Professional Documents
Culture Documents
R
EGISTERED DIETITIANS (RDs) How Does the Academys Scope of Approved November 2012 by the Quality
are credentialed practitioners Practice in Nutrition and Dietetics, Management Committee of the Academy
specically trained and quali- Code of Ethics, and the Scope of Nutrition and Dietetics (Academy) and
ed to provide nutrition and the Academy House of Delegates. Sched-
of Practice for the Registered uled review date: November 2017.
dietetics services and are accountable
and responsible for their practice and Dietitian Guide the Practice and Questions regarding the Revised 2012
service. The Academy of Nutrition and Performance of RDs in All Settings? Standards of Practice in Nutrition Care
Dietetics (Academy) leads the profes- The Scope of Practice in Nutrition and Di- and Standards of Professional Perfor-
mance for Registered Dietitians may be
sion of nutrition and dietetics by etetics is composed of statutory and indi- addressed to the Academy Quality Man-
developing standards against which vidual components; includes the Code of agement Staff: Karen Hui, RD, LDN, man-
the quality of practice and performance Ethics; and encompasses the range of roles, ager, Practice Standards; and Sharon M.
of RDs can be evaluated. The Academys activities, and regulations within which McCauley, MS, MBA, RD, LDN, FADA, di-
Scope of Practice in Nutrition and Dietet- nutrition and dietetics practitioners per- rector, Quality Management at quality@
eatright.org.
ics,1 the 2012 Standards of Practice (SOP) form. For credentialed practitioners, scope
in Nutrition Care and Standards of Pro- of practice is typically established within
fessional Performance (SOPP) for Regis- the practice act and interpreted and con- views are indicated to consider changes
tered Dietitians, along with the Code of trolled by the agency or board that regu- in health care and other business seg-
Ethics2 and the 2012 Scope of Practice for lates the practice of the profession in a ments, public health initiatives, new re-
the Registered Dietitian,3 guide the prac- given state.1 An RDs statutory scope of search that guides evidence-based prac-
tice and performance of RDs in all set- practice can delineate the services that an tice and best practices, consumer
tings. RD is authorized to perform in a state interests, technological advances, and
The standards and indicators found where a practice acts or certication exists. emerging practice environments. Ques-
within the SOP and SOPP reect the min- The RDs individual scope of prac- tions from credentialed practitioners,
imum competent level of nutrition and tice is determined by education, federal and state regulations, accredita-
dietetics practice and professional per- training, credentialing, and demon- tion standards, and other factors necessi-
formance for RDs. The SOP in Nutrition strated and documented competence tated review and revision of the 2008
Care is composed of four standards rep- to practice. Individual scope of prac- Core SOP in Nutrition Care and SOPP for
resenting the four steps of the Nutrition tice in nutrition and dietetics has the RD and Dietetic Technician, Regis-
Care Process as applied to the care of pa- exible boundaries to capture the tered (DTR) to assure safety, quality, and
tients/clients.4 The SOPP for RDs consists breadth of the individuals profes- competence in practice.5
of standards representing six domains of sional practice. The Scope of Practice
professionalism. This article represents Decision Tool, which is an online in-
teractive tool, permits an RD to an-
How Were the Standards Revised?
the 2012 update of the Academys SOP in
swer a series of questions to deter- The members of the Quality Manage-
Nutrition Care and SOPP for Registered
mine whether a particular activity is ment Committee and its Scope of Prac-
Dietitians (Figures 1 and 2).
within his or her scope of practice. tice Subcommittee utilized collective
The tool is designed to allow for an RD experience and consensus in reviewing
Statement of Potential Conict of Interest: to critically evaluate his or her knowl- statements to support safe, quality
The authors have no potential conict of edge, skill, and demonstrated compe- practice and desirable outcomes. The
interest to disclose. tence with criteria resources. review focused on denition of terms,
illustrative gures and tables, lists of
services and activities in current prac-
2212-2672/$36.00 Why Were the Standards Revised? tice, and enhancements to support fu-
doi: 10.1016/j.jand.2012.12.007
There is a scheduled 5-year review pro- ture practice and advancement. The
Available online 28 February 2013
cess for Academy documents. Regular re- standards, rationales, and indicators
2013 by the Academy of Nutrition and Dietetics. JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS S29
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FROM THE ACADEMY
S30 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS June 2013 Suppl 2 Volume 113 Number 6
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June 2013 Suppl 2 Volume 113 Number 6 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS S31
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S32 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS June 2013 Suppl 2 Volume 113 Number 6
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June 2013 Suppl 2 Volume 113 Number 6 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS S33
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S34 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS June 2013 Suppl 2 Volume 113 Number 6
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June 2013 Suppl 2 Volume 113 Number 6 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS S35
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FROM THE ACADEMY
Figure 2. Standards of Professional Performance for Registered Dietitians. Note: The term customer is used in this evaluation
resource as a universal term. Customer could also mean client/patient, client/patient/customer, participant, consumer, or any
individual, group, or organization to which the RD provides service.
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FROM THE ACADEMY
Figure 2. (continued) Standards of Professional Performance for Registered Dietitians. Note: The term customer is used in this
evaluation resource as a universal term. Customer could also mean client/patient, client/patient/customer, participant, consumer,
or any individual, group, or organization to which the RD provides service.
June 2013 Suppl 2 Volume 113 Number 6 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS S37
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FROM THE ACADEMY
Figure 2. (continued) Standards of Professional Performance for Registered Dietitians. Note: The term customer is used in this
evaluation resource as a universal term. Customer could also mean client/patient, client/patient/customer, participant, consumer,
or any individual, group, or organization to which the RD provides service.
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FROM THE ACADEMY
Figure 2. (continued) Standards of Professional Performance for Registered Dietitians. Note: The term customer is used in this
evaluation resource as a universal term. Customer could also mean client/patient, client/patient/customer, participant, consumer,
or any individual, group, or organization to which the RD provides service.
June 2013 Suppl 2 Volume 113 Number 6 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS S39
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FROM THE ACADEMY
Figure 2. (continued) Standards of Professional Performance for Registered Dietitians. Note: The term customer is used in this
evaluation resource as a universal term. Customer could also mean client/patient, client/patient/customer, participant, consumer,
or any individual, group, or organization to which the RD provides service.
S40 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS June 2013 Suppl 2 Volume 113 Number 6
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FROM THE ACADEMY
Figure 2. (continued) Standards of Professional Performance for Registered Dietitians. Note: The term customer is used in this
evaluation resource as a universal term. Customer could also mean client/patient, client/patient/customer, participant, consumer,
or any individual, group, or organization to which the RD provides service.
June 2013 Suppl 2 Volume 113 Number 6 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS S41
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FROM THE ACADEMY
for the 2012 standards were updated reect the training, responsibil- viding consistency in documentation,
using information from questions re- ity, and accountability of the RD. and monitoring and evaluating prog-
ceived by the Academys Quality Man- ress.8 The RD develops and oversees the
The SOP and SOPP comprehensively
agement Department, discussions system for delivery of nutrition care ac-
depict the minimum expectation for
with Dietetic Practice Groups, Mem- tivities, often with the input of others,
competent care of the patient/client or
ber Interest Groups, and member including the DTR. Components of the
other customer and professional be-
comments through focus area SOP nutrition care delivery system can in-
havior for the RD. The term customer is
and SOPP development. clude the following: policies and proce-
used in this evaluation resource as a
This document was presented to and dures, standards of care, forms, docu-
universal term. Customer could also
reviewed by the Academys House of mentation standards, and roles and
mean client/patient, client/patient/
Delegates Leadership Team and the responsibilities of support and techni-
customer, participant, consumer, or
House of Delegates (includes represen- cal personnel participating in the Nutri-
any individual, group, or organization
tation from state afliates and Dietetic tion Care Process. The RD is responsible
to which the RD provides service.
Practice Groups). This provided an op- to complete the nutrition assessment,
portunity to rene the document and determine the nutrition diagnosis(es),
gain consensus from members repre- How Do the SOP in Nutrition implement the nutrition intervention,
senting diverse practice and geo- Care, the SOPP, and Focus Area and evaluate the patients/clients re-
graphic perspectives. Comments re- Standards Relate to Each Other? sponse.7 The RD supervises the activi-
ceived were considered by the Quality ties of support and technical personnel
The Academys SOP and SOPP serve as
Management Committee and its Scope assisting with the patients/clients
blueprints for the development of fo-
of Practice Subcommittee. The revised care.
cus area SOP and SOPP for the RD. Im-
draft document was reviewed and ap- plementation of the Dietetics Career The DTR is an integral contributor to
proved by the House of Delegates in Development Guide in January 2011 re- the nutrition care of patients/clients.
November 2012. vised the terminology from practice- The DTR is often the rst staff from the
specic to focus area of practice and des- nutrition team that a patient or client
ignated levels of practice for focus area meets; serves as a conduit of nutrition
What Are the Standards of
SOP and SOPP as competent, procient, care information to RDs, nurses, and
Practice in Nutrition Care? others at meetings and care conferen-
and expert.6 The 2012 standards will
The SOP in Nutrition Care: continue to serve as the blueprint for ces; and contributes to the continuum
incorporate the Nutrition Care future focus area standards. As of 2012, of care by facilitating communication
Process as a method to manage there are 14 published focus area SOP between staff providing nutrition care
nutrition care activities; SOPPs for RDs that can be accessed on and staff providing nursing care.
apply to RDs who have direct theAcademyswebsiteatwww.eatright. The RD assigns duties to the DTR that
contact with individual patients/ org/sop: are consistent with the DTRs individual
clients in acute and extended Behavioral Health Care; scope of practice. For example, the DTR
health care settings, public Clinical Nutrition Management; might initiate standard procedures,
health, home-based services, and Diabetes Care; such as completing and following up on
ambulatory care settings; Disordered Eating and Eating nutrition screening for assigned units/
are formatted according to the Disorders; patients; performing routine activities
four steps of the Nutrition Care Education of Dietetics Practitio- based on diet order, policies, and proce-
Process (ie, nutrition assessment, ners; dures; completing the intake process
nutrition diagnosis, nutrition in- Extended Care Settings; for a new clinic client; and reporting to
tervention, and nutrition moni- Integrative and Functional Medi- the RD when a patients/clients data
toring and evaluation); and cine; suggest the need for a nutrition assess-
reect the training, responsibil- Intellectual and Developmental ment. The DTR actively participates
ity, and accountability of the RD. Disabilities; in nutrition care by contributing infor-
Management of Food and Nutri- mation and observations, guiding
What Are the Standards of patients/clients in menu selections,
tion Systems;
Professional Performance? Nephrology Care; providing nutrition education on pre-
The SOPP: Nutrition Support; scribed diets, and reporting to the RD
apply to RDs in all practice set- Oncology Nutrition Care; on the patients/clients response, in-
tings; Pediatric Nutrition; and cluding documenting outcomes or pro-
are formatted according to six Sports Dietetics. viding evidence signifying the need to
domains of professional behavior adjust the nutrition care plan.
(ie, quality in practice, compe- What Is the Relationship of the The RD is responsible for supervising
tence and accountability, provi- RD and DTR? any patient/client care activities as-
sion of services, application of In direct patient/client care, the RD and signed to other administrative and
research, communication and DTR work as a team utilizing the Nutri- technical staff, including the DTR, and
application of knowledge, and tion Care Process4 and Standardized can be held accountable to the patient/
utilization and management of Language,7 a structured method for clients and others for services ren-
resources); and guiding nutrition care activities, pro- dered. This description of supervision
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FROM THE ACADEMY
Figure 3. Flow chart on how to use the Standards of Practice and Standards of Professional Performance.1,5 aRDregistered
dietitian. bDTRdietetic technician, registered. cCDRCommission on Dietetic Registration.
June 2013 Suppl 2 Volume 113 Number 6 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS S43
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FROM THE ACADEMY
as it relates to the RD/DTR teams is not departments of health and fed- fessional Development Portfolio en-
synonymous with managerial supervi- eral regulatory agencies, such as courages RDs to engage in reection,
sion or oversight, clinical supervision the Centers for Medicare and self-assessment, and goal setting,
(eg, peer-to-peer), supervision of provi- Medicaid Services, look to pro- which are the critical components of
sional licensees, and/or supervision of fessional organizations to create Commission on Dietetic Registration
dietetic interns and students. Clinical and maintain standards of prac- recertication (Figure 3 presents a ow
supervision is used in medicine and the tice15,16; chart for applying the 2012 SOP in Nu-
mental health elds for the purposes of consistency in practice and per- trition Care and the SOPP into an RDs
case review and professional develop- formance; practice. Self-assessment using the SOP
ment.9 The following resources provide dietetics research, innovation, and SOPP can identify learning needs
additional information about the roles and practice development; and and opportunities for advancement for
and practice of DTRs: Scope of Practice individual advancement. individual practitioners).
for the Dietetic Technician, Regis- RDs might not apply every indicator
The standards provide:
tered,10 the Standards of Practice in and achieve every outcome at once; RDs
minimum competent levels of
Nutrition Care and Standards of Profes- are not limited to the indicators and ex-
practice and performance;
sional Performance for Dietetic Techni- amples of outcomes provided; and all in-
common indicators for self-eval-
cians, Registered,11 Practice Tips: The dicators might not be applicable to all
uation;
RD/DTR Team,12 and Practice Tips: RDs. The standards are written in broad
activities for which RDs are ac-
What Is Meant by Under the Supervi- terms to allow for individual practitio-
countable;
sion of the RD?9 ners handling of nonroutine situations.
a description of the role of nutri-
The standards are geared toward typical
In What Other Settings Do DTRs tion and dietetics and the unique
situations and toward practitioners with
services that RDs offer within the
Provide Services? the RD credential. Strictly adhering to
health care team and in practice
Although many DTRs work in clinical set- standards does not in and of itself consti-
settings outside of health care;
tings, career opportunities for DTRs are tute best care and service. It is the re-
and
broader than clinical settings. The role for sponsibility of individual practitioners to
guidance for policies and proce-
a DTR in providing food and nutrition ser- recognize and interpret situations and to
dures, job descriptions, compe-
vices in nonclinical settings where an RD know what standards apply and in what
tence assessment tools, and aca-
might not be directly involved in the pro- ways they apply.18
demic objectives for education
gram/activity is guided by the DTRs indi- programs.
vidual scope of practice and require- SUMMARY
ments contained in regulations, How Are the Standards
RDs face complex situations every day.
employer or organizational policies and Structured? Competently addressing the unique
procedures, and state statutes and state A standard is a brief description of the needs of each situation and applying
practice acts. These settings include com- competent level of nutrition and dietet- standards appropriately is essential to
munity nutrition programs, tness cen- ics practice. A rationale is a description providing safe, timely, person-centered
ters, school nutrition, child nutrition pro- of the intent, purpose, and importance quality care and service. All RDs are ad-
grams, and foodservice systems of the standard. An indicator is an ac- vised to conduct their practice based on
management outside of health care set- tion statement illustrating how each the most recent edition of the Acade-
tings. The SOPP11 and the Scope of Prac- standard can be applied in practice. Ex- mys Code of Ethics2 and the Scope of
tice for the Dietetic Technician, Regis- amples of outcomes are also included Practice in Nutrition and Dietetics,1 the
tered10 clearly delineate expanded roles that depict measurable results that re- Scope of Practice for the Registered Di-
and opportunities for DTRs. late indicators to practice. etitian,3 the 2012 Standards of Practice
Each standard is equal in relevance in Nutrition Care and Standards of Pro-
Why Are the Standards Important and importance. The content for stan- fessional Performance for RDs, and the
for RDs? dard, rationale, and indicator descrip- applicable focus area SOP and SOPP for
The standards promote: tions in the SOP in Nutrition Care is RDs. These resources provide minimum
safe, effective, and efcient food, adapted from the Academys Interna- standards and tools for demonstrating
nutrition, dietetic, and related tional Dietetics & Nutrition Terminology competence and safe practice, and are
services; (IDNT) Reference Manual: Standardized used collectively to gauge and guide an
evidence-based practice and best Language for the Nutrition Care Process.7 RDs performance in nutrition and di-
practices; etetics practice. The SOP and SOPP for
improved health-related out- the RD are self-evaluation tools that
How Can I Use the Standards to
comes and cost-reduction meth- promote quality assurance and perfor-
ods;
Evaluate and Advance My mance improvement. Self-assessment
quality assurance and perfor- Practice and Performance? provides opportunities to identify areas
mance improvement; The standards can be used as part of the for enhancement, new learning, and
ethical business and billing prac- Commission on Dietetic Registration skill development, and to encourage
tices13,14; Professional Development Portfolio progression of career growth.
practitioner competence and qua- Process17 to develop goals and focus All RDs are advised to have in their
lication verication because state continuing-education efforts. The Pro- personal libraries the most recent copy
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FROM THE ACADEMY
AUTHOR INFORMATION
Members of the Academy Quality Management Committee 2010-2011, 2011-2012, 2012-2013 and Scope of Practice Subcommittee of the
Quality Management Committee 2010-2011, 2011-2012, 2012-2013: Joyce A. Price, MS, RD, LDNChair 2010-2011; Sue Kent, MS, RD, LDChair
2011-2012; Marsha R. Stieber, MSA, RDChair 2012-2013; Valaree M. Williams, MS, RD, LDNVice Chair 2012-2013; Joanne B. Shearer, MS, RD,
LN; Charlotte B. Oakley, PhD, RD, FADA; Sharon A. Cox, MA, RD, LD; Mary J. Marian, MS, RD, CSO; Elise A. Smith, MA, RD, LD; Pamela Charney,
PhD, RD; M. Patricia Fuhrman, MS, RD, LD, FADA; Isabel M. Parraga, PhD, RD, LD; Doris V. Derelian, JD, PhD, RD, FADA; Terry L. Brown, MPH, RD,
CNSC, LD; Susan L. Smith, MBA, RD; Barbara J. Kamp, MS, RD; Gretchen Y. Robinson, MS, RD, LD, FADA; Margaret J. Tate, MS, RD; Carol J. Gilmore,
MS, RD, LD, FADA; Patricia L. Steinmuller, MS, RD, CSSD, LN; Jean A. Anderson, MS, RD; Lois J. Hill, MS, RD, CSR, LD; Sandra J. McNeil, MA, RD,
CDN, FADA; Bethany L. Daugherty, MS, RD, CD; Pauline Williams, PhD, MPA, RD, CD; Melissa N. Church, MS, RD, LD; Karen Hui, RD, LDN; and
Sharon M. McCauley, MS, MBA, RD, LDN, FADA.
ACKNOWLEDGEMENTS
The Academy Quality Management Committee and its Scope of Practice Subcommittee thank the following Academy members for their
assistance with manuscript preparation: COL George A. Dilly, PhD, RD, LD, US Army; LTC Dianne T. Helinski, MHPE, RD, LD, US Army; Martin
Yadrick, MBA, MS, RD, FADA; Elaine Ayres, MS, RD, FAC-PPM; Christina Ferroli, PhD, RD; Connie Mueller, MS, RD, SNS; Diane Duncan-Goldsmith,
MS, RD, LD; Angie Tagtow, MS, RD, LD; Deborah Canter, PhD, RD, LD; Glenna McCollum, DMOL, MPH, RD; and Lindsay Hoggle, MS, RD, PMP.
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