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Academy Scope of Practice Decision Tool: A Self-Assessment Guide

  • The Academy Quality Management Committee and Scope of Practice Subcommittee of the Quality Management Committee
      AS REGISTERED DIETITIANS (RDs) or registered dietitian nutritionists (RDNs) and dietetic technicians, registered (DTRs) enhance their functional areas of practice to elevate their career opportunities, questions about scope of practice often come to mind, such as, “May an RD or RDN teach how to inject insulin? Perform nasogastric tube placement? Obtain approval to perform initial swallowing screening? May a DTR teach carbohydrate counting?”
      To support the RD or RDN and DTR in answering whether a particular activity is within his or her scope of practice, the Academy developed the Scope of Practice Decision Tool. The Tool, available in the Academy Shop (www.eatright.org/shop/product.aspx?id=6442474795), is online and interactive, and includes links to additional Academy resources. It allows RDs or RDNs and DTRs to critically evaluate their knowledge, skill, and demonstrated competence by using criteria resources. RDs or RDNs and DTRs know that competence to perform designated activities within defined practice settings is an essential element of the scope of practice in nutrition and dietetics. Practitioners are expected to practice in the areas in which they are competent, but level of experience, skills, and proficiency to perform designated activities vary, and individual practitioners may not be competent in all aspects of the field. Practitioners are thus encouraged to pursue additional education and experience to expand the individual scope of practice.
      • O'Sullivan-Maillet J.
      • Skates J.
      • Pritchett E.
      Scope of dietetics practice framework.
      The information presented in the Tool is not a substitute for professional judgment by the RD or RDN or for technical decisions by the DTR, but rather an exercise in evaluation by the individual practitioner and his or her organization. The Tool's first question begins the self-evaluation guiding the RD or RDN and DTR: “Has this activity become routine in dietetics or nutrition literature and in nutrition and dietetics practice?” With some activities, like those mentioned above, if answered Yes, then the Tool continues with further questions, such as, “Do you have the necessary knowledge, skills, and demonstrated competence in practice to perform this activity?” and, “If the state(s) where you work license RDs or DTRs, is there any language that prohibits performing this activity?”
      Using the Tool will help the RD or RDN and DTR determine whether or not the activity is within his or her individual scope of practice. If the activity is not found within the individual's scope of practice, the Tool suggests alternatives for consideration:
      • seek options for RD or RDN activity to be included in medical staff bylaws or organization policies and procedures;
      • seek options for attaining the knowledge, skills, and competence to perform this activity; and
      • continue through the decision analysis process using the online Tool to determine whether the activity could be within the RD or RDN or DTR scope of practice.
      To actually perform the activity, the RD or RDN and DTR would need to obtain the necessary education, training, and credential, if needed, along with demonstrating and documenting competence in practice.
      As the RD or RDN and DTR continues through the Tool answering all pertinent questions about the activity, he or she may find the activity is within his or her scope of practice. The Tool provides further guidance before performing the activity:
      • Ensure that this activity is included in the RD or RDN or DTR job description.
      • Ensure that the RD or RDN or DTR personnel file contains documentation of education, training, credentials, if applicable, and competence.
      • Consult the Academy Definition of Terms list in performing this activity.
      • Investigate your organization's liability insurance coverage and need for additional personal liability insurance.
      • For billable services, investigate whether this activity, as performed by an RD or RDN, will be reimbursed by health plan insurers, including Medicare.
      The Tool also directs the RD or RDN and DTR to Academy information and resources, including the Comprehensive Scope of Practice Resources in this supplement, focus area Standards of Practice and Standards of Professional Performance, federal and state regulatory information, legal scope of practice information, a Quality Dietetics Practice video, Quality Management Case Studies and Practice Tips, and a free pre-recorded self study (http://www.eatright.org/cpd/online).
      The Academy hopes that the RD or RDN and DTR find the Tool most helpful in determining whether an activity is within his or her individual scope of practice. It is a great self-assessment device for gauging an RD's or RDN's or DTR's level of knowledge, skill, and involved judgment. Take time to reflect when choosing career options and know that your achievement of the gold standard in nutrition and dietetics—the RD or RDN and DTR credentials—is the key in advancing the profession and protecting the public.

      Reference

        • O'Sullivan-Maillet J.
        • Skates J.
        • Pritchett E.
        Scope of dietetics practice framework.
        J Am Diet Assoc. 2005; 105: 634-640