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Academy of Nutrition and Dietetics: Revised 2019 Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Clinical Nutrition Management

Published:August 22, 2019DOI:https://doi.org/10.1016/j.jand.2019.05.013

      Abstract

      Clinical nutrition management (CNM) encompasses the varied roles of registered dietitian nutritionists (RDNs) with administrative responsibilities for clinical nutrition services within an organization. Although RDNs in CNM are typically employed in acute care, they are also employed in settings where management of nutrition services is required, such as foodservice departments, ambulatory clinics, telehealth services, public health organizations, post-acute and long-term care, rehabilitation, and correctional facilities, or specialty departments, for example, dialysis units or cancer centers. RDNs in CNM aim to create work environments that support high-quality customer-centered care, attract and retain talented staff, and foster an atmosphere of collaboration and innovation. The CNM Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has revised the Standards of Professional Performance (SOPP) for RDNs in CNM for three levels of practice: competent, proficient, and expert. The SOPP describes six domains that focus on professional performance: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Indicators outlined in the SOPP depict how these standards apply to practice. The standards and indicators for RDNs in CNM are written with the leader in mind—to support an individual in a leadership role or who has leadership aspirations. The SOPP is intended to be used by RDNs for self-evaluation to assure competent practice and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.
      Editor’s note: Figure 1 that accompanies this article is available online at www.jandonline.org.The Clinical Nutrition Management (CNM) Dietetic Practice Group (DPG) 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 Dietitian Nutritionists (RDNs) in Clinical Nutrition Management, originally published in 2012.
      • Clark K.M.
      • Moore C.
      • Trombley L.
      • et al.
      Academy of Nutrition and Dietetics: Standards of Professional Performance for Registered Dietitians (Competent, Proficient, Expert) in Clinical Nutrition Management.
      The revised document, Academy of Nutrition and Dietetics: Revised 2019 Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Clinical Nutrition Management, reflects advances in CNM practice during the past 7 years and replaces the 2012 Standards. This document builds on the Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice (SOP) in Nutrition Care and SOPP for RDNs.
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitian Nutritionists.
      The Academy of Nutrition and Dietetics/Commission on Dietetic Registration’s (CDR) 2018 Code of Ethics for the Nutrition and Dietetics Profession,
      Academy of Nutrition and Dietetics/Commission on Dietetic Registration
      Code of Ethics for the Nutrition and Dietetics Profession.
      along with the Academy of Nutrition and Dietetics: Revised 2017 SOP in Nutrition Care and SOPP for RDNs
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitian Nutritionists.
      and the Academy’s Revised 2017 Scope of Practice for the RDN,
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Registered Dietitian Nutritionist.
      guide the practice and performance of RDNs in all settings.
      Scope of practice in nutrition and dietetics is composed of statutory and individual components, includes codes of ethics (eg, Academy/CDR, employer, and/or other national organizations) and other resources, such as Ethics in Action articles,
      • Sauer K.
      Ethics in action: Ethical considerations in management practice.
      and encompasses the range of roles, activities, practice guidelines, 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
      Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Registered Dietitian Nutritionist.
      An RDN’s statutory scope of practice can delineate the services an RDN is authorized to perform in a state where a practice act or certification exists. For more information, see https://www.eatrightpro.org/advocacy/licensure/licensure-map.
      The RDN’s individual scope of practice is determined by education, training, credentialing, experience, and demonstrating and documenting competence to practice. Individual scope of practice in nutrition and dietetics has flexible boundaries to capture the breadth of the individual’s professional practice. Professional advancement beyond the core education and supervised practice to qualify for the RDN credential provides RDNs practice opportunities, such as expanded roles within an organization based on training and certifications, if required; or additional credentials (eg, focus area CDR specialist certification, if applicable; CDR Advanced Practice Certification in Clinical Nutrition [RDN-AP/RD-AP]; Certified Diabetes Educator [CDE]; Certified Case Manager [CCM]; or Certified Professional in Healthcare Quality [CPHQ]). The Scope of Practice Decision Algorithm (www.eatrightpro.org/scope) guides an RDN through a series of questions to determine whether a particular activity is within his or her individual scope of practice. The algorithm is designed to assist an RDN to critically evaluate his or her personal knowledge, skill, experience, judgment, and demonstrated competence using criteria resources.
      Scope of Practice Decision Algorithm
      Academy of Nutrition and Dietetics website.
      Approved April 2019 by the Quality Management Committee of the Academy of Nutrition and Dietetics (Academy) and the Executive Committee of the Clinical Nutrition Management Dietetic Practice Group of the Academy. Scheduled review date: December 2025. Questions regarding the Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists in Clinical Nutrition Management may be addressed to Academy Quality Management Staff: Dana Buelsing, MS, manager, Quality Standards Operations; and Karen Hui, RDN, LDN, scope/standards of practice specialist, Quality Management at [email protected]
      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). The two credentials have identical meanings. In this document, the authors have chosen to use the term RDN to refer to both registered dietitians and registered dietitian nutritionists.

      Academy Quality and Practice Resources

      The Academy’s Revised 2017 SOP in Nutrition Care and SOPP for RDNs
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitian Nutritionists.
      reflect the minimum competent level of nutrition and dietetics practice and professional performance. The core standards serve as blueprints for the development of focus area SOP and SOPP for RDNs in competent, proficient, and expert levels of practice. While this document addresses the SOPP only, each RDN needs to be aware of the minimum competent level of practice for the core SOP in Nutrition Care and relate its quality indicators by drawing upon one’s own applicable practice experience and knowledge. The SOP in Nutrition Care is composed of four standards consistent with the Nutrition Care Process and clinical workflow elements as applied to the care of patients/clients/populations in all settings.
      • Swan W.I.
      • Vivanti A.
      • Hakel-Smith N.A.
      • et al.
      Nutrition Care Process and Model update: Toward realizing people-centered care and outcomes management.
      The SOPP consist of standards representing six domains of professional performance: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. The SOP and SOPP for RDNs are designed to promote the provision of safe, effective, efficient, and quality food and nutrition care and services; facilitate evidence-based practice; and serve as a professional evaluation resource.
      These focus area standards for RDNs in CNM provide a guide for self-evaluation and expanding practice, a means of identifying areas for professional development, and a tool for demonstrating competence in the CNM role and responsibilities. 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 can be used to assist RDNs in transitioning their knowledge and skills to a new focus area of practice. Like the Academy’s core SOP in Nutrition Care and SOPP for RDNs,
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitian Nutritionists.
      the indicators (ie, measurable action statements that illustrate how each standard can be applied in practice) (see Figure 1, available at www.jandonline.org) for the SOPP for RDNs in CNM were revised with input and consensus of content experts representing diverse practice and geographic perspectives. The SOPP for RDNs in CNM were reviewed and approved by the Executive Committee of the CNM DPG and the Academy Quality Management Committee.

      Why Were the Standards Revised?

      It is critical that RDNs in CNM reflect current practice environments with respect to the most recent research, evidenced-based practices, and related laws and regulations in health care and other applicable practice segments. Changes in the practice environment for RDNs and Nutrition and Dietetic Technicians, Registered (NDTRs) can impact care and services provided by RDNs. In addition, enhanced knowledge and skills training in decision making, using evidenced-based resources, and autonomous practice are required of RDNs in CNM to execute these changes. Examples of significant changes are:
      • The Scope of Practice for the RDN
        Academy of Nutrition and Dietetics Quality Management Committee
        Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Registered Dietitian Nutritionist.
        and the Scope of Practice for the NDTR
        Academy of Nutrition and Dietetics Quality Management Committee
        Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Nutrition and Dietetics Technician, Registered.
        were revised and published in the Academy’s Journal in January 2018 and February 2018, respectively. The RDN Scope of Practice reflects changes impacting practice such as the Centers for Medicare and Medicaid Services (CMS) updates to regulations; national efforts to address malnutrition; and sections on coaching, global health, and telehealth among other updates. The NDTR Scope of Practice also includes revisions, such as updated practice areas, and a new individual scope of practice figure.
      • The CMS, Department of Health and Human Services, Hospital
        US Department of Health and Human Services, Centers for Medicare and Medicaid Services
        State Operations Manual. Appendix A-Survey protocol, regulations and interpretive guidelines for hospitals (Rev. 183, 10-12-18; §482.12(a)(1) Medical Staff, non-physician practitioners; §482.23(c)(3)(i) Verbal Orders; §482.24(c)(2) Orders.
        and Critical Access Hospital
        US Department of Health and Human Services, Centers for Medicare and Medicaid Services
        State Operations Manual. Appendix W-Survey protocol, regulations and interpretive guidelines for critical access hospitals (CAHs) and swing-beds in CAHs (Rev. 183, 10-12-18); §485.635(a)(3)(vii) Dietary Services ; §458.635 (d)(3) Verbal Orders.
        Conditions of Participation now allows a hospital and its medical staff the option of including RDNs or other clinically qualified nutrition professionals within the category of “non-physician practitioners” eligible for ordering privileges for therapeutic diets and nutrition-related services if consistent with state law and health care regulations.
        US Department of Health and Human Services
        Centers for Medicare and Medicaid Services. 42 CFR Parts 413, 416, 440 et al. Medicare and Medicaid Programs; Regulatory provisions to promote program efficiency, transparency, and burden reduction; Part II; Final rule (FR DOC #2014-10687; pp 27106-27157).
        For more information, review the Scope of Practice for the RDN
        Academy of Nutrition and Dietetics Quality Management Committee
        Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Registered Dietitian Nutritionist.
        and the Academy’s practice tips that outline the regulations and implementation steps at www.eatrightpro.org/dietorders. For assistance, refer questions to the Academy’s State Affiliate organization.
      • The Long-Term Care Final Rule published October 4, 2016 in the Federal Register, now “allows the attending physician to delegate to a qualified dietitian or other clinically qualified nutrition professional the task of prescribing a resident’s diet, including a therapeutic diet, to the extent allowed by State law” and permitted by the facility’s policies.

        US Department of Health and Human Services, Centers for Medicare and Medicaid Services. Centers for Medicare and Medicaid Services. Medicare and Medicaid Programs; reform of requirements for long-term care facilities. 42 CFR Parts 405, 431, 447, 482, 483, 485, 488, and 489. Final Rule (FR DOC#2016; pp 68688-68872) – Federal Register October 4, 2016; 81(192):68688-68872; §483.30(f)(2) Physician services (pp 65-66), §483.60 Food and Nutrition Services (pp 89-94), §483.60 Food and Nutrition Services (pp 177-178). https://www.federalregister.gov/documents/2016/10/04/2016-23503/medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilities. Accessed June 28, 2019.

        The CMS State Operations Manual, Appendix PP-Guidance for Surveyors for Long-Term Care Facilities contains the revised regulatory language.
        US Department of Health and Human Services, Centers for Medicare and Medicaid Services
        State Operations Manual. Appendix PP Guidance to surveyors for long-term care facilities (Rev. 173, 11-22-17); §483.30 Physician Services, §483.60 Food and Nutrition Services.
        CMS periodically revises the State Operations Manual Conditions of Participation; obtain the current information at www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/som107Appendicestoc.pdf.
      • The Malnutrition Quality Improvement Initiative (MQii) began in 2013, and is an initiative aimed to advance evidence-based care for hospitalized older adults who are malnourished or at-risk for malnutrition. MQii provides support in achieving quality malnutrition standards through an MQii Toolkit and a set of malnutrition electronic Clinical Quality Measures.
        Malnutrition
        Academy of Nutrition and Dietetics website.
        • Khan M.
        • Hui K.
        • McCauley S.
        What is a registered dietitian nutritionist’s role in addressing malnutrition?.
        Malnutrition Toolkit
        Clinical Nutrition Management Dietetic Practice Group website.
        The Academy is the measure steward for the malnutrition electronic Clinical Quality Measures, which use data to measure health care quality, and can assist in increasing screening, assessment, diagnosis, and care for malnourished or at-risk adults.
        Malnutrition
        Academy of Nutrition and Dietetics website.
        • Khan M.
        • Hui K.
        • McCauley S.
        What is a registered dietitian nutritionist’s role in addressing malnutrition?.
      Other significant changes impacting nutrition and dietetics practice are highlighted in both the Revised 2017 SOP in Nutrition Care and SOPP for RDNs
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitian Nutritionists.
      and the Revised 2017 SOP in Nutrition Care and SOPP for NDTRs.
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Nutrition and Dietetics Technicians, Registered.

      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. The first two levels are components of the required didactic education (novice) and supervised practice experience (advanced beginner) that precede credentialing for nutrition and dietetics practitioners. Upon successfully attaining the RDN credential, a practitioner enters professional practice at the competent level and manages his or her professional development to achieve individual professional goals. This model is helpful in understanding the levels of practice described in the SOPP for RDNs in CNM. In Academy focus areas, the three levels of practice are represented as competent, proficient, and expert.
      RDNs in CNM have titles and roles such as lead dietitian, coordinator, supervisor, clinical nutrition manager, and director of clinical nutrition, depending on setting.
      • Rogers D.
      Compensation and benefits survey 2017.
      The SOPP for RDNs in CNM applies to RDNs who practice within management roles or perform managerial tasks. CNM skills and knowledge can apply in many different settings beyond clinical nutrition, including other clinical services (eg, diabetes education center, wound care program), community or public health, informatics, food service, and roles that support quality, public policy, and professional resources.
      Figure 2Standards of Professional Performance for Registered Dietitian Nutritionists (RDNs) (Competent, Proficient, and Expert) in Clinical Nutrition Management (CNM).
      Standards of Professional Performance (SOPP) for RDNs in Clinical Nutrition Management (CNM) are authoritative statements that describe behavior in the professional role, including activities related to Quality in Practice; Competence and Accountability; Provision of Services; Application of Research; Communication and Application of Knowledge; and Utilization and Management of Resources (six separate standards).
      The SOPP, along with the Standards of Practice (SOP) in Nutrition Care, applicable to practitioners who provide direct patient/client nutrition care services, are complementary standards and serve as evaluation resources. All indicators may not be applicable to all RDNs’ practice or to all practice settings and situations. RDNs operate within the directives of applicable federal and state laws and regulations, as well as policies and procedures established by the organization in which they are employed. To determine whether an activity is within the scope of practice of the RDN, the practitioner compares his or her knowledge, skill, experience, judgment, and demonstrated competence with the criteria necessary to perform the activity safely, ethically, legally, and appropriately. The Academy’s Scope of Practice Decision Algorithm is specifically designed to assist practitioners with this process.
      The term customer is used in the SOPP as a universal term. Customer could also mean client, patient, participant, consumer, or any individual, group, or organization to which the RDN provides services. These services are provided to individuals of all ages. The SOPP are not limited to the clinical setting. In addition, it is recognized that administrators, directors, and managers play critical roles in clinical nutrition management, and are important members of the interprofessional team. The term appropriate is used in the standards to mean: Selecting from a range of best practice or evidence-based possibilities, one or more of which would give an acceptable result in the circumstances. The terms organization/facility/department/program are interchangeable in this evaluation resource, with a specific term used in a given performance indicator (see Figure 1) dependent on the situation and setting.
      Each standard is equal in relevance and importance and includes a definition, a rationale statement, indicators, and examples of desired outcomes. A standard is a collection of specific outcome-focused statements against which a practitioner’s performance can be assessed. The rationale statement describes the intent of the standard and defines its purpose and importance in greater detail. Indicators are measurable action statements that illustrate how each specific standard can be applied in practice. Indicators serve to identify the level of performance of competent practitioners and to encourage and recognize professional growth.
      Standard definitions, rationale statements, core indicators, and examples of outcomes found in the Academy of Nutrition and Dietetics: Revised 2017 SOPP for RDNs have been adapted to reflect three levels of practice (Competent, Proficient, and Expert) for RDNs in CNM (see image below). In addition, the core indicators have been expanded to reflect the unique competence expectations for the RDN providing CNM.

      Competent Practitioner

      In nutrition and dietetics, a competent practitioner is an RDN who is either just starting practice after having obtained RDN registration by CDR or an experienced RDN recently transitioning his or her practice to a new focus area of nutrition and dietetics. A focus area of nutrition and dietetics practice is a defined area of practice that requires focused knowledge, skills, and experience that applies to all levels of practice.
      Definition of terms list. Academy of Nutrition and Dietetics website.
      A competent practitioner who has achieved credentialing as an RDN and is starting in professional employment consistently provides safe and reliable services by employing appropriate knowledge, skills, behavior, and values in accordance with accepted standards of the profession; acquires additional on-the-job skills; and engages in tailored continuing education to further enhance knowledge, skills, and judgment obtained in formal education.
      Definition of terms list. Academy of Nutrition and Dietetics website.
      A general practice RDN can include responsibilities across several areas of practice, including, but not limited to: community, clinical, consultation and business, research, education, and food and nutrition management.
      RDNs new to CNM with little or no management experience begin at the competent level; in addition, this level can be demonstrated by more tenured clinicians new to the management role or responsibilities. A new RDN in CNM is typically task-oriented and focused on learning departmental and organizational policies, procedures, and processes, in addition to understanding local, state, and federal regulations. Tasks may include scheduling, budget planning and reporting, setting and monitoring performance measures, and prioritizing work in alignment with departmental and organizational goals. Although task-oriented, the competent-level RDN in CNM demonstrates skills and behaviors that include effectively communicating with customers and staff, holding self and others accountable for actions and responsibilities, recognizing and encouraging professional behaviors that contribute to teamwork, and evaluating the safety and efficacy of services. Processes must be thoroughly considered, and the manager may benefit from guidance and instructions. An RDN in CNM at this level performs best with guidance from a mentor(s) to execute tasks, prioritize, and troubleshoot problems. As the competent-level practitioner progresses, tasks are put into perspective, context is added, decision-making skills are refined, and scopes of responsibility are broadened. To expand knowledge and skills, the RDN in CNM should pursue organizational training opportunities, identify mentor(s), and access the CNM DPG and Academy resources, such as the Academy’s Online Leadership Certificate of Training level 1; applicable focus area SOP and/or SOPPs (www.eatrightpro.org/SOP); and other resources regarding leadership,
      Leadership and Staff Development
      Clinical Nutrition Management Dietetic Practice Group website.
      • Vaterlaus Patten E.
      • Sauer K.
      The framework and future opportunities for leadership in clinical dietetics.
      • Vaterlaus Patten E.
      • Sauer K.
      A leadership taxonomy for clinical dietetics practice.
      privileging,
      Practice Tips: Hospital Regulation–Ordering Privileges for the RDN
      Academy of Nutrition and Dietetics website.
      Practice Tips: Implementation Steps–Ordering Privileges for the RDN
      Academy of Nutrition and Dietetics website.
      Practice Tips: Reform Requirements for RDNs and NDTRs in Long Term Care Facilities. Academy of Nutrition and Dietetics website.
      • Phillips W.
      • Doley J.
      Granting order-writing privileges to registered dietitian nutritionists can decrease costs in acute care hospitals.
      malnutrition,
      Malnutrition
      Academy of Nutrition and Dietetics website.
      • Khan M.
      • Hui K.
      • McCauley S.
      What is a registered dietitian nutritionist’s role in addressing malnutrition?.
      Malnutrition Toolkit
      Clinical Nutrition Management Dietetic Practice Group website.
      coding and payment (www.eatrightpro.org/payment), telehealth,
      Telehealth. Academy of Nutrition and Dietetics website.
      and quality improvement
      Quality Improvement
      Academy of Nutrition and Dietetics website.
      ; The Clinical Nutrition Manager’s Handbook: Solutions for the Busy Professional
      • Grim J.A.
      • Roberts S.R.
      The Clinical Nutrition Manager’s Handbook: Solutions for the Busy Professional.
      ; and other resources in Figure 3 to further develop knowledge.
      Figure 3Clinical Nutrition Management Resources (not all-inclusive).
      ResourceAddress/citationDescription
      Academy of Nutrition and Dietetics (Academy) Resources
      Academy Clinical Nutrition Management Dietetic Practice Group (CNM DPG)https://www.cnmdpg.org/CNM DPG offers resources for RDNs in CNM, such as access to sub-units, a newsletter, electronic mailing list, member resource library, continuing professional education unit opportunities, self-study webinars, and an annual symposium.
      Academy The Clinical Nutrition Manager’s Handbook: Solutions for the Busy Professionalhttps://www.eatrightstore.org/product-type/books/the-clinical-nutrition-managers-handbook-solutions-for-the-busy-professionalThe handbook is written by experienced clinical nutrition managers and provides information on best practices and practical tips for success. Topics include, but are not limited to: strategic planning; hiring, managing, and developing staff; statutory and regulatory issues; and nutrition informatics.
      Academy Health Informatics Infrastructure (ANDHII)https://www.andhii.org/ANDHII is a tool that offers secure online data collection, and has three main components: smart visits, dietetics outcomes registry, and nutrition research informatics.
      Academy Leadership Resourceshttps://www.eatrightpro.org/leadership/volunteering/leadership-resourcesThese online certificate of training programs help to further leadership and communication skills. Programs include: Developing Your Role as Leader and Advancing Your Role as Leader. This website also includes resources such as books, websites, and articles.
      Academy Online Certificate of Training: Executive Managementhttps://www.eatrightstore.org/collections/executive-management-certificateThis online certificate of training program assists managers to further his or her management skills and advance their practice. The program consists of four separate modules that include topics such as managerial communication, career laddering, and succession planning.
      Academy Quality Resource Collectionhttps://www.eatrightpro.org/practice/quality-management/quality-improvement/quality-strategiesThe Quality Resource Collection has over 100 resources and serves to help develop quality management knowledge and skills as a critical component of nutrition and dietetics practice. Resources are categorized based on their quality concept, such as leadership, performance improvement, or quality assurance.
      Academy Webinar–Lessons in Leadership: How to Manage Conflict and Ethical Challengeshttps://www.eatrightstore.org/cpe-opportunities/recorded-webinars/lessons-in-leadership-how-to-manage-conflict-and-ethical-challengesThis webinar focuses on four strategies for working through conflict and ethical dilemmas with case studies shared by Academy members. It promotes the idea that personal growth in emotional intelligence can lead to professional advancement and satisfaction.
      Leadership Resources
      Act Like a Leader, Think Like a LeaderIbarra H. Act Like a Leader, Think Like a Leader. Boston, MA: Harvard Business Review Press; 2015.This book provides practical advice on finding time to develop leadership skills on a day-to-day basis. It also helps leaders learn how to make small changes that will impact leadership, such as diversifying networks, redefining roles, and evolving self-concept.
      Conversational Intelligence: How Great Leaders Build Trust and Get Extraordinary ResultsGlaser JE. Conversational Intelligence: How Great Leaders Build Trust and Get Extraordinary Results. New York, NY: Bibliomotion, Inc; 2014.This book is one of the key resources regarding conversational skills and intelligence. It can help the reader improve these skills, and provides tips to identify types of conversations that can trigger specific reactions.
      Crucial Conversations: Tools for Talking when Stakes are HighPatterson K, Grenny J, McMillan R, et al. Crucial Conversations: Tools for Talking when Stakes are High. Updated ed. New York, NY: McGraw-Hill; 2012.This book gives resources on how to communicate when stakes are high. It provides tools to prepare for high-stakes situations, transform anger and hurt feelings into powerful dialogue, make it safe to discuss most topics, and be persuasive, not abrasive.
      Healthcare Leadership Modelhttps://www.leadershipacademy.nhs.uk/resources/healthcare-leadership-model/The Healthcare Leadership Model is composed of nine leadership dimensions and provides a detailed description of day-to-day tasks performed by leaders. For each dimension, leadership behaviors are shown on a scale that ranges from essential through proficient and strong to exemplary. Readers may decide which dimension will be useful in his or her current role or future goals.
      Health Promotion in Multicultural PopulationsHuff RM, Kline MV, Peterson DV. Health Promotion in Multicultural Populations. 3rd ed. Thousand Oaks, CA: Sage Publications, Inc; 2015.This book provides a practical guide for health care practitioners in the planning, implementation, and evaluation of health promotion topics in a multicultural society.
      The 8th Habit: From Effectiveness to GreatnessCovey S. The 8th Habit: From Effectiveness to Greatness. New York, NY: Free Press; 2004.This book outlines the importance of “finding your voice” and helping others to find theirs. The book outlines four intelligences and how to develop each.
      Turn the Ship Around: A True Story of Turning Followers into LeadersMarquet DL. Turn the Ship Around: A True Story of Turning Followers into Leaders. New York, NY: Penguin Group; 2012.This book provides information regarding creating leadership at all levels, empowering employees, and helping employees to take ownership of actions. This informational tool can help to increase employee satisfaction and engagement.
      Management Resources
      1501 Ways to Reward EmployeesNelson B. 1501 Ways to Reward Employees. New York, NY: Workman Publishing; 2012.This book provides practical, low-cost, and no-cost tips and guidelines to reward and recognize employees.
      First, Break All the Rules: What the World’s Greatest Managers do DifferentlyHarter J, Gallup. First, Break All the Rules: What the World’s Greatest Managers do Differently. Washington, DC: Gallup Press; 2016This book helps managers understand how to increase and maintain employee engagement and which rules of management to break in order to develop and retain the most talented, diverse, and effective teams.
      Project Management for the Unofficial Project ManagerKogan K, Blakemore S, Wood J. Project Management for the Unofficial Project Manager. Dallas, TX: BenBella Books, Inc; 2015.This book helps guide readers through the essentials of the project management process: plan, develop, initiate, and monitor projects in the workplace.
      The New One Minute ManagerBlanchard K, Johnson S. The New One Minute Manager. New York, NY: HarperCollins Publishers; 2015.This short book outlines three practical management techniques: One Minute Goals, One Minute Praising, and One Minute Reprimands. It also provides examples of these techniques in action.
      What Management IsMagretta J. What Management Is. London, UK: Profile Books Ltd; 2013.This book highlights concepts such as change management, value creation, business models, competitive strategy, and organizational design. It assists managers in team development in order to provide the best service to customers.
      Foodservice Resources
      Food for FiftyMolt M. Food for Fifty. 14th ed. Upper Saddle River, NJ: Pearson Inc; 2018.This reference book and teaching text is a resource for food production managers and employees, faculty, and students. Topics address menu planning, purchasing, recipe development and standardization, food production information, food safety, and planning for special foodservice and catering events. Tools include tables, charts, ready-to-use guidelines (eg, menu planning, purchasing, food safety), and standardized recipes that reflect contemporary food preferences and modern eating styles.
      Foodservice Management: Principles and PracticesPayne-Palacio J, Theis M. Foodservice Management: Principles and Practices. 13th ed. New York City, NY: Pearson Education Publishing; 2015.This book provides an in-depth discussion of principles related to foodservice management, including menu planning, marketing, administration, and customer service management. This resource is an overview guide of basic foodservice principles and is not specific to any particular setting (both commercial and non-commercial).
      The Non-Commercial Food Service Manager’s HandbookBrown D, Henkel S. The Non-Commercial Food Service Manager’s Handbook. Ocala, FL: Atlantic Publishing Group, Inc; 2007.This book provides a thorough and comprehensive description of foodservice management specifically designed for the manager of an operation in settings such as acute- and long-term care, schools, and prisons. This book is a key resource for managers who play a role in foodservice management.

      Proficient Practitioner

      A proficient practitioner is an RDN who is generally 3 or more years beyond credentialing and entry into the profession, and consistently provides safe and reliable service; has obtained operational job performance skills; and is successful in the RDN's chosen focus area of practice.
      Definition of terms list. Academy of Nutrition and Dietetics website.
      The proficient practitioner demonstrates additional knowledge, skills, judgment, and experience in CNM. An RDN may acquire specialist credentials, if available, to demonstrate proficiency in a focus area of practice.
      Compared with competent-level practitioners, proficient-level RDNs in CNM function at a higher level of practice by recognizing the value of and having the ability to develop strategic plans, leading initiatives to expand current practice (eg, MQii,
      Malnutrition
      Academy of Nutrition and Dietetics website.
      • Khan M.
      • Hui K.
      • McCauley S.
      What is a registered dietitian nutritionist’s role in addressing malnutrition?.
      Malnutrition Toolkit
      Clinical Nutrition Management Dietetic Practice Group website.
      Standards of Excellence for Organizations,
      Standards of Excellence
      Academy of Nutrition and Dietetics website.
      telehealth services
      Telehealth. Academy of Nutrition and Dietetics website.
      ), and managing human and financial resources
      • Howells A.
      • Sauer K.
      • Shanklin C.
      Evaluating human resources and financial management responsibilities of clinical nutrition managers.
      with finesse and role comprehension. These practitioners function effectively within their organizations to obtain or renew accreditation, institute change, secure needed resources, and advance the practice of medical nutrition therapy. Proficient practitioners develop an intuitive understanding of the role, improving focus on critical issues, and understanding the implications of information and actions. Other skills include creating collaborative and inclusive environments that support creative thinking and innovation, proactively investigating new principles and diverse perspectives, and developing teams in which members accept responsibility and respect others. In addition, RDNs in CNM operationalize clinical processes and provide advice to interprofessional team(s) and coordinators of clinical programs on current nutrition practice. Knowledge is embedded with related skills, allowing the practitioner to form a wider framework of perspectives and priorities, while learning from experience and guidelines developed by others. Learning and skill development should continue with the use of resources, such as the Academy’s Online Leadership Certificate of Training level 2,
      Leadership Resources
      Academy of Nutrition and Dietetics website.
      or articles from the CNM DPG Future Dimensions newsletter and/or other DPG newsletters; see Figure 3 for a list of additional resources.

      Expert Practitioner

      An expert practitioner is an RDN who is recognized within the profession and has mastered the highest degree of skill in, and knowledge of, nutrition and dietetics, leadership, mentorship, staff/team development, and establishment of effective working/collaborative relationships with others. Expert-level achievement is acquired through ongoing critical evaluation of practice and feedback from others. The individual at this level strives for additional knowledge, experience, and training. An expert has the ability to quickly identify “what” is happening and “how” to approach the situation. Experts easily use nutrition and dietetics skills to become successful through demonstrating quality practice and leadership, and to consider new opportunities that build upon nutrition and dietetics.
      Definition of terms list. Academy of Nutrition and Dietetics website.
      An expert practitioner may have an expanded or specialist role, or both, and may possess an advanced degree(s) or credential(s). Generally, the practice is more complex and the practitioner has a high degree of professional autonomy and responsibility.
      The expert level of professional performance correlates with the acquisition of a sound knowledge base and complex decision-making skills that enable the RDN in CNM to rapidly and accurately assess a situation, identify potential effects, and seamlessly move to address problems. Expert-level RDNs in CNM serve as a primary source of information and often share their knowledge via professional publications or speaking engagements; and serve the profession by participating in nutrition and dietetics organizations at a local, state, or national level. They also participate in research and/or quality improvement projects to assess the efficacy of services and contribute to the management and clinical nutrition knowledge base, thus promoting and improving the ability of professionals to base their practice on evidence. Expert practitioners possess an in-depth understanding of role requirements and a keen ability to envision service improvements, expansion, and interface influentially with employees and other stakeholders for planning, problem solving, clinical practice, and making a shared vision a reality. Expert RDNs in CNM use institutional knowledge to advocate for nutrition-related public policy that will benefit their customers.
      Clinical Nutrition is the study of the relationship between food and the body, nutritional disorders, and nutrition-related conditions. It is the science of nutrients and how they are digested, absorbed, transported, metabolized, stored, and eliminated in the body and incorporates the fields of nutrition and dietetics. Clinical nutrition encompasses the prevention, diagnosis, and management of nutrition-related disorders and conditions, malnutrition, macro- and micronutrient abnormalities, sarcopenia, frailty, and metabolic changes related to acute and chronic diseases. Clinical nutrition includes application of the Nutrition Care Process and workflow elements to address the nutritional care of patients/clients with malnutrition, obesity, diabetes, food allergies or intolerances, metabolic diseases, and any other diseases or conditions in which nutrition plays a role in prevention or treatment, such as critical illness, pre-diabetes, cancer or cystic fibrosis.
      Definition of terms list. Academy of Nutrition and Dietetics website.
      • Cederholm T.
      • Barazzoni R.
      • Austin P.
      • et al.
      ESPEN guidelines and definitions and terminology of clinical nutrition.
      These Standards, along with the Academy/CDR Code of Ethics,
      Academy of Nutrition and Dietetics/Commission on Dietetic Registration
      Code of Ethics for the Nutrition and Dietetics Profession.
      answer the following questions: Why is an RDN uniquely qualified to provide CNM services? What knowledge, skills, and competencies does an RDN need to demonstrate for the provision of safe, effective, and quality CNM at the competent, proficient, and expert levels?

      Overview

      The term clinical nutrition management in this document encompasses varied roles of the RDN with administrative responsibilities for clinical nutrition services within an organization. Although the RDN in CNM is often employed in acute care, the SOPP for RDNs in CNM may also be used in other settings where management of nutrition services is required, for example, foodservice departments, ambulatory clinics, telehealth services,
      Definition of terms list. Academy of Nutrition and Dietetics website.
      Telehealth. Academy of Nutrition and Dietetics website.
      public health organizations, post-acute and long-term care, rehabilitation, and correctional facilities, or specialty services, such as dialysis units/centers or cancer centers. Due to the variety of settings and services, the population served can be described using a variety of terms—patients, residents, clients, employees, and stakeholders. In this article, the term customer is used to describe the various populations being served.
      The CNM role may extend beyond the functions described to include responsibility for operations outside of clinical nutrition, such as other clinical services (eg, diabetes education center, wound care program), community or public health, informatics, foodservice, and roles that support quality, public policy, and professional resources. In addition, RDNs in CNM serve as leaders or consultants in professional organizations, are preceptors and liaisons to student/intern educational programs, and contribute to government and legislative initiatives that shape health care policy and delivery. Examples of titles for RDNs in CNM are lead dietitian, coordinator, supervisor, clinical nutrition manager, and director of clinical nutrition.
      • Rogers D.
      Compensation and benefits survey 2017.
      The standards and indicators for RDNs in CNM are written with the leader in mind, to support an individual in a leadership role or who has leadership aspirations.
      • Vaterlaus Patten E.
      • Sauer K.
      A leadership taxonomy for clinical dietetics practice.
      • Phillips W.
      • Bacon C.
      Clinical nutrition leadership at every career stage.
      The indicators identified in Figure 1 (available at www.jandonline.org) provide a structural framework to develop and enhance the variety of skills and knowledge essential to the leadership role. Competent and proficient leaders discern how to further enhance their talents. Expert leaders validate their mastery of the indicator outcomes and use the confidence this assessment provides to strive to achieve greater accomplishments both personally and professionally.
      The CNM DPG selected the National Center for Healthcare Leadership: Health Leadership Competency Model as the base upon which to build the SOPP for RDNs in CNM. The Healthcare Leadership Competency Model’s three equally weighted, yet integrated action competency domain categories— Execution, People, and Transformation—capture the diverse talents required for the work of RDNs in CNM.
      Health Leadership Competency Model 3.0 Now Available
      National Center for Healthcare Leadership website.
      The model also has three enabling competency domains—Health System Awareness and Business Literacy, Self-Awareness and Self-Development, and Values (Professional, Organizational, Personal)—that incorporate the professional knowledge and self-awareness competencies that strengthen the action domains
      Health Leadership Competency Model 3.0 Now Available
      National Center for Healthcare Leadership website.
      (see Figure 4). This model serves as a foundation upon which the unique skills required of effective managers can be described in recognizable terms. The CNM DPG reorganized the Academy SOPP standards (Figure 1, available at www.jandonline.org) to align with the leadership model.
      Figure thumbnail gr1
      Figure 4The National Center for Healthcare Leadership (NCHL) Competency Model 3.0, 2018.
      Health Leadership Competency Model 3.0 Now Available
      National Center for Healthcare Leadership website.
      (Reprinted from www.nchl.org, with permission. No part of this content may be reproduced or transmitted in any form or by any means without the express written consent of the NCHL, except as permitted by applicable law.)
      The RDN in CNM is responsible for the provision of various nutrition services for specific populations; the leadership of individuals who implement these services on a daily basis; the quality, outcomes, and cost of these services; and adhering to all applicable rules, regulations, standards, and laws related to the services provided (see box on following page). To accomplish this, the RDN in CNM develops policies and procedures, staffing plans,
      • Phillips W.
      Clinical nutrition staffing benchmarks for acute care hospitals.
      • Hand R.
      • Jordan B.
      • DeHoog S.
      • et al.
      Inpatient staffing needs for registered dietitian nutritionists in 21st century acute care facilities.
      budgets and financial targets, innovative programs and services, effective strategies to attract and retain employees; and maintains and enhances ongoing relationships that foster professional growth, competence, leadership, and commitment.
      The RDN in CNM is responsible for being familiar with and understanding all applicable laws, regulations, and standards related to their specific responsibilities, department, organization, and other programs within their area of responsibility (eg, home-delivered meals, home care, dialysis unit, acute rehabilitation, and swing beds or skilled nursing unit). These include, but are not limited to:
      Within their sphere of influence, RDNs in CNM are accountable for the smooth, efficient, and collaborative operations associated with clinical nutrition, system sustainment, and service outcomes. Ongoing communication and collaboration with other professionals and service lines within the organization are necessary to foster interprofessional practice and deliver optimal outcomes for customers. Much of the health-related leadership provided by the RDN in CNM is supported by a strong foundation of clinical expertise. Use of the Standards of Practice in Nutrition Care,
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitian Nutritionists.
      Nutrition Care Process
      • Swan W.I.
      • Vivanti A.
      • Hakel-Smith N.A.
      • et al.
      Nutrition Care Process and Model update: Toward realizing people-centered care and outcomes management.
      and workflow elements, standardized terminology, and clinical outcomes data are essential to measure and document effectiveness of nutrition care, processes, and services.
      Top performing RDNs in CNM create or maintain and lead strategies that prevent, diagnose, and manage diseases/conditions; sustain health, wellness, and quality of life; and ensure that effective, safe, and customer-centered nutrition services are provided in a timely and equitable manner.
      The Six Domains of Health Care Quality. Agency for Healthcare Research and Quality website.
      As health care leaders, RDNs in CNM are challenged to create work environments that support high-quality customer-centered care, attract and retain talent to create diverse teams, and foster an atmosphere of collaboration and innovation.
      • Vaterlaus Patten E.
      • Sauer K.
      A leadership taxonomy for clinical dietetics practice.
      The Academy supports a variety of DPGs, such as the CNM DPG. The mission of the CNM DPG is to “empower and support leaders to advance nutrition practices in healthcare.”
      Mission and Vision
      Clinical Nutrition Management Dietetic Practice Group website.
      The CNM DPG provides numerous opportunities for professional growth by offering continuing education through its newsletter, webinars, and annual conference, and providing CNM educational tools and publications available through the DPG’s website (www.cnmdpg.org). The CNM DPG has three subunits that contribute to CNM webinars, article topics in the CNM newsletters, and resources available to CNM DPG members. The subunits are Informatics,
      Informatics Sub-Unit
      Clinical Nutrition Management Dietetic Practice Group website.
      Quality and Process Improvement,
      Quality and Process Improvement Sub-Unit
      Clinical Nutrition Management Dietetic Practice Group website.
      2018 QI-PI Project Award Results
      Clinical Nutrition Management Dietetic Practice Group website.
      and Pediatrics.
      Welcome–Pediatrics Sub-Unit
      Clinical Nutrition Management Dietetic Practice Group website.
      The CNM resource library contains information, forms, and resources on various topics that include, but are not limited to, documentation in the medical record, job descriptions, leadership, staff development and competency, quality improvement, patient education, policies and procedures, and reimbursement.
      Resource Library
      Clinical Nutrition Management Dietetic Practice Group website.

      Academy Revised 2019 SOPP for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Clinical Nutrition Management

      An RDN can use the Academy Revised 2019 SOPP for RDNs (Competent, Proficient, and Expert) in CNM (see Figure 1, available at www.jandonline.org, and Figure 2) to:
      • identify the competencies needed to develop and provide leadership in nutrition and dietetics care and services;
      • self-evaluate whether he or she has the appropriate knowledge, skills, experience, and judgment to provide safe, effective, and quality CNM for their level of practice;
      • identify the areas in which additional knowledge, skills, judgment, and experience are needed to practice at the competent, proficient, or expert level of CNM;
      • provide a foundation for public and professional accountability in CNM;
      • support efforts for strategic planning, performance improvement, outcomes reporting, and assist management in the planning and communicating of CNM services and resources;
      • enhance professional identity and skill in communicating the nature of CNM;
      • guide the development of CNM-related education and continuing education programs, job descriptions, practice guidelines, protocols, clinical models, competence evaluation tools, and career pathways; and
      • assist educators and preceptors in teaching students and interns the knowledge, skills, and competencies needed to work in CNM, 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 new focus area of practice. At the competent level, an RDN in CNM is learning the principles that underpin this focus area and is developing knowledge, skills, experience, and judgment for safe and effective leadership and management of clinical nutrition and other areas of responsibility. This RDN, who may be new to the profession or may be an experienced RDN, 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 CNM must accept the challenge of becoming familiar with the CNM body of knowledge, including critical and beneficial leadership skills, practice guidelines, available resources, applicable federal and state regulations, accreditation standards, and customer and employee safety requirements to support and ensure quality CNM-related nutrition and dietetics practice.
      At the proficient level, an RDN has developed a more in-depth understanding of CNM practice, and is better equipped to adapt and apply evidence-based guidelines and best practices than at the competent level. The proficient-level RDN is able to modify practice according to unique situations, such as organizational restructuring and right-sizing, changes in organizational priorities and expectations, changes in reimbursement and coverage allowances, or organizational technology enhancements and offering telehealth services. The RDN at the proficient level may possess a specialist credential, such as a CDE; an advanced degree; a quality certification, such as LEAN Six Sigma
      • Pyzdek T.
      • Keller K.
      The Six Sigma Handbook.
      ; Advanced Practice Certification in Clinical Nutrition (RDN-AP/RD-AP); and/or a recognition, such as Fellow of the Academy of Nutrition and Dietetics (FAND).
      At the expert level, the RDN thinks critically, reflecting breadth of knowledge and experience in CNM and leadership; demonstrates a more intuitive understanding of the practice area; displays a range of highly developed clinical, managerial, and technical skills; and formulates judgments acquired through a combination of education, experience, and critical thinking. Essentially, practice at the expert level requires the application of composite nutrition, dietetics, and management knowledge, with practitioners drawing not only on their practice experience, but also on the experience of RDNs in CNM in various disciplines and practice settings. Expert RDNs, with their extensive experience and ability to see the significance and meaning of CNM within a contextual whole, are fluid and flexible, and have considerable autonomy in practice. They not only develop and implement clinical nutrition programs and services, they also conduct and collaborate in research, organizational nutrition policy, and advocacy; accept organization leadership roles; engage in scholarly work; train and guide interprofessional teams; and lead the advancement of CNM.
      Indicators for the SOPP for RDNs in CNM are measurable action statements that illustrate how each standard can be applied in practice (Figure 1 SOPP, available at www.jandonline.org). Within the SOPP for RDNs in CNM, an "X" in the competent column indicates that an RDN in CNM 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 CNM could be an RDN starting practice after registration or an experienced RDN who has recently assumed clinical nutrition management responsibility. The competent-level RDN in CNM may complete tasks, such as creating staff schedules, developing and revising policies and procedures, assessing RDN and support staff competence, and obtaining training on the organization’s performance improvement process and models.
      An "X" in the proficient column indicates that an RDN who performs at this level has a more in-depth understanding of CNM and has the ability to modify practice according to unusual and unique situations (eg, department remodeling or changing accreditation organizations). The proficient RDN in CNM may guide strategic plans for nutrition services; develop new or expanded outpatient programs; complete quality management projects; and develop and implement new processes or services (eg, developing a quality improvement study to evaluate processes for identifying patients at risk or with malnutrition
      Malnutrition
      Academy of Nutrition and Dietetics website.
      • Khan M.
      • Hui K.
      • McCauley S.
      What is a registered dietitian nutritionist’s role in addressing malnutrition?.
      Malnutrition Toolkit
      Clinical Nutrition Management Dietetic Practice Group website.
      to enhance care and outcomes).
      An "X" in the expert column indicates that the RDN who performs at this level possesses a comprehensive understanding of CNM 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 and skills, such as leadership and innovative thinking. The expert RDN may participate in activities such as the organization’s strategic planning, interprofessional project management, and industry analysis.
      Standards and indicators presented in Figure 1 (available at www.jandonline.org) in boldface type originate from the Academy’s Revised 2017 SOP in Nutrition Care and SOPP for RDNs
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitian Nutritionists.
      and should apply to RDNs in all three levels. Additional indicators not in boldface type developed for this focus area 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 CNM 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 CNM is warranted. It is the totality of individual practice that defines a practitioner’s level of practice and not any one indicator or standard.
      RDNs should review the SOPP in CNM at determined intervals to evaluate their individual focus area knowledge, skill, and competence. Consistent self-evaluation is important because it helps identify opportunities that improve and enhance practice and professional performance. This self-appraisal also enables CNM RDNs to better utilize these Standards as part of the Professional Development Portfolio recertification process,
      • Weddle D.O.
      • Himburg S.P.
      • Collins N.
      • Lewis R.
      The professional development portfolio process: Setting goals for credentialing.
      which encourages CDR-credentialed nutrition and dietetics practitioners to incorporate self-reflection and learning needs assessment for development of a learning plan for improvement, and commitment to lifelong learning. CDR’s updated system implemented with the 5-year recertification cycle that began in 2015 incorporates the use of essential practice competencies for determining professional development needs.
      • Worsfold L.
      • Grant B.L.
      • Barnhill C.
      The essential practice competencies for the Commission on Dietetic Registration’s credentialed nutrition and dietetics practitioners.
      In the new three-step process, the credentialed practitioner accesses an online Goal Wizard (step 1), which uses a decision algorithm to identify essential practice competency goals and performance indicators relevant to the RDN’s area(s) of practice (essential practice competencies and performance indicators replace the learning need codes of the previous process). The Activity Log (step 2) is used to log and document continuing professional education over the 5-year period. The Professional Development Evaluation (step 3) guides self-reflection and assessment of learning and how it is applied. The outcome is a completed evaluation of the effectiveness of the practitioner’s learning plan and continuing professional education. The self-assessment information can then be used in developing the plan for the practitioner’s next 5-year recertification cycle. For more information, see www.cdrnet.org/competencies-for-practitioners.
      RDNs in CNM are encouraged to pursue additional knowledge, skills, and 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 and regulations. 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.R.
      • Amaya L.
      Ethics opinion: Registered dietitian nutritionists and nutrition and dietetics technicians, registered are ethically obligated to maintain personal competence in practice.
      RDNs should collaborate with other RDNs in CNM as learning opportunities and to promote consistency in practice and performance and continuous quality improvement. See Figure 5 for examples of how RDNs in different roles, at different levels of practice, may use the SOPP in CNM.
      Figure 5Role examples of Standards of Professional Performance (SOPP) for Registered Dietitian Nutritionists (RDNs) (Competent, Proficient, and Expert) in Clinical Nutrition Management. aFor each role, the RDN updates professional development plan to include applicable essential practice competencies for clinical nutrition management care and services.
      RoleExamples of use of SOPP documents by RDNs in different practice rolesa
      Director of clinical nutritionA registered dietitian nutritionist (RDN) employed as director of clinical nutrition in a hospital reviews the SOPP for RDNs in Clinical Nutrition Management (CNM) periodically as a self-assessment tool. The RDN’s goal is to ensure each clinical nutrition manager is competent or is gaining competence to lead the nutrition team. The expectations are to fully grasp the quality indicators required to successfully direct the provision of services, report to and interact effectively with hospital leadership, apply research, communicate and collaborate with others, manage resources, ensure quality of practice, and accept accountability. The director of clinical nutrition uses the SOPP for RDNs in CNM to develop objectives and identify skills needed as part of an annual goal-setting process and career ladder plan.
      Clinical nutrition managerAn RDN with experience as a clinician is hired for the clinical nutrition manager position within the Food and Nutrition Department of an acute care facility. The RDN reviews the position description, identifies resources and learning goals in the SOPP for RDNs in CNM, and seeks mentoring and advice/knowledge from a more experienced clinical nutrition manager. The clinical nutrition manager participates in the hospital’s orientation and leadership meetings to meet other department managers for operations collaboration, background on existing processes and culture, and perceived expectations for positively contributing to the hospital’s mission and vision. The clinical nutrition manager also seeks information from the Academy of Nutrition and Dietetics (Academy) or other interprofessional team members on new and emerging trends.
      System clinical nutrition managerAn RDN is employed to oversee the nutrition services of a system of hospitals, health clinics, nursing homes, and/or other health care settings. This includes the provision, integrity, and integration of nutrition therapy and services in coordination with the onsite managers and RDNs. In addition, the RDN conducts department audits, assists with preparation for regulatory surveys, hires clinical nutrition managers, manages the system’s enteral nutrition formulary, creates budgets, and has oversight of nutritional/menu databases and food procurement systems. The system clinical nutrition manager reviews the SOPP for RDNs in CNM to ensure he or she is competent to lead, manage, and assess competency of the site managers. The system clinical nutrition manager also reviews the SOPP for RDNs in CNM and other focus area Standards of Practice (SOP) and/or SOPPs relevant to the patient population with site managers and RDNs to assist in identifying skill development areas to incorporate into their Professional Development Portfolio.
      Corporate clinical nutrition managerAn RDN is employed to manage the clinical nutrition service line for a corporation with multiple facilities. The corporate clinical nutrition manager works with clients to assess their needs and expectations, develop goals, and implement and coordinate clinical initiatives to meet these goals. The RDN acts as a liaison between clients, the corporate leadership team, and site clinical nutrition managers. This RDN guides the site clinical nutrition managers in coordinating the systems, staffing, and resource management of the clinical nutrition programs, and mentors and leads the site clinical nutrition managers in addressing the goals and expectations of the corporation and each facility. The corporate clinical nutrition manager also has administrative responsibility for ongoing training, development, and mentoring of site managers. The corporate clinical nutrition manager uses the SOPP for RDNs in CNM as an instructional aid to identify competencies for site managers and topics for staff development programs.
      Post-acute and long-term care nutrition managerAn RDN working in a large post-acute and long-term care facility has been tasked to perform managerial duties, such as quality assurance and performance improvement, menu development and approval, and meeting food safety and sanitation standards. The RDN reviews the SOPP in CNM to identify areas for enhancing knowledge and skills to guide quality care and service delivery and provide competent leadership. In addition, the RDN uses the SOP and SOPP in Post-Acute and Long-Term Care Nutrition (www.eatrightpro.org/sop) to learn more about long-term care regulations, and nutrition care and dining service expectations through the lens of an RDN with CNM responsibilities. The RDN seeks mentoring from an experienced clinical nutrition manager or consultant in skilled nursing and long-term care management.
      Manager of telehealth practitionersAn RDN working in a large medical center who has provided consultation through telehealth services to clients in the state’s rural communities has been tasked to perform managerial duties. The RDN reviews the SOPP in CNM to determine expertise needed, including managing multiple RDNs and support staff, working with leadership to create and implement policies and protocols related to telehealth, and being a liaison with information technology staff. The RDN refers to all relevant state laws and regulations, Academy telehealth resources, and organizational policies regarding the practice of telehealth, including requirements if a patient/client lives in another state. The SOPP for RDNs in CNM is used to evaluate competence and identify areas for additional knowledge and/or skills in CNM in order to provide quality services and leadership.
      In some instances, components of the SOPP for RDNs in CNM do not specifically differentiate between proficient-level and expert-level practice. In these areas, it remains 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 RDNs in CNM. The experienced practitioner observes events, analyzes them to make new connections between events and ideas, and produces a synthesized whole. The knowledge and skills acquired through practice will continually expand and mature. The SOPP indicators are refined with each review of these Standards as expert-level RDNs systematically record and document their experiences, often through use of exemplars. The CNM DPG Quality and Process Improvement Sub-Unit highlights exemplars.

      Future Directions

      RDNs in CNM accept the role of guiding the profession into the future. Now more than ever, RDNs in CNM have the opportunity to strengthen the responsibilities of the profession through promotion of clinical privileging
      Practice Tips: Hospital Regulation–Ordering Privileges for the RDN
      Academy of Nutrition and Dietetics website.
      Practice Tips: Implementation Steps–Ordering Privileges for the RDN
      Academy of Nutrition and Dietetics website.
      Practice Tips: Reform Requirements for RDNs and NDTRs in Long Term Care Facilities. Academy of Nutrition and Dietetics website.
      • Phillips W.
      • Doley J.
      Granting order-writing privileges to registered dietitian nutritionists can decrease costs in acute care hospitals.
      for ordering therapeutic diets and nutrition-related services, when consistent with state law and health care regulations. CNM can also be expanded with measurement and reporting of outcomes through the MQii
      Malnutrition
      Academy of Nutrition and Dietetics website.
      • Khan M.
      • Hui K.
      • McCauley S.
      What is a registered dietitian nutritionist’s role in addressing malnutrition?.
      Malnutrition Toolkit
      Clinical Nutrition Management Dietetic Practice Group website.
      ; organization evaluation using the Standards of Excellence tool
      Standards of Excellence
      Academy of Nutrition and Dietetics website.
      ; and increased promotion and use of resources related to telehealth
      Telehealth. Academy of Nutrition and Dietetics website.
      ; malnutrition identification, documentation, and interventions; and billing and coding
      Malnutrition Codes—Characteristics and Sentinel Markers
      Academy of Nutrition and Dietetics website.
      Diagnosis and Procedure Codes
      Academy of Nutrition and Dietetics website.
      for medical nutrition therapy and nutrition education. RDNs in CNM are leaders who accept this responsibility and are poised to be at the forefront to meet tomorrow’s challenges.
      The SOPP for RDNs in CNM is an innovative and dynamic document. Future revisions will reflect changes and advances in practice, changes to dietetics education standards, regulatory changes, and outcomes of practice audits. Continued clarity and differentiation of the three practice levels in support of safe, effective, and quality practice in CNM remains an expectation of each revision to serve tomorrow's practitioners and their patients, clients, and customers.

      Summary

      RDNs face complex situations every day. Addressing the unique needs of each situation and applying standards appropriately is essential to providing safe, timely, person-centered quality care and service. All RDNs are advised to conduct their practice based on the most recent edition of the Code of Ethics for the Nutrition and Dietetics Profession, the Scope of Practice for RDNs and the SOP in Nutrition Care and SOPP for RDNs, along with applicable federal and state regulations and organization accreditation standards. The SOPP for RDNs in CNM are complementary documents and are key resources for RDNs at all knowledge and performance levels. These standards can and should be used by RDNs in daily practice to consistently improve and appropriately demonstrate competency and value as leaders of nutrition services and as providers of safe, effective, and quality nutrition and dietetics care and services. These standards also serve as a professional resource for self-evaluation and professional development for RDNs specializing in CNM. 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 7 years. Current and future initiatives of the Academy, as well as advances in CNM, will provide information to use in future updates and in further clarifying and documenting the specific roles and responsibilities of RDNs in CNM at each level of practice. As a quality initiative of the Academy and CNM DPG, these standards are an application of continuous quality improvement and represent an important collaborative endeavor.
      These standards have been formulated for use by individuals in self-evaluation, practice advancement, development of practice guidelines and specialist credentials, and as indicators of quality. These standards do not constitute medical or other professional advice, and should not be taken as such. The information presented in the standards is not a substitute for the exercise of professional judgment by the nutrition and dietetics practitioner. These standards are not intended for disciplinary actions or determinations of negligence or misconduct. 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.

      Acknowledgements

      Special acknowledgement and thanks to Donna Belcher, MS, RD, LDN, CDE, CNSC, and Moira Faris, MPH, RDN, LD, CDE, FAND, who willingly gave of their time to review these standards, and the Clinical Nutrition Management Dietetic Practice Group’s Executive Committee. The authors also extend thanks to all who were instrumental in the process for the revisions of the article. Finally, the authors thank Academy staff, in particular, Karen Hui, RDN, LDN; Dana Buelsing, MS; Carol Gilmore, MS, RDN, LD, FADA, FAND; and Sharon McCauley, MS, MBA, RDN, LDN, FADA, FAND, who supported and facilitated the development of these SOPPs.

      Author Contributions

      Each author contributed to editing the components of the article (eg, article text and figures) and reviewed all drafts of the manuscript.

      Supplementary Materials

      Figure 1Standards of Professional Performance for Registered Dietitian Nutritionists (RDNs) in Clinical Nutrition Management. Note: The term customer is used in this evaluation resource as a universal term. Customer could also mean client/patient/ customer, family, participant, consumer, or any individual, group, or organization to which the RDN provides service. The terms organization/facility/department/program are interchangeable in this evaluation resource, with a specific term used in a given indicator, dependent on the situation and setting. The term appropriate is used in the standards to mean: Selecting from a range of best practice or evidence-based possibilities, one or more of which would give an acceptable result in the circumstances.
      Standards of Professional Performance for Registered Dietitian Nutritionists in Clinical Nutrition Management

      Standard 1: Quality in Practice

      The registered dietitian nutritionist (RDN) in Clinical Nutrition Management (CNM) provides quality services using a systematic process with identified ethics, leadership, accountability, and dedicated resources.

      Rationale: Quality practice in nutrition and dietetics is built on a solid foundation of education and supervised practice, 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 Indicators
      The “X” signifies the indicators for the level of practice
      Each RDN in CNM possesses the following traits and embodies these through the actions identified based on their level of practice:CompetentProficientExpert
      1.1Achievement Orientation: The RDN in CNM sets goals aimed at achieving or exceeding standards of excellence and improving unit performance and the quality and effectiveness of practice.
      1.1AUses the Standards of Excellence Metric Tool to self-assess quality in leadership, organization, practice, and outcomes for an organization (www.eatrightpro.org/excellencetool)XXX
      1.1A1Demonstrates a commitment to excellence, and makes a conscientious effort to exceed expectationsXXX
      1.1A2Develops and implements quality improvement projects and/or strategic plans based on Standards of Excellence Metric Tool results or other organizational expectationsXX
      1.1A3Achieves and maintains organizational excellence based on the Standards of Excellence Metric Tool or other organizational expectationsX
      1.1BDelivers measurable results on time and within budgetXXX
      1.1B1Maintains commitment to goals; demonstrates determination and persistence in the face of obstacles and frustrationsXXX
      1.1B2Mobilizes resources, removes barriers for success, and supports use of data in decision makingXX
      1.1CTakes responsibility for own actions and approaches to task achievementXXX
      1.1DUnderstands purpose of tasks and their relationship to departmental and organizational goalsXXX
      1.1EIdentifies and prioritizes expectations of individuals and the teamXXX
      1.1E1Translates feedback and ideas into concrete actionsXXX
      1.1E2Challenges mediocrity and expects excellence from the team and organizationXX
      1.1FDisplays an optimistic approach in new and diverse situationsXXX
      1.1GChampions an environment of high expectations and supports initiatives beyond the scope of one’s jobX
      1.2Performance Measurement: Uses statistical and financial methods and metrics to set goals and measure clinical and organizational performance and outcomes. The RDN in CNM views these actions as a continuous cycle, identifying opportunities for improvement as additional techniques, technology, and information become available.
      1.2AUses national quality and safety data (eg, National Academies of Sciences, Engineering, and Medicine: Health and Medicine Division, National Quality Forum, Agency for Healthcare Research and Quality, Institute for Healthcare Improvement) to improve the quality of services provided and to enhance customer-centered servicesXXX
      1.2A1Collects data for tracking daily operations (eg, customer satisfaction metrics)XXX
      1.2A2Creates effective systems that deliver desired results and achieve strategic objectivesXX
      1.2A3Analyzes data and correlates outcomes and trends to benchmarksXX
      1.2A4Performs a root cause analysis using performance measurement results that lead to innovative decision makingX
      1.2BCompares actual performance to performance goals (ie, Gap Analysis, SWOT [Strengths, Weaknesses, Opportunities, and Threats] Analysis, PDCA [Plan-Do-Check-Act] Cycle, DMAIC [Define, Measure, Analyze, Improve, Control])XXX
      1.2B1Keeps the performance measurement system current and relevant to the organization and health care systemXX
      1.2B2Analyzes and incorporates organizational performance data to track progress relative to strategic objectives and action plansXX
      1.2CUses indicators that are specific, measurable, attainable, realistic, and timely (S.M.A.R.T.)XXX
      1.2DMeasures quality of services in terms of structure, process, and outcomesXXX
      1.2D1Monitors organizational performance measures, including key short-term and long-term financial indicatorsXXX
      1.2EIdentifies and addresses potential and actual errors and hazards in provision of services or brings to attention of supervisors and team members as appropriateXXX
      1.2E1Demonstrates a strong sense of urgency to solve problems and accomplish tasksXXX
      1.2E2Anticipates potential problems and develops contingency plans to overcome themXX
      1.2FDocuments outcomes and patient reported outcomes (eg, PROMIS
      PROMIS: The Patient-Reported Outcomes Measurement Information System (https://commonfund.nih.gov/promis/index) (PROMIS) is a reliable, precise measure of patient-reported health status for physical, mental, and social well-being. PROMIS is a web-based resource and is publicly available.
      )
      XXX
      1.2F1Communicates the outcomes of performance measurements both internally and externallyXXX
      1.2GParticipates in, coordinates, or leads program participation in local, regional, or national registries and data warehouses used for tracking, benchmarking, and reporting service outcomesXXX
      1.3Process Management and Organizational Design: Analyzes and designs or improves organizational processes in alignment with the vision, mission, and values of the organization. The RDN in CNM uses this process to make decisions and take actions with the ultimate goal of achieving a vision rather than targeting specific activities. RDNs in CNM are open and alert to information; examining what is happening now so that they can develop plans for improvement.
      1.3AUses a systematic performance improvement model that is based on practice knowledge, evidence, research, and science for delivery of the highest-quality servicesXXX
      1.3BParticipates in or designs an outcomes-based management system to evaluate safety, effectiveness, quality, person-centeredness, equity, timeliness, and efficiency of practiceXXX
      1.3B1Involves colleagues and others, as applicable, in systematic outcomes managementXXX
      1.3B1iDevelops/maintains job descriptions that include team members’ functions and accountabilitiesXXX
      1.3B1iiDelegates authority and responsibility for decision makingXX
      1.3B1iiiFacilitates communication and coordination among members of the organizationX
      1.3B2Defines expected outcomesXXX
      1.3B2iIdentifies the goals and objectives for new projects and processesXXX
      1.3B3Incorporates electronic clinical quality measures to evaluate and improve care of patients/clients at risk for malnutrition or with malnutrition (www.eatrightpro.org/emeasures)XXX
      1.3B4Builds structure into the design of new projects and processes through the use of time-lines, organizational charts, job descriptions, and policies and proceduresXXX
      1.3B5Determines strategies needed to meet project goalsXX
      1.3B6Develops simpler, faster, less costly processes for achieving high-quality resultsXX
      1.3B7Strategizes using new concepts, insights, and analysis to create improved systems and processesX
      1.3CReports and documents action plan to address identified gaps in care and/or service performanceXXX
      1.3C1Develops and maintains effective internal controls to ensure the integrity and scientific foundation of the organization, products, and nutrition-related servicesXX
      1.3DImproves or enhances patient/client/population care and/or services working with others based on measured outcomes and established goalsXXX
      Examples of Outcomes for Standard 1: Quality in Practice
      • Performance improvement systems specific to program(s)/service(s) are established and updated as needed; are evaluated for effectiveness in providing desired outcomes data; and strive for excellence in collaboration with other team members
      • 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.)
      • Relevant performance indicators are identified, measured, and evaluated
      • Performance improvement systems are integrated into routine operations
      • Performance improvement systems are reviewed and revised on a regular basis
      • Performance improvement activities lead to achievement of strategic goals and objectives
      • Results of performance improvement activities direct refinement of practice
      • Performance improvement projects result in measurable gains in the organization’s clinical and/or financial performance
      • Creative methods are developed to improve outcomes
      • Performance improvement outcomes are communicated internally and externally
      • Excellence in practice is achieved/demonstrated
      • Aggregate outcomes results meet pre-established criteria
      Standard 2: Competence and Accountability

      The RDN in CNM demonstrates competence in and accepts accountability and responsibility for ensuring safe, quality practice and services.

      Rationale: Competence and accountability in practice includes continuous acquisition of knowledge, skills, experience, and judgment in the provision of safe, quality customer-centered service.
      Indicators for Standard 2: Competence and Accountability
      Bold Font Indicators are Academy Core RDN Standards of Professional

      Performance Indicators
      The “X” signifies the indicators for the level of practice
      Each RDN in CNM possesses the following traits and embodies these through the actions identified based on their level of practice:CompetentProficientExpert
      2.1Accountability: The ability to hold oneself and others accountable to standards of performance and ensure compliance using the authority of one’s position appropriately and effectively, with the future of the organization in mind. The RDN in CNM acknowledges and assumes responsibility for actions, services, products, decisions, and policies. This includes, but is not limited to, the administration, governance, and implementation of standards within the scope of his or her role or position and encompasses the obligation to report, explain, and be answerable for resulting consequences.
      2.1AComplies with applicable laws and regulations as related to his/her area(s) of practiceXXX
      2.1A1Maintains knowledge of and ensures compliance with all pertinent federal and state regulatory requirements related to food and nutrition services in settings (eg, acute or long-term care) relevant to job responsibilities (eg, ordering privileges, emergency preparedness, telehealth)XXX
      2.1BAdheres to sound business and ethical billing practices applicable to the role and settingXXX
      2.1B1Develops/presents training for staff on ethics and best practices for billing proceduresXX
      2.1CDemonstrates and documents competence in practice and delivery of customer-centered service(s)XXX
      2.1DAssumes accountability and responsibility for actions and behaviorsXXX
      2.1D1Identifies, acknowledges, and corrects errorsXXX
      2.1D2Accepts the responsibilities inherent in the leadership position to serve the well-being of the customerXXX
      2.1D3Takes control of his or her own career by seizing opportunities for growthXXX
      2.1D4Evaluates the impact of decisions and is willing to accept and learn from set-backs, failures, and successesXXX
      2.1ECommunicates with the interprofessional
      Interprofessional: The term interprofessional is used in this evaluation resource as a universal term. It includes a diverse group of team members (eg, organization leaders, department directors or managers, nurse managers and lead nurses, physicians, dietitian nutritionists, pharmacists), depending on the needs of the customer. Interprofessional could also mean interdisciplinary or multidisciplinary.
      team and referring party consistent with Health Insurance Portability and Accountability Act (HIPAA) rules for use and disclosure of customer’s personal health information
      XXX
      2.1FSets and encourages adherence to high standards of performance for self and others; is accountable for ensuring tasks are completed in an appropriate time frame and according to standardsXXX
      2.2Initiative: The ability to anticipate obstacles, developments, and problems by looking ahead strategically. The RDN in CNM displays initiative, seizes opportunities, and is ready to act. The RDN in CNM is a model to others of hard work and dedication. He or she leads through difficult situations and finds creative ways to solve problems. The RDN in CNM’s enterprising efforts can be a catalyst to mobilize others into action.
      2.2AUses and develops or contributes to the selection, design, and maintenance of policies, procedures (eg, discharge planning/transitions of care), protocols, standards of care, technology resources (eg, HIPAA-compliant telehealth platforms), and training materials that reflect evidence-based practice in accordance with applicable laws and regulationsXXX
      2.2BAccepts reasonable risks to improve performance by trying new approaches and processesXXX
      2.2B1Recognizes opportunities and takes action to achieve objectives; challenges the status quoXX
      2.2B2Designs and implements new or cutting-edge programs/processesX
      2.2CEmpowers others to take action, provides support when things go wrong, and encourages others to learn from set-backs and failuresXXX
      2.2C1Creates a work environment that encourages creative thinking and willingness to take risks in order to successfully accomplish individual and organizational goalsXX
      2.3Professionalism: The demonstration of ethical and professional behaviors, including social accountability and community stewardship. The RDN in CNM acts in alignment with the Standards of Professional Performance (SOPP) for RDNs in CNM and the Academy/Commission on Dietetic Registration (CDR) Code of Ethics.
      2.3AAdheres to the code(s) of ethics (eg, Academy of Nutrition and Dietetics (Academy)/CDR, other national organizations, and/or employer code of ethics)XXX
      2.3A1Creates a culture that fosters high standards of ethics by behaving in a fair, honest, inclusive, and ethical manner; demonstrates consistency between words and actionsXXX
      2.3A2Respects the confidentiality and sensitivity of information and concerns shared by othersXXX
      2.3A3Ensures respectful treatment of and is accountable to customers, colleagues, and society for the health needs of the public and the advancement of nutrition and dietetics practiceXXX
      2.3A4Recognizes possible conflicts of interest and avoids relationships that allow personal gain to supersede the best interest of the profession and the customerXXX
      2.3A5Advocates for professional principles despite potential adverse consequencesXX
      2.3A6Serves on an ethics committee as standing member or consultantX
      2.3BDemonstrates a sense of duty by committing to service, meeting the needs of customers, and advocating on their behalf regardless of their ability to reciprocateXXX
      2.3CSeeks active roles in professional organizations and volunteers skills and expertise for the welfare of the profession and communityXXX
      2.3DPerforms within individual and statutory scope of practice and applicable laws and regulationsXXX
      2.3D1Holds self and others accountable for actions, behavior, and responsibilities both personally and professionally. This includes the Academy and CDR Code of Ethics for the Nutrition and Dietetics Profession; recertification requirements; standards of practice and SOPP; facility accreditation standards; federal, state, and local laws and regulationsXXX
      2.4Self-Confidence: A belief and conviction in one’s own ability, success, decisions, and opinions when executing plans and addressing challenges. RDNs in CNM are self-confident, recognize the value of building the self-confidence of others, and are not threatened by doing so.
      2.4ADisplays confidence, optimism, and persistence when pursuing goals and objectivesXXX
      2.4A1Believes in own abilities and ideas to make sound, well-informed decisionsXXX
      2.4A2Demonstrates decisiveness and timeliness in decision making, even when facing crises or oppositionXX
      2.4A3Speaks up to the right person or group at the right time when he or she disagrees with a team decision, process, project, or strategy; offers viable alternatives or solutionsXX
      2.4A4Conveys confidence in embracing change and leading others through periods of transitionXX
      2.4A5Challenges others on issues outside his/her defined responsibility or scope when others fear to actX
      2.4BGives credit to others for their contributionsXXX
      2.5Self-Development: The ability of the RDN in CNM to accurately identify their own strengths and developmental needs, and how these impact others. The RDN in CNM addresses these needs through reflective, self-directed learning, and trying new leadership approaches.
      2.5AIntegrates the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) into practice, self-evaluation, and professional developmentXXX
      2.5A1Integrates applicable focus area(s) SOP SOPP into practice (www.eatrightpro.org/sop)XXX
      2.5A2Uses applicable focus area SOP and/or SOPP to pursue self-development and identify new knowledge and skills to masterXXX
      2.5A3Uses applicable focus area SOP and/or SOPP to guide development of processes, policies, guidelines, career ladders, and other resourcesXX
      2.5BConducts self-evaluation at regular intervalsXXX
      2.5B1Identifies needs for professional developmentXXX
      2.5B1iMonitors trends in science, technology, workforce, business, and industry to identify professional development needsXX
      2.5B1iiDesigns and implements professional development programs and processes integrating analysis of trends in science, technology, workforce, business, state and federal regulations, and industryX
      2.5CDesigns and implements plans for professional developmentXXX
      2.5C1Develops plan and documents professional development activities in career portfolio (eg, organizational policies and procedures, credentialing agency[ies])XXX
      2.5C2Evaluates and improves performance; identifies and learns from challenging situations, interactions with colleagues and employees, and mistakesXXX
      2.5C3Identifies skills to be developed; considers self-evaluation and peer review input as appropriateXXX
      2.5DParticipates in peer review of others as applicable to role and responsibilitiesXXX
      2.5EPursues opportunities (education, training, credentials, certifications) to advance practice in accordance with laws and regulations, and requirements of practice settingXXX
      2.5E1Obtains advanced degree(s), certifications, certificates of training, or specific training related to CNMXXX
      2.5E2Proactively investigates new principles and diverse perspectives; invests time and resources to seek opportunities that will offer growth and development of new knowledge and skills that result in additional responsibilitiesXX
      2.6Team Leadership: The ability to see oneself as a leader and build successful teams composed of diverse members with balanced and diverse knowledge and capabilities. The RDN in CNM effectively leads the team in developing the mission, values, and standards; and holds members accountable for results, both individually and as a group. The RDN in CNM successfully develops the team’s ability to work together by encouraging cooperation and mutual respect and motivating the team to be engaged in working toward a common purpose.
      2.6AProvides opportunities for others to learn to work together as a cohesive team; consistently develops and sustains cooperative working relationships; and fosters commitment, team spirit, pride, and trustXXX
      2.6A1Ensures that all team members are treated fairly, without stigma or bias, and are held equally accountable for their performance regardless of age, medical condition(s), ethnicity, race, culture, religion, sexual orientation, and/or gender identityXXX
      2.6A2Recognizes and encourages professional behaviors that contribute to teamwork; sets clear rules of conductXXX
      2.6A3Creates a shared purpose by leading the team in the development of the mission, vision, goals, and strategiesXX
      2.6A4Creates an environment in which team members accept responsibility for their actions, obligations, and self-developmentXX
      2.6A5Creates an environment of mutual respect and commitment in which team members learn from and appreciate each other’s contributions and values; is recognized as a diversity and inclusion leader/championX
      2.6BCommunicates effectively and clearly with team membersXXX
      2.6B1Keeps the team informed by communicating new information that may impact the team’s mission, goals, or strategiesXXX
      2.6B2Obtains and considers input from team members on the group’s mission, goals, and strategiesXXX
      2.6B3Remains transparent by facilitating open discussion and encouraging productive participation by all membersXXX
      2.6B4Demonstrates positivity when communicating project goals and strategiesXX
      2.6CInspires and motivates the team by recognizing and reinforcing the value of their contributions, celebrating successes, and keeping goals and strategies relevant and meaningfulXXX
      2.6C1Seeks or creates ways to measure performance and behavior against goals and finds opportunities to reward high standardsXX
      2.6DManages the team's communications and relationships with the rest of the organization; provides support to other teams as appropriateXX
      2.6EEncourages the team to cross-train and understand each other’s responsibilities, challenges, and priorities in order to provide seamless service when resources are limitedXX
      2.6FDelegates decision making and other responsibilities to the appropriate individuals to improve engagement and foster team members’ professional developmentXX
      Examples of Outcomes for Standard 2: Competence and Accountability
      • Practice reflects:
        • o
          Code(s) of ethics (eg, Academy/CDR, other national organizations, and/or employer)
        • o
          Scope of Practice, Standards of Practice, and Standards of Professional Performance
        • o
          Evidence-based practice and best practices
        • o
          CDR Essential Practice Competencies and Performance Indicators
      • Actions are within scope of practice and applicable laws and regulations
      • Standards of performance and compliance are upheld
      • Practice reflects a strategic approach and initiative
      • Teams work together effectively to achieve common and meaningful goals
      • Practice incorporates successful strategies for interactions with individuals/groups from diverse cultures and backgrounds
      • Competence is demonstrated and documented
      • Services provided are safe and customer-centered
      • Self-evaluations are conducted regularly to reflect commitment to lifelong learning and professional development and engagement
      • Professional development opportunities are identified and pursued to advance practice
      • Directed learning is demonstrated
      • CDR recertification requirements are met
      • Ethical and transparent financial management and billing practices are used
      Standard 3: Provision of Services

      The RDN in CNM provides safe, quality service based on customer expectations and needs, and the mission, vision, principles, and values of the organization.

      Rationale: Quality programs and services are designed, executed, and promoted based on knowledge, skills, experience, judgment, and competence in addressing the needs and expectations of the organization 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 in CNM possesses the following traits and embodies these through the actions identified based upon their level of practice:CompetentProficientExpert
      3.1Innovative Thinking: The ability to apply complex concepts, develop creative solutions, or adjust tactics in novel ways for breakthrough thinking in the field. This includes the RDN’s in CNM ability to develop, support, and introduce new and improved methods, services, products, procedures, and technologies to his or her team, department, organization, and/or community.
      3.1AContributes to or leads in development and maintenance of programs/services that address needs of the customer or target population(s)XXX
      3.1A1Uses the needs, expectations, and desired outcomes of the customers/populations (eg, patients/clients, families, community, decision makers, administrators, client organization[s]) in program/service developmentXXX
      3.1A2Makes decisions and recommendations that reflect stewardship of time, talent, finances, and environmentXXX
      3.1A3Proposes programs and services that are customer-centered, culturally appropriate, and minimize disparitiesXXX
      3.1A4Motivates others to translate an innovative vision into actionXXX
      3.1A5Recognizes the risks involved with innovation and weighs those risks against the benefitsXX
      3.1A6Identifies and analyzes unconventional ideas and information that could improve or influence nutrition practices or operational processesXX
      3.1A7Identifies and/or develops innovative products, services, methods, technologies, or procedures that consider societal, scientific, and technological changes or trendsXX
      3.1A8Serves as a catalyst and takes a long-term view for organizational changeX
      3.1BContributes to or designs customer-centered servicesXXX
      3.1B1Assesses needs, beliefs/values, goals, resources of the customer, and social determinants of healthXXX
      3.1B2Uses 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
      3.1B2iDesigns and delivers services that address customers’ food and nutrition needs throughout the continuum of careXX
      3.1B3Communicates principles of disease prevention and behavioral change appropriate to the customer or target populationXXX
      3.1B4Collaborates with the customers to set priorities, establish goals, and create customer-centered action plans to achieve desirable outcomesXXX
      3.1B5Involves customers in decision makingXXX
      3.1B6Infers the unspoken needs and agendas of stakeholdersXX
      3.1B7Collaborates effectively with colleagues that may have different standards and/or approachesXX
      3.1CUses and participates in, or leads in the selection, design, execution, and evaluation of customer programs and services (eg, nutrition screening system, medical and retail foodservice, electronic health records, interprofessional programs, community education, grant management)XXX
      3.1DUses and participates in or develops processes for order writing and other nutrition-related privileges, in collaboration with the medical staff,
      Medical staff: A medical staff is composed of doctors of medicine or osteopathy and may in accordance with state law, including scope of practice laws, include other categories of physicians, and non-physician practitioners who are determined to be eligible for appointment by the governing body.8
      or medical director (eg, acute, post-acute care settings, dialysis center, public health, community, free-standing clinic settings), consistent with state practice acts, federal and state regulations, organization policies, and medical staff rules, regulations, and bylaws
      XXX
      3.1D1Uses and participates in or leads development of processes for privileges or other facility-specific processes related to (but not limited to) implementing physician/non-physician practitioner
      Non-physician practitioner: A non-physician practitioner may include a physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse-midwife, clinical social worker, clinical psychologist, anesthesiologist’s assistant, and qualified dietitian or qualified nutrition professional. Disciplines considered for privileging by a facility’s governing body and medical staff must be in accordance with state law.8-10 The term privileging is not referenced in the Centers for Medicare and Medicaid Services long-term care (LTC) regulations. With publication of the Final Rule revising the Conditions of Participation for LTC facilities effective November 2016, post-acute care settings, such as skilled and LTC facilities, may now allow a resident’s attending physician the option of delegating order writing for therapeutic diets, nutrition supplements, or other nutrition-related services to the qualified dietitian or clinically qualified nutrition professional, if consistent with state law, and organization policies.11,12
      -driven delegated orders or protocols, initiating or modifying orders for therapeutic diets, medical foods/nutrition supplements, dietary supplements, enteral and parenteral nutrition, laboratory tests, medications, and adjustments to fluid therapies or electrolyte replacements
      XXX
      3.1D2Uses and participates in or leads development of processes for privileging for provision of nutrition-related services, including (but not limited to) initiating and performing bedside swallow screenings, inserting and monitoring nasoenteric feeding tubes, providing home enteral nutrition or infusion management services (eg, ordering formula and supplies), and indirect calorimetry measurementsXXX
      3.1D2iFollows or develops medical staff/director approved process for RDN application and maintenance of clinical privileges for initiating or modifying orders for diet, enteral and parenteral nutrition, and other nutrition-related servicesXX
      3.1D2iiNegotiates and/or establishes nutrition privileges at a systems level that reflect new advances in practiceX
      3.1EDesigns and implements food delivery systems to meet the needs of customersXXX
      3.1E1Collaborates in or leads the design of food delivery systems to address health care needs and outcomes (including nutrition status), ecological sustainability, and to meet the culture and related needs and preferences of target populations (ie, health care patients/clients, employee groups, visitors to retail venues, schools, child and adult day-care centers, community feeding sites, farm to institution initiatives, local food banks)XXX
      3.1E2Participates in, consults/collaborates with, or leads the development of menus to address health, nutritional, and cultural needs of target population(s) consistent with federal, state, or funding source regulations or guidelinesXXX
      3.1E3Participates in, consults/collaborates with, or leads interprofessional process for determining medical foods/nutritional supplements, dietary supplements, enteral and parenteral nutrition formularies, and delivery systems for target population(s)XXX
      3.2Strategic Orientation: The ability to identify implications and draw conclusions from business, economic, demographic, ethno-cultural, political, technological, and regulatory trends and developments, and to use these insights to develop an evolving strategic plan and vision that results in long-term success and viability. It includes the RDN’s in CNM aptitude to analyze the team’s, department’s, organization’s, and/or community’s competitive position by studying market and industry trends and customers’ expectations, desires, strengths, and weaknesses. This competency is about how well the RDN in CNM understands rapidly changing business environment trends (internal and external), how they compare to competitors, and how he or she responds to strategic information. RDNs in CNM understand how tasks are performed in different teams and organizations; and recognize the significance of different structures, goals, values, and cultures to make links, share risks, and collaborate effectively.
      3.2AAligns program/service development with the mission, vision, principles, values, and service expectations and outputs of the organization/businessXXX
      3.2A1Develops, communicates, and implements effective operational plans and short-term strategies to address key issues and achieve the long-term goals and objectives of the organization (eg, policies and procedures, emergency preparedness, staffing plans, standards of care, performance improvement plans); seeks assistance, if neededXXX
      3.2A2Monitors the progress of goal attainment and modifies operational plans and strategies as neededXXX
      3.2A3Prioritizes work in alignment with current organizational goals, takes responsibility for continuity of service between departments, and acts in accordance with established objectives, goals, laws, and regulationsXXX
      3.2A4Coordinates tactics with other parts of the organization to make well-judged decisions, implement operational plans, and accomplish goalsXXX
      3.2A5Understands the informal power structure and unwritten rules of the organization(s)XX
      3.2A6Establishes strategic relationships with internal and external stakeholdersXX
      3.2A7Develops a long-term strategic plan based upon analysis of the industry, and societal, technological, and scientific trends; the effects of complex connections across the health care economy; and the organization’s current and potential capabilities as compared to competitorsX
      3.2A8Understands how financial issues and industry and other trends affect the organization’s decisions and anticipates how stakeholders will respondX
      3.2BPromotes public access and referral to credentialed nutrition and dietetics practitioners for quality food and nutrition programs and servicesXXX
      3.2B1Contributes to or designs referral systems that promote access to qualified, credentialed nutrition and dietetics practitionersXXX
      3.2B2Refers customers to appropriate providers when requested services or identified needs exceed the RDN’s individual scope of practiceXXX
      3.2B3Monitors effectiveness of referral systems and modifies as needed to achieve desirable outcomesXXX
      3.2B4Promotes provision of nutrition care to customers in alternative health care models (ie, Accountable Care Organizations, Patient Centered Medical Homes)XX
      3.2CEducates customers, health care professionals, decision makers, and the public about the role and value of identifying practitioners with the RDN and the nutrition and dietetics technician, registered (NDTR) credentials as the qualified and preferred providers of food and nutrition servicesXXX
      3.3Information Technology Management: The ability to see the potential in and understand the use of administrative and clinical information technology and decision-support tools in daily operations and performance improvement. RDNs in CNM actively support the utilization and continuous upgrading of information management capabilities. He or she also responds to the changes in health care by the adoption of nutrition informatics to support the Nutrition Care Process and clinical workflow elements, such as screening for nutrition risk or malnutrition, and discharge planning and transitions of care.
      3.3AMaintains records of services providedXXX
      3.3A1Documents according to organization policies, procedures, standards, and systems, including electronic health recordsXXX
      3.3A2Implements data management systems to support interoperable data collection, maintenance, and utilizationXXX
      3.3A2iEffectively retrieves, organizes, stores, and uses information, data, and knowledge for problem solving and decision makingXXX
      3.3A3Uses data to document outcomes of services (ie, staff productivity, cost/benefit, budget compliance, outcomes, quality of services) and provide justification for maintenance or expansion of servicesXXX
      3.3A4Uses data to demonstrate program/service achievements and compliance with accreditation standards, laws, and regulationsXXX
      3.3BSupports nutrition informatics by using information standards, information processes, and information technologyXXX
      3.3B1Uses innovative and new technologies to deliver safe, effective, and equitable nutrition services (eg, telehealth)XXX
      3.3B2Demonstrates and is sought out because of expertise related to technical applications in operations and delivery of nutrition servicesXX
      3.3B3Recognizes the impact of technological change on the organizationXX
      3.3B4Uses information technology to develop solutions for new or highly complex problems that cannot be solved using existing methods or approachesX
      3.4Organizational Awareness: The ability to understand and learn the formal and informal decision-making structures and power relationships in a department or organization. This includes the ability of the RDN in CNM to identify the real decision makers and the individuals who can influence them, and to predict how new events will affect individuals and groups within the organization. RDNs in CNM are aware of the concerns and needs of individuals, departments, groups, and organizations, and use this to create networks of influence and reach consensus about priorities, allocation of resources, or approaches to service delivery.
      3.4AUnderstands how the department’s or team's goals and functions align with the organization's mission, vision, strategic plan, goals, and functionsXXX
      3.4BAdvocates for interdepartmental cooperation, assistance, and support; and complies with organizational requestsXX
      3.4CUnderstands the organization’s social, political, cultural, and technological systems and operates effectively within these systems to gain support and achieve goals and objectivesX
      Examples of Outcomes for Standard 3: Provision of Services
      • Program/service design and systems reflect the organization’s mission, vision, principles, values, and customer needs and expectations
      • Customers participate in establishing program/service goals and customer-focused action plans (eg, in-person or via telehealth)
      • Customer-centered needs and preferences are met
      • Customers are satisfied with services and products
      • Customers have access to food and nutrition services and assistance
      • Foodservice system incorporates sustainability practices addressing energy and water use, and waste management
      • Nutrition services reflect the cultural, health, and/or nutritional needs of target population(s)
      • Nutrition services incorporate and promote ecologically sustainable products and practices
      • Effective screening and referral services are established or implemented as designed
      • Interoperable information technology is used to support practice
      Standard 4: Application of Research

      The RDN in CNM applies, participates in, or generates research to enhance practice. Evidence-based practice incorporates the best available research/evidence and information 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 in CNM possesses the following traits and embodies these through the actions identified based on their level of practice:CompetentProficientExpert
      4.1Commitment to Research and Evidence-based Practice: The ability to understand and value the importance of research to responsible practice, to interpret current research and apply research findings, and to design and implement research for the practice of clinical nutrition and management. It includes the ability to support the design, implementation, publication, and presentation of research by the RDN in CNM and his or her team in order to contribute to the practice of evidence-based nutrition care and services.
      Knowledge of Research Design
      4.1AReviews best available research/evidence and information for application to practiceXXX
      4.1A1Understands basic research design and methodologyXXX
      4.1BContributes to the development of new knowledge and research in nutrition and dieteticsXXX
      4.1B1Identifies research questions and participates in studiesXXX
      4.1B2Participates in practice-based research networks (eg, Nutrition Research Network)XXX
      4.1B3Collaborates with other professionals and organizations to develop new knowledge and researchXX
      4.1B4Initiates and designs research as the primary investigatorX
      Evidence-based Practice
      4.1CUses best available research/evidence and information as the foundation for evidence-based practiceXXX
      4.1DEngages in evidence-based practice and uses best practicesXXX
      4.1D1Encourages and demonstrates the use of evidence-based tools to facilitate integration into current practiceXX
      4.1D2Uses research and analytical techniques to test the merit of ideas or solutionsX
      4.1EIntegrates best available research/evidence and information with best practices, clinical and managerial expertise, and customer valuesXXX
      4.1E1Interprets current research and bases practice on scientific principles and best available research/evidence to improve health outcomes of customers and manage practiceXXX
      4.1E2Applies research methodologies and findings to improve operations and services through the development of policies, procedures, and guidelines for nutrition careXX
      Knowledge Dissemination
      4.1FPromotes application of research in practice through alliances or collaboration with food and nutrition and other professionals and organizationsXXX
      4.1GAuthors professional papers in peer-reviewed journals and gives presentations to communicate research data and activitiesX
      4.1HServes as a role model to promote inclusion of research and evidenced-based knowledge in professional publications and national meetingsX
      Examples of Outcomes for Standard 4: Application of Research
      • Best available research/evidence and information is used as the foundation of evidence-based practice
      • Best available research/evidence is used for the development and revision of resources used in practice
      • Research is published in professional journals and presented to colleagues at regional or national meetings
      • Evidence-based practice, best practices, clinical and managerial expertise, and customer values are integrated in the delivery of nutrition and dietetics services
      • Customers receive appropriate services based on the effective application of best available research/evidence and information
      Standard 5: Communication and Application of Knowledge

      The RDN in CNM effectively applies knowledge and expertise in communications.

      Rationale: RDNs in CNM work with others to achieve common goals by effectively sharing and applying 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 Indicators
      The “X” signifies the indicators for the level of practice
      Each RDN in CNM possesses the following traits and embodies these through the actions identified based on their level of practice:CompetentProficientExpert
      5.1Information Seeking: The desire for knowledge and staying current with health, organizational, community, industry, and professional trends and developments. It is the ability of the practitioner to identify the information needed, seek information from appropriate sources, and use skillful questioning to obtain information when others are reluctant to disclose it. The RDN in CNM effectively relates to others within the organization in order to remain well-informed and integrated with operational issues, advocates for nutrition-related services and innovations, and is a knowledgeable resource for his or her staff.
      5.1ACommunicates and applies current knowledge and information based on evidenceXXX
      5.1A1Demonstrates critical thinking and problem-solving skills when communicating with othersXXX
      5.1BIntegrates knowledge of food and nutrition with knowledge of health, culture, social sciences, communication, informatics, sustainability, and managementXXX
      5.1CIdentifies the specific information needed to clarify a situation or make a decisionXXX
      5.1DObserves staff in their work areas to routinely monitor employee interactions, provide feedback, and learn about problems they encounterXXX
      5.1ESeeks input from peers, colleagues, customers, and professional organizations to gain new insightsXXX
      5.1FAssesses others’ willingness or reluctance to provide information while respecting privacy and requests for confidentialityXX
      5.1GProbes skillfully to obtain information when others are reluctant to disclose itX
      5.2Change Leadership: The ability to energize stakeholders and sustain their commitment to changes in approaches, processes, and strategies. It is the ability to demonstrate support for innovation and organizational changes needed to improve effectiveness; initiate, sponsor, and implement change; and help others to successfully manage change. This competency is about how well the RDN in CNM uses different and innovative approaches and challenges the status quo.
      5.2AWorks cooperatively with others to develop new ideas, coordinate resources, produce innovative solutions, and implement changeXXX
      5.2BBuilds commitment to, excitement for, and ownership of change through communications, education, team development, and coaching to help others see a vivid picture of the futureXX
      5.2CAddresses anxiety about change, explains reasons/rationale, and assists employees and colleagues in adaptingXX
      5.2DFacilitates team problem-solving and creative-thinking processes leading to the development and implementation of new approaches, systems, structures, and methodsXX
      5.2EAdapts quickly to new situations, processes, and culturesXX
      5.2FPromotes and supports innovation and calculated risk-taking to pursue organizational goalsX
      5.2GSeizes opportunities to influence or take the lead in establishing new partnerships, policies, procedures, and business directions that have widespread benefitX
      5.3Communication: The ability to speak and write in a clear, logical, and grammatically correct manner in formal and informal situations, to prepare cogent business presentations, and to facilitate group operations. This competency is about how well the RDN in CNM gives or receives information, and how well he or she adjusts communications to the characteristics and needs of the audience. This competency addresses the CNM’s ability to disseminate information, communicate clearly verbally and in writing, and plan and deliver oral and written communications that make a positive impact and successfully influence intended audiences.
      Interpersonal/Interaction Skills
      5.3ASelects appropriate information and the most effective communication method or format that considers customer-centered care and the needs of the individual/group/populationXXX
      5.3A1Uses communication methods (ie, oral, print, one-on-one, group, visual, electronic, and social media) targeted to various audiencesXXX
      5.3A2Uses information technology to communicate, disseminate, manage knowledge, and support decision makingXXX
      5.3A2iUses social media platforms following organizational standards, ethical guidelines, and legal regulations (eg, copyright) to communicate food and nutrition information and promote health and wellnessXX
      Formal Communication
      5.3BUses professional writing and verbal skills in all types of communicationsXXX
      5.3B1Adjusts approach to ensure that information and ideas are exchanged clearly, logically, and in the most effective manner; uses methods of communication (eg, written and verbal) that are inclusive and appropriate to the situation and audienceXXX
      5.3CCommunicates performance improvement and research results through publications and presentationsXXX
      5.3C1Delivers with confidence well-constructed formal presentations and arguments to large or influential groups using appropriate support materialXX
      Results-Focused Orientation/Facilitation Skills
      5.3DShares current, evidence-based knowledge, and information with various audiencesXXX
      5.3D1Reflects knowledge of population characteristics in communication methods (eg, literacy and numeracy levels, need for translation of written materials and/or a translator, and communication skills)XXX
      5.3D2Communicates effectively across diverse cultures and generationsXXX
      5.3D3Makes effective use of others’ time and availabilityXXX
      5.3D4Communicates relevant evidence-based knowledge and information and expectations openly, honestly, and in a timely fashion using multiple channelsXX
      5.3EMaintains a professional and calm demeanor when under pressureXXX
      5.3E1Responds calmly and professionally to difficult situations or unexpected questionsXX
      5.3E2Deliberates quickly and acts diplomatically when under pressure or criticismXX
      5.3FKeeps superior(s) informed about progress and problemsXXX
      5.3F1Focuses and guides a discussion toward an effective solutionXX
      5.4Collaboration: The ability to work cooperatively as part of a team or group, including demonstrating positive attitudes about the team, its members, and its ability to accomplish its mission. The RDN in CNM develops, maintains, and strengthens partnerships with others inside and outside of the organization who can provide information, assistance, and support.
      5.4AExecutes programs/services in an organized, collaborative, cost effective, and customer-centered mannerXXX
      5.4A1Collaborates and coordinates with peers, colleagues, stakeholders, and within interprofessional teamsXXX
      5.4A1iUnderstands how his or her own actions and emotions affect the teamXXX
      5.4A1iiExpresses gratitude and appreciation to others who provide information, assistance, or supportXXX
      5.4A1iiiShares responsibility and combines knowledge, creativity, and experience of othersXXX
      5.4A2Maintains formal and informal communication channels that permit the collaborative exploration of issues, goals, and objectivesXXX
      5.4A3Shares ideas and resources with customers, vendors, and competitors to acquire capital and human resources in an ethical mannerXX
      5.4A4Recognizes the business concerns and perspectives of othersXX
      5.4BRecognizes and builds upon diversity and individual, group, and organizational strengthsXXX
      5.5Impact and Influence: The ability to persuade others to support a point of view, project, proposal, position, solution, or recommendation. This competency is about how the RDN in CNM appropriately uses interpersonal, communication, and leadership skills to engage and influence others, gain confidence, and enhance their commitment to work. RDNs in CNM inspire hope and help others to see how their work contributes by clearly, consistently, and honestly painting a vivid and attractive picture of the future.
      5.5AAdvocates for provision of quality food and nutrition services as part of public policyXXX
      5.5A1Communicates with policy makers regarding the benefit/cost of qualify food and nutrition servicesXXX
      5.5A2Advocates in support of food and nutrition programs and services for populations with special needs and chronic conditionsXXX
      5.5A3Advocates for protection of the public through multiple avenues of engagement (eg, legislative action, establishing effective relationships with elected leaders and regulatory officials, participation in various Academy committees, workgroups and task forces, Dietetic Practice Groups, Member Interest Groups, and State Affiliates)XXX
      5.5A4Collaborates with other professionals to advocate for amendments to existing, or implementation of new laws and regulations that impact nutrition and health-related public policyXX
      5.5BEstablishes credibility and contributes as a food and nutrition resource within the interprofessional health care and management team, organization, and communityXXX
      5.5B1Signals own commitment by being personally present and involved at key eventsXXX
      5.5B2Develops and delivers presentations that energize and inspire groupsXX
      5.5B3Represents the profession and organization nationally and internationally to gain reputational influence by sharing experiences and best practicesX
      5.5CSeeks opportunities to participate in and assume leadership roles with local, state, and national professional and community-based organizations (eg, government-appointed advisory boards, community coalitions, schools, foundations, or non-profit organizations serving the food insecure) providing food and nutrition expertiseXXX
      5.5DSeeks out and builds relationships with others who can provide information, intelligence, career support, potential business, and other forms of assistanceXXX
      5.5EGenerates enthusiasm for work and commitment to task objectivesXXX
      5.5FExpresses pride in the group and encourages others to feel good about their accomplishments; acknowledges and thanks others for their contributionsXXX
      5.5GDevelops networks and coalitions with others who have mutual interests or goals and complementary skills to build consensus and maximize influenceXX
      5.5HTakes well thought-out actions in order to make a specific impactXX
      5.5IUnderstands when to escalate critical issues if one’s own efforts have not successfully resolved the problemXX
      5.5JRecognizes which battles are worth fighting and when it is appropriate to compromiseXX
      5.5KInfluences situations or persons directly or indirectly by enlisting experts or other third parties to assist in achieving desired outcomesX
      5.6Interpersonal Understanding: The ability to accurately hear and understand the unspoken or partly expressed thoughts, feelings, and concerns of others. The RDN in CNM notices, interprets, and anticipates others’ concerns and feelings, and communicates this awareness empathetically. RDNs in CNM understand the underlying emotions that affect their team, and care for team members as individuals, helping them manage negative emotions to better deliver quality services or products. RDNs in CNM establish, build, and sustain team, department, and organizational relationships for the purpose of building trust, understanding, and a strong work ethic (https://doi.org/10.1016/j.jand.2019.05.001).
      5.6AGuides customers, families, students, and interns in the application of knowledge and skillsXXX
      5.6BAssists individuals and groups to identify and secure appropriate and available educational and other resources and servicesXXX
      5.6CRecognizes and respects the interests and concerns of others; speaks or takes action to address these concerns; notices and accurately interprets what others are feeling based on their choice of words, tone of voice, expressions, and other nonverbal behaviorXXX
      5.6C1Provides direction and information to help others better understand their situationsXXX
      5.6C2Offers solutions that address others’ concerns and issues and looks for win-win outcomesXXX
      5.6C3Minimizes the potential for difficult situations or confrontations; positively manages negative commentsXXX
      5.6C4Identifies the strengths and weaknesses of others; facilitates use of strengths and improvement of weaknessesXX
      5.6C5Anticipates correctly how others will react to different situations and tailors interpersonal and communication approaches effectivelyXX
      5.6C6Identifies and promptly tackles morale problemsXX
      5.6DMakes others feel comfortable by conveying interest in what they have to say; approaches others about sensitive issues in a non-threatening wayXXX
      5.6D1Listens, understands, accepts, and respects the opinions, feelings, perspectives, and motivations of othersXXX
      5.6D2Understand the individual circumstances that drive others’ behaviors and tailors interactions accordinglyXX
      5.6D3Modifies interpersonal interactions to appeal to others, with appreciation for their attitudes, feelings, behaviors, and circumstances; uses this understanding for mutual benefitXX
      5.6EMaintains an open mind and is empathetic to others’ thoughts, feelings, and motivations; is patient and lets others set the pace to express themselvesXXX
      5.6FAssumes the best about employees and customers; focuses on solving problems instead of assigning blameXXX
      5.6GDemonstrates through attitudes and behaviors the importance of team members’ health and welfareXXX
      5.6HDemonstrates self-care for physical and emotional welfare to encourage a positive work environment for the team and organizationXXX
      5.6H1Participates in the development, management, and/or maintenance of an employee wellness programXX
      5.6IShares responsibility for the emotional welfare of their team(s) with other leadersX
      Examples of Outcomes for Standard 5: Communication and Application of Knowledge
      • Expertise in food, nutrition, dietetics, and management is demonstrated and shared
      • Creative solutions are developed in order to challenge the status quo
      • Effective partnerships are established to achieve goals
      • Commitment and support for organizational initiatives are secured
      • Strategies and decisions reflect the culture of the organization
      • An open and supportive environment is established
      • Trusting relationships are established with team members and colleagues
      • Effective and efficient communications occur through appropriate and professional use of e-mail, texting, and social media tools
      • Leadership is demonstrated through active professional and community involvement
      Standard 6: Utilization and Management of Resources

      The RDN in CNM uses resources effectively and efficiently.

      Rationale: The RDN demonstrates leadership through strategic management of time, finances, facilities, supplies, technology, natural, and human resources.
      Indicators for Standard 6: Utilization and Management of Resources
      Bold Font Indicators are Academy Core RDN Standards of Professional

      Performance Indicators
      The “X” signifies the indicators for the level of practice
      Each RDN in CNM possesses the following traits and embodies these through the actions identified based on their level of practice:CompetentProficientExpert
      6.1Analytical Thinking: The ability to understand a situation, issue, or problem by breaking it into constituent parts using a methodical step-by-step approach. This includes systematically organizing the parts of a situation, issue, or problem; comparing different features or aspects; setting priorities rationally; and identifying time sequences and causal or if-then relationships. This competency is about how the RDN in CNM gathers relevant information, identifies key issues or connections, and interprets and uses these data to evaluate root causes of problems, test assumptions, consider alternatives, and commit to actions.
      6.1AUses a systematic approach to manage resources and improve outcomesXXX
      6.1A1Approaches a task or problem by systematically breaking it down into its component parts and considering each part in detailXXX
      6.1BEvaluates safety, effectiveness, efficiency, productivity, sustainability practices, and value while planning and delivering services and productsXXX
      6.1CRecognizes actual or potential problems; identifies possible causes, takes advantage of opportunities, and implements solutionsXXX
      6.1DExplains and justifies decisions based on analytical informationXXX
      6.1EDistinguishes between facts and assumptions and avoids jumping to conclusionsXXX
      6.1FSeeks and implements higher-quality, more-efficient, or cost-effective processes and solutionsXXX
      6.1GWeighs the costs, benefits, risks, and chances for success when prioritizing and developing solutions to complex problemsXX
      6.1HIdentifies discrepancies in data and probes to resolve inconsistenciesXX
      6.2Financial Skills: The ability to understand and explain financial and accounting information, prepare and manage budgets, identify revenue-generating opportunities, and make sound long-term investment decisions. The RDN in CNM uses available financial information and tools to effectively manage resources and plan future commitments.
      6.2AComplies with established billing regulations, organization policies, grant funder guidelines, if applicable to role and setting, and adheres to ethical and transparent financial management and billing practicesXXX
      6.2A1Prepares and justifies budget proposalsXXX
      6.2A2Administers budgets and monitors revenues and expenditures (eg, labor, education/training tools and materials, supplies and food costs when applicable) to ensure support of programs and policiesXXX
      6.2A3Recognizes the implications of key financial indicators related to areas of responsibilityXX
      6.2A4Uses cost/benefit analysis in order to set priorities and make financially sound decisionsXX
      6.2A5Grows and controls revenue-generating activities, which may include program development and implementation, and optimized billing for nutrition servicesX
      6.3Project Management: The ability to plan, execute, and oversee a project. The RDN in CNM constructs a carefully planned and organized effort to accomplish specific objectives.
      6.3AEvaluates interventions and workflow process(es) and identifies service and delivery improvementsXXX
      6.3A1Ensures the success of a project by determining the scope and resources needed; obtains approval for resource acquisition when necessaryXXX
      6.3BEvaluates management of resources with the use of standardized performance measures and benchmarking as applicableXXX
      6.3B1Identifies, evaluates, and implements measurement systems for current and future projectsXXX
      6.3CParticipates in quality assurance and performance improvement (QAPI) and documents outcomes and best practices relative to resource managementXXX
      6.3C1Plans and prioritizes short- and long-term goals, monitors and measures progress, and demonstrates flexibility by changing plans as neededXXX
      6.3C2Assembles and manages the project team; seeks assistance, if neededXXX
      6.3C3Develops a project plan and tracks critical steps to ensure on-time completion; changes the plan as needed while considering the project scope and resourcesXX
      6.3C4Leads large-scale and high-impact projects that require significant resourcesX
      6.3DDevelops, proposes, obtains, and organizes resources for implementation of projectsXXX
      6.3D1Recognizes and follows industry and market trends, and key issues affecting the organization’s competitiveness, products, and servicesXX
      6.3D2Links ideas by sorting information in an ordered scheme—chronological, cause/effect, compare/contrast, similar/different, or classification; organizes ideas into clusters/idea maps; recognizes associations between seemingly unrelated events and their causesXX
      6.3D3Uses prior knowledge and sound reasoning to make inferences, identify trends, interpret data, and draw conclusionsXX
      6.3EMeasures and tracks trends regarding internal and external customer outcomes (eg, satisfaction, key performance indicators)XXX
      6.3E1Coordinates two-way communication with others inside and outside the organization, keeping others informed of progress, successes, and challengesXXX
      6.3E2Monitors internal factors that may affect the department, team, or projectXX
      6.3E3Identifies and analyzes internal and external forces that may affect the department, team, or projectX
      6.4Human Resources Management: The ability of the RDN in CNM to implement staff development plans; comply with legal and regulatory requirements related to human resource management; and optimize the performance of the workforce, including performance assessments, alternative compensation and benefit methods, and the alignment of human resource practices and processes to meet the strategic goals of the organization and foster employee retention. The RDN in CNM commits to building the breadth and depth of the staff’s skills and knowledge by supporting top-performing employees and coaching and mentoring high-potential leaders. RDNs in CNM champion learning and skill development so that they and others gain the competence needed to meet the future needs of the organization and profession, develop their own potential, and learn from both success and failure.
      6.4AUses professional, technical, and support personnel appropriately in the delivery of customer-centered care or services in accordance with laws, regulations, and organization policies and proceduresXXX
      6.4A1Assigns activities, including direct care to patients/clients, consistent with the qualifications, experience, and competence of professional, technical, and support personnelXXX
      6.4A1iEnsures that staff has a clear understanding of expected performance and provides feedback in an accurate, timely, and constructive mannerXXX
      6.4A1iiAssists credentialed nutrition and dietetics practitioners with understanding implications of individual and legal scope of practiceXXX
      6.4A1iiiEnsures that staff have a clear understanding and personal accountability when assigning tasks and responsibilitiesXXX
      6.4A2Supervises professional, technical, and support personnelXXX
      6.4A2iUses objective measures to identify and document employees’ strengths and developmental needsXXX
      6.4A2iiDevelops employees’ ownership by including them in the decision-making and planning processesXXX
      6.4A2iiiEmpowers employees by giving them the authority to accomplish tasks in an efficient and timely mannerXXX
      6.4A2ivRewards, develops, counsels, re-assigns, or terminates employees, as appropriateXXX
      6.4A3Recruits, develops, evaluates, and rewards employees effectively in accordance with state and federal statutes and organizational policies; and seeks assistance, if neededXXX
      6.4A4Works within the organization to provide fair and equitable compensation to staff, as well as develop alternative benefit and compensation practicesXX
      6.4BMentors and/or precepts othersXXX
      6.4B1Mentors and/or precepts students/internsXXX
      6.4B1iIdentifies and uses innovative or modern methods (eg, interprofessional education, simulations) to train/mentor students/internsXX
      6.4B2Builds the self-confidence of others by giving positive and constructive feedback; gives credit for the contributions and successes of others; supports individuals and the team during times of failureXX
      6.4B3Recognizes and encourages excellence; provides employees specific performance-based feedback and coaching/mentoring to maximize the probability of success; and develops practice and leadership skillsXX
      6.4B4Develops career ladders to encourage professional development of staffXX
      6.4B5Develops successors and a talent pool for key positions within the organizationXX
      6.4CAssesses employees’ unique developmental needs; plans and supports opportunities that maximize employees’ potential and contributes to the achievement of the teams’ and organizational goalsXX
      6.4DIdentifies the team(s) knowledge and skill gaps and focuses on development of high-potential employees to bridge gapsXX
      Examples of Outcomes for Standard 6: Utilization and Management of Resources
      • Documentation of resource use is consistent with plan
      • Budget is met for area of responsibility
      • Data are used to promote, improve, and validate services, organization practices, and public policy
      • Employees are retained, engaged, and developed (eg, career ladder is established)
      • Desired outcomes are achieved, documented, and disseminated
      • Resources are effectively and efficiently managed
      • Projects are completed on time and within budget (eg, the renovation or construction of a department, implementation of an enterprise-wide system, or development of a new service line)
      • Documentation of resource use is consistent with operational and sustainability goals
      • Identifies and tracks key performance indicators in alignment with organizational mission, vision, principles, and values
      • Evaluations reflect expected outcomes and established goals
      • Professional, technical, and support personnel are supervised when providing nutrition care to customers
      a PROMIS: The Patient-Reported Outcomes Measurement Information System (https://commonfund.nih.gov/promis/index) (PROMIS) is a reliable, precise measure of patient-reported health status for physical, mental, and social well-being. PROMIS is a web-based resource and is publicly available.
      b Interprofessional: The term interprofessional is used in this evaluation resource as a universal term. It includes a diverse group of team members (eg, organization leaders, department directors or managers, nurse managers and lead nurses, physicians, dietitian nutritionists, pharmacists), depending on the needs of the customer. Interprofessional could also mean interdisciplinary or multidisciplinary.
      c Medical staff: A medical staff is composed of doctors of medicine or osteopathy and may in accordance with state law, including scope of practice laws, include other categories of physicians, and non-physician practitioners who are determined to be eligible for appointment by the governing body.
      US Department of Health and Human Services, Centers for Medicare and Medicaid Services
      State Operations Manual. Appendix A-Survey protocol, regulations and interpretive guidelines for hospitals (Rev. 183, 10-12-18; §482.12(a)(1) Medical Staff, non-physician practitioners; §482.23(c)(3)(i) Verbal Orders; §482.24(c)(2) Orders.
      d Non-physician practitioner: A non-physician practitioner may include a physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse-midwife, clinical social worker, clinical psychologist, anesthesiologist’s assistant, and qualified dietitian or qualified nutrition professional. Disciplines considered for privileging by a facility’s governing body and medical staff must be in accordance with state law.
      US Department of Health and Human Services, Centers for Medicare and Medicaid Services
      State Operations Manual. Appendix A-Survey protocol, regulations and interpretive guidelines for hospitals (Rev. 183, 10-12-18; §482.12(a)(1) Medical Staff, non-physician practitioners; §482.23(c)(3)(i) Verbal Orders; §482.24(c)(2) Orders.
      US Department of Health and Human Services, Centers for Medicare and Medicaid Services
      State Operations Manual. Appendix W-Survey protocol, regulations and interpretive guidelines for critical access hospitals (CAHs) and swing-beds in CAHs (Rev. 183, 10-12-18); §485.635(a)(3)(vii) Dietary Services ; §458.635 (d)(3) Verbal Orders.
      US Department of Health and Human Services
      Centers for Medicare and Medicaid Services. 42 CFR Parts 413, 416, 440 et al. Medicare and Medicaid Programs; Regulatory provisions to promote program efficiency, transparency, and burden reduction; Part II; Final rule (FR DOC #2014-10687; pp 27106-27157).
      The term privileging is not referenced in the Centers for Medicare and Medicaid Services long-term care (LTC) regulations. With publication of the Final Rule revising the Conditions of Participation for LTC facilities effective November 2016, post-acute care settings, such as skilled and LTC facilities, may now allow a resident’s attending physician the option of delegating order writing for therapeutic diets, nutrition supplements, or other nutrition-related services to the qualified dietitian or clinically qualified nutrition professional, if consistent with state law, and organization policies.

      US Department of Health and Human Services, Centers for Medicare and Medicaid Services. Centers for Medicare and Medicaid Services. Medicare and Medicaid Programs; reform of requirements for long-term care facilities. 42 CFR Parts 405, 431, 447, 482, 483, 485, 488, and 489. Final Rule (FR DOC#2016; pp 68688-68872) – Federal Register October 4, 2016; 81(192):68688-68872; §483.30(f)(2) Physician services (pp 65-66), §483.60 Food and Nutrition Services (pp 89-94), §483.60 Food and Nutrition Services (pp 177-178). https://www.federalregister.gov/documents/2016/10/04/2016-23503/medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilities. Accessed June 28, 2019.

      US Department of Health and Human Services, Centers for Medicare and Medicaid Services
      State Operations Manual. Appendix PP Guidance to surveyors for long-term care facilities (Rev. 173, 11-22-17); §483.30 Physician Services, §483.60 Food and Nutrition Services.

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      Biography

      J. Doley is a regional clinical nutrition manager and dietetic internship director, Morrison HealthCare at Carondelet St Mary’s Hospital, Tucson, AZ.
      K. Clark is a system clinical nutrition manager, AVI Foodsystems, Inc, Cincinnati, OH.
      S. Roper is a clinical nutrition/patient services manager, WakeMed, Raleigh, NC.