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Academy of Nutrition and Dietetics: Revised 2021 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Sports and Human Performance Nutrition

      Abstract

      Nutrition in sports and human performance incorporates knowledge of the intersection of human physiology and nutrition. Registered dietitian nutritionist (RDN) practitioners in sports and human performance focus on nutrition care that is specific to the individual and their sport/occupational requirements. The Dietitians in Sports, Cardiovascular and Wellness Dietetic Practice Group, along with the Academy of Nutrition and Dietetics Quality Management Committee, have updated the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs working in sports and human performance. The SOP and SOPP for RDNs in Sports and Human Performance Nutrition provide indicators that describe three levels of practice: competent, proficient, and expert. The SOP uses the Nutrition Care Process and clinical workflow elements for delivering care to athletic/professional populations. The SOPP describes the following 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. Specific indicators outlined in the SOP and SOPP depict how these standards apply to practice. The SOP and SOPP are complementary resources for RDNs and are intended to be used as a self-evaluation tool for assuring competent practice in sports and human performance and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.
      Editor’s note: Figures 1 and 2 that accompany this article are available online at www.jandonling.org.
      The Sports, Cardiovascular, and Wellness Nutrition (SCAN) 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 Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitian Nutritionists (RDNs) in Sports Nutrition and Dietetics, which was originally published in 2014.
      • Steinmuller P.L.
      • Kruskall L.J.
      • Karpinski C.A.
      • Manore M.M.
      • Macedonio M.A.
      • Meyer N.L.
      Academy of Nutrition and Dietetics: Revised 2014 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Sports Nutrition and Dietetics.
      The revised document, Academy of Nutrition and Dietetics: Revised 2021 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Sports and Human Performance (SHP) Nutrition, reflects advances in sports and human performance nutrition practice during the past 7 years and replaces the 2014 Standards. This document builds on 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.
      The Academy of Nutrition and Dietetics/Commission on Dietetic Registration’s (CDR) Code of Ethics for the Nutrition and Dietetics Profession,
      Academy of Nutrition and Dietetics (Academy)/Commission on Dietetic Registration (CDR)
      2018 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 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 the code(s) of ethics (eg, Academy/CDR, other national organizations, or employers’ code of ethics), 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 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, Certified Specialist in Sport Dietetics [CSSD]). 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 their scope of practice. The algorithm is designed to assist an RDN to critically evaluate their personal knowledge, skill, experience, judgment, and demonstrated competence using criteria resources.
      Scope of Practice Decision Algorithm
      Academy of Nutrition and Dietetics.
      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.
      Approved March 2021 by the Quality Management Committee of the Academy of Nutrition and Dietetics (Academy) and the Executive Committee of the Sports, Cardiovascular, and Wellness Nutrition Dietetic Practice Group of the Academy. Scheduled review date: April 2027. Questions regarding the Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists in Sports and Human Performance Nutrition 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].
      The Centers for Medicare and Medicaid Services, Department of Health and Human Services, Hospital
      State Operations Manual
      Appendix A-Survey protocol, regulations and interpretive guidelines for hospitals (Rev. 200, 02-21-20); §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.
      and Critical Access Hospital
      State Operations Manual. Appendix W-Survey protocol, regulations and interpretive guidelines for critical access hospitals (CAHs) and swing-beds in CAHs (Rev.200, 02-21-20); §485.635(a)(3)(vii) Dietary Services; §458.635 (d)(3) Verbal Orders; §458.635 (d)(9) Swing-Beds. US Department of Health and Human Services, Centers for Medicare and Medicaid Services.
      Conditions of Participation now allow 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. RDNs in hospital settings interested in obtaining ordering privileges must review state laws (eg, licensure, certification, and title protection), if applicable, and health care regulations to determine whether any barriers or state-specific processes must be addressed. For more information, review the Academy’s practice tips that outline the regulations and implementation steps for obtaining ordering privileges (www.eatrightpro.org/dietorders/). For assistance, refer questions to the Academy’s State Affiliate organization.
      Medical staff oversight of RDNs occurs in one of two ways. A hospital has the regulatory flexibility to appoint RDNs to the medical staff and grant RDNs specific nutrition ordering privileges, or can authorize the ordering privileges without appointment to the medical staff. To comply with regulatory requirements, an RDN’s eligibility to be considered for ordering privileges must be through the hospital’s medical staff rules, regulations, and bylaws, or other facility-specific process.
      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). US Department of Health and Human Services, Centers for Medicare and Medicaid Services.
      The actual privileges granted will be based on the RDN’s knowledge, skills, experience, and specialist certification, if required, and demonstrated and documented competence.
      Federal, state, and organization regulations, policies, and legally binding documents (eg, contracts) dictate the level of autonomous practice of an RDN in SHP. In the SHP setting, RDNs are empowered to initiate consults, recommend plans for food, hydration, and supplements, and to order laboratory tests within their individual scope of practice and facility privileges or protocols. However, RDN autonomy may be defined by designated medical providers responsible for overarching organization medical oversight.
      Team Physician Consensus Statement: 2013 Update. Medicine & Science in Sports & Exercise 2013 Special Communications.
      Army Health System Support to Maneuver Forces: Army Techniques Publication No. 4-02.3. U.S. Department of the Army.
      Army Health System Support to Special Operations Forces: Army Techniques Publication No. 4-02.43. U.S. Department of the Army.
      Medical Care Management: Air Force Instruction 44-102. Secretary of the Air Force.
      Health Care Quality Assurance Policies for Operating Forces: Chief of Naval Operations Instruction 6320.7A/ Marine Corps Order 6320.4. U.S. Department of the Navy.
      SHP RDNs identify limitations to autonomous practice and work closely with designated medical leads and interprofessional team members to clearly define practice boundaries.

      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. 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, or 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, equitable, 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 SHP nutrition provide a guide for self-evaluation and expanding practice, a means of identifying areas for professional development, and a tool for demonstrating competence in delivering SHP services. 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 general clinical practice with maintaining minimum competence in the focus area and by RDNs 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) (Figures 1 and 2, available at www.jandonline.org) for the SOP and SOPP for RDNs in SHP Nutrition were revised with input and consensus of content experts representing diverse practice and geographic perspectives. The SOP and SOPP for RDNs in SHP Nutrition were reviewed and approved by the Executive Committee of the SCAN DPG and the Academy Quality Management Committee.

      Three Levels of Practice

      The Dreyfus model
      • Dreyfus H.L.
      • Dreyfus S.E.
      Mind over Machine: The Power of Human Intuition and Expertise in the Era of the Computer.
      identifies levels of proficiency (novice, advanced beginner, competent, proficient, and expert) (Figure 3) 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. On successfully attaining the RDN credential, a practitioner enters professional practice at the competent level and manages their professional development to achieve individual professional goals. This model is helpful in understanding the levels of practice described in the SOP and SOPP for RDNs in SHP Nutrition. In Academy focus areas, the three levels of practice are represented as competent, proficient, and expert; each level in SHP nutrition is associated with its own set of characteristics for the target population and the RDN (Figure 4). With the evolution of the field of SHP nutrition, RDNs may need to pursue additional knowledge (Figure 5) for application to practice or seek out a more experienced SHP RDN for assistance when an activity or complex case is beyond their experience level.
      Figure 3Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (RDNs) (Competent, Proficient, and Expert) in Sports and Human Performance Nutrition.
      Standards of Practice are authoritative statements that describe practice demonstrated through nutrition assessment, nutrition diagnosis (problem identification), nutrition intervention (planning, implementation), and outcomes monitoring and evaluation (four separate standards) and the responsibilities for which registered dietitian nutritionists (RDNs) are accountable. The Standards of Practice (SOP) for RDNs in Sports and Human Performance Nutrition presuppose that the RDN uses critical thinking skills; analytical abilities; theories; best-available research findings; current accepted nutrition, dietetics, and medical knowledge; and the systematic holistic approach of the nutrition care process as they relate to the application of the standards. Standards of Professional Performance (SOPP) for RDNs in Sports and Human Performance Nutrition 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).
      SOP and SOPP 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 and in which their clients are governed. To determine whether an activity is within the scope of practice of the RDN, the practitioner compares their 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 athlete/professional is used in the SOP as a universal term, because these Standards relate to direct provision of nutrition care and services. Athlete/professional could also mean client or patient, resident, participant, consumer, or any individual or group who receives sports and human performance nutrition care and services. Customer is used in the SOPP as a universal term. Customer could also mean athlete/professional, client or patient, client, patient, or customer, participant, consumer, or any individual, group, or organization to which the RDN provides services. These services are provided to individuals of all ages. The SOP and SOPP are intended for all settings of sports and human performance nutrition, including clinical. In addition, it is recognized that the family, caregiver(s), and advocates of athletes/professionals of all ages, including individuals with special health care needs, play critical roles in overall health and are important members of the team throughout the assessment and intervention process. 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.
      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 SOP in Nutrition Care and SOPP for RDNs have been adapted to reflect three levels of practice (competent, proficient, and expert) for RDNs in Sports and Human Performance Nutrition (see image below). In addition, the core indicators have been expanded to reflect the unique competence expectations for the RDN providing sports and human performance nutrition services.
      Standards described as proficient level of practice in this document are not equivalent to the CDR certification, Board Certified as a Specialist in Sports Dietetics (CSSD). Rather, the CSSD designation recognizes the skill level of an RDN who has developed and demonstrated through successful completion of the certification examination, sports and human performance nutrition knowledge and application beyond the competent practitioner and demonstrates, at a minimum, proficient-level skills. An RDN with a CSSD designation is an example of an RDN who has demonstrated additional knowledge, skills, and experience in sports and human performance nutrition by the attainment of a specialist credential.
      Figure 4Registered Dietitian Nutritionists (RDNs) in Sports and Human Performance (SHP) Nutrition Practice Level Delineation.
      Registered Dietitian Nutritionists (RDNs) in Sports and Human Performance (SHP) Nutrition

      Practice Level Delineation
      Client/Work Focus
      Competent RDN in SHPProficient RDN in SHPExpert RDN in SHP
      Works with athletes/professionals who:
      • Participate in sport for leisure and are not compensated (recreational athletes)
      • Participate in training to enhance health and performance levels related to work tasks
      Works with athletes/professionals who:
      • Must meet minimum qualifications, typically results or ranking, to compete (competitive athletes)
      • Must meet minimum performance standards to receive occupational compensation or stipend
      In addition to working with athletes/professionals as described in competent and proficient, also works with organizations who:
      • Provide education and services to athletes/professionals
      • Conduct research
      • Develop products
      • Develop policies and protocols
      • Monitor program quality and compliance
      Skill Development
      Competent RDN in SHPProficient RDN in SHPExpert RDN in SHP
      Focuses on expanding knowledge of: basic exercise physiology; training periodization and adaptation principles; metabolism relative to exercise intensity, duration, and modality; and sport- or occupation-specific organizational cultureFocuses on developing and expanding skills in: program development that support a comprehensive SHP nutrition concept (Figure 6), leadership, and mentoringFocuses on integration of SHP nutrition into interprofessional teams and organizations; mentors RDNs in SHP; educates, and consults with other SHP professionals
      Knowledge, Ability, and Experience
      Competent RDN in SHPProficient RDN in SHPExpert RDN in SHP
      • Knowledge of exercise metabolism and basics of SHP culture
      • Able to apply basic principles of SHP nutrition to athletes/professionals
      • 1-3 years’ experience with individuals participating in recreational sports
      Competent plus:
      • Knowledge of levels of athlete/professional and sport or occupation subtleties and culture and impact of athlete’s/professional’s performance on team or organization goals
      • Ability to forecast interconnecting factors and modify recommendations accordingly
      • 3–5 years’ experience working with athletes/professionals/organizations and interprofessional performance enhancement teams
      Proficient plus:
      • Knowledge of and ability to apply leadership principles to directing interprofessional teams, negotiating, conducting research, or mentoring RDNs in SHP
      • 5 or more years’ experience working with athletes/professionals/organizations and interprofessional performance enhancement teams
      Career Advancement Opportunities
      Competent RDN in SHPProficient RDN in SHPExpert RDN in SHP
      • Pursues documented hours applicable toward SHP-related certification or credential such as
        • Certified Specialist in Sport Dietetics (CSSD)
        • International Olympic committee (IOC) Diploma in Sport Nutrition
      • Completes or currently enrolled in undergraduate or graduate-level courses in sports nutrition, exercise physiology/kinesiology
      • Completes SHP-applicable continuing education (CEU) courses, webinars, conferences
      • Obtains a general fitness credential (eg, Certified Personal Trainer, Group Fitness Instructor)
      • Obtains SHP-related certification or credential such as:
        • CSSD
        • IOC Diploma in Sport Nutrition
      • Completes or currently enrolled in undergraduate or graduate-level coursework in sports nutrition, exercise physiology, or kinesiology
      • Completes SHP-applicable CEU courses, webinars, conferences
      • Obtains target population–specific physical training credential (eg, Triathlon or Weightlifting Level 1 Coach, Tactical Strength and Conditioning Facilitator)
      • Participates in SHP-specific professional organizations
      • Maintains SHP-related certification or credential such as the CSSD
      • Completes graduate degree and/or completed or currently enrolled in graduate-level coursework in sports nutrition, exercise physiology, or kinesiology
      • Completes SHP-applicable and/or business, management, and leadership CEU courses, webinars, conferences
      • Obtains advanced SHP-relevant certification (eg, Certified Strength and Conditioning Specialist, International Society for the Advancement of Kinanthropometry)
      • Assumes leadership positions in occupational or SHP-specific professional organizations
      Although SHP nutrition practice involves working with all tiers of athletes/professionals, working with competitive athletes and individuals who are compensated for meeting minimum occupational standards is considered to be at the proficient level of practice for RDNs working in SHP.
      Figure 5Resources for Registered Dietitian Nutritionists (RDNs) in Sports and Human Performance (SHP) Nutrition (not all inclusive).
      ResourceAddressDescription
      General Health, Sport, and Human Performance
      Academy of Nutrition and Dietetics (Academy) Sports and Human Performance Nutrition Dietetic Practice Group (DPG) and Cardiovascular Health and Well-being DPGhttps://www.eatrightpro.org/membership/academy-groups/dietetic-practice-groupsThe Sports, Cardiovascular and Wellnesss Nutrition (SCAN) DPG has expanded into two new DPGs beginning membership year 2021-2022; the Sports and Human Performance Nutrition (SHPN) DPG and the Cardiovascular Health and Well-being (CV-Well) DPG. Both DPGs will provide archived SCAN materials (eg, fact sheets and the Pulse newsletter) as well as resources relevant to their membership.
      Academy Fitness webpagehttps://www.eatright.org/fitnessThis Academy webpage gives consumer information on:
      • fitness,
      • sports,
      • performance,
      • training, and
      • recovery.
      American College of Sports Medicine (ACSM)www.acsm.orgThis organization provides:
      • science-backed information and practical application in the fields of exercise science and sports medicine;
      • certifications, position papers, journals, and policy advocacy;
      • forums for focused discussion, activity, and debate; and
      • Special Interest Groups for nutrition, combat sports, endurance athletes, team sports, health and performance, military, and performing arts.
      Food & Drug Administration (FDA)https://www.fda.gov/food/dietary-supplementsContains consumer and industry information on dietary supplement regulation, including steps to report dietary supplement adverse events.
      Food & Drug Administration (FDA) Tainted Products Marketed as Dietary Supplements databasehttps://www.accessdata.fda.gov/scripts/sda/sdNavigation.cfm?sd=tainted_supplements_cder&displayAll=false&page=6The FDA’s searchable database includes previously identified products with hidden ingredients marketed to consumers as dietary supplements; not all inclusive.
      National Athletic Trainers’ Association (NATA)https://www.nata.orgThis organization provides:
      • evidence-based information on heatlh care topics relative to sports and human performane.
      • educational workshops and continuing education opportunities.
      • position statements and scholarly publications.
      • cultural sensitivity resources.
      • career opportunities.
      National Strength and Conditioning Association (NSCA)https://www.nsca.com/This association offers:
      • research-based information and its practical application of strength and conditioning through certifications, research journals, career development services, and continuing education opportunities; and
      • a forum for engagement with others in Special Interest Groups for nutrition, metabolism, body composition, specific sports, performing arts, sports medicine, and tactical occupations.
      Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performancehttps://www.eatrightpro.org/practice/position-and-practice-papers/position-papers/new-position-papers-and-joint-papers-with-other-organizationsThis position paper gives consensus guidelines on:
      • the type, amount, and timing of intake of food, fluids, and dietary supplements to support athletic performance; and
      • sport performance across training and competitive sport.
      Professionals in Nutrition for Exercise and Sporthttps://pinesnutrition.org/This organization offers members:
      • SHP articles for RDNs; and
      • information on careers and education in sports nutrition.
      Collegiate, Olympic, and Professional Sport Performance
      Australian Institute of Sporthttps://ais.gov.au/nutritionThis website provides:
      • links to full-text evidence-based articles on nutrition, fluid replacement, dietary supplements, relative energy deficiency in sport (RED-S), nutrition support of immunity, and body image;
      • evidence-based dietary supplement classification system that ranks sports foods and supplement ingredients to determine safety and effectiveness;
      • fact sheets on multiple sport nutrition topics; and
      • performance-based recipes.
      Collegiate and Professional Sports Dietitians Associationhttps://www.sportsrd.org/This association has information for registered dietitian nutritionists in the United States who work with athletes in colleges and universities, professional sports, Olympic training centers, the U.S. Military, and in law enforcement.
      National Collegiate Athletic Association (NCAA)http://www.ncaa.org/This website includes:
      • information about policy regarding the provision of on-campus meals and snacks to collegiate student-athletes; and
      • information on sleep, nutrition, and dietary supplements for student-athletes, coaches, and administrators.
      U.S. Anti-Doping Agency (USADA) Substances webpagehttps://www.usada.org/athletes/substances/This USADA webpage provides a search function for ingredients identified by the World Anti-Doping Agency as prohibited.
      U.S. Olympic & Paralympic Committeehttps://www.teamusa.org/nutritionThis website provides:
      • print ready education material on easy, moderate, and hard training day plate guides for use with athletes;
      • fact sheets on multiple sports nutrition topics; and
      • performance-based recipes.
      World Anti-Doping Agency (WADA)https://www.wada-ama.org/The WADA provides an annually updated list of substances and methods that are prohibited to athletes in- and out-of-competition.
      Tactical Performance
      Uniform Services University (USU) Human Performance Resourceshttps://www.hprc-online.org/nutrition/performance-nutritionThis webpage from the Consortium for Health and Military Performance (CHAMP) provides nutrition basics and specialty topics to enhance Service Member performance during workouts, training, missions, and recovery.
      Uniform Services University (USU) Operation Supplement Safety webpagehttps://www.opss.org/This webpage from the Department of Defense (DoD) provides:
      • a DoD prohibited dietary supplement list;
      • safety screening tool for dietary supplements;
      • link to Food and Drug Administrtion (FDA) Safety Reporting Portal to report dietary supplement side effects; and
      • updated links to FDA alerts and announcements regarding dietary supplements, ingredients, and fraudulent products.
      Artistic Performance
      Athletes and the Artshttp://athletesandthearts.com/This website introduces RDNs to the culture of performing artists as athletes.
      Performing Arts Medicine Associationhttp://www.artsmed.org/This website introduces RDNs to events focused on the health and performance of performing artists.
      Sports and Human Performance practice involves working with all tiers of athletes/professionals. The competent-level RDN in SHP may enter the focus area through working with individuals engaging in sports for leisure and health benefits. An RDN in SHP working with competitive athletes and individuals who are compensated for meeting minimum occupational standards is considered to be at the proficient level of practice (Figure 4). In addition to the practitioner progressing through the technical aspects of each level of competency, the SHP RDN should also be progressing through the ethical aspects of the profession. At each level of practice, the RDN must reflect on how personal biases may influence the interpretation of evidence as well as cultural influences affecting their decision-making process.
      Academy of Nutrition and Dietetics (Academy)/Commission on Dietetic Registration (CDR)
      2018 Code of Ethics for the Nutrition and Dietetics Profession.
      This ongoing self-reflection is critical to ensuring fairness and objectivity that supports safe, equitable, timely, and appropriate treatment of individuals and organizations.
      Academy of Nutrition and Dietetics (Academy)/Commission on Dietetic Registration (CDR)
      2018 Code of Ethics for the Nutrition and Dietetics Profession.
      As the SHP RDN’s level of practice advances, these principles must be applied to common SHP nutrition interactions such as contact with industry,
      • Peregrin T.
      Ethics in practice: Guidance regarding the recommendation and sale of dietary supplements.
      performance evaluations, candidate evaluations (eg, for employment, professional association memberships, awards, or scholarships), and allocation of resources.
      Academy of Nutrition and Dietetics (Academy)/Commission on Dietetic Registration (CDR)
      2018 Code of Ethics for the Nutrition and Dietetics Profession.
      Even the perception of differential treatment in these areas has the potential to compromise the best interest of organizations and individuals, making continual introspection a professional imperative. Regardless of level of practice, SHP RDNs act in a caring and respectful manner, mindful of individual differences and cultural and ethnic diversity
      Academy of Nutrition and Dietetics (Academy)/Commission on Dietetic Registration (CDR)
      2018 Code of Ethics for the Nutrition and Dietetics Profession.
      in all interactions with individuals and organizations.
      With safe, efficient, effective, and equitable evidence-based practice
      Definition of terms. Academy of Nutrition and Dietetics.
      as guiding factors when working with athletes/professionals/organizations, the RDN identifies the level of evidence, clearly states research and source limitations, provides efficacy and safety information from reputable sources, and describes the risk and limitations of the intervention(s), when applicable. Sources of evidence include research, national and state guidelines, accreditation agencies, sport/occupational organization policies, consensus statements, systematic analysis of clinical experience, quality improvement data, specialized skills and knowledge of experts from SHP-related organizations (see Figure 5).
      The Academy offers the Evidence Analysis Library (www.andeal.org/) as a resource, which provides a synthesis of systematic reviews on a variety of nutrition and dietetics topics, such as athletic performance, and physical activity. The RDN is responsible for searching literature and assessing the level of evidence to select the best available evidence to inform recommendations. RDNs must evaluate and understand the best available evidence to converse authoritatively with the interprofessional team and adequately involve the athlete/professional or population in shared decision making.

      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 their 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 apply to all levels of practice.
      Definition of terms. Academy of Nutrition and Dietetics.
      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. Academy of Nutrition and Dietetics.
      A suggested starting point for an RDN interested in practicing in SHP nutrition is to gain exposure to a target sport or occupation. Every sport or occupation is a miniature society in that it has its own culture, manifested through specific lingo, social norms, clothing, advancement pathways, role models, sponsorships, media coverage, and food or diet affinities and phobias. Approaches to assimilating to these nuances include, but are not limited to, reading books and articles, following social media, and attending events specific to target sport/occupation. Physical and psychological demands vary greatly across and within sports/occupation, making it critical that RDNs understand the basics of exercise metabolism and training theory to provide effective nutrition interventions. Working toward earning the CSSD certification, achieving the International Olympics Committee (IOC) Diploma in Sports Nutrition, completing college courses in sport nutrition and exercise physiology/kinesiology, and obtaining a general fitness certification are methods to achieving this requisite knowledge.

      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. The proficient practitioner demonstrates additional knowledge, skills, judgment, and experience in a focus area of nutrition and dietetics practice.
      Definition of terms. Academy of Nutrition and Dietetics.
      The proficient-level SHP practitioner may be working toward earning a SHP-related certification that is most applicable to their target athlete/population (eg, sport-specific level 1 coach or tactical strength and conditioning facilitator) to increase knowledge base and incorporate SHP concepts into practice. The RDN has an understanding of sport or occupation foundation and nuances and how to leverage those nuances for effective nutrition interventions (eg, need for a different nutrition strategy for a track vs a road cyclist or for a wildland vs a structural firefighter). The proficient-level RDN develops nutrition programs that support a comprehensive SHP nutrition approach (Figure 6) that takes into account the athlete’s/professional’s performance impact on the team’s or organization’s success and demonstrates understanding of influencing factors on nutrition intervention (eg, leadership and sponsorship influence and collective bargaining). Additionally, this level of practitioner balances short-term task-specific physical performance goals with long-term health and sport or occupation longevity. The RDN may complete undergraduate or graduate level coursework in sports nutrition or exercise physiology or kinesiology and obtain the CSSD or IOC Diploma in Sports Nutrition.
      Figure thumbnail gr1
      Figure 6Comprehensive Sports and Human Performance Nutrition Concept.21

      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. 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 on nutrition and dietetics.
      Definition of terms. Academy of Nutrition and Dietetics.
      An expert practitioner may have an expanded or specialist role or both. Generally, the practice is more complex, and the practitioner has a high degree of professional autonomy and responsibility.
      The expert-level SHP RDN applies leadership principles in directing interprofessional teams to ensure that nutrition education and services are delivered in the comprehensive SHP nutrition approach (Figure 6). The expert-level RDN engages in negotiations concerning financial and human resources to assure adequate resources are available to deliver the SHP services. Additionally, the practitioner at the expert level of SHP nutrition conducts and applies research to advance the body of knowledge and the development of best practices. As a recognized leader in the field, the expert RDN mentors students, other RDNs, and professionals, as well as advocates for the inclusion of nutrition concepts and professionals in SHP. To retain an expert level of practice, the RDN maintains SHP-related certification(s) or credential(s), such as:
      • the CSSD or Certified Eating Disorders Registered Dietitian (CEDRD);
      • completed graduate-level coursework or continuing education opportunities in sport nutrition, exercise physiology/kinesiology, and/or eating disorders or disordered eating; and
      • pursuit of advanced certifications such as the Certified Strength or Conditioning Specialist (CSCS) or the International Society for the Advancement of Kinanthropometry (ISAK).
      Leadership and management skills are enhanced through completing business and leadership courses, webinars, and conferences.
      These Standards, along with the Academy/CDR Code of Ethics,
      Academy of Nutrition and Dietetics (Academy)/Commission on Dietetic Registration (CDR)
      2018 Code of Ethics for the Nutrition and Dietetics Profession.
      answer the questions: Why is an RDN uniquely qualified to provide SHP nutrition services? What knowledge, skills, and competencies does an RDN need to demonstrate for the provision of safe, efficient, effective, equitable, and quality sports and human performance nutrition care and service at the competent, proficient, and expert levels?

      Overview

      Refer to alphabetical Glossary for definitions

      Sports and Human Performance (SHP) Nutrition
      • Daigle K.A.
      • Logan C.M.
      • Kotwal R.S.
      Comprehensive performance nutrition for special operations forces.
      is the practical application of nutrition science, foodservice, and culinary arts to sustained optimal execution of specific sport/occupation tasks (human performance
      • Lunasco T.
      • Chamberlin R.A.
      • Deuster P.A.
      Human performance optimization: An operational and operator-centric approach.
      ). Over the last three decades, the field of SHP nutrition, along with public interest, has evolved from a focus on nutrition for physical activity
      Physical Activity. World Health Organization.
      in the support of health
      Constitution of the World Health Organization. World Health Organization.
      to a focus on nutrition for training
      • Mujika I.
      • Halson S.
      • Burke L.M.
      • Balague G.
      • Farrow D.
      An integrated, multifactorial approach to periodization for optimal performance in individual and team sports.
      in support of sports, human performance, and career longevity.
      American Dietetic Association
      Position of the ADA: Nutrition for physical fitness and athletic performance for adults.
      Position of the American Dietetic Association and the Canadian Dietetic Association
      Nutrition for physical fitness and athletic performance for adults.
      Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance.
      Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance.
      • Thomas D.T.
      • Erdman K.A.
      • Burke L.M.
      Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance.
      • Deuster P.A.
      • O’Connor F.G.
      Human performance optimization: Culture change and paradigm shift.
      • Park G.H.
      • Messina L.A.
      • Deuster P.A.
      A shift from resilience to human performance optimization in special operations training: Advancements in theory and practice.
      This general shift in focus from heath as an endpoint, to a focus on health as just one component of sports and human performance, has changed the way RDNs provide care and services in support of SHP nutrition. This evolved focus allows for a nuanced approach to culturally diverse nutrition recommendations that balance short-term performance optimization with long-term health and career longevity.
      • Burke L.M.
      • Castell L.M.
      • Casa D.J.
      • et al.
      International Association of Athletics Federations Consensus Statement 2019: Nutrition for athletics.
      SHP RDNs are uniquely qualified to provide services within a holistic SHP nutrition framework for all levels of athletes/professionals. This comprehensive approach includes proactive, active, and reactive components (Figure 6).
      • Daigle K.A.
      • Logan C.M.
      • Kotwal R.S.
      Comprehensive performance nutrition for special operations forces.
      Proactive education and services establish foundational health through chronic disease prevention and immune system enhancement. Physical activity and appropriate nutrition facilitate foundational health by contributing to chronic disease and cancer prevention, cardiovascular and brain health, and appropriate body weight maintenance.
      Agricultural Research Service
      Scientific report of the 2015 dietary guidelines advisory committee.
      ,
      U.S. Public Health Service
      2018 Physical activity guidelines advisory committee scientific report.
      Emerging fields in nutrition approaches for foundational health include injury and illness prevention,
      • Close G.
      • Sale C.
      • Baar K.
      Nutrition for the prevention and treatment in track and field athletes.
      sleep enhancement,
      • Pot G.K.
      Sleep and dietary habits in the urban environment: The role of chrono-nutrition.
      ,
      • St-Onge M.-P.
      • Mikic A.
      • Peitrolungo C.E.
      Effects of diet on sleep quality.
      and traumatic brain injury protection.
      • Lewis M.D.
      • Bailes J.
      Neuroprotection for the warrior: Dietary supplementation with omega-3 fatty acids.
      ,
      • Oliver J.M.
      • Anzalone A.J.
      • Turner S.M.
      Protection before impact: The potential neuroprotective role of nutritional supplementation in sports-related head trauma.
      Active component nutrition education and services support task- and environment-specific human performance through event fueling, post-event recovery, body composition management, cognitive performance enhancement, and arduous environment preparedness.
      • Daigle K.A.
      • Logan C.M.
      • Kotwal R.S.
      Comprehensive performance nutrition for special operations forces.
      ,
      • Mujika I.
      • Halson S.
      • Burke L.M.
      • Balague G.
      • Farrow D.
      An integrated, multifactorial approach to periodization for optimal performance in individual and team sports.
      By using periodized nutrition
      • Jeukendrup A.E.
      Periodized nutrition for athletes.
      strategies to be integrated and synchronized with training cycles and competition or operational readiness or performance schedules, nutrition enhances training adaptations and recovery.
      • Mujika I.
      • Halson S.
      • Burke L.M.
      • Balague G.
      • Farrow D.
      An integrated, multifactorial approach to periodization for optimal performance in individual and team sports.
      ,
      • Jeukendrup A.E.
      Periodized nutrition for athletes.
      Short-term nutrition strategies to optimize SHP sometimes contradict long-term strategies for foundational health.
      • Mujika I.
      • Halson S.
      • Burke L.M.
      • Balague G.
      • Farrow D.
      An integrated, multifactorial approach to periodization for optimal performance in individual and team sports.
      ,
      • Jeukendrup A.E.
      Periodized nutrition for athletes.
      This balance between nutrition strategies for short-term physical and mental performance with strategies for long-term health and sport or occupation longevity require advanced knowledge by a SHP RDN.
      Reactive component care and services address medical nutrition therapy and counseling to support illness and injury recovery
      • Tipton K.D.
      Nutritional support for exercise-induced injuries.
      and long-term conditions. Medical nutrition therapy for acute and chronic diseases and conditions serve to expeditiously return athletes/professionals to sustainable activity/duty,
      • Oliver J.M.
      • Anzalone A.J.
      • Turner S.M.
      Protection before impact: The potential neuroprotective role of nutritional supplementation in sports-related head trauma.
      whereas nutrition in support of long-term conditions
      • Scaramella J.
      • Kirihennedige N.
      • Broad E.
      Key nutritional strategies to optimize performance in para athletes.
      (eg, impaired ability to thermoregulate in athletes/professionals with spinal cord injuries
      • Pritchett K.
      • Broad E.
      • Scaramella J.
      • Baumann S.
      Hydration and cooling strategies for paralympic athletes: Applied focus: Challenges athletes may face at the upcoming Tokyo Paralympics.
      ) serves to optimize the performance of para athletes and persons with a physical impairment.
      Information for Para athletes and IPC members on COVID-19. International Paralympic Committee.
      By combining this holistic approach to SHP nutrition with the history, diversity, and current status of individuals and teams, RDNs develop and deliver care and services within the context of the athlete’s/professional’s training cycle,
      Constitution of the World Health Organization. World Health Organization.
      competition or operational readiness or performance schedule,
      Constitution of the World Health Organization. World Health Organization.
      organization culture,
      • Wagstaff C.R.D.
      • Burton-Wylie
      Organizational culture in sport: A conceptual, definitional, and methodological review.
      and available resources.

      The RDN Practicing in Sports and Human Performance Nutrition

      Within the context of evidence-based practice,
      Nutrition and Physical Activity
      Academy of Nutrition and Dietetics Evidence Analysis Library.
      the SHP RDN provides consultation to a range of athletes/professionals, including those with and without physical impairments who participate in recreational or competitive sport,
      Sports Nutrition Care Manual
      Nutrition Care Manual.
      ,
      Sport. Dictionary.com.
      work in tactical occupations,
      TSAC professionals
      National Strength and Conditioning Association.
      ,
      • Scofield D.E.
      • Kardouni J.R.
      The tactical athlete: A product of 21st century strength and conditioning.
      or perform in artistic fields.
      Artistic Fields
      National Endowment for the Arts.
      About US
      Stuntmen’s Association.
      About US
      Stuntwomen’s Association of Motion Pictures.
      2018 Standard Occupational Classification System. U. S. Bureau of Labor Statistics.
      The SHP RDNs work in settings such as colleges and universities
      • Thomas D.T.
      • Erdman K.A.
      • Burke L.M.
      Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance.
      ; athletic performance and training centers
      Nutrition. U.S. Olympic and Paralympic Committee.
      Nutrition Services
      EXOS.
      Coaches at IMG Academy. IMG Academy.
      ; sports medicine facilities
      • Thomas D.T.
      • Erdman K.A.
      • Burke L.M.
      Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance.
      ; National Sport Governing Body (NGB); Olympic and professional sports organizations
      • Bonci L.
      Fueling the professional athlete: Dietitians in sports. Academy of Nutrition and Dietetics.
      ,
      • Yeager D.
      Big League RDs: Refereeing players’ diets in the NFL.
      ; law enforcement and first responder departments
      Human Resources Division: MCFRS Dietitian Services
      Montgomery County Fire and Rescue Service.
      ,
      Meet our Team
      O2X.
      ; government agencies
      • Thomas D.T.
      • Erdman K.A.
      • Burke L.M.
      Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance.
      ; military training and operational organizations
      • Story K.L.
      • Bukhari A.S.
      • Bovill M.
      Roles of military dietitian in combat operations and humanitarian assistance – professional development and utilization.
      ,
      • Young C.
      Military RDs on the front lines.
      ; and dance and performance companies. Potential future settings may include but are not limited to stunt production venues and e-sports (eg, competitive video gaming).
      SHP RDNs view athletes/professionals holistically and consider multiple factors that affect nutritional intake and requirements when developing nutrition strategies. Individual athlete/professional assessment factors include food choice determinants (eg, physiological, biological, lifestyle, beliefs, knowledge, psychological, social, and economic),
      • Birkenhead K.
      • Slater G.
      A review of factors influencing athletes’ food choices.
      health and fitness status,
      • Lee E.C.
      • Fragala M.S.
      • Kavouras S.A.
      • et al.
      Biomarkers in sports and exercise: Tracking health, performance, and recovery in athletes.
      medical history, environmental, performance targets, body composition, food preference,
      • Gilbert N.
      Symposium on ‘performance, exercise and health’ practical aspects of nutrition in performance.
      and career transition.
      • Buckley G.L.
      • Hall L.E.
      • Lassemillante A.-C.M.
      • Ackerman K.E.
      • Belski R.
      Retired athletes and the intersection of food and body: A systematic literature review exploring compensatory behaviours and body change.
      Critical to the assessment, SHP RDNs assess associations between histories of training and performance outcomes, injury, and illness with histories of diet, body composition, and dietary supplement
      Definition of terms. Academy of Nutrition and Dietetics.
      use. Sport- or occupation-specific factors include physiological requirements,
      • Lunasco T.
      • Chamberlin R.A.
      • Deuster P.A.
      Human performance optimization: An operational and operator-centric approach.
      regulations, culture,
      • Wagstaff C.R.D.
      • Burton-Wylie
      Organizational culture in sport: A conceptual, definitional, and methodological review.
      training cycles, competition/operational readiness or performance schedules,
      • Mujika I.
      • Halson S.
      • Burke L.M.
      • Balague G.
      • Farrow D.
      An integrated, multifactorial approach to periodization for optimal performance in individual and team sports.
      environment, and travel.
      • Gilbert N.
      Symposium on ‘performance, exercise and health’ practical aspects of nutrition in performance.
      Sport or occupation team factors include food preferences of the team, catering arrangements (or lack of), resource limitations (ie, money, personnel, time), team dietary supplement use, sponsorships,
      • Gilbert N.
      Symposium on ‘performance, exercise and health’ practical aspects of nutrition in performance.
      and culinary skill set. The impact of additional influencers on nutrition intake of both individuals and teams, including coaches, leadership, teammates, peers, and family, are assessed.
      SHP RDNs combine this assessment with a thorough understanding of periodized nutrition
      • Mujika I.
      • Halson S.
      • Burke L.M.
      • Balague G.
      • Farrow D.
      An integrated, multifactorial approach to periodization for optimal performance in individual and team sports.
      ,
      • Jeukendrup A.E.
      Periodized nutrition for athletes.
      to develop effective nutrition strategies that address proactive, active, and reactive components throughout the athlete’s/professional’s competitive/operational readiness or performance schedule.
      Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance.
      Education, anthropometric and biochemical assessments, as well as nutrient intake plans, are synchronized with the primary goals of each training session and phase.
      • Mujika I.
      • Halson S.
      • Burke L.M.
      • Balague G.
      • Farrow D.
      An integrated, multifactorial approach to periodization for optimal performance in individual and team sports.
      ,
      • Burke L.M.
      • Castell L.M.
      • Casa D.J.
      • et al.
      International Association of Athletics Federations Consensus Statement 2019: Nutrition for athletics.
      RDNs working in SHP nutrition maintain the delicate balance between short-term performance optimization with long-term health and sport or occupation longevity. Examples of contradictory short-term strategies include:
      • decreasing energy or macronutrient intake or availability to enhance training adaptations or cognitive performance enhancement,
        • Thomas D.T.
        • Erdman K.A.
        • Burke L.M.
        Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance.
        ,
        • Jeukendrup A.E.
        Periodized nutrition for athletes.
        ,
        • Robson S.
        • Manacapilli T.
        Enhancing Performance under Stress: Stress Inoculation Training for Battlefield Airmen.
      • modifying body fat composition to levels traditionally considered unhealthy to meet weight class or aesthetic requirements,
        New criteria for judging female physiques. International Federation of Body Builders.
        • Pettersson S.
        • Ekstrom M.P.
        • Berg C.M.
        Practices of weight regulation among elite athletes in combat sports: A matter of mental advantage?.
        • Reale R.
        • Burke L.M.
        • Cox G.R.
        • Slater G.
        Body composition of elite Olympic combat sport athletes.
      • anticipating periods of food insufficiency (eg, military survival training or accelerated fuel stores depletion),
        • Reale R.
        • Burke L.M.
        • Cox G.R.
        • Slater G.
        Body composition of elite Olympic combat sport athletes.
        • Berryman C.E.
        • Young A.J.
        • Karl J.P.
        • et al.
        Severe negative energy balance during 21 days at high altitude decreases fat-free mass regardless of dietary protein intake: A randomized controlled trial.
        • Castellani J.W.
        • Spitz M.G.
        • Karis A.J.
        • et al.
        Cardiovascular and thermal strain during 3–4 days of a metabolically demanding cold-weather military operation.
        • Friedl K.E.
        Body composition and military performance: Many things to many people.
        and
      • deliberate nonadherence to recommended Adequate Intake (AI) or Tolerable Upper Intake Levels (UL) for nutrients (or vitamins or minerals) to prepare for event-specific environmental limitations (eg, fiber intake below AI for operations with restricted bowel evacuation opportunities or sodium intake above UL for events occurring in excessive heat and humidity).
      As a proactive and integral member of an organization’s human performance program
      • Daigle K.A.
      • Logan C.M.
      • Kotwal R.S.
      Comprehensive performance nutrition for special operations forces.
      ,
      • Friedl K.E.
      Body composition and military performance: Many things to many people.
      and performance enhancement team,
      Preservation of the Force and Family: Human Performance Program. U.S. Special Operations Command.
      Athlete Services: High performance programs. U.S. Olympic Committee.
      Athlete Services: Sports medicine. U.S. Olympic Committee.
      RDNs provide education, services, and care that are integrated and synchronized with training cycles, competition or operational readiness or performance schedules, and the efforts of other interprofessional team members. Thorough knowledge of performance enhancement team members’ scopes of practice, areas of expertise, and style of practice facilitates interprofessional team effectiveness and referrals that are seamless and timely.
      • Balague N.
      • Torrents C.
      • Hristovski R.
      • Kelso J.A.S.
      Sport science integration: An evolutionary synthesis.
      • Dijkstra H.P.
      • Pollock N.
      • Chakraverty R.
      • Alonso J.M.
      Managing the health of the elite athlete: A new integrated performance health management and coaching model.
      • Reid C.
      • Stewart E.
      • Thorne G.
      Multidisciplinary sport science teams in elite sport: Comprehensive servicing or conflict and confusion?.
      SHP RDNs balance athlete/professional confidentiality mandated by the Health Insurance Portability and Accountability Act of 1996 with providing status updates to coaches, leadership, and decision makers regarding athlete’s/professional’s health and performance status. A comprehensive understanding of the athlete’s/professional’s role and contribution to their organization enables the RDN to evaluate return to activity or duty implications for both the athlete/professional and the organization.
      • Mountjoy M.
      • Sundgot-Borgen J.
      • Burke L.
      • et al.
      The IOC consensus statement: Beyond the female athlete triad: relative energy deficiency in sport (RED-S).

      Academy Revised 2021 SOP and SOPP for RDNs (Competent, Proficient, and Expert) in Sports and Human Performance Nutrition

      An RDN can use the Academy Revised 2021 SOP and SOPP for RDNs (Competent, Proficient, and Expert) in Sports and Human Performance Nutrition (Figures 1 and 2, available at www.jandonline.org, and Figure 3) to:
      • identify the competencies needed to provide SHP nutrition care and services;
      • self-evaluate whether they have the appropriate knowledge, skills, cultural competencies, and judgment to provide safe, efficient, effective, equitable and quality SHP nutrition care and service for their level of practice;
      • identify the areas in which additional knowledge, skills, and experience are needed to practice at the competent, proficient, or expert level of SHP nutrition practice;
      • provide a foundation for public and professional accountability in SHP nutrition care and services;
      • support efforts for strategic planning, performance improvement, and outcomes reporting, and assist management in the planning and communicating of SHP nutrition services and resources;
      • enhance professional identity and skill in communicating the nature of SHP nutrition care and services;
      • guide the development of diverse SHP nutrition-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 culturally informed practice-based competencies needed to work in SHP nutrition, 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 SHP nutrition is learning the principles that underpin this focus area and is developing knowledge, skills, and judgment, and gaining experience for safe and effective SHP nutrition practice. 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 or practice in another focus area. However, the RDN new to the focus area of SHP nutrition must accept the challenge of becoming familiar with the body of knowledge, practice guidelines, and available resources to support and ensure quality SHP nutrition-related practice. At the competent level, the RDN works with:
      • athletes/professionals through volunteer and paid experiences in SHP fields;
      • noncompensated recreational athletes
        • Laquale K.M.
        Nutritional needs of the recreational athlete. Bridgewater State University. Published 2009.
        through intramural clubs, high school programs, recreational facilities, rehabilitation programs, internship programs, and event organizations; and
      • tactical and artistic professionals through Reserve Officer Training Corps programs, recruiting events, community programs, and internship opportunities.
      At the proficient level, an RDN has developed a more in-depth understanding of SHP nutrition practice and is more skilled at adapting and applying evidence-based guidelines and best practices than at the competent level. At the proficient level, the RDN works with competitive athletes (ie, those who must meet minimum qualifications to compete) through positions with collegiate, professional, Olympic/Paralympic, and other national-level sport programs and training centers. The RDN works with tactical and artistic professionals through training units or academies, operational units' or departments’ human performance programs, and performing arts organizations. The RDN at the proficient level may possess a specialist credential(s) such as the CSSD. By identifying the RDN as having specialized SHP nutrition knowledge, the CSSD credential has become a sought-after credential for professional SHP jobs.
      At the expert level, the RDN thinks critically about SHP nutrition, demonstrates a more intuitive understanding of the practice area, displays a range of highly developed clinical 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 nutrition, biochemistry, exercise physiology, and sport- or occupation-specific knowledge, with practitioners drawing not only on their practice experience, but also on the experience of other SHP RDNs in various disciplines and practice settings. Expert RDNs, with their extensive experience and ability to see the significance and meaning of SHP nutrition within a contextual whole, are fluid and flexible and have considerable autonomy in practice. The expert-level RDN applies leadership principles in directing interprofessional teams to ensure that nutrition education and services are delivered in the comprehensive SHP nutrition approach (Figure 6). Additionally, the practitioner at the expert level of SHP nutrition conducts and applies research to advance the body of knowledge and the development of best practices. As a recognized leader in the field, the expert RDN mentors students, other RDNs, and professionals, as well as advocates for nutrition content and professionals in SHP. To retain an expert level of practice, the RDN maintains SHP-related certification(s) or credential(s), such as the CSSD, may complete graduate-level coursework or continuing education opportunities in sport nutrition or exercise physiology or kinesiology, and may pursue advanced certifications such as CSCS or ISAK. Leadership and management skills are enhanced through completing business and leadership courses, webinars, and conferences.
      Indicators for the SOP and SOPP for RDNs in SHP Nutrition are measurable action statements that illustrate how each standard can be applied in practice (Figures 1 SOP and 2 SOPP, available at www.jandonline.org). Within the SOP and SOPP for RDNs in SHP Nutrition, an “X” in the competent column indicates that an RDN who is caring for athletes/professionals is expected to complete this activity or seek assistance to learn how to perform at the level of the standard. A competent RDN in SHP nutrition could be an RDN starting practice after registration or an experienced RDN who has recently assumed responsibility to provide SHP nutrition care for athletes/professionals as described in Figure 4.
      An “X” in the proficient column indicates that an RDN who performs at this level has a deeper understanding of SHP nutrition and has the ability to modify or guide therapy to meet the needs of athletes/professionals, with or without medical conditions, at all levels and phases of sport or occupation.
      An “X” in the expert column indicates that the RDN who performs at this level possesses a comprehensive understanding of SHP nutrition and a highly developed range of skills and judgments acquired through a combination of experience and education. The expert RDN builds and maintains the highest level of knowledge, skills, and behaviors, including leadership, vision, and credentials (Figure 4).
      Standards and indicators presented in Figure 1 and Figure 2 (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 SHP nutrition 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 SOP and SOPP for RDNs in SHP Nutrition 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 SOP and SOPP in SHP Nutrition at determined intervals to evaluate their individual focus area knowledge, skill, and competence. Consistent self-evaluation is important because it helps identify opportunities to improve and enhance practice and professional performance and set goals for professional development. This self-appraisal also enables SHP nutrition RDNs to better use 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 the Competency Plan Builder
      Commission on Dietetic Registration
      Competency Plan Builder Instructions.
      (step 1), which is a digital tool that assists practitioners in creating a continuing professional education Learning Plan. It helps identify focus areas during each 5-year recertification cycle for verified CDR credentialed nutrition and dietetics practitioners. 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 https://www.cdrnet.org/competencies-for-practitioners.
      RDNs are encouraged to pursue additional knowledge, skills, and training, regardless of practice setting, to maintain currency and to expand their individual scope of practice within the limitations of the legal scope of practice, as defined by state law. RDNs are expected to practice only at the level at which they are competent, and this will vary depending on education, training, and experience.
      • Gates G.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 SHP nutrition as learning opportunities and to promote consistency in cultural competencies, practice, performance, and continuous quality improvement. Figure 7 gives role examples of how RDNs in different roles, at different levels of practice, may use the SOP and SOPP in SHP Nutrition.
      Figure 7Role Examples of Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitian Nutritionists (RDNs) (Competent, Proficient, and Expert) in Sports and Human Performance (SHP) Nutrition.
      RoleExamples of use of SOP and SOPP documents by RDNs in different practice roles
      For each role, the RDN updates their professional development plan to include applicable essential practice competencies for SHP nutrition care and services.
      Collegiate sports team practitionerAn RDN new to a collegiate team environment is responsible for providing sport-specific nutrition education, individual and team meal planning, and ancillary services to support extensive training, travel, and play with which the RDN has limited knowledge and experience. The RDN uses the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs in Sports and Human Performance (SHP) Nutrition as a guide to ensure their service is at the appropriate level of practice, and to identify areas that may require collaboration with other SHP professionals that have more experience with this specific population, environment, and culture.
      Human performance program manager or collegiate athletic directorAn RDN who oversees an interprofessional human performance team wants to ensure the RDN team members are being used appropriately. The director uses the SOP and SOPP for RDNs in SHP Nutrition to ensure duties are appropriately assigned, that individual RDNs are functioning at the appropriate level of practice required for the program’s population, and to identify continuing training and experiences required to develop and maintain a high level of practice.
      Consulting practitionerAn RDN in private practice who has been consulting with recreational athletes is contacted by a university to provide SHP nutrition services to its scholarship athletes via telehealth. The RDN uses the SOP and SOPP for RDNs in SHP Nutrition to determine additional competencies required when providing services to this level of competitive athletes and for determining any additional considerations for delivering services via telehealth. The RDN refers to all relevant state laws and regulations, the Academy of Nutrition and Dietetics telehealth resources, and organization policies regarding the practice of telehealth, including requirements if the athlete/professional lives in another state. The SOP and SOPP in SHP Nutrition is used to evaluate competence and identify areas for additional knowledge or when an RDN with more expertise in SHP nutrition needs to be consulted or to make a referral for assuring quality care.
      Private practice practitionerAn RDN in private practice who provides a range of services for physically active individuals has decided to offer consulting to firefighter and police agencies. The RDN uses the SOP and SOPP for RDNs in SHP Nutrition to evaluate the knowledge, skills and competencies required to provide quality services to this tactical population (eg, interpersonal skills and assessment/intervention competency). The RDN sets goals to increase tactical SHP knowledge base and builds a network of mentors and colleagues to improve competency before providing services independently to this population.
      Military practitionerAn RDN working in a military environment is directed to provide nutrition education and services in support of an operational unit’s field training event with which they have limited knowledge and experience. The RDN uses the SOP and SOPP for RDNs in SHP Nutrition as a guide to ensure their organization intervention is at the appropriate level of practice and to identify areas that may require collaboration with other SHP or military professionals that have more experience with this specific population and event.
      Clinical practitioner, outpatient careAn RDN working in a health care facility with an outpatient clinic that offers education and services to local recreational sports teams and athletes, has been asked to provide nutrition and education services. The RDN reviews available resources and the SOP and SOPP for RDNs in SHP Nutrition to evaluate the knowledge, skills and competencies required to provide quality services to individuals participating in recreational sports (eg, nutrient timing, recovery nutrition). The RDN sets goals to increase their SHP knowledge base and builds a network of mentors and colleagues to improve competence before providing services independently to this population.
      Professional nutrition and dietetics writerAn RDN freelance writer is commissioned to write an article on sports nutrition for a nationally distributed fitness magazine. The RDN reviews available resources regarding SHP nutrition applicable to the publication’s target audience and identifies knowledge deficits. The RDN refers to the SOP and SOPP for SHP Nutrition, and consults with proficient- or expert-level SHP nutrition RDNs, to identify knowledge needed, and resources available, to provide evidence-based information that would benefit the publication’s audience.
      ResearcherAn RDN working in a research setting is awarded a grant to demonstrate the impact of SHP nutrition services on athletic and tactical human performance program outcomes. The RDN consults with proficient- and expert-level SHP nutrition RDNs in designing the research protocol. The RDN uses the SOP and SOPP as tools for identifying key resources and for identifying when to collaborate with an RDN more experienced in SHP nutrition research.
      a For each role, the RDN updates their professional development plan to include applicable essential practice competencies for SHP nutrition care and services.
      In some instances, components of the SOP and SOPP for RDNs in SHP Nutrition 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 RDN practitioners. 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 SOP and 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. Exemplary actions of SHP nutrition RDNs in practice settings and professional activities that enhance athlete/professional or organization care or services can be used to illustrate outstanding practice models.

      Future Directions

      The SOP and SOPP for RDNs in SHP Nutrition are innovative and dynamic documents. Future revisions will reflect changes and advances in practice, changes to dietetics education standards, regulatory changes, evidence-based guidelines,
      Nutrition and Physical Activity
      Academy of Nutrition and Dietetics Evidence Analysis Library.
      and outcomes of practice audits. Continued clarity and differentiation of the three practice levels in support of safe, effective, and quality practice in SHP nutrition remains an expectation of each revision to serve tomorrow's practitioners and their athletes/professionals or organizations. Sports and Human Performance is a rapidly advancing field in which nutrition is poised to play an increasingly critical role. Through integration and synchronization with training cycles, competition, operational readiness, performance schedules, and efforts of other SHP disciplines and professionals, RDNs have the opportunity to profoundly impact the health, quality of life, success, and career longevity of athletes/professionals.
      The evolution of the field of SHP nutrition has necessitated a concomitant evolution of the SCAN DPG. Therefore, the SCAN DPG has expanded into two new DPGs, beginning membership year 2021–2022. The Sports and Human Performance Nutrition DPG will be a network of credentialed nutrition and dietetics practitioners working with athletes and individuals at all levels to optimize human performance and holistic health for a lifetime. The Sports and Human Performance Nutrition DPG will deliver content tailored for human performance in sports as well as for in tactical occupations and the performing arts. Cardiovascular Health and Well-being DPG will equip members to be the experts promoting the prevention and treatment of cardiovascular disease through nutrition, well-being, and physical activity. The Cardiovascular Health and Well-being DPG will provide in-depth content in cardiovascular nutrition and well-being so members can optimize their work in diverse health arenas such as clinical settings, corporate well-being, community nutrition, private practice, research, education, and government.
      Announcing SCAN’s Expansion into two new dietetic practice groups. Sports and Cardiovascular Nutrition Dietetic Practice Group.

      Summary

      RDNs face complex situations every day. Addressing the unique needs of each situation and applying standards appropriately and equitably 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 facility accreditation standards. The SOP and SOPP for RDNs in SHP Nutrition 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 who provide care to individuals in SHP nutrition to consistently improve and appropriately demonstrate competence and value as providers of safe, efficient, effective, equitable, 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 SHP nutrition practice. Just as a professional’s self-evaluation and continuing education process is an ongoing cycle, these standards are also a work in progress and will be reviewed and updated every 7 years.
      Current and future initiatives of the Academy, as well as advances in SHP nutrition care and services, will provide information to use in future updates and in further clarifying and documenting the specific roles and responsibilities of RDNs at each level of practice. As a quality initiative of the Academy and the SCAN Dietetic Practice Group, 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 credentialed 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.

      Glossary

      Artistic fields are trades and occupations that involve a physical performance for audience entertainment, such as dancers, aerial artists, noncompetitive gymnastics, and stunt performers.
      Artistic Fields
      National Endowment for the Arts.
      About US
      Stuntmen’s Association.
      About US
      Stuntwomen’s Association of Motion Pictures.
      2018 Standard Occupational Classification System. U. S. Bureau of Labor Statistics.
      A competitive athlete is an individual who “participates in an organized team or individual sport that requires regular competition against others as a central component, places a high premium on excellence and achievement, and requires some form of systematic (and usually intense) training.”
      Female athlete triad refers to the interrelationships among energy availability, menstrual function, and bone mineral density, which may have clinical manifestations, including functional hypothalamic amenorrhea and osteoporosis.
      • Reid C.
      • Stewart E.
      • Thorne G.
      Multidisciplinary sport science teams in elite sport: Comprehensive servicing or conflict and confusion?.
      ,
      • Manore M.M.
      • Thompson T.A.
      Sport Nutrition for Health and Performance.
      Health is a “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
      Constitution of the World Health Organization. World Health Organization.
      Human performance involves the “accomplishment of a given task measured against preset known standards.”
      • Lunasco T.
      • Chamberlin R.A.
      • Deuster P.A.
      Human performance optimization: An operational and operator-centric approach.
      Human performance program is the systematic, integrated, and synchronized application of knowledge, skills, and emerging technologies by interprofessional performance enhancement teams to improve and sustain the health and task-specific performance of athletes/professionals and organizations.
      • Daigle K.A.
      • Logan C.M.
      • Kotwal R.S.
      Comprehensive performance nutrition for special operations forces.
      ,
      • Friedl K.E.
      Body composition and military performance: Many things to many people.
      An interprofessional research team within athletic performance/sports settings may include any or all of the following: principal investigator, co-principal investigators, project consultants, laboratory technicians, and statisticians.
      Periodization is a “logical method of planning training interventions in a sequential and integrative fashion to maximize training-induced physiological and performance outcomes.”
      • Alvar B.A.
      • Sell K.
      • Deuster P.A.
      NSCA’s Essentials of Tactical Strength and Conditioning.
      Periodized nutrition is the “planned delivery of specific nutritional interventions to enhance the adaptations targeted by individual exercise sessions or periodic training plans, or to obtain other effects that will enhance performance longer term.”
      • Jeukendrup A.E.
      Periodized nutrition for athletes.
      A performance enhancement team is an interprofessional group of professionals whose focus is on athlete/professional health and enhancement of human performance. Team members include human performance professionals and licensed medical providers, such as sport coaches, strength and conditioning coaches, physiologists, biomechanists, technologists, data scientists, physicians, chiropractors, physical therapists, registered dietitian nutritionists, chefs, psychologists, cognitive enhancement specialists, athletic trainers, acupuncturists, and massage therapists.
      Preservation of the Force and Family: Human Performance Program. U.S. Special Operations Command.
      Athlete Services: High performance programs. U.S. Olympic Committee.
      Athlete Services: Sports medicine. U.S. Olympic Committee.
      Physical activity is “any bodily movement produced by skeletal muscles that requires energy expenditure.”
      Physical Activity. World Health Organization.
      Exercise and training are types of physical activity.
      Professional, in the context of sports and human performance, is an individual who must perform employment/work tasks and may or may not be required to meet minimum performance standards to receive occupational compensation or a stipend (eg, firefighters, armed forces service members, dancers).
      A recreational athlete is an individual who “is physically active but who does not train for competition at the same level of intensity and focus as a competitive athlete.”
      • Laquale K.M.
      Nutritional needs of the recreational athlete. Bridgewater State University. Published 2009.
      Relative Energy Deficiency in Sport (RED-S) refers to impaired physiological function, including but not limited to metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health caused by relative energy deficiency.
      New criteria for judging female physiques. International Federation of Body Builders.
      Sport is an “athletic activity requiring skill or physical prowess and often of a competitive nature.”
      Sport. Dictionary.com.
      Sports and human performance nutrition is the practical application of nutrition science, food service, and culinary arts to the sustained optimal execution of specific sport/occupation tasks.
      • Daigle K.A.
      • Logan C.M.
      • Kotwal R.S.
      Comprehensive performance nutrition for special operations forces.
      Tactical occupations include military, fire and rescue, law enforcement, protective services, and other emergency personnel fields.
      TSAC professionals
      National Strength and Conditioning Association.
      ,
      • Scofield D.E.
      • Kardouni J.R.
      The tactical athlete: A product of 21st century strength and conditioning.
      Task-specific physical performance encompasses physical activity related to sport, military training and military operations, and training and performance of law enforcement officers, firefighters, professional emergency responders, and others whose occupations require physical labor or maintenance of specified levels of physical conditioning or body weight and body composition.
      Training is the process of physically and mentally preparing for task-specific performance that typically includes strength and conditioning, skill acquisition, nutrition, psychological skills, and recovery.
      • Mujika I.
      • Halson S.
      • Burke L.M.
      • Balague G.
      • Farrow D.
      An integrated, multifactorial approach to periodization for optimal performance in individual and team sports.

      Acknowledgements

      Special acknowledgement to Roberta Anding, MS, RDN, CSSD, CDE; Melissa Brown, PhD, RD, CSSD; Shawn Hueglin, PhD, RD, CSSD; Linda Samuels, MS, RD, CSSD, LDN; and Lindzi Torres, MS, MPH, RDN, CSSD, LD, ACSM EP-C, who reviewed these standards and to the Academy staff, in particular, Karen Hui, RDN, LDN; Dana Buelsing, MS, CAPM; Carol Gilmore, MS, RDN, LD, FADA, FAND; and Sharon McCauley, MS, MBA, RDN, LDN, FADA, FAND who supported and facilitated the development of these SOP and SOPPs. Additional thanks go to the Sports, Cardiovascular, and Wellness Nutrition Dietetic Practice Group’s Executive Committee. Finally, the authors acknowledge the significant influence of RDNs currently practicing in sports, tactical, and artistic fields in the shaping of these standards.

      Author Contributions

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

      Supplementary Materials

      Figure 1Standards of Practice for Registered Dietitian Nutritionists (RDNs) in Sports and Human Performance Nutrition. Note: The terms athlete, professional, patient, client, customer, individual, person, group, organization, or population are used interchangeably with the actual term used in a given situation, depending on the setting and the population receiving care or services. Sub-indicators refer to “in the context of the sports and human performance nutrition” (ie, majority of responsibilities or actions are not intended to be entry-level).
      Standards of Practice for Registered Dietitian Nutritionists in Sports and Human Performance Nutrition

      Standard 1: Nutrition Assessment

      The registered dietitian nutritionist (RDN) in sports and human performance (SHP) nutrition uses accurate and relevant data and information to identify nutrition-related problems.

      Rationale:

      Nutrition screening is the preliminary step to identify individuals who require a nutrition assessment performed by an RDN. Nutrition assessment is a systematic process of obtaining and interpreting data to make decisions about the nature and cause of nutrition-related problems and provides the foundation for nutrition diagnosis. It is an ongoing, dynamic process that involves not only initial data collection, but also reassessment and analysis of athlete/professional or population needs. Nutrition assessment is conducted using validated tools based in evidence, the five domains of nutrition assessment, and comparative standards. Nutrition assessment may be performed via in-person, facility/practitioner assessment application, or Health Insurance Portability and Accountability Act (HIPAA) compliant video conferencing telehealth platform.
      Indicators for Standard 1: Nutrition Assessment
      Bold font indicators are Academy Core RDN Standards of Practice indicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      1.1Athlete/professional/population history: Assesses current and past information related to personal, medical, family, and psychosocial or social history Assesses:XXX
      1.1APersonal history relative to age, gender self-identification, race/ethnicity, language, education, role in the family or organization, physical and/or developmental disabilities, injury, and rehabilitationXXX
      1.1BAthlete/professional medical or genetic disease states, conditions, and illnesses that may have nutritional impactXXX
      1.1B1Family history of and risk factors for medical conditions and chronic diseases (eg, diabetes, cardiovascular disease, hypertension, osteoporosis, dyslipidemia, obesity, disordered eating, behavioral or mental health issues)XXX
      1.1B2
      • Athlete/professional history of:
      • metabolic and hormonal conditions (eg, diabetes, metabolic syndrome, polycystic ovary syndrome, thyroid abnormalities, exercise-induced asthma)
      • chronic disease clinical factors (eg, mechanical, physiological, or psychological) that may interfere with the ingestion, digestion, absorption, metabolism
      • utilization of nutrients
      • muscular/skeletal injuries (eg, sprains, stress fractures, traumatic injuries)
      • past and recurrent sleep disturbances, insomnia
      • past and current impact of stress on dietary intake
      • body composition
      • menstrual history and status
      XXX
      1.1B3Effect of athlete’s/professional’s condition on ingestion, digestion, and absorption and metabolism of nutrients, including food allergies/intolerances (eg, gluten sensitivity or intolerance, lactose intolerance)XX
      1.1B4Athlete’s/professional’s history of fluid or electrolyte abnormalities (eg, hyponatremia, hypernatremia)X
      1.1B5Athlete/professional undergoing gender transitionX
      1.1CAthlete/professional lifestyle history (eg, use of alcohol or tobacco and recreational drugs)XXX
      1.2Anthropometric assessment: Assesses anthropometric indicators (eg, height, weight, body mass index, waist circumference, arm circumference), comparison with reference data (eg, percentile ranks/z-scores), and individual patterns and history Assesses:XXX
      1.2ABody composition/growth/weight history:

      Assessment measures may include: height, weight, weight change, frame size, waist circumference, growth pattern indices/percentile ranks, body compartment estimates
      XXX
      1.2A1Anthropometric measures, such as skinfold thickness, that require specialized trainingXX
      1.2A2Body compartment estimates/advanced techniques (eg, densitometry [water or air displacement], bioelectrical impedance analysis, dual-energy X-ray absorptiometry)XX
      1.2BInterpretation of body composition for optimal task-specific physical performanceXX
      1.3Biochemical data, medical tests, and procedure assessment: Assesses laboratory profiles (eg, acid-base balance, renal function, endocrine function, inflammatory response, vitamin/mineral profile, microbiome and phytonutrient profile, lipid profile), and medical tests and procedures (eg, gastrointestinal study, metabolic rate) Assesses:XXX
      1.3ARoutine diagnostic tests and therapeutic procedures (eg, vitamin D, ferritin)XXX
      1.3BAppropriateness and recommendation for additional diagnostic tests and therapeutic procedures (eg, complete blood count, comprehensive metabolic panel, endocrine markers, urinary analysis, gastric emptying study, esophagogastroduodenoscopy)XX
      1.3CAppropriateness and recommendation for additional specific diagnostic tests (eg, gluten intolerance, endocrine workup, malabsorption studies, sickle cell trait or disease, bone mineral density)XX
      1.3DAppropriateness of tests: a) for specific populations (eg, age, sex, gender self-identification, periodized training plan, environmental conditions); b) for selection of best-fit equations in producing measurement results; and c) to manage complications (eg, pre-exercise and post-exercise glycemic control in athletes with diabetes)XX
      1.4Nutrition-focused physical examination may include visual and physical examination: Obtains and assesses findings from nutrition-focused physical examination (eg, indicators of vitamin or mineral deficiency or toxicity, edema, muscle wasting, subcutaneous fat loss, altered body composition, oral health, feeding ability [suck/swallow/breathe], appetite, and affect) Assesses:XXX
      1.4AClinical signs of fluid imbalance (eg, skin turgor with dehydration, fatigue, muscle cramps, dark urine, rapid weight change with fluid overload or loss, constipation)XXX
      1.4BClinical signs of nutrition-related chronic disease (eg, acanthosis nigricans, waist circumference, body mass index)XXX
      1.4CClinical signs of malnutrition and undernutrition (eg, lanugo, muscle wasting, dry, brittle, or thinning hair and nails)XXX
      1.4DClinical signs of malnutrition that includes eating disorders and disordered eating (eg, hypothermia, bradycardia, lanugo, muscle wasting, tooth erosion, bony protrusions, postural orthostatic tachycardia syndrome, parotid gland enlargement, gastrointestinal distress, or dry, brittle, or thinning hair and nails)XXX
      1.5Food and nutrition–related history assessment (ie, dietary assessment)

      Evaluates the following components:
      1.5AFood and nutrient intake, including composition and adequacy, meal and snack patterns, and appropriateness related to food allergies and intolerances

      Evaluates:
      XXX
      1.5A1Adequacy of nutrition intake to maintain energy balance under various conditions (eg, recreational sports activities)XXX
      1.5A2Total food and beverage intake (eg, type, amount, and pattern of intake of foods and food groups, indices of diet quality, intake of fluids), including macronutrient nutrient timing and special dietary and beverage patterns associated with recreational sportXXX
      1.5A2iTotal food and beverage intake (eg, type, amount, and pattern of intake of foods and food groups, indices of diet quality, intake of fluids), including nutrient timing and special dietary and beverage patterns associated with training cycle and competition or operational readiness or performance scheduleXX
      1.5A3Athlete/professional history of food allergies/intolerances (eg, gluten sensitivity or intolerance, lactose intolerance)XXX
      1.5A4Current and past use of nicotine, alcohol, specialized diets, sport foods or drinks, energy drinks, functional foods, liquid meal replacements, dietary supplementsXXX
      1.5A5Energy balance assessment to determine energy availability for adequacy of energy intake/expenditure (eg, intake via calorie counts), including changes in body weight or composition, menstrual function, medication use, health status, or attempts at weight gain or lossXXX
      1.5A6Changes in appetite or usual intake (eg, as a result of weight control, alteration in body composition/physique, change in training volume/intensity, travel/jet lag, unfamiliar environments, training cycle and competition or operational readiness or competition schedule, medical conditions, illnesses and injuries, treatment and rehabilitation), and psychological issues (eg, stress, trauma, depression)XX
      1.5A7Special energy and nutrient needs (eg, macronutrients or micronutrients) for task-specific physical performanceXX
      1.5A8Daily fluid needs for task-specific physical performance based on sweat rate, environmental conditions, fluid balance assessments (eg, urine specific gravity), and patterns of fluid replacement (eg, training cycle and competition or operational readiness or competition schedule)XX
      1.5A9Changes in usual intake as a result of dietary manipulation to optimize task-specific physical performance (eg, tapers, carbohydrate loading, glycogen restoration, rehydration, recovery nutrition after pre-competition weigh-in)XX
      1.5BFood and nutrient administration, including current and previous diets and diet prescriptions and food modifications, eating environment, and enteral and parenteral nutrition administration Evaluates:XXX
      1.5B1Diet experience (eg, previously prescribed diets, previous diet or nutrition education or counseling, self-selected diets followed, dieting attempts, food allergies, food intolerances)XXX
      1.5B2Eating environment (eg, culinary skill set, location, atmosphere, caregiver or companion, eats alone)XXX
      1.5B3Nutrition issues that require medical nutrition therapy (MNT) (eg, controlled type 1 diabetes, managed gastrointestinal diseases and conditions) related to food intake and clinical complications in individuals exposed to variable training and task-specific physical performance situationsXX
      1.5B4Multiple or ongoing comorbidities or complications (eg, newly diagnosed type 1 diabetes, uncontrolled diabetes, recovery from injury or illness) related to food intake and clinical complications in one or more individuals or teams and their management within 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, physicians, nurses, dietitian nutritionists, pharmacists, psychologists, social workers, strength and conditioning coaches, certified athletic trainers, and occupational and physical therapists), depending on the needs of the athlete/professional. Interprofessional could also mean interdisciplinary or multidisciplinary.
      treatment or performance enhancement team
      X
      1.5CMedication and dietary supplement use, including prescription and over-the-counter medications, and integrative and functional medicine products Evaluates:XXX
      1.5C1Interactions between diet and prescription and over-the-counter medications, and integrative and functional medicine products in the context of health and performanceXXX
      1.5C2Safety of dietary supplements usedXXX
      1.5C2iActual or potential drug/nutrient/dietary supplement interactionsXXX
      1.5C2iiRisk of adverse events associated with dietary supplement intake; reports all adverse events to the Food and Drug Administration’s Adverse Event Reporting Program and designated medical professionals in accordance with organization policy and guidelinesXXX
      1.5C2iiiDietary supplements for purity and actual or potential risk for contamination or adulteration by considering evaluations by reputable third-party independent organizations (eg, ConsumerLab.com, Natural Medicines Comprehensive Database, Natural Standard, US Pharmacopeial Convention, National Science Foundation International) that certify dietary supplements or test for banned substancesXXX
      1.5C3Efficacy of dietary supplements using evidence-based practice and using other reputable resources (eg, National Institute of Health Office of Dietary Supplements, National Center for Complementary and Alternative Medicine)XXX
      1.5C4Legality of dietary supplements usedXXX
      1.5C4iCompliance with Federal and state laws and regulations (eg, Drug Enforcement Agency [www.dea.gov])XXX
      1.5C4iiCompliance with sport and organization regulations and policies (eg, Department of Defense [DoD], International Olympic Committee [IOC; www.olympic.org], Major League Baseball [www.mlb.com], National Collegiate Athletic Association [NCAA; www.ncaa.org], National Federation of High School Associations [www.nfhs.org], US Anti-Doping Agency [www.usantidoping.org], US Olympic and Paralympic Committee [www.teamusa.org], World Anti-Doping Agency [WADA; www.wada-ama.org])XX
      1.5C4iiiCompliance with occupational regulations and policies (eg, aviation, sky diving, underwater diving)XX
      1.5C5Appropriateness of dietary supplements regimenXXX
      1.5C5iAdding, maintaining, changing, or discontinuing dietary supplement use based on athlete’s or professional’s age, career longevity, level of competitiveness, duty status, training cycle, competitive or operational readiness or performance schedule, and travel scheduleXX
      1.5C4iiDose and timing of medications and dietary supplements relative to meal timing, training cycles, competition or operational readiness, or performance schedules, travel schedules, and time zone changesXX
      1.5DKnowledge, beliefs, and attitudes (eg, understanding of nutrition-related concepts, emotions about food/nutrition/health, body image, preoccupation with food and/or weight, readiness to change nutrition- or health-related behaviors, and activities and actions influencing achievement of nutrition-related goals)

      Evaluates:
      XXX
      1.5D1General food and nutrition knowledge, skills, or strategiesXXX
      1.5D2Risk for or history of eating disorder or disordered eating and related factors (eg, limited food choices, distorted body image, preoccupation with food or nutrients); See Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs in Eating Disorders for additional informationXXX
      1.5D3SHP food and nutrition knowledge, skills, or strategiesXX
      1.5D4Beliefs and attitudes (eg, behavioral mediators or antecedents related to SHP nutrition, intentions, readiness and willingness to change, appropriateness of goals and coping strategies)XX
      1.5D5Knowledge, beliefs, or attitudes that are not evidence-based (eg, misinformation regarding nutrition for task-specific physical performance, weight management, and culture of sport or organization)XX
      1.5D6Risk or history of SHP-related eating disorders and disordered eating factors such as participation in weight class, aesthetic, and weight-to-strength ratio sports and occupations with stringent height and weight standardsX
      1.5EFood security defined as factors affecting access to a sufficient quantity of safe, healthful food and water, as well as food- or nutrition-related supplies Evaluates:XXX
      1.5E1Presence and level of food insecurity (eg, high, marginal, low, and very low) and access to safe, healthful food and meal availability (eg, financial resources, access to farmers’ markets or groceries; access to performance-based menus in institutional food service; procurement of fresh, healthful, and safe food; access to appropriate kitchen, pantry, and equipment for cooking, serving, and safe food storage)XXX
      1.5E2Access to food and nutrition related to living situation (eg, dorm, apartment, hotel, military barracks, austere deployment settings, firehouse)XXX
      1.5E3Safe water availability (eg, international travel, military operations, emergency situations, disaster events) for daily needs, including before, during, and after task-specific physical performanceXX
      1.5FPhysical activity, cognitive and physical ability to engage in developmentally appropriate nutrition-related tasks (eg, self-feeding and other activities of daily living [ADLs]), instrumental activities of daily living (IADLs) (eg, shopping, food preparation), and breastfeeding Evaluates:XXX
      1.5F1Physical limitations affecting shopping and food preparation (eg, visual impairment, immobility)XXX
      1.5F2Availability of community resources to assist and support athlete’s/professional’s limitations in ADLs and IADLsXX
      1.5F3Ability of organization to assist and support athlete’s/professional’s limitations in ADLs and IADLsX
      1.5GOther factors affecting intake and nutrition and health status (eg, cultural, ethnic, religious, lifestyle influencers, psychosocial, and social determinants of health)

      Evaluates:
      XXX
      1.5G1Adherence to goals (eg, self-reported adherence, visit attendance, recall of nutrition goals, self-monitoring, and self-management as agreed on)XXX
      1.5G2Various influences (eg, language, sport or organization culture, ethnicity, religion) that relate to the potential for behavior changeXXX
      1.5G3Sport or organization cultures that relate to the potential for behavior changeXX
      1.5G4Social network, social pressures, perceived social support (eg, ability to use social network, and social life, school, work influences and obligations, teammates, peers, coaches, leadership, sponsors)XX
      1.6Comparative standards: Uses reference data and standards to estimate nutrient needs and recommended body weight, body mass index, and desired growth patternsXXX
      1.6AIdentifies the most appropriate reference data and/or standards (eg, international, national, state, institutional, and regulatory) based on practice setting and athlete-/professional-specific factors (eg, age and disease state)XXX
      1.6A1Evaluates:
      • energy needs, energy balance
      • macronutrient and micronutrient needs
      • fluid needs, hydration guidance, fluid balance, and electrolyte balance
      • weight and growth recommendations, body weight management and guidance in body weight, anthropometrics, and body composition
      • signs and symptoms of the female athlete triad and relative energy deficiency in sport (RED-S)
      • dietary supplements
      XXX
      1.7Physical activity habits and restrictions: Assesses physical activity, history of physical activity, and physical activity training Assesses:XXX
      1.7ANontraining physical activity and exercise history and statusXXX
      1.7A1History of leisure and recreational activitiesXXX
      1.7A2Current status of leisure and recreational activities (eg, frequency, intensity, length, and duration)XXX
      1.7BTraining and performance history and statusXXX
      1.7B1History of SHP trainingXXX
      1.7B2Current status of SHP training (eg, frequency, intensity, length, and duration)XXX
      1.7B3Effect of past and current dietary interventions on SHP performance outcomes, in both training and competition, operations, and performanceXX
      1.7B4History and current status of components of fitness (eg, maximal aerobic capacity, maximal rate of oxygen consumption, or maximal oxygen uptake, strength, power) and sport or occupation benchmark assessments (eg, National Football League [www.nfl.com] Combine, Army Physical Fitness Test, Firefighter’s Work Capacity “pack” Test)XX
      1.7B5Classification level of sport/occupation (eg, developmental or National Team athlete, police academy recruit or special weapons and tactics team member, conventional or special operations forces)XX
      1.7B6Current training cycle and competition, operational readiness, or performance scheduleXX
      1.7CLimitations and special circumstances that affect nutrient intake and utilizationXX
      1.7C1Environmental conditions (eg, altitude training camps, operations in subtropical locations, summer wildland firefighting season)XX
      1.7C2Food availability (eg, international travel, logistics chain constraints)XX
      1.7C3Circadian misalignment and sleep deprivation (eg, shift work, international travel, night operations)XX
      1.7C4Situation-specific stress (eg, international competition stage, combat mission, hostage negotiations, disaster relief)X
      1.7C5Physical disability or limitations (eg, slower gastric emptying and altered sweat response with spinal cord injury, altered thermoregulation and energy requirements with spinal cord injury and amputation)X
      1.8Collects data and reviews data collected and/or documented by the nutrition and dietetics technician, registered, other health care practitioner(s), athlete/professional, or staff for factors that affect nutrition and health statusXXX
      1.9Uses collected data to identify possible problem areas for determining nutrition diagnosesXXX
      1.10Documents and communicates:
      1.10ADate and time of assessmentXXX
      1.10BPertinent data (eg, medical, social, behavioral)XXX
      1.10CComparison with appropriate standardsXXX
      1.10DAthlete/professional or population perceptions, values, and motivation related to presenting problemsXXX
      1.10EChanges in athlete/professional or population perceptions, values, and motivation related to presenting problemsXXX
      1.10FReason for discharge, discontinuation, or referral, if appropriateXXX
      Examples of Outcomes for Standard 1: Nutrition Assessment
      • Appropriate assessment tools and procedures are used in valid and reliable ways
      • Appropriate and pertinent data are collected
      • Effective interviewing methods are used
      • Data are organized and in a meaningful framework that relates to nutrition problems
      • Use of assessment data leads to the determination that a nutrition diagnosis or problem does or does not exist
      • Problems that require consultation with or referral to another provider are recognized
      • Documentation and communication of assessment are complete, relevant, accurate, and timely
      Standard 2: Nutrition Diagnosis

      The registered dietitian nutritionist (RDN) identifies and labels specific nutrition problem(s) or diagnosis(es) that the RDN is responsible for treating.

      Rationale:

      Analysis of the assessment data leads to identification of nutrition problems and a nutrition diagnosis(es), if present. The nutrition diagnosis(es) is the basis for determining outcome goals, selecting appropriate interventions, and monitoring progress. Diagnosing nutrition problems is the responsibility of the RDN.
      Indicators for Standard 2: Nutrition Diagnosis
      Bold font indicators are Academy Core RDN Standards of Practice indicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      2.1Diagnoses nutrition problems based on evaluation of assessment data and identifies supporting concepts (ie, etiology, signs, and symptoms)XXX
      2.1AOrganizes and groups data consisting of intake, clinical, physical function, behavioral–environmental, and other assessmentsXXX
      2.1BIntegrates medical condition(s) (eg, hyperlipidemia, hypertension) when deriving the nutrition diagnosis(es)XXX
      2.1CUses multiple sources of information and data (eg, biochemical, body composition, diagnostic and therapeutic procedures) obtained from assessment when deriving the nutrition diagnosis(es)XX
      2.1DCompares and contrasts findings in formulating a nutrition diagnosis (eg, unintended weight loss associated with increased training volume vs purposeful weight loss via energy restriction)XX
      2.2Prioritizes the nutrition problem(s)/diagnosis(es) based on severity, safety, athlete/professional needs and preferences, ethical considerations, likelihood that nutrition intervention/plan of care will influence the problem, discharge or transitions of care needs, and athlete/professional/advocate
      Advocate: An advocate is a person who provides support and/or represents the rights and interests at the request of the athlete/professional. The person may be a family member or an individual not related to the athlete/professional who is asked to support the athlete/professional with activities of daily living or is legally designated to act on behalf of the athlete/professional, particularly when the athlete/professional has lost decision-making capacity. (Adapted from definitions within The Joint Commission Glossary of Terms15 and the Centers for Medicare and Medicaid Services, Hospital Conditions of Participation6).
      perception of importance

      Uses reasoning and clinical judgment to:
      XXX
      2.2ASelect from a range of possibilities with consideration to SHP when ranking nutrition diagnoses in order of importance and urgency for the athlete/professionalXXX
      2.2BDetermine differences in various levels of athletes/professionals or clinical conditions (eg, newly diagnosed type 1 diabetes, uncontrolled type 1 diabetes, extreme environmental conditions, clinical complications) when ranking nutrition diagnoses in order of importance and urgency for the athlete/professionalXX
      2.2CLead interprofessional team discussions to address nutrition needs and plans of care for athletes/professionals with multiple complex care issues to achieve positive outcomesX
      2.3Communicates the nutrition diagnosis(es) to athlete/professional, advocates, community, family members, or other health care professionals when possible and appropriateXXX
      2.3AConfirms and provides evidence to substantiate the nutrition diagnosis(es) with athlete/professional, family members, or other health care professionals (eg, interprofessional team) when possible and appropriateXXX
      2.3BReports implications of nutrition diagnosis(es) to organization leadership on impact to training cycle or competition, operational readiness, or performance schedule within HIPAA limitationsXX
      2.4Documents the nutrition diagnosis(es) using standardized terminology and clear, concise written statement(s) (eg, using Problem [P], Etiology [E], and Signs and Symptoms [S] [PES statement(s)] or Assessment [A], Diagnosis [D], Intervention [I], Monitoring [M], and Evaluation [E] [ADIME statement(s)])XXX
      2.4AUses the electronic Nutrition Care Process Terminology (http://www.ncpro.org/) for reporting nutrition diagnosis and terminology whenever possibleXXX
      2.5Reevaluates and revises nutrition diagnosis(es) when additional assessment data become availableXXX
      2.5ACommunicates new information with nutrition implications with the athlete/professional, the interprofessional team, and other health care practitioners (eg, behavioral, medical, physical therapist), and coaches and leadership, as applicableXXX
      Examples of Outcomes for Standard 2: Nutrition Diagnosis
      • Nutrition Diagnostic Statements accurately describe the nutrition problem of the athlete/professional or organization in a clear and concise way
      • Documentation of nutrition diagnosis(es) is relevant, accurate, and timely
      • Documentation of nutrition diagnosis(es) is revised as additional assessment data become available
      • Provision of relevant, accurate, and timely communication with appropriate stakeholders following HIPAA protocol
      Standard 3: Nutrition Intervention/Plan of Care

      The registered dietitian nutritionist (RDN) identifies and implements appropriate, person-centered interventions designed to address nutrition-related problems, behaviors, risk factors, environmental conditions, or aspects of health status for an individual, target group, or the community at large.

      Rationale:

      Nutrition intervention consists of two interrelated components—planning and implementation.
      • Planning involves prioritizing the nutrition diagnoses, conferring with the athlete/professional and others, reviewing practice guidelines, protocols, and policies, setting goals, and defining the specific nutrition intervention strategy.
      • Implementation is the action phase that includes carrying out and communicating the intervention/plan of care, continuing data collection, and revising the nutrition intervention/plan of care strategy, as warranted, based on change in condition and/or the athlete/professional response.
      An RDN implements the interventions or assigns components of the nutrition intervention/plan of care to professional, technical, and support staff in accordance with knowledge, skills, and judgment, applicable laws and regulations, and organization policies. The RDN collaborates with or refers to other health care professionals and resources. The nutrition intervention or plan of care is ultimately the responsibility of the RDN.
      Indicators for Standard 3: Nutrition Intervention
      Bold font indicators are Academy Core RDN Standards of Practice indicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      Plans the Nutrition Intervention/Plan of Care:
      3.1Addresses the nutrition diagnosis(es) by determining and prioritizing appropriate interventions for the plan of careXXX
      Prioritization considerations may include:
      3.1AImmediacy of the problemXXX
      3.1BAthlete’s/professional’s available resources and supportXXX
      3.1CReadiness of athlete/professional to receive selected nutrition interventionsXXX
      3.1DPresence of medical conditions (eg, diabetes, dyslipidemia, depression, eating disorders, low bone mass, anemia, gastrointestinal conditions and disease, autoimmune disease, musculoskeletal injury)XX
      3.1ETiming of the problem relative to training cycle and competition, operational readiness, or performance scheduleX
      3.1FPrediction of potential effects of future health and performance outcomes (eg, gastrointestinal problems, dehydration, glycogen depletion, diminished mental or physical performance, nutrient or dietary supplement–drug interactions, late effects of treatments such as weight loss or gain, compromised immune system, suboptimal training adaptation)X
      3.2Bases intervention/plan of care on best available research or evidence and information, evidence-based guidelines, and best practicesXXX
      3.2AUses professional judgment that draws from scientific literature and practice experience applicable to specific athlete’s/professional’s unique status and circumstances in developing an intervention plan; seeks assistance from experienced practitioner if neededXXX
      3.2BRecognizes when it is appropriate and safe to deviate from established nutrition guidelines and evidence-supported SHP practices; seeks assistance from experienced practitioner if neededXX
      3.3Refers to policies and procedures, protocols, and program standardsXXX
      3.3AAssesses for adverse events associated with dietary supplement intakeXXX
      3.3BComplies with sport and organization guidance, regulations, and policies regarding food and nutrition and dietary supplements (eg, DoD, IOC, Major League Baseball [www.mlb.com], NCAA, National Federation of High School Associations [www.nfhs.org], US Anti-Doping Agency [www.usantidoping.org], US Olympic and Paralympic Committee [www.teamusa.org], World Anti-Doping Agency [www.wada-ama.org])XX
      3.3CEducates athletes/professionals and others regarding applicable organization guidance and regulations concerning use of dietary supplements, including banned or prohibited substances for specific athletic and tactical populations (eg, NCAA, Olympic and professional athletes, and DoD service members)XX
      3.4Collaborates with athlete/professional, advocate, or population, caregivers, interprofessional team, and other health care professionalsXXX
      3.4ARecognizes specific knowledge and skills of interprofessional team members, and collaborates to provide comprehensive careXXX
      3.4BProvides rationales for nutrition interventions to colleagues and interprofessional team membersXX
      3.5Works with athlete/professional, advocate, or organization to identify goals, preferences, discharge or transitions of care needs, plan of care, and expected outcomesXXX
      3.5AConducts thorough analysis of athlete's/professional’s expectations in context of organization competition, operational readiness, or performance scheduleXX
      3.6Develops the nutrition prescription and establishes measurable athlete-/professional–focused goals to be accomplishedXXX
      3.6AConsiders the educational needs of the athlete/professional, including cultural competencyXXX
      3.6BPlans intervention to address current issues (eg, fatigue, dehydration, muscle cramping, inadequate recovery, exercise, task-specific physical performance improvement and training adaptation, diarrhea and other gastrointestinal issues, illness, injury, disordered eating, female athlete triad, RED-S, dietary supplement use, or other clinical issues)XXX
      3.6CSelects intervention strategies that are based on evidence, best practices, and professional experienceXXX
      3.6C1Identifies barriers to successful implementation (eg, athlete/professional compliance, time constraints, food availability, storage, and culinary skill set, financial issues, regulations of sport governing bodies and associations, organization culture and policies, situations in occupational settings, athlete/professional influencer dynamics)XXX
      3.6C2Balances short-term task-specific physical performance goals with long-term career longevity goals and outcomesXX
      3.6DAddresses issues related to off-season or transition body composition changes, detraining, and scheduled and unscheduled breaks in training such as holidays, post-deployment military block leave, and extended travelXX
      3.6EDevelops and implements strategies to minimize barriers and other issues, using concepts of the three components of the SHP program model (eg, timing of intervention relative to annual training and competition, operational readiness, or performance schedule and travel plans; prevent treatment delays; reduce relapse; and reduce the need for more advanced/involved treatment options)XX
      3.7Defines time and frequency of care, including intensity, duration, and follow-upXXX
      3.7AIdentifies time and frequency for ordering and monitoring results of diagnostic tests or procedures and laboratory tests, based on athlete/professional needs, established goals and outcomes, and expected response to intervention(s), reflecting organization or program policies or regulations when applicableXX
      3.7BConsiders organization’s talent development and longitudinal health and performance surveillance strategies when ordering laboratory tests and proceduresX
      3.8Uses standardized terminology for describing interventionsXXX
      3.8AUses standardized electronic Nutrition Care Process Terminology, when applicable, and other SHP terms to describe interventionsXX
      3.9Identifies resources and referrals neededXXX
      3.9ACollaborates with and refers to qualified RDNs for complex cases (eg, eating disorders, nutrition support, diabetes, oncology)XXX
      3.9BIdentifies resources to assist athlete/professional in using available resources (eg, meal preparation or delivery services, websites)XXX
      3.9CUnderstands the role of various disciplines (eg, strength and conditioning, physical therapy, athletic training, cognitive performance, foodservice) to facilitate appropriate referrals as neededXXX
      Implements the Nutrition Intervention or Plan of Care:
      3.10Collaborates with colleagues, interprofessional team, and other health care professionalsXXX
      3.10AParticipates in communications within the interprofessional team or performance enhancement teamXXX
      3.10BFacilitates and fosters active communication, learning partnerships, and collaboration with the interprofessional team or with other providers or consultants within the SHP program conceptXXX
      3.10CSeeks opportunities to collaborate and share information that supports the integration of SHP nutrition with other discipline interventions, particularly when results are not being achieved (eg, expected training adaptations or rehabilitation outcomes)XX
      3.10DIdentifies and seeks opportunities for external and interagency collaboration, specific to the athlete’s/professional’s needsX
      3.11Communicates and coordinates the nutrition intervention/plan of careXXX
      3.11ACommunicates nutrition intervention/plan of care with athlete/professionalXXX
      3.11BCommunicates and coordinates nutrition intervention/plan of care with appropriate members of the interprofessional team or performance enhancement team, particularly for awareness of potentially conflicting or problematic interventions (eg, increased energy intake to facilitate healing process and decreased need for energy intake because of injury-induced decreased training volume or intensity)XX
      3.11CCoordinates nutrition intervention/plan of care with training cycle and competition, operational readiness, and performance schedule and with rehabilitation during recovery from illness or injuryXX
      3.11DCommunicates nutrition intervention/plan of care with coaches and leadership within regulatory limitations; seeks support when neededXX
      3.12Initiates and individualizes the nutrition intervention/plan of careXXX
      3.12AUses approved clinical privileges, physician or 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, qualified dietitian or qualified nutrition professional, occupational and physical therapists. Disciplines considered for privileging by a facility’s governing body and medical staff must be in accordance with state law.6,7
      –driven orders (ie, delegated orders), protocols, or other facility-specific processes for order writing or for provision of nutrition-related services consistent with applicable specialized training, competence, medical staff, and/or organizational policy
      XXX
      3.12A1Implements, initiates, or modifies orders for therapeutic diet, nutrition-related pharmacotherapy management, or nutrition-related services (eg, food texture modifications, intravenous fluid infusions, laboratory tests, and medications)XXX
      3.12A1iUses physician- or referring practitioner–driven protocols to manage the use of dietary supplements, sports and functional foods (eg, portion or dosage adjustments based on energy needs, anthropometric data, or laboratory results; addition of new dietary supplements, sports foods, functional foods; or modifications for fluid intake) consistent with organization policy, if applicableXXX
      3.12A2Manages nutrition therapies (eg, medical foods, dietary supplements [vitamins and minerals], and oral nutrition supplements); collaborates with or refers to an applicable expert RDN when appropriateXXX
      3.12A3Initiates and performs nutrition-related services (eg, education, health and wellness coaching, and counseling)XXX
      3.12BUses appropriate goal setting and behavior change strategies and techniques to facilitate self-management and self-careXXX
      3.12CUses critical thinking and synthesis skills to guide decision making in routine situations integrating nutrition with task-specific physical performanceXX
      3.12DUses critical thinking and synthesis skills to guide decision making in MNT issues (eg, controlled type 1 diabetes, managed gastrointestinal conditions and diseases)XX
      3.12EUses critical thinking and synthesis skills to guide decision making in multiple or unmanaged MNT issues, and dynamic situations (eg, newly diagnosed type 1 diabetes, uncontrolled diabetes, extreme environmental conditions, clinical complications)X
      3.13Assigns activities to nutrition and dietetics technician, registered, and other professional, technical, and support personnel in accordance with qualifications, organization policies or protocols, and applicable laws and regulationsXXX
      3.13ASupervises support personnelXXX
      3.13BProvides professional, technical, and support personnel with information and guidance needed to complete assigned activities (eg, collecting and reporting anthropometric data, purchase and distribution of dietary supplements, or managing fueling stations)XX
      3.14Continues data collectionXXX
      3.14AIdentifies and records specific data collection for athlete/professional, including weight change, biochemical, behavioral, and lifestyle factors, using prescribed and standardized formatXXX
      3.14BIdentifies and records specific data collection for athlete/professional, including training cycle, and competition, operational readiness, or performance schedule, using prescribed, standardized formatXX
      3.15Documents:
      3.15ADate and timeXXX
      3.15BSpecific and measurable treatment goals and expected outcomesXXX
      3.15CRecommended interventionsXXX
      3.15DAthlete/professional/advocate/caregiver/community receptivenessXXX
      3.15EReferrals made and resources usedXXX
      3.15FAthlete/professional, advocate, caregiver, and community comprehensionXXX
      3.15GBarriers to changeXXX
      3.15HOther information relevant to providing care and monitoring progress over timeXXX
      3.15IPlans for follow-up and frequency of careXXX
      3.15JRationale for discharge or referral, if applicableXXX
      Examples of Outcomes for Standard 3: Nutrition Intervention/Plan of Care
      • Goals and expected outcomes are appropriate and prioritized
      • Athlete/professional, advocate, population, caregivers, and interprofessional teams collaborate and are involved in developing nutrition intervention/plan of care
      • Appropriate individualized athlete-/professional-centered nutrition intervention/plan of care, including nutrition prescription, is developed
      • Nutrition intervention/plan of care is delivered, and actions are carried out as intended
      • Discharge planning and transitions of care needs are identified and addressed
      • Documentation of nutrition intervention/plan of care is:
        • Specific
        • Measurable
        • Attainable
        • Relevant
        • Timely
        • Comprehensive
        • Accurate
        • Dated and timed
      Standard 4: Nutrition Monitoring and Evaluation

      The registered dietitian nutritionist (RDN) monitors and evaluates indicators and outcomes data directly related to the nutrition diagnosis, goals, preferences, and intervention strategies, to determine the progress made in achieving desired results of nutrition care and whether planned interventions should be continued or revised.

      Rationale:

      Nutrition monitoring and evaluation are essential components of an outcomes management system to assure quality athlete-/professional- or population-centered care and to promote uniformity within the profession in evaluating the efficacy of nutrition interventions. Through monitoring and evaluation, the RDN identifies important measures of change or outcomes relevant to the nutrition diagnosis and nutrition intervention/plan of care; describes how best to measure these outcomes; and intervenes when the intervention/plan of care requires revision.
      Indicators for Standard 4: Nutrition Monitoring and Evaluation
      Bold font indicators are Academy Core RDN Standards of Practice indicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      4.1Monitors progress:
      4.1AAssesses athlete/professional understanding and compliance with nutrition intervention/plan of careXXX
      4.1A1Assesses compliance with recommended energy, fluid, and dietary supplement amounts and timingXXX
      4.1BDetermines whether the nutrition intervention/plan of care is being implemented as prescribedXXX
      4.1B1Evaluates implementation of nutrition intervention plan in all levels of athletes/professionals relative to training and task-specific physical performance issues; seeks assistance if neededXXX
      4.1B2Evaluates implementation of nutrition intervention plan in athletes/professionals balancing multiple situations (eg, environmental extremes, rapid weight changes, travel, sporting events, disaster or emergency situations, military operations, and/or clinical complications); seeks assistance from experienced practitioner if neededXX
      4.1B3Evaluates implementation of nutrition intervention plan in athletes/professionals with MNT issues (eg, controlled diabetes, managed gastrointestinal conditions and diseases)XX
      4.2Measures outcomes:
      4.2ASelects the standardized nutrition care measurable outcome indicator(s)

      Considers:
      XXX
      4.2A1Physical measures I (eg, weight maintenance, body weight, anthropometric measures, body composition changes, laboratory values)XXX
      4.2A2Physical measures II (eg, fluid and electrolyte balance, bone density) relative to physical and task-specific physical performance indicatorsXX
      4.2A3Behavioral and treatment outcomes (eg, minimize barriers, prevent treatment delays, reduce relapse, and the need for more advanced or involved treatment options)XX
      4.2A4Quality of life and task-specific physical performance indicators (eg, full participation in sport or work assignment, improved mood and cognitive function, progress in rehabilitation, minimization of fatigue, absence of muscle cramping, avoidance of gastrointestinal problems)X
      4.2BIdentifies positive or negative outcomes, including impact on potential needs for discharge or transitions of careXXX
      4.2B1Documents progress in meeting desired goals (eg, energy balance, fluid, nutrient intake, body weight, anthropometric measures, body composition, overall performance)XXX
      4.2B2Determines whether outcomes meet expectationsXX
      4.2B3Identifies unintended consequences (eg, not meeting set weight class goal for competition) or the use of inappropriate methods of achieving goalsX
      4.3Evaluates outcomes:
      4.3ACompares monitoring data with nutrition prescription and established goals or reference standardXXX
      4.3A1Uses athlete’s/professional’s current and historical data and trends to evaluate against reference standardsXX
      4.3BEvaluates impact of the sum of all interventions on overall athlete/professional or population health outcomes and goalsXXX
      4.3B1Evaluates sum of all interventions against overall organization outcomes and goalsXX
      4.3CEvaluates progress or reasons for lack of progress related to problems and interventionsXXX
      4.3C1Uses multiple data sources to evaluate progress; examples may include:
      • nutrition-focused physical examination, including but not limited to signs of fluid, energy, or nutrition depletion or excess
      • adequacy of energy and nutrient intake from all sources
      • fluid and electrolyte balance
      • gastrointestinal tolerance
      • changes in body weight, anthropometric measures, body composition
      • signs and symptoms of disordered eating, the female athlete triad, and RED-S
      Seeks assistance if needed
      XXX
      4.3C2Uses multiple data sources to evaluate progress in more complex situations; examples may include:
      • pertinent medications and dietary supplements and implementation of nutrition intervention
      • effects of intervention on task-specific physical performance and recovery
      • effects of intervention on progress in rehabilitation and recovery from injury
      XX
      4.3C3Considers organization’s culture, policies, and procedures (eg, organization cultural aversion to seeking follow-up care, lack of organization support for dedicated time required for intervention)X
      4.3DEvaluates evidence that the nutrition intervention/plan of care is maintaining or influencing a desirable change in the athlete/professional or population behavior or statusXXX
      4.3D1Monitors and interprets laboratory and other data that may reflect a change in the athlete’s/professional’s behavior or statusXXX
      4.3D2Monitors factors (eg, physical, social, cognitive, environmental) that may reflect a change affected by the nutrition interventionXXX
      4.3ESupports conclusions with evidenceXXX
      4.3E1Documents processes and outcomes using PES statementsXXX
      4.4Adjusts nutrition intervention/plan of care strategies, if needed, in collaboration with athlete/professional, population, advocate, or caregiver and interprofessional teamXXX
      4.4AImproves or adjusts intervention/plan of care strategies based on outcomes data, trends, best practices, and comparative standardsXXX
      4.4BModifies nutrition intervention based on athlete/professional tolerance, response, environmental limitations, changes to training cycle, and competition, operational readiness, or performance schedule, and outcome measures with regard to documented goals and objectivesXX
      4.4CAdjusts intervention strategies by drawing on experience, clinical judgment, and research- or evidence-based practice guidelines about the athlete/professional populations in complicated and unpredictable situations (eg, pregnancy, eating disorders, cancer)X
      4.5Documents:
      4.5ADate and timeXXX
      4.5BIndicators measured, results, and the method for obtaining measurementXXX
      4.5CCriteria with which the indicator is compared (eg, nutrition prescription or goal or a reference standard)XXX
      4.5DFactors facilitating or hampering progressXXX
      4.5EOther positive or negative outcomesXXX
      4.5FAdjustments to the nutrition intervention/plan of care, if indicatedXXX
      4.5GFuture plans for nutrition care, nutrition monitoring and evaluation, follow-up, referral, or dischargeXXX
      Examples of Outcomes for Standard 4: Nutrition Monitoring and Evaluation
      • The athlete/professional outcome(s) directly relate to the nutrition diagnosis and the goals established in the nutrition intervention/plan of care. Examples include, but are not limited to:
        • Nutrition outcomes (eg, change in knowledge, behavior, food, or nutrient intake)
        • Clinical and health status outcomes (eg, change in laboratory values, body weight, blood pressure, risk factors, signs and symptoms, clinical status, infections, complications, morbidity, and mortality)
        • Athlete-/professional-centered outcomes (eg, quality of life, satisfaction, self-efficacy, self-management, functional ability)
      • Nutrition intervention/plan of care and documentation is revised, if indicated
      • Documentation of nutrition monitoring and evaluation is:
        • Specific
        • Measurable
        • Attainable
        • Relevant
        • Timely
        • Comprehensive
        • Accurate
        • Dated and timed
      a Interprofessional: The term interprofessional is used in this evaluation resource as a universal term. It includes a diverse group of team members (eg, physicians, nurses, dietitian nutritionists, pharmacists, psychologists, social workers, strength and conditioning coaches, certified athletic trainers, and occupational and physical therapists), depending on the needs of the athlete/professional. Interprofessional could also mean interdisciplinary or multidisciplinary.
      b Advocate: An advocate is a person who provides support and/or represents the rights and interests at the request of the athlete/professional. The person may be a family member or an individual not related to the athlete/professional who is asked to support the athlete/professional with activities of daily living or is legally designated to act on behalf of the athlete/professional, particularly when the athlete/professional has lost decision-making capacity. (Adapted from definitions within The Joint Commission Glossary of Terms
      The Joint Commission
      Glossary.
      and the Centers for Medicare and Medicaid Services, Hospital Conditions of Participation
      State Operations Manual
      Appendix A-Survey protocol, regulations and interpretive guidelines for hospitals (Rev. 200, 02-21-20); §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.
      ).
      c 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, qualified dietitian or qualified nutrition professional, occupational and physical therapists. Disciplines considered for privileging by a facility’s governing body and medical staff must be in accordance with state law.
      State Operations Manual
      Appendix A-Survey protocol, regulations and interpretive guidelines for hospitals (Rev. 200, 02-21-20); §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.200, 02-21-20); §485.635(a)(3)(vii) Dietary Services; §458.635 (d)(3) Verbal Orders; §458.635 (d)(9) Swing-Beds. US Department of Health and Human Services, Centers for Medicare and Medicaid Services.
      Figure 2Standards of Professional Performance for Registered Dietitian Nutritionist in Sports and Human Performance Nutrition. Note: The term customer is used in this evaluation resource as a universal term. Customer could also mean athlete/professional; client or patient; client, patient, or customer; participant; consumer; or any individual, group, or organization for whom the RDN provides service. Sub-indicators refer to “in the context of the sports and human performance nutrition” (ie, majority of responsibilities or actions are not intended to be entry level).
      Standards of Professional Performance for Registered Dietitian Nutritionists in Sports and Human Performance Nutrition

      Standard 1: Quality in Practice

      The registered dietitian nutritionist (RDN) 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 indicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      1.1Complies with applicable laws and regulations as related to their area(s) of practiceXXX
      1.1AComplies with Health Insurance Portability and Accountability Act (HIPAA) and organization’s regulations and standards regarding sharing of protected health information and personally identifiable informationXXX
      1.1BComplies with state licensure or certification laws and regulations, if applicable, including telehealth and continuing education requirementsXXX
      1.1CAddresses dietary supplement products to ensure compliance with anti-doping rules and regulations of sports organizations and governing bodies (eg, International Olympic Committee [IOC; www.olympic.org], International Paralympic Committee [IPC; www.paralympic.org], National Collegiate Athletic Association [NCAA], National Federation of High School Associations [NFHS; www.nfhs.org], US Anti-Doping Agency [USADA; www.usantidoping.org],

      US Olympic and Paralympic Committee [USOPC; http://www.teamusa.org/], World Anti-Doping Agency [WADA; www.wda-ama.org])
      XX
      1.2Performs within individual and statutory scope of practice and applicable laws and regulationsXXX
      1.2ADemonstrates competence to practice within job description and contract, and maintains qualifications, as outlined in contractual statements of work or position descriptionXXX
      1.2BFollows any scope of practice requirements related to additional credentialing or position (eg, Certified Specialist in Sport Dietetics [CSSD], Certified Strength and Conditioning Coach [CSCC])XX
      1.3Adheres to sound business and ethical billing practices applicable to the role and settingXXX
      1.3AAssures ethical and accurate reporting of SHP nutrition services (eg, billing codes) and compliance with contracts or funder requirements, when applicableXXX
      1.4Uses national quality and safety data (eg, National Academies of Sciences, Engineering, and Medicine: Health and Medicine Division, National Quality Forum, Institute for Healthcare Improvement) to improve the quality of services provided and to enhance customer-centered servicesXXX
      1.5Uses a systematic performance improvement model that is based on practice knowledge, evidence, research, and science for delivery of the highest quality servicesXXX
      1.5AIdentifies performance improvement criteria to monitor effectiveness of servicesXXX
      1.5BAssists in designing performance improvement programs that use evidence-based protocols to evaluate effectiveness of servicesXX
      1.5CDevelops implementation strategies and leads quality improvement activities (eg, identification and adaptations of evidence-based practice guidelines and protocols, skills training or reinforcement, organization support and incentives)X
      1.5DAssures completeness of organization testing protocols (ie, proactive, active, and reactive component relevant tests) within regulatory standards and for integration with other multidisciplinary testingX
      1.6Participates in or designs an outcomes-based management system to evaluate safety, effectiveness, quality, person-centeredness, equity, timeliness, and efficiency of practiceXXX
      1.6AInvolves colleagues and others, as applicable, in systematic outcomes managementXXX
      1.6A1Participates in and/or uses collected data as part of a quality improvement process relative to outcomes, quality of care, and services renderedXXX
      1.6A2Engages organization leadership in developing and monitoring outcomes-based management systemsXX
      1.6A3Engages organization data analysts to evaluate both relative and absolute differences of outcomes data between different subpopulations to monitor program equityX
      1.6BDefines expected outcomesXXX
      1.6B1Considers available resources (eg, time, personnel, infrastructure) when developing expected outcomesXX
      1.6B2Considers organization mission, vision, objectives, and values when defining expected outcomesX
      1.6CUses indicators that are specific, measurable, attainable, realistic, and timely (S.M.A.R.T.)XXX
      1.6C1Identifies and promotes use of evidence-based evaluation criteria applicable to SHP nutritionXXX
      1.6C2Relates program outcomes to multilevel outcomes (eg, organization, program, and/or individual outcomes or needs)XX
      1.6DMeasures quality of services in terms of structure, process, and outcomesXXX
      1.6D1Collects data to evaluate, improve, and document outcomes and servicesXXX
      1.6D2Practices in accordance with the goals and objectives of continuous quality improvementXXX
      1.6D3Considers short-, medium-, and long-term outcomes, including cost-effectiveness, collaborating with interprofessional
      Interprofessional: The term interprofessional is used in this evaluation resource as a universal term. It includes a diverse group of team members (eg, physicians, nurses, dietitian nutritionists, pharmacists, psychologists, social workers, strength and conditioning coaches, certified athletic trainers, and occupational and physical therapists), depending on the needs of the athlete/professional. Interprofessional could also mean interdisciplinary or multidisciplinary.
      team and others
      XX
      1.6D4Initiates and/or facilitates the development and evaluation of processes and outcomesXX
      1.6D5Monitors and evaluates data against expected outcomes; adjusts processes based on resultsXX
      1.6D6Leads in educating and mentoring practitioners in measuring SHP nutrition processes to determine effectivenessX
      1.6D7Ensures quality of service measures are aligned with organization mission, vision, and objectivesX
      1.6D8Incorporates SHP nutrition-relevant return on investment measures into evaluation of processes and outcomesX
      1.6EIncorporates electronic clinical quality measures to evaluate and improve care of athlete/professional at risk for malnutrition or with malnutrition (www.eatrightpro.org/emeasures)XXX
      1.6E1Ensures that screening for nutrition risk (eg, anemia, relative energy deficiency in sport [RED-S]) is a component of program admission process or nutrition assessment using evidence-based screening tools for the setting or populationXXX
      1.6E2Collects data using quality measures applicable to population and setting (eg, screening timeframes, number at risk or with malnutrition, and services provided [eg, nutrition assessment, nutrition and/or dietary supplements, nutrition counseling])XX
      1.6FDocuments outcomes and patient-reported outcomes (eg, PROMIS
      PROMIS: The Patient-Reported Outcomes Measurement Information System (PROMIS) (https://commonfund.nih.gov/promis/index) 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
      1.6F1Documents objective and subjective outcomes in accordance with organization policies and standardsXXX
      1.6GParticipates in, coordinates, or leads program participation in local, regional, or national registries and data warehouses used for tracking, benchmarking, and reporting service outcomesXXX
      1.6G1Directs the development, monitoring, and evaluation of practice-specific benchmarks (eg, appropriate hydration practices, body weight and body composition management strategies) relevant to national initiatives (eg, Academy, Dietitians of Canada, American College of Sport Medicine [ACSM; http://www.acsm.org], NCAA, sports organizations and governing bodies, and occupational organizations) to improve outcomesXX
      1.6HAdvocates for and participates in developing a system for clinical, operational, and financial data collection and analysis on which outcomes can be derived, reported, and used for improvementXX
      1.7Identifies and addresses potential and actual errors and hazards in provision of services or brings to attention of supervisors and team members as appropriateXXX
      1.7ARecognizes potential drug–nutrient interactions, dietary supplement safety and interactions, and potential interactions between interventions and other therapies as potential hazards; provides education and counseling as appropriateXXX
      1.7BEvaluates dietary supplement product and manufacturing practices, quality control, error prevention recommendations (eg, as provided by The Institute for Safe Medication Practices [www.ismp.org], the Food and Drug Administration, the US Pharmacopeial Convention [www.usp.org])XXX
      1.7CReports dietary supplement adverse events to the Food and Drug Administration’s Adverse Event Reporting System and appropriate medical provider per organization guidelinesXXX
      1.7DAddresses and documents the potential for errors and hazards, and implements corrective or preventive measures (eg, education programs, system alerts) with periodic audits or according to organization policy; works with organization staff to reduce errors and hazardsXX
      1.7EReviews dietary supplement products to ensure compliance with organization drug abuse programs, policies, and guidelinesXX
      1.7FDevelops protocols to identify, address, and prevent errors and hazards in the delivery of SHP nutrition servicesX
      1.8Compares actual performance to performance goals (ie, gap analysis, SWOT analysis [strengths, weaknesses, opportunities, and threats], PDCA Cycle [plan-do-check-act], DMAIC [define, measure, analyze, improve, control])XXX
      1.8AReports and documents action plan to address identified gaps in care and/or service performanceXXX
      1.8BCompares individual performance with self-directed goals and expected outcomes and improvement recommendationsXXX
      1.8CCompares department or organization performance with goals and expected outcomes to identify improvement recommendations or actions in collaboration with interprofessional team and other stakeholdersXX
      1.8DBenchmarks department or organization performance with national programs and standardsXX
      1.9Evaluates interventions and workflow process(es) and identifies service and delivery improvementsXXX
      1.9AEngages athletes/professionals in intervention evaluations (eg, athlete/professional satisfaction surveys) to identify service and delivery improvementsXXX
      1.9BApplies performance improvement and research data to SHP nutrition practice to improve effectiveness and efficiencyXX
      1.9CDesigns and implements nutrition evaluation protocols, analyzes data, and implements improvementsX
      1.10Improves or enhances athlete/professional or population care and/or services, working with others based on measured outcomes and established goalsXXX
      1.10AEvaluates and improves professional performance in relation to established outcomes of quality in SHP nutrition servicesXXX
      1.10BAssesses outcomes to identify areas that need improvement in SHP nutrition servicesXXX
      1.10CDirects the development and management of systems, processes, and programs that advance best practices and the core values and objectives of SHP nutrition servicesXX
      1.10DLeads local, state, national, or international quality initiative efforts to support goals and best practices of SHP nutritionX
      Examples of Outcomes for Standard 1: Quality in Practice
      • Actions are within scope of practice and applicable laws and regulations
      • National quality standards and best practices are evident in customer-centered services
      • Performance improvement systems specific to program(s) or service(s) are established and updated as needed; are evaluated for effectiveness in providing desired outcomes data and striving for excellence in collaboration with other team members
      • Performance indicators are specific, measurable, attainable, realistic, and timely (S.M.A.R.T.)
      • Aggregate outcomes results meet preestablished criteria
      • Quality improvement results direct refinement and advancement of practice
      Standard 2: Competence and Accountability

      The registered dietitian nutritionist (RDN) demonstrates competence in and accepts accountability and responsibility for ensuring 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 indicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      2.1Adheres to the code(s) of ethics (eg, Academy/Commission on Dietetic Registration [CDR], other national organizations, and/or employer code of ethics)XXX
      2.1ADiscloses any financial relationships regarding the sale or recommendation of food, beverages, and/or dietary supplements to athlete/professional or organizationXXX
      2.1BInforms athlete/professional or organization on the availability of products being recommended as well as equivalent products on the marketXXX
      2.1CEnsures compliance with organization policies regarding contact with industry in all vendor interactionsXX
      2.1DConsiders organization’s sponsorship or endorsement exclusivity agreementsX
      2.2Integrates the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) into practice, self-evaluation, and professional developmentXXX
      2.2AIntegrates applicable focus area(s) SOP and/or SOPP into practice (www.eatrightpro.org/sop)XXX
      2.2A1Uses the SOP and SOPP for RDNs in SHP Nutrition to:
      • assess performance at the appropriate level of practice
      • develop and implement a professional development plan to enhance practice and performance
      • develop and implement a professional development plan to advance practice and performance to a higher level
      XXX
      2.2A2Develops and/or maintains department or organization policy, guidelines, resource materials (eg, position description or agency nutrition service performance standards, career ladders, acceptable performance level) reflecting the SOP and SOPP for RDNs in SHP Nutrition and evidence-based research and best practicesXX
      2.2A3Develops performance criteria for employment setting and for nutrition programs within local, state, and/or federal agencies, reflecting levels of practice described in the SOP and SOPP for RDNs in SHP NutritionX
      2.3Demonstrates and documents competence in practice and delivery of customer-centered service(s)XXX
      2.3ASeeks out qualified peers to demonstrate and document competencyXXX
      2.4Assumes accountability and responsibility for actions and behaviorsXXX
      2.4AIdentifies, acknowledges, and corrects errorsXXX
      2.4BRecognizes and informs athlete/professional or organization of strengths and limitations of current information, research, and evidence when making recommendations; seeks assistance if neededXXX
      2.4CEvaluates RDNs in SHP nutrition performance based on level of education, skills, and performance requirements when in supervisory or management positionXX
      2.4DDevelops and implements policies and procedures that ensure staff accountability and responsibilityXX
      2.5Conducts self-assessment at regular intervalsXXX
      2.5AIdentifies needs for professional developmentXXX
      2.5A1Uses self-assessment tools to evaluate personal and professional factors (eg, personality type, communication style, management style)XXX
      2.5A2Uses self-assessment tools to evaluate SHP nutrition professional knowledge, skill, and practice consistent with best practices and research findings according to level of practice (eg, Academy’s Scope of Practice Decision Algorithm)XXX
      2.5A3Engages in self-assessment to ascertain progress in meeting desired performance outcomesXXX
      2.5BSeeks opportunities for professional development by reviewing evidence-based guidelines, and current research findings, consistent with identified needs and career goalsXXX
      2.5CSeeks opportunities for multi-source feedback when in supervisory or management positionsXX
      2.6Designs and implements plans for professional developmentXXX
      2.6ADevelops plan and documents professional development activities in career portfolio (eg, organizational policies and procedures, credentialing agency[ies])XXX
      2.6A1Documents, in professional development plan, activities that demonstrate professional responsibilities at the appropriate level of practiceXXX
      2.6A2Reviews current literature and education materials specific to SHP nutrition (eg, peer-reviewed articles, textbook chapters, books, podcasts, and webinars from content experts); consults with RDN experienced in SHP nutrition as neededXXX
      2.7Engages in evidence-based practice and uses best practicesXXX
      2.7AUses evidence, including research, national guidelines, policies, consensus statements, systematic analysis of clinical experience, quality improvement data, and specialized knowledge and skills of experts from organizations such as, but not limited to, the Academy, Australian Institute of Sport (www.ais.gov.au), US Department of Defense (DoD; http://www.defense.gov/), IOC, National Academy of Science, Engineering and Medicine (National Academies; www.nationalacademies.org), USOPC as basis of practiceXXX
      2.7BIntegrates research findings and evidence into peer-reviewed publications and recommendations for practiceXX
      2.7CMentors others in developing skills in accessing and critically analyzing research for application to practiceX
      2.7DIntegrates evidence and best practices into program and organization policies, procedures, and practicesX
      2.8Participates in peer review of others as applicable to role and responsibilitiesXXX
      2.8AParticipates in peer evaluation, including but not limited to peer supervision, clinical chart review, professional practice, and performance evaluations, as applicableXXX
      2.8BServes as an editorial board member or reviewer for professional organizations, journals, or booksXX
      2.8CServes as an editor of a journal or other scholarly work, including but not limited to professional articles, chapters, and booksX
      2.9Mentors and/or precepts othersXXX
      2.9ASeeks out mentors in SHP nutritionXXX
      2.9BServes as mentor and/or preceptor for nutrition and dietetics students or interns; seeks guidance as neededXXX
      2.9CDevelops mentoring or internship opportunities for nutrition and dietetics students or interns and practitioners, and other sports and health care professionals as appropriateXX
      2.9DDirects and implements internships and mentoring programs for nutrition and dietetics students or interns and practitioners, and other sports and health care professionals as appropriateX
      2.10Pursues opportunities (education, training, credentials, certifications) to advance practice in accordance with laws and regulations, and requirements of practice settingXXX
      2.10ACompletes or is currently enrolled in undergraduate or graduate-level courses in sport nutrition, exercise physiology, or kinesiologyXXX
      2.10BCompletes SHP nutrition-applicable continuing education courses; attends webinars and SHP-applicable conferencesXXX
      2.10CPursues documented hours applicable toward SHP nutrition-related certifications or credentials, such as CSSD and IOC Diploma in Sports NutritionXXX
      2.10DObtains and maintains a general fitness credential (eg, Certified Personal Trainer, Group Fitness Instructor)XXX
      2.10EParticipates in SHP-specific professional organizationsXXX
      2.10FObtains target population-specific physical training credential (eg, Triathlon or Weightlifting Level 1 Coach, Tactical Strength and Conditioning Facilitator)XX
      2.10GObtains advanced SHP-relevant certifications (eg, Certified Strength and Conditioning Specialist, International Society for the Advancement of Kinanthropometry)X
      2.10HAssumes high-level leadership positions in occupational or SHP-specific professional organizations (eg, national elected positions, board member, or chair)X
      Examples of Outcomes for Standard 2: Competence and Accountability
      • Practice reflects:
        • Code(s) of ethics (eg, Academy or CDR, other national organizations, or employer code of ethics)
        • Scope of Practice, Standards of Practice, and Standards of Professional Performance
        • Evidence-based practice and best practices
        • Commission on Dietetic Registration Essential Practice Competencies
      • Practice incorporates successful strategies for interactions with individuals or groups from diverse cultures and backgrounds
      • Competence is demonstrated and documented
      • Services provided are safe, effective, and athlete-/professional-centered
      • Self-evaluations are conducted regularly to reflect commitment to lifelong learning and professional development and engagement
      • Professional development needs are identified and pursued
      • Directed learning is demonstrated
      • Relevant opportunities (education, training, credentials, certifications) are pursued to advance practice
      • Commission on Dietetic Registration recertification requirements are met
      • Leadership roles are pursued in professional organization(s)
      Standard 3: Provision of Services

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

      Rationale:

      Quality programs and services are designed, executed, and promoted based on the RDN’s knowledge, skills, experience, judgment, and competence in addressing the needs and expectations of the organization or business and its customers.
      Indicators for Standard 3: Provision of Services
      Bold font indicators are Academy Core RDN Standards of Professional Performance indicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      3.1Contributes to or leads in development and maintenance of programs or services that address needs of the customer or target population(s)XXX
      3.1AAligns program or service development with the mission, vision, principles, values, and service expectations and outputs of the organization or businessXXX
      3.1A1Participates in SHP nutrition program or practice in compliance with evidence-based guidelines and best business management practices; seeks assistance as neededXXX
      3.1A2Develops or maintains SHP nutrition program or practice in compliance with evidence-based guidelines and best business management practices; seeks assistance as neededXX
      3.1A3Develops programs aligned with organization goals, mission, and visionX
      3.1BUses the needs, expectations, and desired outcomes of the customers or populations (eg, athletes/professionals, families, community, decision makers, administrators, client organization[s]) in program or service developmentXXX
      3.1B1Participates in SHP nutrition program and service planning (eg, business planning and organization program development)XXX
      3.1B2Integrates anticipated needs, identified goals, and objectives into program development and delivery; engages in long-term strategic planningXX
      3.1B3Leads in strategic and operational planning, implementation, and monitoring of SHP nutrition programs and servicesX
      3.1CMakes decisions and recommendations that reflect stewardship of time, talent, finances, and environmentXXX
      3.1C1Shapes, modifies, and adapts program and service delivery in alignment with budget requirements and prioritiesXX
      3.1C2Emphasizes the application of SHP nutrition components (Figure 6) to organization and population-level programsX
      3.1DProposes programs and services that are customer-centered, culturally appropriate, and minimize disparitiesXXX
      3.1D1Uses evidence-based guidelines, best practices, and national and international guidelines (eg, Academy, Dietitians of Canada, ACSM, National Athletic Trainers Associations [NATA; www.nata.org], National Academies, IOC) in the delivery of nutrition services and physical activity recommendationsXXX
      3.1D2Develops nutrition programs, protocols, and policies based on evidence-based guidelines, best practices, and national and international guidelines (eg, Academy, Dietitians of Canada, ACSM, NATA, National Academies, IOC)XX
      3.1D3Directs the development of nutrition programs, protocols, and policies based on evidence-based guidelines, best practices, and national and international guidelines (eg, Academy, Dietitians of Canada, ACSM, NATA, National Academies, IOC)X
      3.2Promotes public access and referral to credentialed nutrition and dietetics practitioners for quality food and nutrition programs and servicesXXX
      3.2AContributes to or designs referral systems that promote access to qualified, credentialed nutrition and dietetics practitionersXXX
      3.2A1Ensures that RDNs are part of an interprofessional approach across collaborative SHP nutrition programs and effortsXXX
      3.2A2Creates referral tools and processesXX
      3.2A3Directs and manages referral process and system, including establishing agreements and developing or modifying referral systems with SHP partnersX
      3.2BRefers customers to appropriate providers when requested services or identified needs exceed the RDN’s individual scope of practiceXXX
      3.2B1Receives referrals from and refers customers to sports medicine and other SHP staff (eg, physician, sport psychologist, physical therapist, exercise physiologist, athletic trainer, strength coach, other coaches) as appropriateXXX
      3.2B2Verifies potential referral provider’s or professional’s care or services reflects evidence-based information or research and professional standards of practiceXXX
      3.2B3Establishes and maintains networks to support overall care and services for athletes/professionalsXXX
      3.2B4Supports referral sources with curriculum and training regarding SHP nutrition needs of athletes/professionalsXX
      3.2B5Establishes organization processes and policies for internal and external referralsX
      3.2CMonitors effectiveness of referral systems and modifies as needed to achieve desirable outcomesXXX
      3.2C1Provides leadership in documenting, evaluating, and updating referral processesXX
      3.2C2Directs and manages referral processes and systemsX
      3.2DEvaluates the effectiveness of SHP nutrition referral tools (eg, USOPC Sport Dietitian Registry, and state, local affiliate, and other referral mechanisms)XX
      3.3Contributes to or designs customer-centered servicesXXX
      3.3AAssesses needs, beliefs or values, goals, resources of the customer, and social determinants of healthXXX
      3.3A1Applies goal setting and behavior change strategies and techniques (eg, stages of change, motivational interviewing techniques) in practiceXXX
      3.3BUses knowledge of the customer’s or target population’s health conditions, cultural beliefs, and business objectives or services to guide design and delivery of customer-centered servicesXXX
      3.3B1Applies principles of SHP nutrition to task-specific physical performance and behavior change appropriate for diverse populationsXXX
      3.3B2Recognizes how the athletic or occupation environment, culture, health literacy, and socioeconomic status may influence task-specific physical performance and athlete/professional population use of SHP and health care servicesXXX
      3.3B3Adapts practice to meet the needs of ethnically and culturally diverse populations (eg, uses interpreters, selects appropriate levels of interventions, adapts SHP nutrition education or counseling approaches and materials)XXX
      3.3B4Applies working knowledge of SHP nutrition, evidence-based guidelines, best practices, and clinical judgment and experience to provide customer-centered services when combining multiple intervention approachesXX
      3.3B5Applies advanced and comprehensive knowledge of SHP nutrition, target sport or organization, evidence-based guidelines, best practices, and clinical judgment and experience to determine the most appropriate action plan in complicated, unpredictable, and dynamic situationsX
      3.3CCommunicates principles of disease prevention and behavioral change appropriate to the athlete/professional populationXXX
      3.3C1Recognizes athlete/professional population’s concepts of illness, injury, and rehabilitation and their cultural beliefsXXX
      3.3C2Considers organization culture when communicating disease and injury prevention and behavior change strategiesXX
      3.3DCollaborates with athletes/professionals and organizations to set priorities, establish goals, and create athlete-/professional-centered action plans to achieve desirable outcomesXXX
      3.3D1Consults with coaches and organization leadership to ensure athlete/professional goals, action plans, and desirable outcomes are aligned with organization goals and desirable outcomes, as appropriateXX
      3.3EInvolves customers in decision makingXXX
      3.3E1Works in partnership with the athletes/professionals to determine goals, changes necessary to achieve goals and metrics of evaluating progressXXX
      3.3E2Consults with coaches and organization leadership when determining goals, changes to action plans, and metrics of evaluating progressXX
      3.4Executes programs or services in an organized, collaborative, cost-effective, and athlete-/professional-centered mannerXXX
      3.4ACollaborates and coordinates with peers, colleagues, stakeholders, and within interprofessional teamsXXX
      3.4A1Works in partnership with SHP professionals, other health care providers, and ancillary referral sourcesXXX
      3.4A2Serves as a consultant for medical nutrition therapy for the SHP population in the management of nutrition-related illnesses and conditionsXX
      3.4BUses and participates in, or leads in the selection, design, execution, and evaluation of athlete/professional programs and services (eg, nutrition screening system, medical and retail foodservice, electronic health records, interprofessional programs, community education, grant management)XXX
      3.4B1Develops and delivers nutrition education programs and services that integrate components of SHP nutrition across all levels of athletes/professionalsXX
      3.4B2Develops and manages SHP nutrition programs and education materials based on athlete/professional needs, cultural beliefs, and evidence-based guidelines (eg, Academy, Dietitians of Canada, ACSM, IOC, National Academies, NATA), and available resourcesXX
      3.4B3Plans, develops, and implements programs for delivery of SHP nutrition services, using evidence-based guidelines and best practicesXX
      3.4B4Directs programs delivering SHP nutrition servicesX
      3.4B5Evaluates the appropriateness and validity of emerging SHP nutrition toolsX
      3.4CUses and develops or contributes to selection, design, and maintenance of policies, procedures (eg, discharge planning or transitions of care, disaster and emergency planning), 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
      3.4C1Participates in developing and updating policies and procedures and evidence-based SHP nutrition practice toolsXXX
      3.4C2Develops policies and procedures for quality improvement (eg, identifies or adapts evidence-based practice guidelines, protocols, or tools, skill training and reinforcement, and organizational incentives and supports) tailored to the needs of the organization and athlete/professional populationsXX
      3.4C3Leads the process of developing, monitoring, evaluating, and improving protocols, guidelines, and practice tools (eg, Academy, Dietitians of Canada); implements changes as appropriateX
      3.4C4Evaluates organization policies and procedures for vulnerabilities in the context of regional and national-level disasters and emergencies (eg, weather events, public health pan-/epidemics, national or homeland security incidences, cyber-attacks)X
      3.4DUses 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 nonphysician practitioners who are determined to be eligible for appointment by the governing body.6
      or medical director (eg, 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
      3.4D1Uses and participates in or leads development of processes for privileges or other facility-specific processes related to (but not limited to) implementing physician or 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, qualified dietitian or qualified nutrition professional, occupational and physical therapists. Disciplines considered for privileging by a facility’s governing body and medical staff must be in accordance with state law.6,7
      -driven delegated orders or protocols, initiating or modifying orders for therapeutic diets, medical foods, dietary supplements (vitamins/minerals), oral nutrition supplements, laboratory tests, medications, and adjustments to fluid therapies or electrolyte replacements; seeks assistance if needed
      XXX
      3.4D2Uses and participates in or leads development of processes for privileging for provision of nutrition-related services, including (but not limited to) initiating or modifying orders for medical foods, dietary supplements (vitamins/minerals), oral nutrition supplements, and indirect calorimetry measurements; seeks assistance if neededXXX
      3.4D3Uses and participates in or leads development of processes for coordination of care for athletes/professionals with inpatient facilities and/or clinical service providersXXX
      3.4EComplies 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
      3.4FCommunicates with the interprofessional team and referring party consistent with the HIPAA rules for use and disclosure of customer’s protected health informationXXX
      3.5Uses 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
      3.5AAssigns activities, including direct care to athlete/professional, consistent with the qualifications, experience, and competence of professional, technical, and support personnelXXX
      3.5A1Ensures consistent nutrition messaging and maintenance of scopes of practice when using health educators, strength and conditioning coaches, physical therapists, sport psychologists, and others as nutrition education extendersXX
      3.5BSupervises professional, technical, and support personnelXXX
      3.5B1Trains professional, technical, and support personnel and evaluates and documents their skills or competence, following organization or program guidelinesXX
      3.6Designs and implements food delivery systems to meet the needs of customersXXX
      3.6ACollaborates 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, athletes/professionals, employee groups, visitors to retail venues, schools, community feeding sites, farm-to-institution initiatives, local food banks)XXX
      3.6A1Participates in foodservice planning and delivery in various situations (eg, community sporting events, training tables, eating out or eating on the road while traveling for competition, military dining programs, humanitarian operations, wildfire emergency response plan)XX
      3.6BParticipates in, consults or 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
      3.6B1Consults and provides guidance to organizations interested in SHP nutrition approach regarding foods to incorporate into menus, snack options, and beverages for the population(s) servedXX
      3.6CParticipates in, consults or 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
      3.6C1Participates as a member of an interprofessional team to provide guidance to local and regional physically active and athletic communities regarding dietary supplements and food products and pertinent regulatory issuesXXX
      3.6C2Consults within an interprofessional team to provide guidance regarding dietary supplements and food products that are in compliance with, and those that do not comply with, anti-doping rules, regulations, and procedures of sports organizations and governing bodies (eg, NCAA, NFHS, IOC, USADA, WADA, professional sports) and organization policies (eg, DoD service-specific drug abuse policies)XX
      3.6C3Promotes and recommends use of dietary supplements based on overarching organization philosophy, vision, and image and sponsor or endorsement exclusivity agreementsX
      3.6C4Assumes a leadership role within an interprofessional team to interact with national and international sports governing bodies (eg, NCAA, NFHS, IOC, USADA, WADA, professional sports, occupation organizations) regarding anti-doping rules, regulations, and procedures (eg, facilitates communication between USADA and elite athletes and DoD or military services and service members; contributes to anti-doping policy review and evaluation)X
      3.7Maintains records of services providedXXX
      3.7ADocuments according to organization policies, procedures, standards, and systems, including electronic health recordsXXX
      3.7A1Collects data and documents outcomes relative to compliance with evidence-based guidelines and best practicesXXX
      3.7A2Maintains documentation as mandated by applicable regulatory agencies, accrediting or credentialing bodies, local, state, and federal regulations and/or laws, organization policies; and consistent with the Nutrition Care Process where appropriateXXX
      3.7A3Uses electronic health records within the worksite as appropriateXXX
      3.7BImplements data management systems to support interoperable data collection, maintenance, and utilizationXXX
      3.7CUses 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
      3.7C1Shares program outcomes and impact with organization, athletes/professionals, or community participantsXXX
      3.7C2Provides structure and systems for staff to create reports to identify program outcomes and gapsXX
      3.7C3Analyzes and uses data to communicate value of conventional nutrition and SHP nutrition services in relation to athlete/professional population and organization outcomes and goalsXX
      3.7C4Collaborates with interprofessional team members to articulate contribution of SHP nutrition services to overall team outcomesX
      3.7DUses data to demonstrate program or service achievements and compliance with accreditation standards, laws, and regulationsXXX
      3.8Advocates for provision of quality food and nutrition services as part of public policyXXX
      3.8ACommunicates with policy makers regarding the benefit or cost of quality food and nutrition servicesXXX
      3.8A1Participates in legislative and policy-making activities that influence SHP nutrition services and practicesXXX
      3.8A2Participates in national-level governing body (eg, USOPC, DoD) workgroups and task forces that influence SHP nutrition services and practicesXX
      3.8A3Provides leadership in advocacy activities or issues; authors scholarly work and delivers presentations on topic; networks with other advocacy-oriented parties and organizationsX
      3.8BAdvocates in support of food and nutrition programs and services for populations with special needs and chronic conditions (eg, paralympic population)XXX
      3.8CAdvocates 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
      Examples of Outcomes for Standard 3: Provision of Services
      • Program or service design and systems reflect organization or business mission, vision, principles, values, and customer needs and expectations
      • Customers participate in establishing program or service goals and customer-focused action plans or nutrition interventions (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 assistance
      • Customers have access to food and nutrition services
      • Foodservice system incorporates sustainability practices addressing energy and water use and waste management
      • Menus reflect the cultural, health, and/or nutritional needs of target population(s) and consideration of ecological sustainability
      • Evaluations reflect expected outcomes and established goals
      • Effective screening and referral services are established or implemented as designed
      • Professional, technical, and support personnel are supervised when providing nutrition care to customers
      • Advocates for the provision of SHP nutrition services
      • Ethical and transparent financial management and billing practices are used per role and setting
      Standard 4: Application of Research

      The registered dietitian nutritionist (RDN) applies, participates in, and/or generates research to enhance practice. Evidence-based practice incorporates the best available research or 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 indicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      4.1Reviews best available research or evidence and information for application to practiceXXX
      4.1AUnderstands basic research design and methodologyXXX
      4.1A1Demonstrates understanding of research design and methodology, data collection, interpretation of results, application, and use of the Academy of Nutrition and Dietetics Evidence Analysis Library (EAL; www.andeal.org)XXX
      4.1BIdentifies and reads evidence-based information from multiple reputable disciplines and sources (eg, guidelines, practice guidelines, and related resources)XXX
      4.1CUses the EAL as a resource in writing or reviewing research papersXXX
      4.1DDemonstrates understanding of current research, trends, and epidemiological surveys in SHP nutrition, SHP nutrition education, and related areas of exercise scienceXX
      4.1EInterprets current research in SHP nutrition and related areas and applies to professional practice as appropriateXX
      4.1FIdentifies key health and performance questions and uses systematic methods to apply evidence-based guidelines to answer questionsXX
      4.1GDemonstrates the professional judgment and critical thinking skills required to evaluate the strength of original research and evidence-based guidelines relevant to SHP nutrition practiceX
      4.1HFunctions as a primary or senior author or reviewer of research and organization position papers and other scholarly workX
      4.2Uses best available research or evidence and information as the foundation for evidence-based practiceXXX
      4.2AFollows evidence-based practice guidelines (eg, EAL, Academy, Dietitians of Canada, ACSM, National Academies, IOC) to provide quality care for athletes/professionalsXXX
      4.2BSystematically reviews and applies the best available research where evidence-based practice guidelines for SHP nutrition are not establishedXX
      4.2CFollows evidence-based practice guidelines to provide safe, effective SHP nutrition services specific to activity or position, health status, age, gender, skill or fitness level of the target population, and environmentXX
      4.2DFollows evidence-based practice guidelines to provide safe, effective SHP nutrition services for athletes/professionals who are balancing multiple situations, complications, or medical conditionsX
      4.3Integrates best available research or evidence and information with best practices, clinical and managerial expertise, and customer valuesXXX
      4.3AIdentifies and uses evidence-based policies, procedures, and resources for SHP nutrition practiceXXX
      4.3BDevelops and implements evidence-based policies, procedures, and resources for SHP nutrition practiceXX
      4.3CDirects the integration of evidence-based policies, procedures, and resources into organization SHP nutrition practiceX
      4.4Contributes to the development of new knowledge and research in nutrition and dieteticsXXX
      4.4AParticipates in efforts to extend research to practice through journal clubs, professional supervision, and the Academy’s Research workgroups (eg, EAL)XXX
      4.4BParticipates in interprofessional research teams identifying research issues or questions and collaborative research activities related to SHP nutritionXXX
      4.4CUses evidence-based guidelines, best practices, and clinical or practice experience to generate new knowledge and develop guidelines, programs, and policies in SHP nutritionXX
      4.4DParticipates in practice-based research networks (eg, Nutrition Research Network) and the development and/or implementation of practice-based research and peer-reviewed publicationsXX
      4.4EFunctions as a primary or senior author of research or organization position papers (eg, Academy, ACSM, National Strength and Conditioning Association [http://www.nsca-lift.org]), and other scholarly workX
      4.4FServes as an advisor, mentor, preceptor, and/or committee member for graduate-level researchX
      4.4GServes as SHP nutrition representative on organization research advisory committeesX
      4.5Promotes application of research in practice through alliances or collaboration with food and nutrition and other professionals and organizationsXXX
      4.5AParticipates as a member or consultant to or investigator in collaborative research teams that examine relationships among nutrition, task-specific physical performance, and career longevityXX
      4.5BBuilds relationships among researchers and decision-makers to influence policy development and to translate evidence-based guidelines into SHP nutrition practiceXX
      4.5CServes as a primary or senior investigator in collaborative research teams that examines relationships among nutrition, task-specific physical performance, and career longevityX
      Examples of Outcomes for Standard 4: Application of Research
      • 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 or evidence and information
      • Peer-reviewed publications related to SHP nutrition demonstrate contribution of SHP RDNs
      • Best available research or evidence and information is used as the foundation of evidence-based practice
      Standard 5: Communication and Application of Knowledge

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

      Rationale:

      The RDN works 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 indicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      5.1Communicates and applies current knowledge and information based on evidenceXXX
      5.1ADemonstrates critical thinking and problem-solving skills when communicating with othersXXX
      5.1BTranslates evidence-based research and other sources of evidence to practical application in communicationsXXX
      5.1CDemonstrates critical thinking, reflection, and problem-solving skills (eg, uses evidence-based guidelines and selects best format for presentation) in all forms of communicationsXXX
      5.1DUses clinical judgment and experience to integrate current research- and evidence-based guidelines in communications with special populations (eg, disabled athletes and military service members) and in addressing medical nutrition therapy issuesXX
      5.1EUses clinical judgment and experience to integrate current research and evidence-based guidelines into organization policies, procedures, and practicesX
      5.2Selects appropriate information and the most effective communication method or format that considers customer-centered care and the needs of the individual, group, or populationXXX
      5.2AUses communication methods (ie, oral, print, one-on-one, group, visual, electronic, and social media) targeted to various audiencesXXX
      5.2BUses information technology to communicate, disseminate, manage knowledge, and support decision makingXXX
      5.2B1Uses the Nutrition Care Process, EAL, and the Academy’s electronic Sports Nutrition Care Manual when making decisions about athlete/professional careXXX
      5.2B2Contributes to the advancement of technology/informatics (eg, informatics research, software program design) in SHP nutritionXX
      5.2B3Leads in the advancement of technology or informatics (eg, informatics research, software program design) in SHP nutritionX
      5.3Integrates knowledge of food and nutrition with knowledge of health, culture, social sciences, communication, informatics, sustainability, and managementXXX
      5.3AIntegrates new scientific knowledge and SHP nutrition experience into practice in new and varied contextsXX
      5.3BLeads the integration of new scientific knowledge and professional judgment in SHP nutrition into practice for the most advanced nutrition problems or in new research methodologiesX
      5.4Shares current, evidence-based knowledge, and information with various audiencesXXX
      5.4AGuides customers, families, students, and interns in the application of knowledge and skillsXXX
      5.4A1Develops action plans for athletes/professionals that include specific actions or changes and timelinesXXX
      5.4A2Serves on planning committees or task forces to develop continuing education, activities, and programs in SHP nutrition for students and practitionersXX
      5.4A3Participates in updating the Academy’s EAL and Sports Nutrition Care Manual in SHP nutrition and related areasXX
      5.4A4Develops and updates SHP nutrition education materials (eg, e-books, e-manuals, webinars, web-based tools, social media, informatics)XX
      5.4A5Contributes to the education and professional development of RDNs, students, and SHP professionals through formal and informal teaching and mentoringXX
      5.4A6Develops mentor and preceptor programs and interprofessional learning opportunities in SHP nutritionXX
      5.4BAssists individuals and groups to identify and secure appropriate and available educational and other resources and servicesXXX
      5.4B1Recommends current, credible SHP nutrition education resources (eg, USOPC sports nutrition resources and fact sheets, USADA anti-doping education and resources, DoD Human Performance Resource Center) to individuals and groupsXXX
      5.4B2Serves as a consultant to organizations (eg, business, industry, government) to address the needs of consumers, SHP professionals, and health providers for SHP nutrition educationXX
      5.4CUses professional writing and verbal skills in all types of communicationsXXX
      5.4C1Uses professional writing and verbal skills to provide credible information and quotes for the general public (eg, local media, social media, interviews) in various situations (eg, sport and occupational events)XXX
      5.4C2Authors texts, scholarly work, and authoritative articles for consumers and for SHP professionalsXX
      5.4C3Serves as invited reviewer, author, and/or presenter at local, regional, national, or international meetings and to the mediaXX
      5.4C4Serves as local, regional, national, and international SHP nutrition media spokespersonXX
      5.4C5Serves as an opinion leader in SHP nutritionX
      5.4C6Directs and manages professional meetings, workshops, task forces, and conferencesX
      5.4DReflects knowledge of population characteristics in communication methods (eg, literacy and numeracy levels, need for translation of written materials or a translator, communication skills, and learning, hearing or vision disabilities)XXX
      5.5Establishes credibility and contributes as a food and nutrition resource within the interprofessional health care and management team, organization, and communityXXX
      5.5ACommunicates with the interprofessional team to promote the use of evidence-based guidelines that integrate food and nutrition with task-specific physical performanceXXX
      5.5BConsults with physicians and other health and sports or performance professionals and interprofessional team members on clinical and other health-related issuesXXX
      5.5CParticipates in interprofessional collaborations at a systems level (eg, incorporating SHP nutrition within programs aimed at optimizing training and task-specific physical performance)XX
      5.5DContributes nutrition-related expertise to national projects and professional organizations (eg, DoD, IOC, IPC, NATA, NCAA, NFHS, National Strength and Conditioning Association [http://www.nsca-lift.org], USADA, WADA) as appropriateXX
      5.5EPromotes the specialized knowledge and skills of the SHP RDN to the interprofessional teamXX
      5.5FConsults as an expert or resource on emerging scientific information in SHP nutrition or related field with colleagues or medical and SHP communitiesX
      5.5GIdentifies new opportunities for leadership across disciplines to promote SHP nutritionX
      5.6Communicates performance improvement and research results through publications and presentationsXXX
      5.6APresents evidence-based SHP nutrition research and information to organizations and colleaguesXXX
      5.6BPresents evidence-based SHP nutrition research and information at professional meetings and conferences (eg, local, regional, national, international)XX
      5.6CAuthors peer-reviewed articles in SHP nutrition and related areasXX
      5.6DServes in a leadership role for SHP nutrition-related scholarly work (eg, reviewer, editor, editorial advisory board) and in program planning for conferences (eg, local, regional, national, international)XX
      5.6ETranslates research findings for incorporation into development of policies, procedures, and guidelines for SHP nutrition at national and international levelsX
      5.6FDirects collation of research data into publications (eg, position papers, practice papers, meta-analyses, review articles) and presentationsX
      5.7Seeks 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 nonprofit organizations serving the food insecure) providing food and nutrition expertiseXXX
      5.7AFunctions as an SHP nutrition resource as an active member of local, state, or national organizationsXXX
      5.7BServes on SHP nutrition or related committees, task forces, and panels (local, regional, national, and international) for SHP and health care professionalsXX
      5.7DSeeks and generates opportunities (local, regional, state, national, international levels) to integrate SHP nutrition practices and programs within larger systems (eg, DoD, IOC, IPC, NCAA, USADA, WADA, USOPC)XX
      5.7DManages and directs the integration of SHP nutrition principles within larger systems (eg, DoD, IOC, NCAA, USADA, USOPC)X
      Examples of Outcomes for Standard 5: Communication and Application of Knowledge
      • Expertise in food, nutrition, dietetics, and management is demonstrated and shared
      • Interoperable information technology is used to support practice
      • Effective and efficient communications occur through appropriate and professional use of e-mail, texting, social media tools, applications, and videoconference tools
      • Individuals, groups, and stakeholders:
        • Receive current and appropriate information and customer-centered service
        • Demonstrate understanding of information and behavioral strategies received
        • Know how to obtain additional guidance from the RDN or other RDN-recommended resources
      • Leadership is demonstrated through active professional and community involvement
      Standard 6: Utilization and Management of Resources

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

      Rationale:

      The RDN demonstrates leadership through strategic management of time, finances, facilities, supplies, technology, and natural and human resources.
      Indicators for Standard 6: Utilization and Management of Resources
      Bold font indicators are Academy Core RDN Standards of Professional Performance indicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      6.1Uses a systematic approach to manage resources and improve outcomesXXX
      6.1AImplements administratively sound programs (eg, Nutrition Care Process protocols, food quality and food safety, SHP nutrition counseling, and education)XXX
      6.1BParticipates in operational planning of food and nutrition programs and services (eg, meals and menu planning, delivery, and execution; food systems consultation; Nutrition Care Process; nutrition education, program planning and development)XXX
      6.1CCollaborates with medical, sports, administrative, military, and food systems staffs in achieving desired outcomes, securing resources and servicesXX
      6.1DDirects medical, sports, administrative, military, and food systems staffs in achieving desired outcomes, securing resources and servicesX
      6.2Evaluates management of resources with the use of standardized performance measures and benchmarking as applicableXXX
      6.2AUses the Standards of Excellence Metric Tool to self-assess quality in leadership, organization, practice, and outcomes for an organization (www.eatrightpro.org/excellencetool)XXX
      6.2BManages effective delivery of nutrition programs and services (eg, business and marketing planning, program administration, education program delivery, materials development) to related SHP nutrition programsXX
      6.2CDirects or manages business and strategic planning for the design and delivery of nutrition services in SHP programs in various settings (eg, clinic, cafeteria, travel, corporate, military, research, artistic performance)X
      6.3Evaluates safety, effectiveness, efficiency, productivity, sustainability practices, and value while planning and delivering services and productsXXX
      6.3AParticipates in evaluations, selection, and implementation of services and products (eg, surveys, data collection)XXX
      6.3BManages the evaluation of services and products (eg, food quality, food safety, team meals, military dining, sports and dietary supplements, sports nutrition products)XX
      6.3CEvaluates the following at the systems level: safety, effectiveness, and budgeting, in planning and delivering nutrition products and servicesX
      6.4Participates in quality assurance and performance improvement and documents outcomes and best practices relative to resource managementXXX
      6.4AApplies quality assurance and performance improvement to budget management, inventory tracking, ordering and distribution, negotiations for compensation and additional resources (staff, funding, supplies)XXX
      6.4BProactively and systematically anticipates needs, identifies goals and objectives, and engages in long-term strategic planningXX
      6.4CAnticipates outcomes and consequences of different approaches and makes necessary modifications to achieve desired outcomesXX
      6.4DPartners with relevant SHP professionals to assess return on investment of services and programs in accordance with continuous quality improvement systemsX
      6.5Measures and tracks trends regarding internal and external customer outcomes (eg, satisfaction, key performance indicators)XXX
      6.5ACommunicates the need for change based on collected dataXXX
      6.5BImplements, monitors, and evaluates changes based on collected dataXX
      Examples of Outcomes for Standard 6: Utilization and Management of Resources
      • Resources are effectively and efficiently managed
      • Documentation of resource use is consistent with operational and sustainability goals
      • Data are used to promote, improve, and validate services, organization practices, and public policy
      • Desired outcomes are achieved, documented, and disseminated
      • Key performance indicators are identified and tracked in alignment with organization mission, vision, principles, and values
      a Interprofessional: The term interprofessional is used in this evaluation resource as a universal term. It includes a diverse group of team members (eg, physicians, nurses, dietitian nutritionists, pharmacists, psychologists, social workers, strength and conditioning coaches, certified athletic trainers, and occupational and physical therapists), depending on the needs of the athlete/professional. Interprofessional could also mean interdisciplinary or multidisciplinary.
      b PROMIS: The Patient-Reported Outcomes Measurement Information System (PROMIS) (https://commonfund.nih.gov/promis/index) 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.
      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 nonphysician practitioners who are determined to be eligible for appointment by the governing body.
      State Operations Manual
      Appendix A-Survey protocol, regulations and interpretive guidelines for hospitals (Rev. 200, 02-21-20); §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.
      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, qualified dietitian or qualified nutrition professional, occupational and physical therapists. Disciplines considered for privileging by a facility’s governing body and medical staff must be in accordance with state law.
      State Operations Manual
      Appendix A-Survey protocol, regulations and interpretive guidelines for hospitals (Rev. 200, 02-21-20); §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.200, 02-21-20); §485.635(a)(3)(vii) Dietary Services; §458.635 (d)(3) Verbal Orders; §458.635 (d)(9) Swing-Beds. US Department of Health and Human Services, Centers for Medicare and Medicaid Services.

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      Biography

      K. Daigle is a Director, Human Performance Program, US Army Special Operations Command, Fort Bragg, NC.
      R. Subach is an Associate Professor, West Chester University, West Chester, PA.
      M. Valliant is a Professor and Chair, The University of Mississippi, Oxford, MS.