. In 2009, The American Journal of Occupational Therapy issued guidelines for Supervision, Roles, and Responsibilities for the Delivery of Occupational Therapy[ii] stating that, “Supervision is viewed as a cooperative process in which two or more people participate in a joint effort to establish, maintain, and or elevate a level of competence and performance.”

The Supervisor/ Supervisee Relationship

Marie Toole is an OT with 28 years of experience working in hospitals, schools, and private practice. On the GoToForOT website, she offered advice regarding the fostering of relationships between Supervising OTs, OTAs and aides[iii]. The factors which she felt are instrumental in a professional rehabilitation relationship included: knowing state guidelines regarding supervision, the length of time supervision is required, and the scope of practice for not just your role but that of your coworkers, as well as working out a supervision schedule and method which would allow everyone to feel comfortable with the relationship as well as ethical within their scope of practice. Toole considers mutual respect, communication and trust to be the most important part of a Supervisor/ Supervisee relationship.

She recounts a situation in which she transitioned from working under the medical model at a hospital to that of an educational model within a school system. Toole leaned heavily on her COTA who had years of experience and was able to help her navigate the various timelines and regulations within this new setting. She wrote, “I could not have done this job without her” “She was and still is a wealth of knowledge.”

Toole discusses how the role of Supervisor does not mean “superior,” and she urges all clinicians to know their limitations, to honor and be open to the various skills that clinicians at all levels can bring to the table.

When Lack of Collaboration Threatens Patient Care

What happens when there is a breakdown in the relationship – a failure in communication and lack of collaboration that threatens not only the clinician’s employment but also patient care? A 2016 article in PT in Motion[iv] posed an ethical dilemma regarding a situation in which a PTA had been told to complete an iontophoresis intervention on a patient who presented with a painful, severely blistered ankle and foot with what looked to be “sunburned” skin. The PTA glanced at the chart and noted that the patient had undergone about 45 previous iontophoresis treatments which, in his experience, was about four times the amount necessary. The PTA privately spoke to his PT supervisor, who was the owner of the clinic, and tactfully attempted to discuss the condition of the patient’s affected skin and the possible overuse of this modality. The PT supervisor dismissed his concerns, and when the PTA re-attempted to discuss his discomfort in applying this intervention, the PT supervisor threatened to fire him.

This scenario was left open-ended and readers were encouraged to share their thoughts regarding the issues raised, and the actions that the PTA should take to resolve this situation. Many readers stressed the importance of documentation, one even going so far as to say that the PTA should take a picture of the affected area, obtain the patient’s signed permission to specifically treat with iontophoresis, and if the PTA should get fired, to sue the PT and report the incident to the state board. Another reader cautioned about going against one’s own moral and ethical judgment, and the inability to successfully communicate and collaborate such a situation with a supervisor, stating that the only resolution in this case would be for the clinician to look for different employment.

Many readers both hoped and concluded that this was an extreme, possibly fictitious scenario, however they all agreed that there were definite parallels to real life situations, and that this was an important scenario for both supervisors and supervisees to consider, as well as lessons that could be learned from it and applied to real life.

Staff Resilience in a Stressful Clinical Environment

Regardless of whether you are a supervisor or supervisee, the presence of work-related stress and adverse conditions is universal.  However, the ability of clinicians to solve complex problems as well as to take a professional and appropriate course of action in the midst of workplace adversity is imperative for both the health of the staff as well as patient outcomes.

A key factor that determines workplace success is staff resilience in response to work stressors. Resilience considers the way a person reacts, adapts, and protects themselves when confronted with adverse or stressful situations. Being able to focus one’s attention, address job difficulties, and complete tasks under a time limit could be affected or enhanced by a person’s ability to be resilient. A study published in 2016 in Work magazine[v] considered the development and testing of a Workplace Resilience Instrument (WRI)[vi], which they distributed to American hospital-based executives and nurses in order to understand, measure and improve staff resilience in an effort to reduce workplace stress.

In this study, four factors determined the respondents’ level of resilience. The first was the ability to take action in the midst of a problem. The respondents who scored highest were those who weren’t simply worrying and whining, but instead deployed a method of coping by actively problem solving the situation. The second factor was that of team efficacy, in which respondents not only rated themselves on their ability to work “as a team” but also considered their own understanding of the various team members’ roles and the various methods used to achieve overall goals. The third factor was the ability to have confidence in making sense of a chaotic or stressful situation, including the weeding out of extraneous or irrelevant information in order to make an action-based decision. Lastly, the fourth factor was the ability to attempt new methods under extreme pressure, or what this article called the respondents’ ability and willingness to take “intelligent risks”.

The results of the study found that hospital executives scored higher on the WRI scale than nurses, and that there was a correlation between experience and resilience, as those who had been practicing for longer often scored higher on all four factors of the WRI. The study also noted that respondents who scored high in resilience on the WRI weren’t necessarily scoring low in the amount of perceived work-related stress. This brought up the possibility that people who score high in resilience may simply respond to stress differently than their less-resilient coworkers, which may explain differences in productivity.

The use of the WRI would be beneficial in helping a Supervisor better understand the level of resilience in a recent grad, transitioned clinician, or a new supervisee, in an effort to guide them toward less stress and more confidence as a team member.  Indeed, the WRI could assist a Supervisor, executive or rehab director with understanding their own limitations and level of resilience in an effort to become more collaborative and supportive of their staff.

As an OT, I’ve had the great fortune of both supervising and mentoring other recent OT grads and OTAs, and have cherished their feedback regarding my skills as their supervisor. The key approaches that I personally find beneficial are: establishing a safe and judgment-free environment for them to come to me with questions and concerns, genuinely listening to their past experiences both clinical and personal in order to understand their personal strengths and weaknesses, sharing my own no-holds-barred experiences and honest self-assessment findings as well as methods for self-change and growth, and lastly, striving to approach and cultivate work relationships with the same amount of excitement, hope, and good intentions that I wished to feel when I was in their shoes.


[i] Bradberry, Travis. “8 Bad Mistakes That Make Good Employees Leave.” Forbes, Forbes Magazine, 10 Sept. 2016,

[ii] Clark, Gloria Frolek, et al. “Guidelines for Supervision, Roles, and Responsibilities during the Delivery of Occupational Therapy Services.” American Journal of Occupational Therapy, vol. 63, no. 6, Nov/Dec2009, pp. 797-803. EBSCOhost,

[iii] Toole, Marie. “OTR and COTA Relationships.” GoToForOT Blog, Katherine Colmer, 26 May 2016,

[iv] Kirsch, Nancy R. “Modality Realities.” PT in Motion, APTA, June 2016,

[v] Mallak, Larry A. and Mustafa Yildiz. “Developing a Workplace Resilience Instrument.” Work, vol. 54, no. 2, June 2016, pp. 241-253. EBSCOhost, doi:10.3233/WOR-162297.

[vi] “Workplace Resilience Instrument (WRI).”,