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FROMTHEACADEMY
Standards of Practice & Professional Performance
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
Patricia L. Steinmuller, MS, RDN, CSSD, LN; Laura J. Kruskall, PhD, RDN, CSSD, LD, FACSM; Christine A. Karpinski, PhD, RD, CSSD, LDN;
Melinda M. Manore, PhD, RDN, CSSD, FACSM; Michele A. Macedonio, MS, RDN, CSSD, LD; Nanna L. Meyer, PhD, RDN, CSSD, FACSM
ABSTRACT
Sports nutrition and dietetics addresses relationships of nutrition with physical activity, including weight management, exercise, and
physical performance. Nutrition plays a key role in the prevention and treatment of obesity and chronic disease and for maintenance of
health, and the ability to engage in physical activity, sports, and other aspects of physical performance. Thus, the Sports, Cardiovascular,
and Wellness Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management
Committee, has developed the Revised 2014 Standards of Practice and Standards of Professional Performance as a resource for Regis-
tered Dietitian Nutritionists working in sports nutrition and dietetics to assess their current skill levels and to identify areas for further
professional development in this emerging practice area. The revised document reflects advances in sports nutrition and dietetics
practice since the original standards were published in 2009 and replaces those standards. The Standards of Practice represents the four
steps in the Nutrition Care Process as applied to the care of patients/clients. The Standards of Professional Performance covers six
standards 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. Within each standard, specific indicators
provide measurable action statements that illustrate how the standards can be applied to practice. The indicators describe three skill
levels (competent, proficient, and expert) for Registered Dietitian Nutritionists working in sports nutrition and dietetics. The Standards
of Practice and Standards of Professional Performance are complementary resources for Registered Dietitian Nutritionists in sports
nutrition and dietetics practice.
J Acad Nutr Diet. 2014;114:631-641.
Editor’snote:Figures1,2,and5that Dietetics: Revised 2014 Standards of past 5 years and replace the 2009 Stan-
accompany this article are avail- Practice and Standards of Professional dards. These documents build on the
able online at www.andjrnl.org Performance for Registered Dietitian Academy of Nutrition and Dietetics
HESPORTS, CARDIOVASCULAR, Nutritionists (Competent, Proficient, Revised 2012 SOP in Nutrition Care
and Wellness Nutrition (SCAN) and Expert) in Sports Nutrition and Di-
Dietetic Practice Group (DPG) etetics, reflect advances in sport nutri-
Tofthe Academy of Nutrition tion and dietetics practice during the
and Dietetics (Academy), under the Approved December 2013 by the Quality
guidance of the Academy Quality Management Committee of the Academy
Management Committee, has revised of Nutrition and Dietetics (Academy) and
the Standards of Practice (SOP) and All registered dietitians are nutritionists— the Executive Committee of the Sports,
but not all nutritionists are registered di- Cardiovascular, and Wellness Nutrition Di-
Standards of Professional Performance etitians. The Academy’s Board of Directors etetic Practice Group of the Academy.
(SOPP) for Registered Dietitians (RDs) and Commission on Dietetic Registration Scheduled review date: April 2018.
in Sports Dietetics originally published have determined that those who hold Questions regarding the Standards of
1 the credential Registered Dietitian (RD) Practice and Standards of Professional
in March 2009. The revised docu- may optionally use “Registered Dietitian Performance for Registered Dietitian Nutri-
ments, Academy of Nutrition and Nutritionist” (RDN) instead. The two cre- tionists in Sports Nutrition and Dietetics
dentials have identical meanings. In this may be addressed to Academy quality-
document, the expert working group has management staff: Sharon McCauley, MS,
chosen to use the term RDN to refer to MBA, RD, LDN, FADA, FAND, director,
2212-2672/$36.00 both registered dietitians and registered Quality Management at quality@eatright.
http://dx.doi.org/10.1016/j.jand.2013.12.021 dietitian nutritionists. org.
ª2014 by the Academy of Nutrition and Dietetics. JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 631
FROMTHEACADEMY
2 6
andSOPPforRDs. TheAcademyof clients. The SOPP consist of standards practice after having obtained RDN
Nutrition and Dietetics/Commission on representing six domains of profes- registration by CDR or an experienced
Dietetic Registration’s (CDR) Code of sionalism. The SOP and SOPP are de- RDN who has recently assumed re-
Ethics3 along with the Academy of signedtopromotetheprovisionofsafe, sponsibility to provide nutrition ser-
Nutrition and Dietetics Revised 2012 effective, and efficient food and nutri- vices in a new focus area. A focus area
SOPinNutrition Care and SOPP for tion services; facilitate evidence-based is defined as an area of nutrition and
RDs2aretoolswithintheScopeofPrac- practice; and serve as a professional dietetics practice that requires focused
tice in Nutrition and Dietetics4 and evaluation resource. knowledge, skills, and experience.8 A
ScopeofPractice for the RD5 that guide These focus area standards for RDNs competent practitioner who has ob-
the practice and performance of regis- in sports nutrition and dietetics pro- tained RDN status and is starting in
tered dietitian nutritionists (RDNs) in vide a guide for self-evaluation and professional employment acquires
all settings. expanding practice, a means of identi- additional on-the-job skills and en-
Thescopeofpracticeinnutritionand fying areas for professional develop- gages in tailored continuing education
dietetics is composed of statutory and ment, and a tool for demonstrating to further enhance knowledge and
individual components; includes the competence in the delivery of sports skills obtained in formal education. An
Code of Ethics; and encompasses the nutrition and dietetics care and ser- RDN starts with technical training and
range of roles, activities, and regula- vices. RDNs use these standards to professional interaction for advance-
tions within which nutrition and assess their current level of practice ment and expanding breadth of
dietetics practitioners perform. For and to determine the education and competence. A general practice RDN
credentialed practitioners, scope of training required to maintain currency may include responsibilities across
practice is typically established within in their focus area and advancement to several areas of practice, including, but
the practice act and interpreted and a higher level of practice. In addition, not limited to community, clinical,
controlled by the agency or board that the standards may be used to assist consultation and business, research,
regulates the practice of the profession RDNs in transitioning their knowledge education, and food and nutrition
4 and skills to a new focus area of prac- 8
in a given state. An RDN’s statutory management.
scope of practice may delineate the tice. Like the SOP in Nutrition Care and
services an RDN is authorized to SOPP for RDs,2 the indicators (ie, Proficient Practitioner
perform in a state where a practice act measureable action statements that Aproficientpractitioner is an RDN who
or certification exists. illustrate how each standard can be is generally 3 or more years beyond
The RDN’s individual scope of prac- applied inpractice) (see Figures 1 and 2 entry into the profession, has obtained
tice is determined by education, available online at www.andjrnl.org, operational job performance skills, and
training, credentialing, and demon- and Figure 3) for the SOP and SOPP is successful in the RDN’s chosen focus
strated and documented competence for RDNs in Sports Nutrition and Di- 8
to practice. Individual scope of practice etetics were developed with input area of practice. The proficient practi-
in nutrition and dietetics has flexible and consensus of content experts tioner demonstrates additional knowl-
boundaries to capture the breadth of representing diverse practice and edge, skills, and experience in a focus
the individual’s professional practice. geographic perspectives. The SOP and area of dietetics practice. An RDN may
The Scope of Practice Decision Tool, an SOPP for RDNs in Sports Nutrition and acquire specialist credentials, if avail-
online, interactive tool, permits an RDN Dietetics were reviewed and approved able, to demonstrate proficiency in a
to answer a series of questions to by the Executive Committee of the focus area of practice.
determinewhetheraparticularactivity SCAN DPG and the Academy Quality
is within his or her scope of practice. Management Committee. Expert Practitioner
The tool is designed to assist an RDN AnexpertpractitionerisanRDNwhois
in critically evaluating personal recognized within the profession and
knowledge, skill, and demonstrated THREE LEVELS OF PRACTICE has mastered the highest degree of
competence with criteria resources The Dreyfus model7 identifies levels skill in or knowledge of a certain focus
(access tool in the Academy Shop, of proficiency (novice, advanced be- or generalized area of dietetics through
www.eatright.org/shop/product.aspx? ginner, competent, proficient, and additional knowledge,formalacademic
id=6442474794). 8
expert) (refer to Figure 3) during the preparation, experience, or training.
The Academy’s Revised 2012 SOP in acquisition and development of knowl- An expert practitioner exhibits a set of
Nutrition Care and SOPP for RDs2 characteristics that include leadership
reflect the minimum competent level edgeandskills. This model is helpful in and vision and demonstrates effec-
of nutrition and dietetics practice and understanding the levels of practice tiveness in planning, achieving, evalu-
professional performance for RDNs. describedintheSOPandSOPPforRDNs ating, and communicating targeted
These standards serve as blueprints for in Sports Nutrition and Dietetics. In outcomes. An expert practitioner may
the development of focus area SOP and Academy focus areas, the levels are have an expanded or specialist role, or
SOPP for RDNs in competent, profi- represented as competent, proficient, both, and may possess an advanced
cient, and expert levels of practice. The andexpertpracticelevels. credential, if available, in a focus area of
SOP in Nutrition Care is composed of practice. Generally, the practice is more
four standards representing the four Competent Practitioner complex and the practitioner has a
steps of the Nutrition Care Process In dietetics, a competent practitioner is high degree of professional autonomy
(NCP)asappliedtothecareofpatients/ an RDN who is either just starting and responsibility.
632 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS April 2014 Volume 114 Number 4
FROMTHEACADEMY
These Standards, along with the importance of regular PA and adequate Board Certification as a Specialist
Academy and CDR’s Code of Ethics,3 nutrition for attaining optimal weight in Sports Dietetics
answer the questions: Why is an RDN and overall health has also been high- In 2006, CDR launched the Board Cer-
uniquely qualified to provide sports lighted in a number of recent US tification as a Specialist in Sports Di-
nutrition and dietetics care and ser- Department of Health and Human etetics (CSSD). An RDN who has earned
vices? What knowledge, skills, and Services and US Department of Agri- the CSSD has met minimum practice
competencies does an RDN need to culture documents. These include the experience requirements and has suc-
demonstrate for the provision of safe, 2010 Dietary Guidelines for Ameri- cessfully completed the CSSD exami-
18 19
effective, and quality sports nutrition cans, Healthy People 2020, and the nation. An RDN who has earned the
and dietetics care and services at 2008 PA Guidelines Advisory Commit- CSSDcertification has demonstrated, at
11
the competent, proficient, and expert tee Report. The 2008 PA Guidelines minimum, proficient-level skills pre-
levels? Advisory Committee Report11 is the sented in this document. Increasingly,
first report issued by the US Govern- job descriptions for sports RDNs are
OVERVIEW ment specifically for the American writtentorequiresuccessfulcandidates
Public interest in the relationships of public with regard to the health bene- toholdtheCSSDcertification.Eligibility
nutrition with physical activity (PA) fits of PA and includes a summary of criteria for the credential and other
andexercisehasdramaticallyincreased the science supporting its recommen- information are available from CDR
during the last 25 years, fueled in part dations. In 2013, the US Department of (www.cdrnet.org). To enhance delivery
by the rising incidence of obesity and Health and Human Services released and consistency of sports nutrition
chronic disease. In addition, interest the PA Guidelines for Americans services to Olympic-caliber athletes,
in relationships between nutrition and Midcourse Report, Strategies to In- The US Olympic Committee sport nu-
sport and physical performance has crease PA Among Youth.20 This report trition team has initiated a US Olympic
greatly expanded due to an increase in further emphasizes the importance of Committee Sport Dietitian Registry to
the general population’s participation PA for health in children and youth maintain a roster of prescreened CSSDs
in competitive exercise/training pro- andoutlines methods for achieving the as resources for National Governing
grams and events (eg, CrossFit, Tough recommended 60 minutes of PA per Bodies of Olympic, Paralympic, and Pan
9,10 day. In addition, the Institute of Medi- 23
Mudder, P90X routine). The focus American Sports.
area of sports nutrition and dietetics cine issued Dietary Reference Intakes
addresses all aspects of relationships for energy intake in 2005, which, for Scope of Practice for the RDN in
of nutrition with PA. Although often the first time, specifically included Sports Nutrition and Dietetics
used interchangeably, PA is any bodily recommendations for the level of PA
movement produced by the contrac- required for weight maintenance and The Scope of Practice for the RD5 de-
tion of skeletal muscle, while exercise weight loss.21 Finally, the US Depart- scribes the sports nutrition practice
is a subcategory of PA that is planned, ment of Agriculture, American College area of nutrition and dietetics per-
11 of Sports Medicine, and the Academy formed by RDNs who apply evidence-
structured, and repetitive in nature.
The term exercise refers to PA that have also jointly emphasized the syn- based knowledge in PA and exercise/
contributes to health, fitness, and ergismofnutritionandPAforachieving training to address the diverse nutri-
11 energy balance.22 Thus, RDNs whose tional needs of physically active in-
chronic disease prevention. The term
training and conditioning refers to PA skills include weight management and dividuals. Sports RDNs provide medical
that contributes to task-specific phys- nutrition for PA are well positioned to nutrition therapy (MNT) in direct care
ical performance. The term task-specific assist individuals and organizations in and design, implement, and manage
physical performance encompasses PA integrating nutrition with PA to pro- safe and effective nutrition strategies
related to sport, military training and mote overall health, wellness, and that enhance lifelong health, fitness,
military operations, and training and optimal physical performance. and optimal physical performance.
performance of law enforcement offi- Theyassess,educate,andcounselwhat,
cers, firefighters, professional emer- SCAN DPG howmuch,andwhentoconsumefoods
gency responders, and others whose In 1982 the SCAN DPG was established and fluids to maintain health, appro-
occupations require physical labor and/ to bring together nutrition practi- priate body weight and composition,
or maintenance of specified levels of tioners with expertise in sports and PA, and how to properly fuel the body for
physical conditioning or body weight cardiovascular health, wellness, and PA and exercise, training and condi-
and body composition. disordered eating and eating disorders. tioning, and physical performance.
Poor dietary habits and low levels of In 2004, Sports Dietetics-USA, a sub- Valued for their ability to positively
PA are strongly linked to overweight/ unit within SCAN, was launched impact behavior and promote behavior
obesity and some chronic diseases (eg, to promote nutrition practices that change, sports RDNs assist individuals
cardiovascular disease, hypertension, enhance lifelong health, fitness, and in implementing nutrition plans that
12 achieve their goals. In addition, sports
diabetes, and some cancers). It is not sports performance, and advance the
surprising that interest in the syner- vocation of sports nutrition and di- RDNs generate and analyze data to
gistic roles of nutrition and PA has etetics. The SCAN website (www. monitor and evaluate the effectiveness
13-16 scandpg.org) offers sports nutrition of their interventions.
heightened. The role PA plays in
promoting weight loss and preventing fact sheets, webinars, and other re- Sports RDNs use the SOP SOPP for
weight gain subsequent to weight sources targeted to practitioners and RDNs in Sports Nutrition and Dietetics
11,17 physically active individuals. to assess their knowledge, skills, and
loss is also well documented. The
April 2014 Volume 114 Number 4 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 633
FROMTHEACADEMY
Standards of Practice are authoritative statements that describe practice demonstrated through nutrition assessment, nutrition
diagnosis(problemidentification),nutritionintervention(planning,implementation),andoutcomesmonitoringandevaluation(four
separate standards) and the responsibilities for which registered dietitian nutritionists (RDNs) are accountable. The Standards of
Practice for RDNs in Sports Nutrition and Dietetics presuppose that the RDN uses critical thinking skills, analytical abilities, theories,
best available research findings, current accepted 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 for RDNs in Sports
Nutrition and Dietetics are authoritative statements that describe behavior in the professional role, including activities related to
quality in practice; competence and professional accountability; provision of services; application of research; communication and
application of knowledge; and utilization and management of resources (six separate standards).
Standards of Practice and Standards of Professional Performance are evaluation resources with complementary sets of
standards—both serve to describe the practice and professional performance of RDNs. All indicators may not be applicable to
all RDNs’ practice or to all practice settings and situations. RDNs operate within the directives of applicable federal and state
laws and regulations as well as policies and procedures established by the organization in which they are employed. To
determine whether an activity is within the scope of practice of the RDN, the practitioner compares his or her knowledge, skill,
and competence with the criteria necessary to perform the activity safely, ethically, legally, and appropriately. The Academy’s
Scope of Practice Decision Tool, an online, interactive tool, is specifically designed to assist practitioners with this process.
The term patient/client is used in the Standards of Practice as a universal term as these Standards relate to direct provision of
nutrition care and services. Patient/client could also mean client/patient, resident, customer, participant, consumer, or any individual
or group who receives sports nutrition and dietetics care. Customer is used in the Standards of Professional Performance as a
universal term. Customer could also mean client/patient, client/patient/customer, participant, consumer, or any individual, group, or
organization the RDN provides services. These services are provided to individuals of all ages. These Standards of Practice and
Standards of Professional Performance are not limited to the clinical setting. In addition, it is recognized that the family and
caregiver(s) of patients/clients 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. The term exercise refers to physical activity that contributes to health, fitness, and chronic
disease prevention. The term training and conditioning refers to physical activity that contributes to task-specific physical
performance. The term 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 and/or maintenance of specified levels of physical conditioning or body weight and
body composition. Sports nutrition and dietetics practice is performed by RDNs who apply evidence-based nutrition and dietetics
knowledge in exercise and sports. They assess, educate, and counsel athletes and physically active individuals. They design,
implement, and manage safe and effective nutrition strategies that enhance lifelong health, fitness, and optimal performance.
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 2012 Standards of Practice in Nutrition Care and Standards of Professional Performance for RDNs have been
adapted to reflect three levels of practice (competent, proficient and expert) for RDNs in sports nutrition and dietetics (see
figure on page 635). In addition, the core indicators have been expanded to reflect the unique competence expectations for the
RDN providing sports nutrition and dietetics care.
Standards described as proficient level of practice in this document are not equivalent to the Commission on Dietetic
Registration certification, Board Certification 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 nutrition and dietetics 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 dietetics by the attainment of a specialist credential.
(continued on next page)
Figure 3. Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent,
Proficient, and Expert) in Sports Nutrition and Dietetics.
634 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS April 2014 Volume 114 Number 4
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