CHAPTER 24 | Scope and Standards of Practice for the RDN and NDTR 383
In keeping with the code of ethics for the nutrition and dietetics profession, RDNs and NDTRs can only practice in areas in which they are qualified. They must be able to demonstrate competence in delivery of food and nutrition services that achieve safe, eth- ical, and quality outcomes. Code of ethics principle 1, competence and professional development in prac- tice (nonmaleficence), is dedicated to the concept of competence. This principle has various standards that integrate with the concepts discussed earlier and include the following24
:
• Practice using an evidence-based approach within areas of competence, continuously develop and enhance expertise, and recognize limitations.
• Recognize and exercise professional judgment within limits of individual qualifications and collaborate with others, seek counsel, and make referrals as appropriate.
• Practice within the limits of their scope and col- laborate with the interprofessional team.
When the individual serves in a management or
supervisory role, assessing competence means eval- uating the staff member’s skill set needed to perform the job. Assessment of competence is not simply verifying education or validation of other training but rather the actual assessment of a skill by a quali- fied person. Education alone (through attendance at in-services or continuing education programs) is not a measure of competence unless a validation method (eg, case study, return demonstration) is incorporated into the process. Managers and supervisors must take the following steps to ensure that RDNs and NDTRs are competent to practice25
:
• Ensure that organization or facility policies and procedures regarding documentation of staff com- petence are in place.
• Develop and use documentation forms with required organization or facility competencies and methods of validation defined.
• Ensure that qualified individuals are completing assessments of competence and that the qualified individuals have the education, experience, or knowledge related to the skills being assessed.
• Complete assessments of competence in a timely manner per organization or facility policies and procedures.
• Maintain documentation to support completion of competence assessments in personnel files
Defining Levels of Practice
The SOP in nutrition care and the SOPP for RDNs and NDTRs outline the minimum competent levels of practice and performance. The SOP and SOPP arti- cles use the Dreyfus model, which identifies levels of proficiency (novice, advanced beginner, competent, proficient, and expert) during the acquisition and development of knowledge and skills.26
The first two
levels precede credentialing for RDNs and NDTRs. The focus area SOP and SOPP for RDNs (eg,
PALTC, diabetes care, nephrology nutrition, and management of food and nutrition systems) incor- porate three levels of practice: competent, proficient, and expert.20
Box 24.2 on page 384 provides defini-
tions for competent, proficient, and expert levels of practice as defined in the Commission on Dietetic Registration Definition of Terms List. (Note that the following definitions include both the RDN and NDTR; however, focus area SOP and SOPP are cur- rently only for the RDN.) The terms list is a cumu- lative anthology of definitions that are broad based, have implications for use across the nutrition and dietetics profession, and are consistent with the reg- ulatory and legal needs of the profession. The terms have citations and are cross-referenced with other sound resources. Terms are reviewed, revised, and added per the needs of the profession over time.3 The SOP in nutrition care and the SOPP for
RDNs serve as blueprints for the development of focus area SOP and SOPP for RDNs. Although the standard SOP and SOPP reflect the minimum competent level of nutrition and dietetics practice, focus area SOP and SOPP for RDNs contain the three levels just described (competent, proficient, and expert) to convey the continuum of practice. As of 2023, there are 17 published focus area SOP and SOPP for RDNs.20
Examples of these focus areas
include PALTC nutrition, diabetes care, renal nutri- tion, intellectual and developmental disabilities, and management of food and nutrition systems.
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