Developing an advanced practice credential for registered dietitian nutritionists in clinical nutrition practice.

A T ENTRY-LEVEL, REGISTERED dietitian nutritionists (RDNs) have a broad set of skills intended to support practice in a variety of areas. As RDNs progress beyond entry-level (defined as the first 3 years of practice), personal preference or job demands may create a need for deeper levels of knowledge and skill. Many RDNs elect to concentrate on a particular facet of dietetics, accumulating focused knowledge and experience within a narrow practice area, and may become credentialed specialists. A small group of RDNs accumulate advanced practice skills and experience beyond and different from specialist practice. RDNs who perform their jobs with autonomy, expertise, intuition, leadership, and initiative have been described as advanced practitioners. Formalizing an advanced practice role would benefit patients, clients, and employers, and could also increase the visibility of RDN expertise and provide career advancement opportunities. E f f o r t s t o i d en t i f y and define advanced-level practice (ALP) have been complicated by a lack of widespread understanding of what constitutes advanced practice in dietetics. Previous attempts to define advanced practice have focused on all RDNs, independent of practice area. However, results from the 2007 Commission on Dietetic Registration (CDR) advanced practice audit suggested that narrowing the focus of advanced practice would aid in detecting an advanced practice skill set. Based on ongoing interest in advanced practice and prior Academy and CDR task force and committee work, CDR appointed a task force to identify advanced practice skills among RDNs who provide patient or client care. Traditionally, “clinical” patient or client care has been in acute-care settings. However, to expand the definition of clinical and include the increasing number of RDNs practicing outside of acute-care settings, advanced clinical nutrition practice was not considered setting-specific. Thus, the task force defined clinical nutrition practice as the “provision of direct nutrition care to individuals or groups.” This population offered the advantage of being the largest practice segment in the dietetics profession, with more than 60% of RDNs providing direct nutrition care to individuals and/or groups. Given that Bradley estimated that less than 10% of the profession practiced at an advanced level, this population would afford the largest sample of ALP RDNs. This article outlines the steps taken to establish the need and justification for an advanced practice certification program for RDNs in clinical nutrition practice and the processes used to develop the advanced-level clinical practice audit. A complementary research paper describes the practice audit results.