Nationwide survey helps formalize career path for advance practice RDNs

A nationwide survey of registered dietitian nutritionists (RDNs) is helping to formalize a career path for RDNs seeking more responsibility and autonomy as clinicians, according to a paper published in the Journal of the Academy of Nutrition and Dietetics.

The results of the survey describe, for the first time, what advanced practice RDNs do that distinguishes them from entry level and early career RDNs. Using this profile of an advanced practitioner, the Commission of Dietetic Registration developed a new credentialing exam for advance practice RDNs, which will be offered beginning in the fall of 2015.

RDNs have long been important members of health care teams, providing counseling and oversight on food and nutrition. RDNs have a wide range of autonomy in clinical settings - from needing supervision on most tasks to writing complicated medical orders and independently running clinics - but efforts to credential RDNs based on advanced or specialized clinical skills have fallen short of other fields.

"As nurse practitioners have grown in popularity in the last 20 years, the idea of advanced practice health professionals has really taken off," said Charles Mueller, clinical assistant professor of clinical nutrition at NYU Steinhardt School of Culture, Education, and Human Development and the study's lead author. "Nurse practitioners often take the place of physicians on the front lines. We want to create a pathway for dietitians to practice autonomously, too."

A separate study by co-author Rebecca Brody, concurrently published in the Journal of the Academy of Nutrition and Dietetics, found a significant demand for advanced practice RDNs who can care for patients independently.

"Physicians are saying, 'I want someone to run my diabetes clinic or nutrition support service, and I don't want to have to give them permission,'" Mueller added.

Earlier efforts to create credentials for advanced practice RDNs have recognized leadership in the field but haven't delineated what the clinicians actually do - the work that sets them apart from entry level and early career RDNs. As a result, the Advanced Clinical Dietetics Practice Audit Taskforce (which included Mueller and Brody) developed a survey looking at all aspects of the profession, including level of education, years registered as an RDN, experience presenting or publishing research, standards of care, and autonomy in clinical practice.

Nearly 30,000 RDNs responded to the initial exploratory survey; the taskforce focused on the 16,253 respondents who were actively involved in clinical care. In a follow-up survey of the clinical RDNs, the researchers received 7,822 responses.

The surveys were successful in distinguishing advanced practice RDNs from those earlier in their careers. Results indicated that advanced practitioners have more years of experience under their belts, are more likely to have a graduate degree, and have achieved professional milestones, all of which were supported by earlier research.

However, the follow-up survey also measured specific tasks within different areas of clinical care, and found for the first time that certain tasks are unique to advanced practice RDNs. RDNs at all levels are involved in nutrition assessment, diagnosis, intervention, monitoring, and evaluation. However, advanced practice RDNs have higher levels of involvement in support nutrition care; managing, designing, and developing systems of nutrition care; and conducting research.

"The survey confirmed that advanced practice dietitians practice with more autonomy, which along with clinical knowledge, will be measured in the new credentialing exam," Mueller said.

Based on the survey results, the taskforce set eligibility requirements for advanced practice RDNs as being an RDN for at least four years, having a graduate degree, and logging 8,000 hours of clinical nutrition practice within the past 15 years (including 800 hours within the past two years). An alternate pathway for RDNs without graduate degrees has also been defined.

An RDN who meets the criteria and passes the credentialing exam will become an RD-AP (registered dietitian-advanced practitioner) or RDN-AP (registered dietitian nutritionist-advanced practitioner).