Multiskilling

Key Considerations for Audiologists, Speech-Language Pathologists, and Assistants

In today’s diverse practice environments, audiologists, speech-language pathologists (SLPs), and assistants are often asked to perform tasks that are beyond their traditional roles and scopes of practice. This practice is often referred to as multiskilling, reflecting the expansion of roles that can occur in today’s collaborative care environments.

In response to the increase in multiskilling among audiologists and SLPs, ASHA has developed this online resource on multiskilling. It offers practical guidance for navigating multiskilling tasks in ways that support safety, advocate for positive outcomes, and highlight the unique expertise that you—as CSD professionals and clinicians—bring to your role.

For setting-specific scenarios that illustrate how this may look in practice, see Navigating Multiskilling: Setting-Specific Scenarios.

What It Is

Multiskilling means performing job responsibilities outside of your formal clinical training or scope of practice. These tasks often arise from efforts to

improve workflow,
meet regulatory or payer requirements, or
support integrated care.

They can range from low-risk activities like administering screening tools to complex clinical procedures such as endotracheal suctioning.

Professional responsibilities like assessment, treatment, and counseling depend on the provider’s unique clinical knowledge and professional judgment. These tasks are best carried out by a provider who is appropriately trained and credentialed—this ensures diagnostic accuracy, strong clinical outcomes, and safety of students, patients, clients, and clinicians.

In contrast, other job responsibilities that audiologists and SLPs do—such as recording vital signs or collecting intake information—are considered basic care. These tasks do not require the distinct expertise of someone from within a single profession and, with appropriate training, may be shared across team members.

Multiskilling can be part of safe, effective, and collaborative care—when you have the training and resources to perform the task safely and when the activity aligns with licensure, ethics, and employer policies.

Determining whether a task is or is not a reasonable multiskilling activity depends on a few important elements:

If a task is commonly performed by many professionals, support staff, or care partners, it may be a reasonable multiskilling activity.
If a task relies heavily on the specialized training or decision-making of an individual discipline, it warrants a closer look.
If a task interferes with your ability to carry out a treatment plan or IEP with fidelity, you may not be the best candidate for the task.

When someone assigns you a task, ask yourself and your administrators: Even though the task is something I could do, is it something that I should do?

Key Considerations

Your employer has assigned you a task that’s new—or new to you—and it’s not immediately clear how it fits within your professional role. Or maybe you’ve identified a task that could improve your efficiency or enhance care. Think before you respond: Is that task appropriate, and allowable, for you to do?

Licensure, Ethics, and Employer Policies

ASHA’s scopes of practice for audiologists, audiology assistants, SLPs, and speech-language pathology assistants are intentionally broad. But what’s permitted in practice often depends on more specific guardrails—including your state license, professional ethics, and employer policies.

Here are some action steps that you can take:

Check your state’s licensing regulations. Look for specific allowances or restrictions that apply to that particular task. Licensing regulations supersede ASHA, employer, or other established policies.
Review your codes of ethics. Both ASHA’s and your state’s code of ethics may include language about competence, supervision, and delegation.
Confirm any relevant employer policies. Some organizations have protocols or credentialing pathways for certain tasks.

A task may be allowable but not ethical. Or, a task may be ethical but not allowed under employer policy. When in doubt, check all three:

your state’s practice act
your codes of ethics
your organization’s written policies

Training and Competency

No matter the task, you must be trained and competent to perform it safely and effectively. It’s your employer’s responsibility to ensure that all of the following actions occur:

You receive training from a qualified provider.
Your employer has assessed and documented your competency, and has a plan for periodic re-assessment.
You have access to appropriate materials and equipment that are in good working order.
You know what to do if something seems out of the ordinary—including following protocols for responding to unexpected or urgent situations.

Competency isn’t a one-time checkbox. If you haven’t done a task in a while, or if protocols change, ask for a refresher or get written guidance.

Balancing Time, Safety, and Treatment Priorities

Multiskilling tasks can support coordinated care, but they also have the potential to introduce safety risks, reduce treatment time, or shift your focus away from skilled services. Some responsibilities may help you deliver services more efficiently. Others may delay therapeutic activities, increase risk, or limit how many goals you can address in a visit.

Ask your supervisor or administrator to think through these questions with you:

Do I have the time, training, and support to complete this task without compromising care?
Does the task introduce safety risks for me or the client that I or my employer cannot effectively mitigate?
Often, multiskilling tasks are not billable on their own. How will performing this task impact productivity, IEP-mandated service delivery time, or workload?

If a multiskilling task replaces or delays treatment, then be sure to document what changed—and why. This critical step protects you, keeps the care team informed, and shows your responsible role in coordinated care.

Liability and Risk Mitigation

Multiskilling activities may involve additional risk for the clinician and the organization. These risks can range from patient safety concerns to regulatory or policy noncompliance. If a provider performs a multiskilling task incorrectly, the risk doesn’t just fall on the person who did it: Employers, supervisors, and the organization as a whole may also be accountable.

Follow these steps to reduce risk and liability:

Check your coverage. Review your employer’s or your own professional liability insurance to understand what’s covered.
Confirm protocols for escalating or handing off tasks. Know who to contact if a task deviates from your training and established competency.
Document everything. Ensure that you clearly document your training and competency. Request that the requirements for multiskilling activities be written in (or added to) your organization’s standard operating procedures or other policy documents.

Teaching and Learning Across Disciplines

In collaborative settings, it’s common for professionals to teach and learn from each other—especially when working toward shared goals.

Some responsibilities, like sharing general strategies or demonstrating a routine screener, are appropriate to do, provided the individual has the proper training.
Other responsibilities—especially those requiring discipline-specific knowledge or professional judgment—should remain within the scope of the trained, credentialed provider.

Ask yourself these key questions:

Does this task require the unique skills or clinical reasoning of a trained provider within my profession?
What is the goal—to share information or to transfer clinical responsibility?
Would this task typically be delegated to trained support personnel within my field?

The answers to the above questions can help you determine whether you can safely and appropriately perform the task that is being requested of you. Take part in interprofessional education and interprofessional collaborative practice (IPE/IPP), but limit training to tasks that do not require the unique expertise of individuals within your profession.

Working Through Concerns

Even after walking through all the considerations—scope, training, safety, ethics, practicality—you may still have concerns about a task that your employer has assigned to you. In many workplaces, declining outright isn’t an option, but you can still communicate your concerns and work toward solutions that protect client safety, uphold professional standards, maintain provider ethics, and meet organizational needs.

Consider doing any or all of the following things:

Ask for a conversation. Walk through your concerns with your supervisor or administrator.
Frame your concern using professional resources. Cite specific language from licensure, ethics, or policy, highlighting potential risks. Remember that state licensing regulations supersede other policies and guidance.
Offer or brainstorm alternatives. Suggest ways to meet the need—ways that stay within your scope or that shift responsibility at the appropriate time.
Document your concerns. Get the request in writing. Then, summarize your case with a neutral tone, focusing on client care and safety. Keep the document updated, noting any follow-up actions or outcomes as they occur.

Grounding the conversation in professional standards and shared goals can help you find solutions that work for everyone—while keeping safety and quality at the forefront.

Seeking Professional Consultation

If you have questions about how multiskilling applies in your practice, contact our staff audiologists and SLPs, who will

help you think through multiskilling requests in your specific setting;
point you to relevant resources—ASHA publications, webpages, policies, and ethical guidance; and
talk through strategies for documentation, communication with employers, and patient safety.

Contact ASHA staff at the email addresses listed below.

Team		Email Address
Audiology	Audiologists and audiology assistants who work in all audiology settings	audiology@asha.org
Clinical Services	SLPs and SLP assistants who work in early intervention and private practice	SLPinfo@asha.org
Health Care Services	SLPs who work in all health care settings	healthservices@asha.org
School Services	SLPs who work in all school settings	schools@asha.org