Scope of Practice
Regulated professions define their profession’s scope of practice1 in legislation. Standards of practice also describe the dietetic scope of practice.
Both standards of practice (ICDEPs) and standards of ethical practice (code of ethics) state that dietitians must practice within their individual scope of practice2 and recognize and address situations beyond personal capacity by consultation, referral or further learning (ICDEP 1.04). A professional’s scope of employment is set by the employer.
Practice Illustration: A public health nutritionist delivers presentations at family resource centres on general nutrition guidelines. A member of the public asks the nutritionist a question about her infant who has gastrointestinal reflux. Replying to this question is within the professional scope of practice, but the nutritionist does not have the current knowledge to provide nutrition counselling for this scenario. It is also not her employer’s expectation for her to provide one-on-one counselling for medical conditions. This is an example of a scenario that is within the dietetic scope of practice, but not the dietitian’s individual or employment scopes of practice.
It is essential to recognize when an activity is out of one’s individual scope of practice and refer to another qualified health care professional.
It is essential to understand the scopes of practice of interprofessional team colleagues, respect where they overlap with the dietetic scope of practice, and collaborate effectively to provide optimal patient care.
Practice Illustration: A dietitian works within a primary health care clinic with a speech language pathologist (SLP), physician and physiotherapist. The dietitian’s client is reporting signs of dysphagia. The dietitian does not have current knowledge or skills to perform a bedside swallowing assessment, although the SLP has the ability. Although this activity falls within the dietetic scope of practice, the dietitian must refer her client to the SLP and collaborate with the SLP to develop, implement and monitor the nutrition care plan.
There are activities that health professionals perform that are considered within the public domain. These are activities that non-regulated professionals may perform. For example, providing information about healthy eating guidelines, taking a person’s blood pressure, or measuring a person’s height and weight.
Practice Illustration: A dietitian with recent experience practising in an acute care hospital as a clinical dietitian accepts a position as a continuing care coordinator. Clients often ask questions about nutritional concerns. Whereas the dietitian has the current knowledge and skills to answer clients’ nutrition-related questions, it is not within her job description. This is an example of the activity falling within both individual and professional scopes of practice, but not within the employment scope of practice.
1 Professional scope of practice - Scope of practice of the profession - the roles, functions and accountabilities that dietitians are educated and authorized to perform (Dietitians Act, 2009).
2 Individual scope of practice - the roles, functions and accountabilities that an individual is educated and authorized to perform (Dietitians Act, 2009).
Note: The Dietitians Act (2009) was approved in 2009, but is not yet in effect.