Overview of the Scope of Dietetics Practice Framework

The Scope of Dietetics Practice Framework and supporting documents described here are part of an effort to describe the broad range of services and expectations of the profession and are not intended to be exhaustive; however, the activities described reflect current practice within the profession. We recognize that the level of experience, skill, and proficiency with respect to identified activities varies among individual providers. Dietetics practitioners may not be competent to practice in all areas of the field of dietetics. Individuals are expected to practice only in designated areas where they are competent based on their education, training, and experience. Dietetic practitioners are encouraged to pursue additional education or training to expand their personal scope of dietetics practice.

The Framework and its applications are described on the pages that follow. The American Dietetic Association House of Delegates approved the Framework on November 3, 2004. For more history behind its development, refer to the Framework History.

The Framework is:

  • a response to the changing health environment in the United States. Rapid developments in health knowledge, medical technology, and federal law necessitate that the American Dietetic Association re-examine the profession and equip its members with new tools to operate in a diverse, highly changeable environment.
  • a cornerstone for the profession. It provides a flexible decision-making structure that empowers its practitioners to provide safe, effective, timely healthcare services.
  • an umbrella that encompasses the entire practice of dietetics. The Framweork is for use by practicing Registered Dietitians (RDs), Dietetic Technician, Registered (DTRs) and students to guide their career development. It can also be used as an aid to organizations when making employment decisions.

The Framework covers three broad areas:

  • Foundation Knowledge — definition of dietetics as a profession, five characteristics of the profession and educational resources. These are information and resources every professional should know.
  • Evaluation Resources — code of ethics, standards of practice and professional performance outlined for RDs, DTRs and specialty or advanced professionals. These are evaluation tools practitioners and their managers can use to gauge and channel performance. For example, a DTR can apply the DTR Standards of Practice to ensure he/she is following accepted practice in his or her day-to-day work; determine whether a particular competency falls within scope for his or her work; or ensure that his or her role description is accurate and comprehensive.
  • Decision Aids — decision tree, decision analysis tool, definition of terms and other resources practitioners can apply in their situation to further define the scope of their practice. The first two aids can be used to determine whether a requested service, such as providing instruction on use of an insulin pump for a patient with diabetes, falls within one’s legitimate, qualified scope of practice. These tools are especially helpful when state, federal and ADA documents do not clearly delineate responsibility. The Definition of Terms sets a common vocabulary for practitioners to use when discussing professional matters.

Framework Diagram

The diagram shows all the Framework pieces together. It also explains how the Framework functions as an algorithm: a series of steps to solve a specific issue or accomplish a specific goal. Remember, this approach was adopted to reflect the breadth of the profession while at the same time allowing individual practitioners the flexibility they need to tailor and manage their careers. At the collective level, the Framework is dynamic: it can grow and change as our profession evolves. At the individual level, it is also dynamic: choices made at each step — from what to study, to what state to practice in, to the type of environment in which we work, to the research we engage in —  progressively influences our scope of practice and the resources and options we can draw upon to safely and effectively advance it.

How the Framework is Structured
The Framework consists of three building blocks which, when viewed together, describe the full range of roles, responsibilities and activities that dietetics practitioners are educated and authorized to perform today. To facilitate the movement of the profession and individual practitioners into new roles and areas of responsibility, the blocks have been designed with flexible boundaries. Within the blocks, specific tools are provided to inform, enable and support practitioners’ career decisions. Some of these tools are well known to the profession; many are new and additional tools will continue to be added.

Dietetics practitioners work in a variety of environments and serve many different functions. Because of the dynamic nature of our profession a flexible algorithmic approach was adopted. An algorithm is a series of steps that can be followed to solve a problem or achieve a goal. In the ADA’s case, there are a multitude of goals and pathways. For example, the needs of RDs who specialize in witness testimony or diabetes care are quite different from those of DTRs who have just entered the profession. Given this variance in applications and needs, the Framework should be viewed as an umbrella that describes, rather than defines, the safe, sanctioned practice of dietetics including its foundations, career progression, and tools for negotiating the practice.

The Framework captures core responsibilities based on formal education and training at the entry level (Foundation Knowledge), then builds from there to encompass practice grounded in knowledge, skills and experience, including additional certification or advanced degrees (Evaluation Resources). The Framework also provides tools to help practitioners grow their practice in response to changing role or job needs (Decision Aids). This approach allows our profession to evolve as new research and practice trends emerge. Viewed in entirety, the Framework can be seen as a series of stepping stones that guide the profession into the future — at the individual practitioner level and at the collective level through our combined efforts.

Each block will be discussed in order below. For a diagram of the entire framework, please refer to page 1 of this overview and Section 2.

Block One: Foundation Knowledge
Every profession — from clergy to accounting to medicine — defines precisely what it is that the profession does and the specific behaviors that practitioners must demonstrate to engage in the profession. That is, the profession itself gives the key characteristics by which their practitioners operate and distinguish themselves from others. Generally, those characteristics are code of ethics, body of knowledge, education, level of autonomy and service. The definition of the profession and its key characteristics are the foundation of our profession — the everyday, working knowledge of who we are and what we do as professionals; why we are uniquely, distinctly dietetics professionals and not physicians or nurses. This clear understanding guides our practice along safe, acceptable lines; trains students for successful practice; ensures our certification process adequately measures competence; and holds us accountable for the services we render and methods we pursue to offer them to the public.

The first step, then, in establishing dietetics as a profession is to define what it does and the characteristics its practitioners uniquely share. The table to the right shows this. As you will see, the 5 characteristics fall below the definition of dietetics as a profession, adopted by the ADA Board of Directors (BOD) in 1985 and reaffirmed by the BOD September 13, 2003. This is because the definition itself is the first piece of knowledge; from it, the rest is derived. For links on the ADA website to many of the core professional resource listed in Block One: Foundation Knowledge go to Appendix B.

Block Two: Evaluation Resources
The evaluation resources shown below in Block Two are intended for use in conjunction with relevant state, federal and licensure laws. Together with the laws, they serve as a guide for ensuring safe and effective dietetics practice. Practitioners can use them to determine whether a particular activity falls within their legitimate scope of practice, evaluate their performance, make hiring decisions and as a basis for initiating regulatory reform. Throughout our career, we utilize our Code of Ethics, Standards of Practice, and Standards of Professional Performance. Together, these resources guide our decisions as to whether a given activity falls within an individuals understood scope of practice. The Code of Ethics and Standards of Professional Performance are already well established within our profession. The Standards of Practice in Nutrition Care is a new combination of our Nutrition Care Process (NCP), the Commission on Accreditation for Dietetics Education (CADE) educational core competencies and research impacting the profession. It is divided into separate RD and DTR competencies and allows for progression into specialty or advanced practice. The specialty or advanced standards build on the foundation of other levels by adding additional criteria and performance indicators.

For copies of the Code of Ethics, Standards of Practice in Nutrition Care and Standards of Professional Performance, please refer to and Additional Resources Section.

Block Three: Decision Aids
Dietetics practitioners must practice safely, ethically, and effectively when presented with new challenges within a healthcare environment that is highly diverse and evolving. While the dietetics profession as a whole has flexible boundaries; individual practitioners must take responsibility for determining their competence to provide a specific service. The resources listed below in Block Three are intended to help dietetics practitioners do this. By using the Decision Analysis Tool, Decision Tree and other dietetics profession decision aids, dietetics practitioners can accomplish the following:

  • Fully consider whether a new service is within their legitimate scope of practice.
  • Articulate their reason for including the service based on education, credentials, licensure and certification rules, recertification requirements, organizational setting, etc.

The Decision Tree and Decision Analysis Tool are particularly helpful when state, federal, organizational and educational guidelines have not yet expanded to address a need. However, the extent and scope of individual dietetics practice is dependent upon all the resources listed in Block Three. Practitioners should apply them to seek guidance when making individual scope of practice decisions, or when trying to effect change at the local or national level to reflect emerging trends and needs. For copies of the Decision Tree, Decision Analysis Tool and Definition of Terms please refer to Sections 4A and 4B: Decision Aids.

Summary
As a whole, the Framework provides a structure for our profession by describing the full range of resources available to us all, at every stage of development. At the broadest end of the spectrum, the Framework emphasizes the dietetic practitioner's professional accountability and places decisions about boundaries of practice in the hands of the individual practitioner. It is intended to be used throughout the profession — by students and educators, individual RDs and DTRs, individuals who have just entered the profession, individuals who have progressed to advanced or specialty practice, retired dietetics professionals who maintain the active RD or DTR credential, hiring managers, certification and licensure boards, national committee members, researchers and individuals who are encountering new challenges in their work. It serves as a tool for everyone who engages in the profession of dietetics. And, as we individually and collectively change to respond to new developments in the healthcare environment, so, too, will the Framework evolve over time to reflect this.

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