Key Licensure Issues

Overlapping Scopes of Practice

It is not uncommon for two or more professions (particularly in healthcare fields) to have certain overlapping elements of their scopes of practice. For example, RDNs, nurses and pharmacists all deliver Diabetes Self-Management Training, which is within their respective scopes of practice and in line with their respective training and qualifications.

Sometimes a member of one profession will go beyond their scope of practice and engage in activity for which they are not qualified. Often referred to as “scope creep,” this can be dangerous and put patients and clients at risk of harm. The Academy believes that the provision of medical nutrition therapy and other complex dietetics and nutrition services should only be provided by individuals who have at minimum the specialized training and competencies of RDNs. Therefore the Academy works with other disciplines practicing in the nutrition space — such as physicians, chiropractors, pharmacists, certified nutrition specialists, naturopaths, health coaches and others — on various legislative and licensure activities. When appropriate and necessary, the Academy provides feedback and testimony to legislative bodies to ensure MNT is exclusively provided by licensed professionals who have, at minimum, met the standards of an RDN.

State and Federal Facility Regulations

State and federal statutes and regulations may specifically require or exempt licensure or an RDN credential in order to practice. Additionally, individual facilities may have their own standards beyond those based in law.   Qualified nutrition practitioners are encouraged to consult their specific statutes and/or facility policies for clarification.

Collecting Stories of Success and Adverse Events

Although professional standards of practice and existing consumer protection laws are effective in keeping the number of incidents of harm low, it is crucial to document instances when a consumer has reported harm — either directly to one of our members or through the media or courts. This documentation demonstrates to state legislators the risks of failing to sufficiently protect consumers from incompetent or unethical providers who practice in states without sufficiently strong licensure laws that include an exclusive scope of practice for licensed dietitian nutritionists.

CMS Rules on Therapeutic Diet Orders

The Center for Medicare and Medicaid Services rules regulating the ordering of therapeutic diets in various facilities (such as acute care hospitals, Critical Access Hospitals and long-term care facilities) allow RDNs to order diets in accordance with state law and facilities’ policies and procedure approvals. The Academy has prepared state-by-state guidance documents for hospitals and for long-term care facilities.