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Academy Scope of Practice: Tools for Determining Competence and Advancing Practice

      IN THE PURSUIT of lifelong learning, professional development, and the highest level of scope of practice, the individual registered dietitian (RD) or registered dietitian nutritionist (RDN) and dietetic technician, registered (DTR) must continually self-assess his or her skills, education, training, and knowledge, as well as his or her autonomy, responsibility, and accountability in the practice of nutrition and dietetics. These are the critical components of a profession. How a profession determines its unique role is answered through sources of professional direction. “Professions develop documents or statements about what the members feel is important in order to guide their practice, to establish control over practice, and to influence the quality of that practice.”
      • Finkelman A.
      • Kenner C.
      Professional Nursing Concepts: Competencies for Quality Leadership.
      Examples are social policy statements, scope and standards of practice, code of ethics, and state boards that operate under a practice act detailing regulations to protect the health and safety of the public.
      Responding to our members' requests, the Academy of Nutrition and Dietetics defined professional scope of practice characteristics and metrics through the development of the Comprehensive Scope of Practice Resources for the Registered Dietitian or Registered Dietitian Nutritionist
      The Academy adopted the registered dietitian nutritionist (RDN) credential on March 13, 2013 (National RD Day), after the electronic publication of the five scope and standards of practice articles collected in this supplement to the Journal. All references to the registered dietitian (RD) in these articles and tools also apply to the RDN.
      low asteriskThe Academy adopted the registered dietitian nutritionist (RDN) credential on March 13, 2013 (National RD Day), after the electronic publication of the five scope and standards of practice articles collected in this supplement to the Journal. All references to the registered dietitian (RD) in these articles and tools also apply to the RDN.
      and the Comprehensive Scope of Practice Resources for the Dietetic Technician, Registered.
      The Resources are an all-inclusive set of documents that describe the knowledge and skills the RD or RDN and DTR need to acquire in order to provide quality nutrition and dietetics care. The Resources describe the tasks and services RDs or RDNs and DTRs perform to meet employer, government, customer/client/patient, and other stakeholder requirements and opportunities. The Comprehensive Scope of Practice Resources assist the RD or RDN and DTR in their commitment to improving the nation's health through food and nutrition.
      What is the next step in the process of defining competence in practice? Competence is essential for quality assurance and performance improvement. Competence is “a principle of professional practice, identifying the ability of the provider to administer safe and reliable services on a consistent basis”.
      According to Principle 14 of the Academy of Nutrition and Dietetics and Commission on Dietetic Registration (CDR) Code of Ethics, “The dietetics practitioner assumes a lifelong responsibility and accountability for personal competence in practice, consistent with accepted professional standards, continually striving to increase professional knowledge and skills and to apply them in practice.”
      American Dietetic Association, Commission on Dietetic Registration
      Code of ethics for the profession of dietetics and process for consideration of ethical issues.
      And according to an Academy/CDR Ethics Opinion, “Professionals who are competent use up-to-date knowledge and skills; make sound decisions based on appropriate data; communicate effectively with patients, customers, and other professionals; critically evaluate their own practice; and improve performance based on self-awareness, applied practice, and feedback from others.”
      • Gates G.
      Ethics opinion: Dietetics professionals are ethically obligated to maintain personal competence in practice.
      Credentialed nutrition and dietetics practitioners' effectiveness is gauged through the use of self-assessment competence tools. The Academy provides tools for determining competence and advancing practice via the Comprehensive Resources. They are:
      • 1
        Scope of Practice in Nutrition and Dietetics
      • 2
        Scope of Practice for the Registered Dietitian
      • 3
        Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians
      • 4
        Scope of Practice for the Dietetic Technician, Registered
      • 5
        Standards of Practice in Nutrition Care and Standards of Professional Performance for Dietetic Technicians, Registered
      • 6
        Definition of Terms List
      • 7
        Scope of Practice Decision Tool

      Scope of Practice in Nutrition and Dietetics

      The Scope of Practice in Nutrition and Dietetics is an overview of the profession that describes components of the scope of practice in nutrition and dietetics and assists with RD or RDN and DTR scope of practice decision making to provide safe, high-quality food and nutrition services. The article includes a Scope of Practice figure, a visual that outlines the education and credentials required for the RD or RDN and DTR, the references needed for managing and advancing practice, and the available standards and resources from the Academy and quality organizations.

      Scope of Practice for the Registered Dietitian

      The Scope of Practice for the RD describes the roles and activities within which the RD or RDN performs. The RD's or RDN's scope of practice expands with advances in nutrition and food science, health care, and information technology, and is driven by national health quality initiatives and evidence-based research that demonstrates the impact of food and nutrition on health status, disease prevention and treatment, quality of life, and the safety and well-being of the public.

      Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians

      The Revised 2012 Standards of Practice (SOP) in Nutrition Care and Standards of Professional Performance (SOPP) for Registered Dietitians provide a synopsis of the rationale for the RD or RDN standards, details quality indicators, and reviews the role delineation and relationship between the RD or RDN and DTR. The SOP/SOPP is utilized by RDs or RDNs to:
      • evaluate practice and performance through self-assessment;
      • reflect the minimum competent level of practice and professional performance;
      • measure quality and performance improvement through outcomes examples;
      • outline quality indicators for practice and performance; and
      • guide professional continuum growth and practice development.
      The supplementary flowchart on how to use the SOP/SOPP in Figure 3 of the article illustrates the best method for implementing the 2012 SOP for RDs in Nutrition Care and the SOPP for RDs.

      Scope of Practice for the Dietetic Technician, Registered

      The Scope of Practice for the DTR describes the roles and activities within which the DTR performs. The Scope of Practice for the DTR focuses on food and nutrition and related services provided by the DTR who works under the supervision of an RD or RDN when in direct patient/client nutrition care for the delivery of medical nutrition therapy (MNT). DTRs also work independently in areas such as community/public health, business and industry, research, and management of food and nutrition services in a variety of practice settings.

      Standards of Practice in Nutrition Care and Standards of Professional Performance for Dietetic Technicians, Registered

      The Revised 2012 Standards of Practice (SOP) in Nutrition Care and Standards of Professional Performance (SOPP) for Dietetic Technicians, Registered, provide a conceptual overview of the rationale for the DTR standards, details quality indicators, and reviews the relationship between the RD or RDN and DTR. The SOP/SOPP is utilized by DTRs to:
      • evaluate practice and performance through self-assessment;
      • reflect the minimum competent level of practice and professional performance;
      • measure quality and performance improvement through outcomes examples;
      • outline quality indicators for practice and performance; and
      • guide professional continuum growth and practice development.
      The supplementary flowchart on how to use the SOP/SOPP in Figure 3 of the article illustrates the best method for implementing the 2012 SOP for DTRs in Nutrition Care and the SOPP for DTRs.

      Practice Tools

      The RD or RDN and DTR use practice tools such as the Definition of Terms, the Scope of Practice Decision Tool, and Quality Management Practice Tips and Case Studies to assist in providing safe, culturally competent, high-quality food and nutrition services. The Definition of Terms is a cumulative anthology of definitions developed by the Academy. The term list is alphabetical and cross-referenced and includes descriptions, key considerations, and references. The definitions are broad based, have implications for use across the nutrition and dietetics profession, and are consistent with the regulatory and legal needs of the profession. The terms are a resource for the RD or RDN, the DTR, and other food and nutrition practitioners. As a reference document, the definitions serve as standardized language with standardized application in various practice settings.
      The Scope of Practice Decision Tool is an online, interactive tool that permits an RD or RDN and DTR to answer a series of questions to determine whether a particular activity is within his or her scope of practice. The Tool is designed to allow RDs or RDNs and DTRs to critically evaluate, by using criteria resources, their knowledge, skill, and demonstrated competence. RDs or RDNs and DTRs utilize the Tool to define their individual competence within each separate activity. The Quality Management Practice Tips and Case Studies outline steps for frequently asked questions on quality care and service and review actual scenarios affecting credentialed nutrition and dietetics practitioners.

      RD or RDN and DTR Responsibility

      All RDs or RDNs and DTRs are individually responsible for knowledge and understanding of all Scope of Practice and Standards of Practice and Professional Performance resources and practice tools. The resources and tools aid RDs or RDNs and DTRs in assessing their individual scope of practice and, if applicable, statutory scope of practice, and support RDs or RDNs and DTRs in providing safe, high-quality food and nutrition services. The Academy's Quality Management Committee advises all RDs or RDNs and DTRs to have the most recent copy of the Scope of Practice in Nutrition and Dietetics and its components (as found in this supplement) in their personal libraries. The documents will continue to be reviewed and revised as new trends in the profession of nutrition and dietetics and external influences emerge.

      References

        • Finkelman A.
        • Kenner C.
        Professional Nursing Concepts: Competencies for Quality Leadership.
        in: Jones and Bartlett Publishers, Sudbury, MA2010: 21
      1. Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health. ed 7. 2003
        • American Dietetic Association, Commission on Dietetic Registration
        Code of ethics for the profession of dietetics and process for consideration of ethical issues.
        J Am Diet Assoc. 2009; 109: 1461-1467
        • Gates G.
        Ethics opinion: Dietetics professionals are ethically obligated to maintain personal competence in practice.
        J Am Diet Assoc. 2003; 103: 633-635