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From the Academy Standards of Professional Performance| Volume 114, ISSUE 7, P1104-1112.e21, July 2014

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Academy of Nutrition and Dietetics: Revised 2014 Standards of Professional Performance for Registered Dietitian Nutritionists in Management of Food and Nutrition Systems

      Abstract

      Management in food and nutrition systems is presented with an ever-challenging tension between effective utilization of manpower resources, mechanical equipment, financial management, material production, and time constraints to produce optimal products. Management drives opportunities for personal development for multiple levels of its employee workforce. Given an increasing need to deliver high-quality food and services to satisfied customers, the Management in Food and Nutrition Systems Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed the Revised 2014 Standards of Professional Performance, which replace the 2009 Standards, as a tool for registered dietitian nutritionists working in food and nutrition systems management within health care and non−health care organizations. These Standards of Professional Performance consist of six domains of professionalism: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how strong communication skills, attention to customer satisfaction, use of various resources, and application of personnel management principles can be applied to practice. The indicators describe three skill levels (ie, competent, proficient, and expert) for registered dietitian nutritionists managing food and nutrition systems.
      Editor's note: Figure 1 that accompanies this article is available online at www.andjrnl.org.
      The Management in Food and Nutrition Systems Dietetic Practice Group of the Academy of Nutrition and Dietetics (Academy), under the guidance of the Academy Quality Management Committee, has revised the Standards of Professional Performance (SOPP) for Registered Dietitians in Management of Food and Nutrition Systems,
      • Puckett R.P.
      • Barkley W.
      • Dixon G.
      • et al.
      American Dietetic Association Standards of Professional Performance for Registered Dietitians (Generalist and Advanced) in Management of Food and Nutrition Systems.
      originally published in 2009. The revised document, the Academy of Nutrition and Dietetics: Revised 2014 Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Management of Food and Nutrition Systems, reflect advances in management of food and nutrition systems practice during the past 5 years and replace the 2009 Standards. These documents build on the Academy of Nutrition and Dietetics Revised 2012 SOP in Nutrition Care (SOP) and SOPP for RDs.
      Academy of Nutrition and Dietetics Quality Management Committee and Scope of Practice Subcommittee of the Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2012 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians.
      The Academy of Nutrition and Dietetics/Commission on Dietetic Registration's Code of Ethics
      American Dietetic Association/Commission on Dietetic Registration Code of Ethics for the Profession of Dietetics and process for consideration of ethics issues.
      along with the Academy of Nutrition and Dietetics Revised 2012 Standards of Practice in Nutrition Care and SOPP for RDs
      Academy of Nutrition and Dietetics Quality Management Committee and Scope of Practice Subcommittee of the Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2012 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians.
      are tools within the Scope of Practice in Nutrition and Dietetics
      Academy of Nutrition and Dietetics Quality Management Committee and Scope of Practice Subcommittee of the Quality Management Committee
      Academy of Nutrition and Dietetics: Scope of Practice in Nutrition and Dietetics.
      and Scope of Practice for the RD,
      Academy of Nutrition and Dietetics Quality Management Committee and Scope of Practice Subcommittee of the Quality Management Committee
      Academy of Nutrition and Dietetics: Scope of Practice for the Registered Dietitian.
      that guide the practice and performance of Registered Dietitian Nutritionists (RDNs) in all settings.
      The scope of practice in nutrition and dietetics is composed of statutory and individual components; includes the Code of Ethics; and encompasses the range of roles, activities, and regulations within which RDNs perform. For credentialed practitioners, scope of practice is typically established within the practice act and interpreted and controlled by the agency or board that regulates the practice of the profession in a given state.
      Academy of Nutrition and Dietetics Quality Management Committee and Scope of Practice Subcommittee of the Quality Management Committee
      Academy of Nutrition and Dietetics: Scope of Practice in Nutrition and Dietetics.
      An RDN's statutory scope of practice may delineate the services an RDN is authorized to perform in a state where a practice act or certification exists.
      The RDN's individual scope of practice is determined by education, training, credentialing, and demonstrated and documented competence to practice. Individual scope of practice in nutrition and dietetics has flexible boundaries to capture the breadth of the individual's professional practice. The Scope of Practice Decision Tool, an online, interactive tool, permits an RDN 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 assist an RDN in critically evaluating personal knowledge, skill, and demonstrated competence with criteria resources.
      Academy of Nutrition and Dietetics Quality Management Committee and Scope of Practice Subcommittee of the Quality Management Committee
      Academy of Nutrition and Dietetics. Academy Scope of Practice Decision Tool: A self-assessment guide.
      All registered dietitians are nutritionists, but not all nutritionists are registered dietitians. The Academy's Board of Directors and Commission on Dietetic Registration have determined that those who hold the credential Registered Dietitian (RD) may optionally use Registered Dietitian Nutritionist (RDN) instead. The two credentials have identical meanings. In this document, the expert working group has chosen to use the term RDN to refer to both registered dietitians and registered dietitian nutritionists.
      Approved February 2014 by the Quality Management Committee of the Academy of Nutrition and Dietetics and the Executive Committee of the Management of Food and Nutrition Services Dietetic Practice Group of the Academy. Scheduled review date: November 2018. Questions regarding the Standards of Professional Performance for Registered Dietitian Nutritionists in Management of Food and Nutrition Systems may be addressed to Academy quality-management staff: Sharon McCauley, MS, MBA, RDN, LDN, FADA, FAND, director, Quality Management, at .
      The Academy's Revised 2012 SOP in Nutrition Care and SOPP for RDs
      Academy of Nutrition and Dietetics Quality Management Committee and Scope of Practice Subcommittee of the Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2012 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians.
      reflect the minimum competent level of nutrition and dietetics practice and professional performance for RDNs. These standards serve as blueprints for the development of focus area SOP and SOPP for RDNs in competent, proficient, and expert levels of practice. The SOP in Nutrition Care is composed of four standards representing the four steps of the Nutrition Care Process as applied to the care of patients/clients.
      Nutrition Care Process and Model Part 1. The 2008 update.
      The Management in Food and Nutrition Systems Dietetic Practice Group does not include the SOP competencies in its standards, but does recognize their importance in other focus areas that participate in direct patient and client care. The SOPP consist of standards representing the following six domains of professionalism: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. The SOPP for RDNs are designed to promote the provision of safe, effective, and efficient food and nutrition services; facilitate evidence-based practice; and serve as a professional evaluation resource.
      These focus area standards for RDNs in management of food and nutrition systems provide a guide for self-evaluation and expanding practice, a means of identifying areas for professional development, and a tool for demonstrating competence in managing food and nutrition systems. They are used by RDNs to assess their current level of practice and to determine the education and training required to maintain currency in their focus area and advancement to a higher level of practice. In addition, the standards may be used to assist RDNs in transitioning their knowledge and skills to a new focus area of practice. Like the SOPP for RDs,
      Academy of Nutrition and Dietetics Quality Management Committee and Scope of Practice Subcommittee of the Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2012 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians.
      the indicators (ie, measureable action statements that illustrate how each standard can be applied in practice) (see Figure 1, available online at www.andjrnl.org) for the SOPP for RDNs in Management of Food and Nutrition Systems were developed with input and consensus of content experts representing diverse practice and geographic perspectives. The SOPP for RDNs in Management of Food and Nutrition Systems were reviewed and approved by the Executive Committee of the Management in Food and Nutrition Systems Dietetic Practice Group and the Academy Quality Management Committee.

      Three Levels of Practice

      The Dreyfus model
      • Dreyfus H.L.
      • Dreyfus S.E.
      Mind over Machine: The Power of Human Intuition and Expertise in the Era of the Computer.
      identifies levels of proficiency (novice, advanced beginner, competent, proficient, and expert) (refer to Figure 2) during the acquisition and development of knowledge and skills. This model is helpful in understanding the levels of practice described in the SOPP for RDNs in Management of Food and Nutrition Systems. In Academy focus areas, the levels are represented as competent, proficient, and expert practice levels.
      Figure 2Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Management of Food and Nutrition Systems.
      Table thumbnail gr2

      Competent Practitioner

      In dietetics, a competent practitioner is an RDN who is either just starting practice after having obtained RDN registration by the Commission on Dietetic Registration (CDR), or an experienced RDN who has recently assumed responsibility to provide nutrition and dietetics services in a new focus area.

      Academy of Nutrition and Dietetics. Definition of Terms. http://www.eatright.org/scope. Accessed May 4, 2014.

      A focus area is defined as an area of nutrition and dietetics practice that requires focused knowledge, skills, and experience.

      Academy of Nutrition and Dietetics. Definition of Terms. http://www.eatright.org/scope. Accessed May 4, 2014.

      A competent practitioner who has obtained RDN status and is starting in professional employment acquires additional on-the-job skills and engages in tailored continuing education to enhance knowledge and skills obtained in formal education. An RDN starts with technical training and professional interaction for advancement and expanding breadth of competence. A general practice RDN may include responsibilities across several areas of practice, including, but not limited to community, clinical, consultation and business, research, education, and food and nutrition management.

      Academy of Nutrition and Dietetics. Definition of Terms. http://www.eatright.org/scope. Accessed May 4, 2014.

      Proficient Practitioner

      A proficient practitioner is an RDN who is generally 3 or more years beyond entry into the profession, who has obtained operational job performance skills and is successful in the RDN's chosen focus area of practice.

      Academy of Nutrition and Dietetics. Definition of Terms. http://www.eatright.org/scope. Accessed May 4, 2014.

      The proficient practitioner demonstrates additional knowledge, skills, and experience in a focus area of dietetics practice. An RDN may acquire specialist credentials, certifications, or advanced degrees to demonstrate proficiency in a focus area of practice.

      Expert Practitioner

      An expert practitioner is an RDN who is recognized within the profession and has mastered the highest degree of skill in or knowledge of a certain focus or generalized area of dietetics through additional knowledge, experience, or training.

      Academy of Nutrition and Dietetics. Definition of Terms. http://www.eatright.org/scope. Accessed May 4, 2014.

      An expert practitioner exhibits a set of characteristics that includes leadership and vision, and demonstrates effectiveness in planning, achieving, evaluating, and communicating targeted outcomes. An expert practitioner may have an expanded or specialist role, and may possess an advanced credential, if available, in a focus area of practice. Generally, the practice is more complex, and the practitioner has a high degree of professional autonomy and responsibility.
      These Standards, along with the Academy/CDR Code of Ethics,
      American Dietetic Association/Commission on Dietetic Registration Code of Ethics for the Profession of Dietetics and process for consideration of ethics issues.
      answer the questions: Why is an RDN uniquely qualified to manage food and nutrition systems? What knowledge, skills, and competencies does an RDN need to demonstrate for the provision of safe, effective, quality, and cost-effective management of food and nutrition systems at the competent, proficient, and expert levels?

      Overview

      In a climate of change in health care delivery and payment systems, tight operating budgets, and heightened focus on customer service in all segments (eg, health care, college and university, school nutrition, and retail venues), RDNs in management roles (eg, manager, director, administrator) are challenged to lead fiscally sound, quality focused, outcomes-oriented food and nutrition systems. Effective leadership and mentoring of staff at all levels is critical to achieving customer-centered services that meet organization objectives, safety standards (ie, state or US Food and Drug Administration Food Code, Occupational Safety and Health Administration), regulatory agency (ie, state and local health departments, Occupational Safety and Health Administration), and accreditation organization standards (ie, The Joint Commission, Healthcare Facilities Accreditation Program, Det Norske Veritas Healthcare). RDNs in management of food and nutrition systems confront ethical dilemmas daily. They serve as role models exemplifying ethical business practices, professional ethics as outlined in the Academy/CDR Code of Ethics,
      American Dietetic Association/Commission on Dietetic Registration Code of Ethics for the Profession of Dietetics and process for consideration of ethics issues.
      and accountability for complying with organization guidelines. RDNs in management practice promote and model use of evidence-based standards and guidelines, business best practices, and effective and efficient use of human, material, and financial resources in achieving food and nutrition system objectives and outcomes.
      • Cluskey M.
      • Gerald B.
      • Gregoire M.
      Management in dietetics: Are we prepared for the future?.
      RDNs in management roles lead the management team and employees in a systematic quality assurance and performance improvement process to monitor, evaluate, and refine processes and services to assure safe, quality, customer-centered, financially accountable food and nutrition services.
      While management skills are promoted for food and nutrition practitioners in all practice areas, the SOPP for RDNs in Management of Food and Nutrition Systems focus primarily on the management of food and nutrition systems in a variety of settings in health care or other institutional settings (eg, hospitals, long-term care facilities, corrections), colleges and universities, Veteran's and military facilities, schools, and commercial settings. Management roles vary (eg, supervisor, manager, director, system director, or administrator) along with scope and size of operations (eg, unit, department, multi-department, multi-location, health care system with multiple sites, individual school or school district, and single or multiple retail venues). Responsibility areas can encompass foodservice for patients/residents/students, retail operations (eg, visitor and employee cafeteria, coffee kiosks, coffee shop, restaurant, and onsite and offsite catering), and oversight for inpatient and outpatient clinical nutrition programs and services plus additional responsibilities when in multi-department management.
      Management of food and nutrition systems is a diverse, dynamic area of practice that requires RDN leaders who are effective in the management of human, material, and financial resources and visionary in navigating their programs and services through ever-changing times in health care and other business segments. Public interest in healthier eating options is growing in response to the incidence of pediatric and adult obesity, and a general interest in healthier lifestyles. Hospitals are being challenged to offer healthier food and beverage options in employee and visitor dining venues (eg, Partnership for a Healthier America: Healthier Hospital Food Initiative at www.ahealthieramerica.org [Our Partners]; Healthier Hospitals Initiative: Healthier Food Challenge at www.healthierhospitals.org). School nutrition programs have revamped menus in response to new regulations. Nutrition standards are being developed and promoted for vending, concessions, and foods provided in worksites and public spaces (eg, Centers for Disease Control and Prevention at www.cdc.gov/salt/resources.htm [Guides], National Alliance for Nutrition & Activity at www.cspinet.org/nutritionpolicy/foodstandards.html). With this heightened awareness, now is the time to seize opportunities for advancing practice and promoting the RDN's expertise in the management of food and nutrition systems.

      Academy Revised 2014 Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Management of Food and Nutrition Systems

      An RDN can use the Academy Revised 2014 SOPP for RDNs (Competent, Proficient, and Expert) in Management of Food and Nutrition Systems (see the website exclusive Figure 1, available online at www.andjrnl.org) to:
      • identify the competencies to provide nutrition and dietetic services in the management of food and nutrition systems;
      • self-assess whether he or she has the appropriate knowledge base and skills to provide safe and effective management of food and nutrition systems for his or her level of practice;
      • identify the areas in which additional knowledge and skills are needed to practice at the competent, proficient, or expert level in management of food and nutrition systems;
      • provide a foundation for public and professional accountability in the management of food and nutrition systems;
      • support efforts for strategic planning and assist in or direct the planning and delivery of food and nutrition services and resources;
      • enhance professional identity and communicate the nature of management of food and nutrition systems and services;
      • guide the development of management of food and nutrition systems-related education and continuing education programs, job descriptions, and career pathways; and
      • assist educators and preceptors in teaching students and interns the knowledge, skills, and competencies needed to work in management of food and nutrition systems and the understanding of the full scope of this focus area of practice.

      Application to Practice

      All RDNs, even those with significant experience in other practice areas, must begin at the competent level when practicing in a new setting or a new focus area of practice. At the competent level, an RDN in management of food and nutrition systems has the core knowledge to manage human, material, and financial resources, and is developing more advanced management skills required for advancing the administrative ranks (eg, strategic planning, team building, marketing, conflict management, emergency management).
      • Gould R.A.
      • Canter D.
      Management matters.
      • Canter D.D.
      • Nettles M.F.
      Dietitians as multidepartment managers in health care settings.
      This RDN, who may be an experienced RDN or may be new to the profession, has a breadth of knowledge in nutrition and dietetics and may have proficient or expert knowledge/practice in another focus area. However, the RDN new to the focus area of management of food and nutrition systems may experience a steep learning curve when becoming familiar with the body of knowledge and available resources to support management of food and nutrition systems−related practice.
      At the proficient level, an RDN has developed a deeper understanding of managing food and nutrition systems and is better equipped to apply evidence-based guidelines and best practices than at the competent level. This RDN is able to modify typical practices according to unique situations (eg, adapt operational processes to achieve sustainability best practices
      • Peregrin T.
      Sustainability in foodservice operations: An update.
      • Robinson-O'Brien R.
      • Gerald B.L.
      Practice paper of the Academy of Nutrition and Dietetics: Promoting ecological sustainability within the food system.
      ; apply critical thinking and decision making to influence and achieve organizational goals, evaluate, and guide management team and staff in designing and adopting new work flow processes to reflect best practices; manage resources of significant value to the organization; and direct unit's emergency preparedness response during utility outage or natural disaster). An RDN at the proficient level may possess an advanced degree, additional credentials, and certifications to support management practice (eg, Academy Certificate of Training Programs: Developing Your Role as a Leader (Level I), Advancing Your Role as Leader (Level II), and Executive Management; go to http://www.eatright.org/cpd/online/).
      At the expert level, the RDN thinks critically about the management of food and nutrition systems, demonstrates a more intuitive understanding of continuous process improvement in managing food and nutrition systems, displays a range of highly developed managerial and technical skills, leads strategic planning, and formulates judgments acquired through a combination of education, experience, and critical thinking. Essentially, practice at the expert level requires the application of complex food and nutrition systems knowledge, business, and dietetics knowledge, with practitioners drawing not only on their various practice and leadership experiences, but also on the experiences of RDN's in management roles and clinical RDN's in various disciplines and practice settings. Expert RDNs, with their extensive experience and ability to see the significance and meaning of the managerial role in delivering safe, quality, and cost-effective food and nutrition services and outcomes within a contextual whole, are fluid and flexible and, to some degree, autonomous in practice. They not only implement evidence–based food and nutrition management best practices, they also manage, drive, and direct departments, multiple departments, organizations, and systems, varied foodservice venues (eg, patient/resident, retail, catering, senior feeding, schools), and inpatient and outpatient nutrition programs; conduct and collaborate on research; serve as faculty in academic and culinary programs; serve on or lead multidisciplinary and interdisciplinary teams; and lead the advancement of management in food and nutrition systems.
      RDNs in management of food and nutrition systems confront ethical dilemmas daily. The CDR and the American Dietetic Association reviewed and published a revised Code of Ethics for its members in 2009, with effective implementation on January 1, 2010. The fundamental principles are as follows: the dietetics practitioner conducts himself or herself with honesty, integrity, and fairness; the dietetics practitioner supports and promotes high standards of professional practice; and the RDN utilizes the principles of the Code of Ethics along with critical thinking skills to make a decision that best serves the interests of clients, employers, employees and other stakeholders.
      • Barkley W.C.
      Ethics in action: Ethical practice in foodservice management.
      The RDN must be familiar with standards issued by their facility's accreditation organization (eg, The Joint Commission, Healthcare Facilities Accreditation Program, Det Norske Veritas Healthcare), state and local health departments, and federal regulatory agencies.
      • Barkley W.C.
      Ethics in action: Ethical practice in foodservice management.
      The breadth and depth of an RDN's knowledge, including mentoring opportunities offered by the Academy and several dietetic practice groups provides the tools to make quick, validated decisions.
      Indicators for the SOPP (Figure 1, available online at www.andjrnl.org) for RDNs in Management of Food and Nutrition Systems are measurable action statements that illustrate how each standard can be applied in practice. Within the SOPP for RDNs in Management of Food and Nutrition Systems, an “X” in the competent column indicates that an RDN who is managing food and nutrition systems is expected to complete this activity and/or seek assistance to learn how to perform at the level of the standard. A competent RDN in management of food and nutrition systems could be an RDN starting practice after registration or an experienced RDN who has recently assumed a management role in a food and nutrition department or food/foodservice organization. An “X” in the proficient column indicates that an RDN who performs at this level has a deeper understanding of management of food and nutrition systems and has the ability to modify their practice to meet the needs of patients/clients/customers in various situations. An “X” in the expert column indicates that the RDN who performs at this level possesses a comprehensive understanding of the requirements and expectations for effective management of food and nutrition systems and a highly developed range of skills and judgments acquired through a combination of experience and education. The expert RDN builds and maintains the highest level of knowledge, skills, and behaviors, including leadership, vision, strategic planning, business principles, ethical practices, research, and credentials.
      Standards and indicators presented in online Figure 1 (available at www.andjrnl.org) in boldface type originate from the Academy's Revised 2012 SOPP for RDs
      Academy of Nutrition and Dietetics Quality Management Committee and Scope of Practice Subcommittee of the Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2012 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians.
      and should apply to RDNs in all three levels. Several indicators developed for this focus area not in boldface type are identified as applicable to all levels of practice. Where an “X” is placed in all three levels of practice, it is understood that all RDNs in management of food and nutrition systems are accountable for practice within each of these indicators. However, the depth with which an RDN performs each activity will increase as the individual moves beyond the competent level. Several levels of practice are considered in this document; thus taking a holistic view of the SOPP for RDNs in Management of Food and Nutrition Systems is warranted. It is the totality of the individual's practice that defines the level of practice and not any one indicator or standard.
      RDNs should review the SOPP in Management of Food and Nutrition Systems at regular intervals to evaluate their individual focus area management, food and nutrition knowledge, skill, and competence. Regular self-evaluation is important because it helps identify opportunities to improve and/or enhance practice and professional performance. This self-appraisal also enables RDN managers of food and nutrition systems to better utilize these Standards in the CDR Professional Development Portfolio process and each of its five steps for self-assessment, planning, improvement, and commitment to lifelong learning
      • Weddle D.O.
      • Himburg S.P.
      • Collins N.
      • Lewis R.
      The Professional Development Portfolio Process: Setting goals for credentialing.
      (Figure 3). RDNs are encouraged to pursue additional training, regardless of practice setting, to maintain currency and to expand individual scope of practice within the limitations of the legal scope of practice, as defined by state law. RDNs are expected to practice only at the level at which they are competent, and this will vary depending on education, training, and experience.
      • Gates G.
      Ethics opinion: Dietetics professionals are ethically obligated to maintain personal competence in practice.
      RDNs are encouraged to pursue additional knowledge and skill training, and collaboration with other RDNs in management of food and nutrition systems to promote consistency in practice and performance and continuous quality improvement. See Figure 4 for case examples of how RDNs in different roles, at different levels of practice, may use the SOPP for RDNs in Management of Food and Nutrition Systems.
      Figure 3Application of the Commission on Dietetic Registration Professional Development Portfolio Process.
      How to Use the Standards of Professional Performance (SOPP) for Registered Dietitian Nutritionists (RDNs) (Competent, Proficient, Expert) in Management of Food and Nutrition Systems as part of the Professional Development Portfolio Process
      The Commission on Dietetic Registration Professional Development Portfolio process is divided into five interdependent steps that build sequentially upon the previous step during each 5-year recertification cycle and succeeding cycles.
      1. ReflectAssess your current level of practice and whether your goals are to expand your practice or maintain your current level of practice. Review the SOPP for RDNs in Management of Food and Nutrition Systems document to determine what you want your future practice to be and assess your strengths and areas for improvement. These documents can help you set short- and long-term professional goals.
      2. Conduct learning needs assessmentOnce you have identified your future practice goals, you can review the SOPP for RDNs in Management of Food and Nutrition Systems document to assess your current knowledge, skills, behaviors, and define what continuing professional education is required to achieve the desired level of practice.
      3. Develop learning planBased on your review of the SOPP for RDNs in Management of Food and Nutrition Systems, you can develop a plan to address your learning needs as they relate to your desired level of practice.
      4. Implement learning planAs you implement your learning plan, keep reviewing the SOPP for RDNs in Management of Food and Nutrition Systems document to reassess knowledge, skills, and behaviors and your desired level of practice.
      5. Evaluate learning plan processOnce you achieve your goals and reach or maintain your desired level of practice, it is important to continue to review the SOPP for RDNs in Management of Food and Nutrition Systems document to re-assess knowledge, skills, and behaviors and your desired level of practice.
      a The Commission on Dietetic Registration Professional Development Portfolio process is divided into five interdependent steps that build sequentially upon the previous step during each 5-year recertification cycle and succeeding cycles.
      Figure 4Case Examples of Standards of Professional Performance for Registered Dietitian Nutritionists (RDNs) (Competent, Proficient, and Expert) in Management of Food and Nutrition Systems.
      RoleExamples of use of Standards of Professional Performance (SOPP) documents by Registered Dietitian Nutritionists (RDNs) in different practice roles
      Food Systems Management DirectorThe director is responsible for the overall operation of foodservice and nutrition providing quality, nutritious food to the customer. The SOPP is used to delineate the functions of the foodservice department to provide effective and efficient service within the financial parameters. Skills are used to develop an organization that works with other departments and practices team management within. The director recognizes the SOPP as a tool to assess specific competencies and assign tasks to personnel at different levels of performance. The RDN utilizes the SOPP to strategically plan his or her professional development activities, enhancing growth experienced in tenure at the facility.
      Retail ManagerThe retail manager is responsible for meal service for staff and visitors. This service may include a cafeteria, physicians private dining, coffee shops, kiosks, catering, gift shops, and convenience stores. The RDN retail manager uses the SOPP for self-assessment to identify continuing education activities to increase business and marketing skills to support evaluation and modification of existing processes and programs to enhance customer service outcomes, budget, and volume targets.
      School Foodservice ManagerThe school foodservice manager oversees a foodservice operation that provides meals to children in multiple settings (Head Start to grade 12). The manager is responsible for following all local, state, and federal laws, regulations, and standards. This RDN manager uses the SOPP to review performance outcomes for a manager in a foodservice operation and to identify knowledge and skills for competent practice to guide review of work processes. The SOPP indicators identify knowledge and skill areas for investigation for applicability to the school foodservice setting and to use for personal continuing education plans and supervisory staff development.
      Clinical Nutrition ManagerThe clinical nutrition manager is an RDN in management practice who has the responsibility to oversee medical nutrition therapy provided to clients and their families. The RDN reviews available resources for the patient population for both inpatients and outpatients.
      Patient Service ManagerAn experienced clinical RDN new to the patient service manager role is responsible for overseeing patient foodservice operations, which include planning regular and modified diet menus, preparation of supplemental feedings, patient menu system, meal tray and snack preparation and delivery. The RDN uses the SOPP to evaluate personal performance with new responsibilities to identify areas for knowledge and skill development to incorporate into personal development plans. The RDN uses the SOPP to identify areas for obtaining mentoring from a more experienced manager in order to enhance skills and to help with problem-solving operational issues not covered in policies and procedures.
      Educator of Health ProfessionalsThe RDN educator of health professionals teaches, demonstrates procedures, and plans for internships and advance degree opportunities for the students. The RDN uses the SOPP to develop program goals and course learning objectives that prepare students for the profession. Students view and understand the practice level expectations for practitioners. Using the SOPP in this manner allows the students to develop skills to meet the standards.
      In some instances, components of the SOPP for RDNs in Management of Food and Nutrition Systems do not specifically differentiate between proficient-level and expert-level practice. In these areas, it was the consensus of the content experts that the distinctions are subtle, captured in the knowledge, experience, and intuition demonstrated in the context of practice at the expert level, which combines dimensions of understanding, performance, and value as an integrated whole.
      • Chambers D.W.
      • Gilmore C.J.
      • Maillet J.O.
      • Mitchell B.E.
      Another look at competency-based education in dietetics.
      A wealth of knowledge is embedded in the experience, discernment, and practice of expert-level RDN practitioners. The knowledge and skills acquired through practice will continually expand and mature. The indicators will be refined with each review of these Standards as expert-level RDNs systematically record and document their experience. The experienced practitioner observes managerial and clinical events, analyzes them to make new connections between events and ideas, and produces a synthesized whole. Practice exemplars provide outstanding models of actions of individual RDNs in management roles and the professional and leadership activities that have enhanced customer services and food and nutrition systems, operations, and outcomes.

      Future Directions

      The SOPP for RDNs in Management of Food and Nutrition Systems is an innovative and dynamic document. Future revisions will reflect changes and advances in practice, dietetics education programs, and outcomes of practice audits. The authors acknowledge that the three practice levels may require more clarity and differentiation in content and role delineation, and that competency statements that better characterize differences among the practice levels is a goal with each revision. Creation of this clarity, differentiation, and definition are the challenges of today's RDN managers of food and nutrition systems to better serve tomorrow's practitioners and their patients, clients, and customers.
      Individual practitioners as well as the profession must take responsibility for the future of RDNs in management of food and nutrition systems. Management knowledge and skills should be valued and nurtured in every practitioner.
      • Cluskey M.
      • Gerald B.
      • Gregoire M.
      Management in dietetics: Are we prepared for the future?.
      In 2003, the Academy House of Delegates conducted a dialogue session on “The Future of Management in Dietetics,” which resulted in the creation of a task force and a campaign to promote management in nutrition and dietetics. In 2010, a House of Delegates dialogue session addressed “Management and Leadership Across Practice” with identified guiding principles for individuals and the Academy to emphasize leadership and management skills, including the Academy's development of a management or leadership credential or certification program (see http://www.eatright.org/cpd/online/ for available certificate programs). The need for strong leadership and management skills in advancing the profession and the roles of individual practitioners continues to be a focus of Academy initiatives, as was stated by Mary Cluskey and colleagues: “The future demands food and nutrition professionals who can function at many levels in achieving outcomes. The success of food and nutrition professionals may be contingent upon their continuing to enhance their knowledge of and competency in management.”
      • Cluskey M.
      • Gerald B.
      • Gregoire M.
      Management in dietetics: Are we prepared for the future?.
      The May 2012 supplement to the Journal of the Academy of Nutrition and Dietetics compiles nine previously published articles, some cited in this article, into this resource titled “Management in the Dietetics Profession: Building a Framework for Success.”
      Management in the Dietetics Profession: Building a framework for success.

      Conclusions

      RDNs in management of food and nutrition systems face complex situations and ever-challenging tensions involving effective utilization of manpower resources, mechanical equipment, financial management, material production, and time constraints to produce optimal products. Addressing the unique needs of each situation and applying standards appropriately is essential to providing safe, timely, person-centered, ethical, quality care and service. All RDNs are advised to conduct their practice based on the most recent edition of the Code of Ethics, the Scope of Practice in Nutrition and Dietetics, the Scope of Practice for RDs, and SOPP for RDs. The SOPP for RDNs in Management of Food and Nutrition Systems is a complementary document and is a key resource for RDNs at all knowledge and performance levels. These standards can and should be used by RDNs in management practice in daily practice to consistently improve and appropriately demonstrate competency and value as providers of safe and effective nutrition and dietetics care and services. These standards also serve as a professional resource for self-evaluation and professional development for RDNs focusing on management of food and nutrition systems practice. Just as a professional's self-evaluation and continuing education process is an ongoing cycle, these standards are also a work in progress and will be reviewed and updated every 5 years. Current and future initiatives of the Academy as well as advances in the management of food and nutrition systems and services will provide information to use in these updates and in further clarifying and documenting the specific roles and responsibilities of RDNs at each level of practice. As a quality initiative of the Academy and the Management of Food and Nutrition Systems Dietetic Practice Group, these standards are an application of continuous quality improvement and represent an important collaborative endeavor.
      These standards have been formulated to be used for individual self-evaluation and the development of practice guidelines, but not for institutional credentialing or for adverse or exclusionary decisions regarding privileging, employment opportunities or benefits, disciplinary actions, or determinations of negligence or misconduct. These standards do not constitute medical or other professional advice, and should not be taken as such. The information presented in these standards is not a substitute for the exercise of professional judgment by the health care professional. The use of the standards for any other purpose than that for which they were formulated must be undertaken within the sole authority and discretion of the user.

      Supplementary Data

      Figure 1Standards of Professional Performance for Registered Dietitian Nutritionists (RDNs) in Management of Food and Nutrition Systems. Note: The term customer is used in this evaluation resource as a universal term. Customer could also mean client/patient, client/patient/customer, resident, participant, consumer, or any individual, group, student/intern, or organization the RDN provides service.
      Standard 1: Quality in Practice

      The registered dietitian nutritionist (RDN) provides quality services using a systematic process with identified leadership, accountability, and dedicated resources.

      Rationale:

      Quality practice in nutrition and dietetics is built on a solid foundation of education, credentialing, evidence-based practice, demonstrated competence, and adherence to established professional standards. Quality practice requires systematic measurement of outcomes, regular performance evaluations, and continuous improvement.
      Indicators for Standard 1: Quality in Practice
      Bold Font Indicators are Academy Core RDN Standards of Professional Performance IndicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      1.1Complies with applicable laws and regulations as related to his or her area(s) of practiceXXX
      1.2Performs within individual and statutory scope of practiceXXX
      1.3Adheres to sound business and ethical billing practices applicable to the settingXXX
      1.3AServes as a role model for ethical behaviorXXX
      1.3BPrepares appropriate charges according to services providedXXX
      1.3CDevelops orientation and professional development activities for staff on ethicsXX
      1.3DEstablishes protocols/algorithms for making judgment call on professional/ethical behavior and consequences as related to billing practicesX
      1.4Utilizes national quality and safety data (eg, Institute of Medicine, National Quality Forum, Institute for Healthcare Improvement, state or US Food and Drug Administration [FDA] Food Code, Occupational Safety and Health Administration [OSHA]) to improve the quality of services provided and to enhance customer-centered serviceXXX
      1.4AEvaluates data from various quality-assurance processesXXX
      1.5Utilizes a systematic performance improvement model that is based on practice knowledge, evidence, research, and science for delivery of the highest-quality servicesXXX
      1.5AUtilizes critical performance measures to monitor effectiveness and safety of serviceXXX
      1.5A1Monitors effectiveness of systematic performance improvement program for area of responsibilityXX
      1.5A2Designs a systematic performance improvement process for department/programX
      1.6Participates in or designs an outcomes-based management system to evaluate safety, effectiveness, and efficiency of practiceXXX
      1.6AInvolves colleagues and others, as applicable, in systematic outcomes managementXXX
      1.6A1Promotes active participation of stakeholdersXXX
      1.6A2Participates in interdepartmental quality assurance and performance improvement initiativesXXX
      1.6A3Develops and implements an outcomes management system to evaluate effectiveness and efficiency of practiceXX
      1.6A4Determines and involves stakeholders in the implementation and evaluation of an outcomes-based management systemXX
      1.6A5Analyzes variations in processes utilizing root cause analysis protocolsX
      1.6BUtilizes indicators that are specific, measurable, attainable, realistic, and timely (S.M.A.R.T.)XXX
      1.6B1Differentiates long-term and short-term goals to measure progressXXX
      1.6CDefines expected outcomesXXX
      1.6C1Utilizes institutional expectations to set desired outcomesXXX
      1.6C2Utilizes industry standards and institutional expectations to set desired outcomesXX
      1.6DMeasures quality of services in terms of process and outcomesXXX
      1.6D1Identifies appropriate measures of quality for the process and outcomesXX
      1.6D2Modifies quality measures as needed based on outcomes and/or new needsXX
      1.6EDocuments outcomesXXX
      1.6E1Uses a systematic process for collecting and reporting outcomes dataXXX
      1.7Identifies and addresses potential and actual errors and hazards in provision of servicesXXX
      1.7AComplies with local and state regulations and interpretive guidelinesXXX
      1.7BComplies with Hazard Analysis and Critical Control Points guidelinesXXX
      1.7COrients staff to the importance of food safety practicesXXX
      1.7DDevelops and implements training programs on food safety standards and department policies and proceduresXXX
      1.7ECompletes risk analysis in food and nutrition servicesXX
      1.7E1Utilizes results of risk analysis to plan departmental activities to improve food safety outcomesXX
      1.7FDetermine root-cause analysis of errors and hazardsX
      1.8Compares actual performance to performance goals (eg, Gap Analysis, SWOT Analysis [Strengths, Weaknesses, Opportunities, and Threats], PDCA Cycle [Plan-Do-Check-Act])XXX
      1.8AReports and documents action plan to address identified gaps in performanceXXX
      1.8A1Compares actual performance to expected outcomesXXX
      1.8A2Uses appropriate analytical tools to evaluate and enhance servicesXXX
      1.8A3Designs interventions to improve processes and servicesXX
      1.8A4Participates in peer comparison of services (benchmarking)XX
      1.8A5Evaluates on a continuous basis, improving services based on measureable outcomesXX
      1.9Evaluates interventions to improve processes and servicesXXX
      1.9AAnalyzes benchmark dataXXX
      1.9BInterprets benchmark data related to program processesXXX
      1.9CImplements change in the process and re-measuresXXX
      1.9DTakes action when discrepancies exist between actual performance and expected outcomesXXX
      1.9EInterprets benchmark data, addressing variancesXX
      1.10Improves or enhances services based on measured outcomesXXX
      1.10AReviews current literature and industry trends to identify best practicesXXX
      1.10BImproves the industry by publishing outcomes and best practices to enhance industry outcomesXX
      Examples of Outcomes for Standard 1: Quality in Practice
      • Actions are within scope of practice and applicable laws and regulations
      • Use of national quality standards and best practices are evident in customer-centered services
      • Performance indicators are specific, measurable, attainable, realistic, and timely (S.M.A.R.T.)
      • Aggregate outcomes results meet pre-established criteria
      • Results of quality improvement activities direct refinement and advancement of practice
      Standard 2: Competence and Accountability

      The registered dietitian nutritionist (RDN) demonstrates competence in and accepts accountability and responsibility for ensuring safety and quality in the services provided.

      Rationale:

      Competence and accountability in practice includes continuous acquisition of knowledge, skills, and experience in the provision of safe, quality patient/client-centered service.
      Indicators for Standard 2: Competence and Accountability
      Bold Font Indicators are Academy Core RDN Standards of Professional Performance IndicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      2.1Adheres to the Code of EthicsXXX
      2.1AChampions ethics in all areas of practiceXXX
      2.1BInterprets and shares ethics guidelines as applicable to areas of responsibilityXX
      2.2Integrates the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) into practice, self-assessment, and professional developmentXXX
      2.2AUses the SOPP as a guide for management and leadership, self-evaluation, and professional developmentXXX
      2.2BUses the SOPP to develop and implement a plan to advance practice to a higher level of competenceXXX
      2.3Demonstrates and documents competence in practice and delivery of patient/client/customer-centered serviceXXX
      2.3AImplements quality practice by following an evidence-based/best practice approach that includes adhering to credentialing, licensure, and regulatory requirements; competency standards; policies, procedures, and practice guidelinesXXX
      2.3BModels customer service behaviors in delivering patient/client/customer-centered serviceXXX
      2.3CIncorporates customer service competencies into staff development and performance evaluationsXX
      2.3DDefines competencies for patient/client/customer-centered service in areas of responsibilityX
      2.4Assumes accountability and responsibility for actions and behaviorsXXX
      2.4AAcknowledges and corrects errorsXXX
      2.4BMonitors accountability and behaviors for areas of responsibilityXX
      2.4CDefines corrective actions for critical errors and behaviors in areas of responsibility consistent with organization policiesXX
      2.5Conducts self-assessment at regular intervalsXXX
      2.5AIdentifies needs for professional developmentXXX
      2.5BEvaluates level of practice to determine whether additional skill sets and knowledge are needed for advancing practiceXXX
      2.5CReviews skills and knowledge to determine whether they meet future market expectationsXXX
      2.6Designs and implements plans for professional developmentXXX
      2.6ADocuments professional development activities in career portfolioXXX
      2.6A1Develops a plan to acquire knowledge and skills to meet future market expectationsXXX
      2.6BDocuments professional development activities as per organization guidelinesXXX
      2.6CMaintains continuing education and lifelong learning in current areas of practiceXXX
      2.6DAssesses staff needs for professional development and develops opportunities for growth and trainingXX
      2.6EDesigns career development programs in conjunction with organization and community needsX
      2.7Engages in evidence-based practice and utilizes best practicesXXX
      2.7AEvaluates evidence-based practices for application to services provided (eg, healthy eating guidelines, sustainability practices, use of social media for consumer outreach)XXX
      2.7BApplies evidence-based practice models in areas of responsibilityXXX
      2.7CShares research data and activities to meet patient's/client's needsXXX
      2.7DDesigns new practice models for testing and applicationXX
      2.7EPromotes best practices to staff and other professionals internally and externallyX
      2.8Participates in peer review of self and othersXXX
      2.9Mentors othersXXX
      2.9ASeeks opportunities to serve as a mentor for management staff, entry-level management RDNs; dietetic technicians, registered; interns; and studentsXXX
      2.9BServes as preceptor for dietetic students, interns, and culinary students/apprenticesXX
      2.9CEstablishes mentoring and internship opportunities for entry-level RDNs and students/internsXX
      2.9DServes as a mentor or preceptor outside of the professionXX
      2.9EPromotes the RDN food systems management role at the local, state, and national levelXX
      2.10Pursues opportunities (education, training, credentials) to advance practice in accordance with laws and regulations and requirements of practice settingXXX
      2.10AAcquires knowledge related to specifics of management practiceXXX
      2.10A1Uses major management publications to increase knowledgeXXX
      2.10A2Acquires knowledge of trends in systems, technology, research, equipment, and sustainability practices (eg, energy, water, waste management) to apply in practiceXXX
      2.10BApplies knowledge of regulatory issues (eg, health department rules and regulations, OSHA, Centers for Medicare and Medicaid Services [CMS]), and accreditation program standards (eg, The Joint Commission, Health Facilities Accreditation Program, Det Norske Veritas Healthcare) to management practiceXXX
      2.10CExpands scope of practice with increased job responsibilitiesXX
      2.10DFunctions with autonomy within organization or practiceXX
      2.10EProvides leadership to multiple departments/unitsXX
      2.10FMaintains expert knowledge base as applied to professional practiceX
      Examples of Outcomes for Standard 2: Competence and Accountability
      • Practice reflects the Code of Ethics
      • Practice reflects the Standards of Practice and Standards of Professional Performance
      • Competence is demonstrated and documented
      • Safe, quality, patient/client-centered service is provided
      • Self-assessments are conducted regularly
      • Professional development needs are identified
      • Directed learning is demonstrated
      • Practice reflects evidence-based practice and best practices
      • Relevant opportunities (education, training, credentials, certifications) are pursued to advance practice
      • Commission on Dietetic Registration recertification requirements are met
      Standard 3: Provision of Services

      The registered dietitian nutritionist (RDN) provides safe, quality service based on customer expectations and needs, and the mission and vision of the organization/business.

      Rationale:

      Quality programs and services are designed, executed, and promoted based on the RDN's knowledge, experience, and competence in addressing the needs and expectations of the organization/business and its customers.
      Indicators for Standard 3: Provision of Services
      Bold Font Indicators are Academy Core RDN Standards of Professional

      Performance Indicators
      The “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      3.1Contributes to or leads in development and maintenance of programs/services that address needs of the customer or target population(s)XXX
      3.1AAligns program/service development with the mission, vision, and service expectations and outputs of the organization/businessXXX
      3.1A1Employs management knowledge and leadership skills effectively and efficiently to meet the department and organization strategic planXXX
      3.1A2Manages functional units in areas of responsibilityXXX
      3.1A3Directs functional units in areas of responsibilityXXX
      3.1A4Prepares staff for necessary changeXXX
      3.1BUtilizes the needs, expectations, and desired outcomes of the customer (eg, patient/client, administrator, client organization[s]) in program/service developmentXXX
      3.1B1Applies creative thinking and decision making to influence and achieve organization goals and objectivesXXX
      3.1B2Participates in organizational development of quality improvement programs and strategic and business planningXX
      3.1B3Uses complex decision-making skills at a higher level of risk to the organization (eg, new program development impacting broader organization, complex changes in service delivery models, opening/closing units of operation)XX
      3.1B4Defines departmental standards to support the organization's efforts for excellenceXX
      3.1CProposes programs and services that are patient/client-centered, culturally appropriate, and minimize health disparitiesXXX
      3.1DMakes decisions and recommendations that reflect stewardship of time, talent, finances, and environmentXXX
      3.1D1Maintains budgetary controlXXX
      3.1D2Maintains statistical reports, performance reports, and financial dataXXX
      3.1D3Monitors storage procedures for temperature control, sanitation, and safety of food and suppliesXXX
      3.1D4Compares received items against specifications and invoicesXXX
      3.1D5Manages resources of significant valueXX
      3.1D6Creates teams to address quality, productivity, and operational issues to achieve desired performance outcomesXX
      3.1D7Leads the process of developing, monitoring, and evaluating the use of guidelines, programs, resources, and changeXX
      3.1D8Prepares operating budget and capital requestsXX
      3.1D9Compares operating budget data with budget forecast and reconciles discrepanciesXX
      3.1D10Conducts financial analysis and audits for all financial functions (eg, budgets, products, supplies, and equipment)XX
      3.1D11Writes specifications for food supplies and equipmentXX
      3.1D12Maintains cost controls to meet budget projectionsXX
      3.1D13Represents the organization on purchasing groups consortiumXX
      3.1D14Implements an inventory system that meets the organization's needsXX
      3.1D15Selects vendors and/or purchasing groups to meet financial plan, budget, and sustainability of productsXX
      3.1D16Evaluates the need for an ingredient control system for productionXX
      3.1D17Determines priorities and funding sources for implementation of programs and equipment purchases for food and nutritionXX
      3.1EDesigns emergency preparedness programXX
      3.1FDevelops contingency plans for emergencies and disasters, bioterrorism, and pandemics for the safe and sanitary production and service of food to personnel, volunteers, and customersXX
      3.2Promotes public access and referral to credentialed dietetics practitioners for quality food and nutrition programs and servicesXXX
      3.2AContributes to or designs referral systems that promote access to qualified, credentialed dietetics practitionersXXX
      3.2BRefers customers to appropriate providers when requested services or identified needs exceed the RDN's individual scope of practiceXXX
      3.2CMonitors effectiveness of referral systems and modifies as needed to achieve desirable outcomesXXX
      3.3Contributes to or designs customer-centered servicesXXX
      3.3AAssesses needs, beliefs/values, goals, and resources of the customerXXX
      3.3A1Conducts surveys, focus groups, or uses other assessment tools to determine customer needsXXX
      3.3A2Designs needs assessment tools to survey target audiences for program developmentX
      3.3A3Uses analytic tools to interpret needs of target audiencesX
      3.3BUtilizes knowledge of the customer's/target population's health conditions, cultural beliefs, and business objectives/services to guide design and delivery of customer-centered servicesXXX
      3.3B1Designs a marketing program for food and nutrition service operationsXX
      3.3CCommunicates principles of disease prevention and behavioral change appropriate to the customer or target populationXXX
      3.3C1Develops menus that are evidenced-based for disease treatment and preventionXXX
      3.3C2Advocates behavioral nutrition principles to target audiences related to disease treatment and preventionXXX
      3.3C3Applies knowledge and principles of disease prevention and food science for diverse populationsXXX
      3.3C4Utilizes current food science principles for recipe development, food production, and serviceXXX
      3.3C5Develops programs for target audiences in relation to nutritional interventions addressing disease treatment and preventionXX
      3.3DCollaborates with customers to set priorities, establish goals, and create patient/client/customer-centered action plans to achieve desirable outcomesXXX
      3.3EInvolves customers in decision makingXXX
      3.3E1Interviews customers to determine needsXXX
      3.3E2Communicates decisions affecting customers with appropriate toolsXXX
      3.4Executes programs/services in an organized, collaborative, and customer-centered mannerXXX
      3.4ACollaborates and coordinates with peers, colleagues, and within interdisciplinary teamsXXX
      3.4A1Works in interdisciplinary teams to coordinate areas of responsibilityXXX
      3.4A2Leads interdisciplinary teams in areas of responsibilityXX
      3.4BParticipates in or leads in the design, execution, and evaluation of programs and services (eg, nutrition screening system, medical and retail foodservice, electronic health records, interdisciplinary programs, community education) for customersXXX
      3.4CDevelops or contributes to design and maintenance of policies, procedures, protocols, standards of care, technology resources, and training materials that reflect evidence-based practice in accordance with applicable laws and regulationsXXX
      3.4C1Ensures compliance with established policies, procedures, protocols, standards of care, technology resources, and training material that reflect evidence-based practiceXXX
      3.4C2Develops policies, procedures, protocols, standards of care, technology resources, and training that reflect evidence-based practiceXX
      3.4DParticipates in or develops process for clinical privileges required for expanded roles and enhanced activities (eg, implement physician-driven protocols to initiate or modify orders for diet, nutrition supplements, dietary supplements, enteral and parenteral nutrition, nutrition-related laboratory tests, and medications) consistent with state practice acts, regulations, organization policies, and medical staff bylaws, if applicableXXX
      3.4EComplies with established billing regulations and adheres to ethical billing practicesXXX
      3.4E1Develops pricing standards for goods and services for customersXXX
      3.4E2Authorizes pricing for products, services, and menu itemsXX
      3.4E3Establishes methodologies for cash handling and billing proceduresXX
      3.4FCommunicates with the interdisciplinary team and referring party consistent with the Health Insurance Portability and Accountability Act (HIPAA) rules for use and disclosure of customer's personal health informationXXX
      3.4F1Complies with HIPAA concepts in areas of responsibilityXXX
      3.4F2Communicates to staff HIPAA concepts for areas of responsibilityXXX
      3.4F3Develops programs for HIPAA compliance for areas of responsibilityXXX
      3.5Utilizes support personnel appropriately in the delivery of customer-centered care in accordance with laws, regulations, and organization policiesXXX
      3.5AAssigns activities, including direct care to patients/clients, consistent with the qualifications, experience, and competence of support personnelXXX
      3.5A1Ensures adequate staffing for areas of responsibilityXXX
      3.5A2Schedules support personnel for meeting needs of patients/clients/customersXXX
      3.5A3Adjusts staffing of support personnel to meet organization mission and needsXX
      3.5BSupervises support personnelXXX
      3.5B1Coaches support personnel to meet organization missionXXX
      3.5B2Provides developmental training for support personnelXXX
      3.5B3Conducts performance review of support personnel according to organization policyXXX
      3.5B4Disciplines support personnel due to evidence of noncompliance with department or organization policyXXX
      3.6Designs and implements food delivery systems to meet the needs of customersXXX
      3.6ACollaborates on or designs food delivery systems to address nutrition status, health care needs, and outcomes, and to satisfy the cultural preferences and desires of target populations (eg, health care patients/clients, employee groups, visitors to retail venues)XXX
      3.6A1Provides highest-quality service based on requirements of the facility, customer expectationsXXX
      3.6A2Utilizes manpower, machines, money, and innovative approaches to exceed both internal and external customers'/clients' needs and expectationsXXX
      3.6A3Applies knowledge and skills to determine the most appropriate action planXXX
      3.6A4Implements meal service delivery systems for all customersXXX
      3.6A5Directs catering eventsXXX
      3.6A6Ensures safety of clients/customers in relation to facility design and operationXX
      3.6A7Designs meal service delivery systems for all customersXX
      3.6BParticipates in, consults with others, or leads in developing menus to address health and nutritional needs of target population(s)XXX
      3.6B1Serves well-prepared, safe, hot and cold foods to customers to meet their needs and wantsXXX
      3.6B2Develops standardized recipes; modifies for individual and group needs and acceptabilityXXX
      3.6B3Develops master menus with modifications to address health and nutrition needs of target population(s)XXX
      3.6B4Evaluates menus for acceptability, compliance with nutritional parameters, cost, and sustainabilityXXX
      3.6B5Monitors and evaluates healthy promotion menu for sales and marketing outcomes; realigns to improve programXX
      3.6CParticipates in, consults, or leads interdisciplinary process for determining nutritional supplements, dietary supplements, enteral and parenteral nutrition formularies, and delivery systems for target population(s)XXX
      3.6C1Collaborates with interdisciplinary team in the development of medical nutrition formularies and supply sourcesXX
      3.7Maintains records of services providedXXX
      3.7ADocuments according to organization policy, standards, and system including electronic health recordsXXX
      3.7A1Applies Hazard Analysis and Critical Control Points principles to provide safe and sanitary food and supplies; emphasizes that employees follow personal hygiene codesXXX
      3.7A2Maintains records of food safety and sanitation in accordance with government regulations and accrediting agency standardsXXX
      3.7BImplements data-management systems to support data collection, maintenance, and utilizationXXX
      3.7B1Utilizes information technology to improve operationsXXX
      3.7B2Determines needs for improvement in data-management systemsXX
      3.7B3Evaluates cost/benefit of new or replacement data-management systemsX
      3.7CUses data to document outcomes of services (eg, staff productivity, cost/benefit, budget compliance, quality of services) and provide justification for maintenance or expansion of servicesXXX
      3.7C1Compiles data for benchmarking outcomes of serviceXXX
      3.7C2Utilizes forecasting methods to save resourcesXXX
      3.7C3Interprets benchmarking data to explain outcomes of servicesXX
      3.7C4Develops forecasting methodologiesX
      3.7C5Chooses the best food production systemX
      3.7DUses data to demonstrate compliance with accreditation standards, laws, and regulationsXXX
      3.8Advocates for provision of quality food and nutrition services as part of public policyXXX
      3.8ACommunicates with policy makers regarding the benefit/cost of quality food and nutrition servicesXXX
      3.8A1Determines needs for new programs, equipment, or systems to support food and nutrition servicesXX
      3.8A2Conducts cost benefit analysis of new programs, equipment, or systems for food and nutrition servicesXX
      3.8BAdvocates in support of food and nutrition programs and services for populations with special needsXXX
      3.8B1Collaborates with interdisciplinary teams to advocate for appropriate services for populations with special needsXX
      3.8CParticipates in food safety and security advocacy activitiesXXX
      Examples of Outcomes for Standard 3: Provision of Services
      • Program/service design and systems reflect organization/business and customer needs and expectations
      • Customers participate in establishing goals and customer-focused action plans
      • Customers needs are met
      • Customers are satisfied with services and products
      • Evaluations reflect expected outcomes
      • Effective screening and referral services are established
      • Customers have access to food assistance
      • Customers have access to food and nutrition services
      • Support personnel are supervised when providing nutrition care to customers
      • Ethical billing practices are utilized
      Standard 4: Application of Research

      The registered dietitian nutritionist (RDN) applies, participates in or generates research to enhance practice. Evidence-based practice incorporates the best available research/evidence in the delivery of nutrition and dietetics services.

      Rationale:

      Application, participation and generation of research promote improved safety and quality of nutrition and dietetics practice and services.
      Indicators for Standard 4: Application of Research
      Bold Font Indicators are Academy Core RDN Standards of Professional

      Performance Indicators
      The “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      4.1Accesses and reviews best available research/evidence for application to dietetics practiceXXX
      4.1AReviews current literature and industry trends to identify best practicesXXX
      4.1BDemonstrates understanding of research design and methodologyXXX
      4.1CUnderstands how to interpret results and study outcomesXX
      4.2Utilizes best available research/evidence as the foundation for evidence-based practiceXXX
      4.2AEncourages the use of evidence-based tools and resources as the basis for integration into current practiceXXX
      4.2BInterprets current research as applicable to practiceXX
      4.3Integrates best available research/evidence with best practices, clinical/ managerial expertise, and customer valuesXXX
      4.3AApplies evidence-based research results as a foundation for practiceXXX
      4.3BParticipates in the implementation of new knowledge and research in dieteticsXXX
      4.3CSupports staff awareness and incorporates evidence-based practices into program policies, protocols, and staff developmentXX
      4.3DLeads the development of program protocols, policies, procedures, and staff development programs and materialsX
      4.4Contributes to the development of new knowledge and research in nutrition and dieteticsXXX
      4.4AMaintains awareness of research in nutrition and dietetics through a variety of resources (eg, Evidence Analysis Library) and continuing education activitiesXXX
      4.4BIdentifies research issues/questions related to areas of responsibilityXXX
      4.4CParticipates in or conducts research following ethical standardsXXX
      4.4DShares best practice ideas/interventions that improve foodservice systemsXX
      4.4EParticipates in practice-based research networksXX
      4.4FDesigns market research in practice field to determine best practice and customer expectationsXX
      4.4GParticipates in studies on management topics for publicationXX
      4.4HInitiates research relevant to management practice as the primary investigator or as a collaborator with other members of the teamX
      4.4IDesigns and conducts research projects to investigate opportunities to improve foodservice processesX
      4.4JDesigns and implements research studies to examine the benefits on cost/quality from enhanced foodservice processesX
      4.4KCreates a culture supporting management-based researchX
      4.4LContributes significantly to body of knowledge regarding food and nutrition systems managementX
      4.5Promotes research through alliances and collaboration with food and nutrition and other professionals and organizationsXXX
      4.5AEncourages professional staff to join pertinent professional organizations to promote evidence-based practiceXXX
      4.5BActively participates in professional organizations to promote evidence-based practicesXXX
      4.5CAssumes a leadership role in professional organizations on the local or regional level to promote evidence-based practice and researchXX
      4.5DAssumes a leadership role in professional organizations on the national levelX
      Examples of Outcomes for Standard 4: Application of Research
      • Patients/clients receive appropriate services based on the effective application of best available research/evidence
      • Best available research/evidence is used as the foundation of evidence-based practice
      • Evidence-based practice, best practices, clinical and managerial expertise, and patient/client values are integrated in the delivery of nutrition and dietetics services
      Standard 5: Communication and Application of Knowledge

      The registered dietitian nutritionist (RDN) effectively applies knowledge and expertise in communications.

      Rationale:

      The RDN works with and through others to achieve common goals by effective sharing and application of their unique knowledge, skills, and expertise in food, nutrition, dietetics, and management services.
      Indicators for Standard 5: Communication and Application of Knowledge
      Bold Font Indicators are Academy Core RDN Standards of Professional Performance IndicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      5.1Communicates current, evidence-based knowledge related to a particular aspect of the profession of nutrition and dieteticsXXX
      5.1ACommunicates current evidence-based management knowledge to staff and othersXXX
      5.2Communicates and applies best available research/evidenceXXX
      5.2ADemonstrates critical thinking and problem-solving skills when communicating with othersXXX
      5.2BShares performance objectives during orientation of new employees and on routine basis with all staffXXX
      5.2CDemonstrates the ability to integrate new knowledge into program processesXX
      5.2DProvides professional development opportunities in critical thinking for staffXX
      5.2EDemonstrates the ability to apply new knowledge of management systems in new and varied contexts at an advanced levelX
      5.3Selects appropriate information and most effective method or format when communicating informationXXX
      5.3AUtilizes communication methods (ie, oral, print, one-on-one, group, visual, electronic, and social media) targeted to audienceXXX
      5.3A1Shares information with staff using respectful, supportive methodsXXX
      5.3BUses information technology to communicate, manage knowledge, and support decision makingXXX
      5.3B1Accesses electronic health records within work setting consistent with responsibilities, if applicableXXX
      5.3B2Participates in or determines electronic foodservice management systems used in operations (eg, purchasing, inventory management, recipe and menu development and nutritional analysis, patient/resident services [eg, room service systems], retail venues [eg, cash registers, catering billing, event room scheduling])XX
      5.4Integrates knowledge of food and nutrition with knowledge of health, social sciences, communication, and management in new and varied contextsXXX
      5.4AProvides effective interpretation of management systems to staffXXX
      5.4BArticulates effective interpretation of management systems to interdisciplinary teams and communityXX
      5.5Shares current, evidence-based knowledge, information with patients/clients, staff, colleagues, and the publicXXX
      5.5AGuides patients/clients, staff, students, and interns in the application of knowledge and skillsXXX
      5.5BAssists individuals and groups to identify and secure appropriate and available resources and servicesXXX
      5.5B1Defines and makes available to staff and clients reliable sources of informationXXX
      5.5B2Utilizes social media to convey accurate information to staff and clients following professional and organization guidelinesXXX
      5.5B3Presents information at appropriate level of understanding of patients/clients and staffXXX
      5.5CUtilizes professional writing and verbal skills in communicationsXXX
      5.5C1Utilizes appropriate written and oral language in all communicationXXX
      5.5C2Uses written communication tools that succinctly informs staff and colleagues of important informationXXX
      5.5C3Demonstrates professional writing skills in communicating new knowledge and research in nutrition and dieteticsXX
      5.6Establishes credibility and contributes as a resource within the interdisciplinary health care and management team promoting food and nutrition strategies that enhance health and quality of life outcomes of target populationsXXX
      5.6ACreates a positive, patient/client/customer-focused work environment by leading teams with courtesy, focus to detail and commitmentXXX
      5.6BCultivates internal and external networking relationships that foster both individual and organizational goalsXXX
      5.6CUtilizes formal and informal communication methods to maintain employee awareness of personal and departmental improvementsXXX
      5.6C1Recognizes personal achievement of staff within the department and facilityXXX
      5.6DDemonstrates ability to communicate strategies to improve patient/client/customer satisfactionXX
      5.7Communicates performance improvement and research results through publications and presentationsXXX
      5.7AShares performance improvement and research data and activities to meet staff and patient's/client's/customer's needsXXX
      5.7BPublishes performance improvement results in organization newsletterXXX
      5.7B1Publishes performance improvement results in community publicationsXX
      5.7B2Presents process improvement results in professional newsletters or journals or through presentationsX
      5.7CPresents evidence-based research at the local levelXXX
      5.7DWrites for food-management publicationsXX
      5.7EServes in a leadership role for foodservice-management publications (eg, reviewer, editorial board, editor)X
      5.8Seeks opportunities to participate in and assume leadership roles in local, state, and national professional and community-based organizationsXXX
      5.8AServes in a leadership role in professional dietetics, food, foodservice-related associations and organizationsXXX
      5.8A1Serves in a leadership role in local dietetics, food, foodservice, or community organizationsXXX
      5.8A2Serves in a leadership role in state affiliate dietetics, food, foodservice, or community organizationsXX
      5.8A3Serves in a leadership role in professional organizations related to food and nutrition managementX
      5.8BContributes food systems management expertise to community-based organizations, advisory boards, nonprofit organizations addressing food system issues (eg, local food system, community health initiatives, food insecurity, sustainability)XX
      5.8CParticipates in food systems management program planning at the state and national levelXX
      Examples of Outcomes for Standard 5: Communication and Application of Knowledge
      • Expertise in food, nutrition, and management is demonstrated and shared
      • Information technology is used to support practice
      • Individuals and groups:
        • Receive current and appropriate information and customer-centered service
        • Demonstrate understanding of information received
        • Know how to obtain additional guidance from the RDN
      • Leadership is demonstrated through active professional and community involvement
      Standard 6: Utilization and Management of Resources

      The registered dietitian nutritionist (RDN) uses resources effectively and efficiently.

      Rationale:

      The RDN demonstrates leadership through strategic management of time, finances, facilities, supplies, technology, and human resources.
      Indicators for Standard 6: Utilization and Management of Resources
      Bold Font Indicators are Academy Core RDN Standards of Professional Performance IndicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      6.1Uses a systematic approach to manage resources and improve operational outcomesXXX
      6.1ADevelops staffing model to meet service and facility needs and accountability for resourcesXXX
      6.1A1Implements staffing modelXXX
      6.1A2Develops job analysis, job descriptions to meet service needsXXX
      6.1A3Implements job descriptions that meet regulatory requirementsXXX
      6.1A4Administers performance evaluations in area of responsibility for effective job development and improved performanceXXX
      6.1A5Conducts orientation, in services education, and training to support employee performanceXXX
      6.1A6Provides staff coaching and corrective action as appropriateXXX
      6.1A7Terminates staff when job performance does not meet performance standards and/or competencesXXX
      6.1A8Plans and uses time prudentlyXXX
      6.1A9Champions diversity and generational differences in team building to create a climate of inclusion and dynamic creativityXXX
      6.1A10Applies negotiation and risk-management skills in contract and labor relationsXX
      6.1BDevelops procedures for evaluation and documentation of resource use and needsXXX
      6.1B1Participates in renovation or new construction of department including layout, design, and equipment selectionXXX
      6.1B2Determines equipment cleaning/functional ability and preventative maintenance programXXX
      6.1CLeads in strategic and operational planningXX
      6.2Quantifies management of resources in the provision of nutrition and dietetics services with the use of standardized performance measures and benchmarking as applicableXXX
      6.2AControls the use of measurable resources in the provision of services based on a budgetXXX
      6.2A1Implements strategies for expense adjustments in relation to volumes and organizational goalsXXX
      6.2A2Coordinates purchasing contracts to optimize food, equipment, and supply cost savingsXXX
      6.2A3Investigates opportunities for local purchasing of produceXXX
      6.2A4Evaluates the staffed hours needed to meet the production and service needsXXX
      6.2A5Compares the human resource assets with potential technology available to meet production needsXX
      6.2A6Designs strategies for adjusting expenses in relation to volumes and organizational goalsXX
      6.3Evaluates safety, effectiveness, productivity, and value when planning and delivering services and productsXXX
      6.3ADevelops processes to promote effective, timely delivery of products and servicesXXX
      6.3BDesigns a programmatic approach to promote a culture of safety in the area, including education and performance evaluationXXX
      6.3CImplements a programmatic safety plan, including an area-specific safety task forceXXX
      6.3DComplies with local, state, and federal regulatory agencies (eg, CMS, OSHA) and accreditation organizations (eg, The Joint Commission) as related to safety standardsXXX
      6.3EImplements programs for the control of microbial, chemical and physical hazards following the state or FDA Food CodeXXX
      6.3FAssesses and designs worksites and layouts to maximize productivity, ergonomic improvement, and safetyXX
      6.3GEvaluates food production and service workflows against published workflow best practicesXX
      6.4Participates in quality assurance and performance improvement (QAPI) and documents outcomes and best practices relative to resource managementXXX
      6.4AParticipates in QAPI program for departmentXXX
      6.4BSeeks input from interdisciplinary team and others where responsibilities are sharedXXX
      6.4CShares QAPI program with administration and interdisciplinary teamXXX
      6.4DMeasures outcomesXXX
      6.4EFollows accreditation survey quality standardsXXX
      6.4FDevelops QAPI program for area of responsibilityXX
      6.4GAuthors articles and training programs for food and nutrition industry publicationsX
      6.5Measures and tracks trends regarding patient/customer, employee, and stakeholder satisfaction in the delivery of products and servicesXXX
      6.5AAdministers satisfaction surveys to appropriate audiencesXXX
      6.5BUses systemic process to collect dataXXX
      6.5CAnalyzes data using basic statistical processes (eg, Likert scale)XXX
      6.5DUses data to improve services and utilize resources as appropriateXXX
      6.5EDesigns or joins customer satisfaction benchmarking programsXXX
      6.5E1Publishes customer satisfaction survey methodology in appropriate food and nutrition publicationsXX
      6.5FImplements a continuous improvement effort programXXX
      6.5GDesigns productivity measures for departmentXXX
      6.5HImplements measures of productivityXXX
      6.5IDocuments results of related productivity studiesXXX
      6.5JRefines program as necessaryXXX
      Examples of Outcomes for Standard 6: Utilization and Management of Resources
      • Documentation of resource use is consistent with operation
      • Data are used to promote, improve, and validate services
      • Desired outcomes are achieved and documented
      • Resources are effectively and efficiently managed

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        Academy of Nutrition and Dietetics: Revised 2012 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians.
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      Biography

      R. M. Berthelsen is dean of health, biological & sports science, Iowa Western Community College, Council Bluffs.
      W. C. Barkley is general manager and foodservice director, Sodexho Healthcare Management, The Children's Hospitals and Clinics, Kansas City, MO.
      P. Oliver is director of nutrition, UCLA Healthcare, Los Angeles, CA.
      V. McLymont is director of food and nutrition services, Memorial Sloan-Kettering Cancer Center, New York, NY.
      R. Puckett is program director, Dietary Manager Training, Division of Continuing, Distance, and Executive Education, University of Florida, Gainesville.