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Part III Standards for Compliance

provider to administer safe and reliable services on a consistent basis” (1). Competence is integral to the delivery of safe, quality health care and other services that credentialed nutrition and dietetics practitioners provide.

The RDN gains competence through knowledge, abilities, skills acquisition, training, experience, applied judgment, and attitude. Competence to perform designated activities within defined practice settings is an essential element of the scope of practice in nutri- tion and dietetics, as demonstrated by the following principles:

1. Level of experience, skills, and proficiency to perform designated activities varies among individuals.

2. Individual practitioners might not be competent in all aspects of the field.

3. Practitioners are expected to practice in the areas in which they are competent.

4. Practitioners pursue additional education and experience to expand their individual scope of practice (13).

In keeping with the Academy of Nutrition and Dietetics Code of Ethics (14), RDNs and NDTRs can only practice in areas in which they are qualified and have demonstrated competence in delivery of food and nutrition services that achieve safe, ethical, and quality outcomes. RDNs and NDTRs are expected to be com- petent in and accept accountability and responsibility for ensuring safety and quality in the services they provide. As performance measurement and improve- ment continues to be on the forefront for providers in health care, demonstrated competency will be essen- tial. A competency is a synthesis of knowledge, skills, abilities, behaviors, and other characteristics an indi- vidual must demonstrate in order to perform work roles or occupational functions successfully (1). Assessing competence is evaluating the staff

member’s skill set to perform the job. Assessment of competence is not education or validation of other training but rather the actual assessment of a skill by a qualified person. According to the Institute of Medicine, “traditional methods of continuing education for health professionals, such as formal conferences and dissemination of educational materials, have been shown to have little effect by themselves on changing clinician behaviors or health outcomes. Education alone, through attendance at in-services or continuing education programs, is not a measure of competence, unless a validation method (ie, case study, return demonstration) is incorporated into the class or program. Demonstration or verification of the

knowledge or ability to perform the skill is the focus of competence assessment” (15).

Competencies are used for assessing and selecting candidates for a job, assessing and managing employee performance, planning a workforce, and training and developing employees. Competencies are defined behaviors that are observable and measurable. Competencies reflect effective performance and may be evaluated against well-accepted standards and quality indicators. Competencies may serve a wide variety of purposes, including self-assessment and pro- fessional development planning, employee evaluations, job up-skilling, privileging, and credentialing (1).

DEFINING LEVELS OF PRACTICE The Academy’s Dietetics Career Development Guide forms the cornerstone for practice management and advancement in nutrition and dietetics (16). The guide uses the Dreyfus model of skill acquisition (17) to illustrate how a practitioner attains increasing levels of knowledge and skill throughout a career. Through life- long learning and professional development, practi- tioners acquire and develop skills that lead to increased competence and higher levels of practice. The levels of practice and hierarchy of practice standards defined for the RDN and NDTR are competent, proficient, and expert.

When defining these terms and many others, the Academy Quality Management Committee ensured that the definitions are broad-based, have implications for use across the nutrition and dietetics profession, and are consistent with the regulatory and legal needs of the profession. Why use definitions? Many profes- sions depend on clear definitions because definitions play a major role in communicating policies and stan- dards, clarifying a description of a new development or a new technology in a technical field, and helping specialists communicate with less-knowledgeable readers. The terms set a common vocabulary for prac- titioners to use when discussing and referencing pro- fessional matters. The Definition of Terms list is included as a part of the Academy’s practitioner program for Scope and Standards of Practice as well as its Comprehensive Scope of Practice Resources for best utilization by RDNs, NDTRs, and other nutrition and dietetics practitioners. The current Definition of Terms List from the Definition of Terms Workgroup, Quality Management Committee was approved in January 2016 (18).

Competent level of practice is defined as a nutri- tion and dietetics practitioner who has just obtained RDN or NDTR status, is starting in an employment sit- uation as a professional or in technical support, and