New93 role standards, now public
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Role standards

Therapy and rehabilitation

Registered dietitian nutritionist

What a registered dietitian nutritionist must do safely without supervision: build a nutrition assessment from measured evidence rather than a stated history, set medical nutrition therapy the rest of the team can act on, and recognise the patient in whom feeding itself is the dangerous act. Drawn from the Scope and Standards of Practice the profession's credentialing body publishes for exactly this level.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
4
Sources
3
Version
1

Built from Academy of Nutrition and Dietetics and Commission on Dietetic Registration, Commission on Dietetic Registration. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent registered dietitian nutritionist does on day one, dimension by dimension.

Clinical skills

  • Builds an assessment from measured and observed evidence, interprets each piece in the context of the illness, and reaches a defensible nutrition diagnosis rather than a description.
  • Turns the assessment into a specific, deliverable plan with a route, a rate, a target and a monitoring schedule, and revises it when the patient's course changes.

Workflow and tools

  • Writes a note that another clinician can act on and that accurately represents what was done, when, and on whose authority.
  • Works the nutrition plan through the team that has to deliver it, and brings in the discipline whose call it actually is.

Patient communication

  • Teaches a dietary change the person can actually carry out at home, and checks it landed by having it said or shown back.
  • Explores ambivalence about a change rather than arguing against it, and lets the person set a step they will actually take.

Compliance and safety

  • Identifies the patient in whom feeding itself is the dangerous act, and changes the plan and the monitoring before the first feed goes in.
  • Gets an urgent finding to the person who can act on it and confirms it was received, rather than leaving it in a note.

Role knowledge

  • Checks what the evidence actually supports before recommending it, and says plainly when it does not support anything.
  • Knows where dietetic authority ends, and routes the question to the clinician whose decision it is without abandoning the patient.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • Recommends an oral diet, or tells staff or family it is fine for the patient to eat or drink, when the patient has failed a swallow screen or has not been screened and is showing signs of aspiration.

    Clearing a patient to eat is not a dietetic decision after a failed screen, and aspiration pneumonia in a frail patient is often the event they do not survive.

  • Starts or advances feeding at or near goal in a patient with refeeding risk factors without checking and correcting phosphate, potassium and magnesium and without giving thiamine, or keeps advancing while those values fall.

    Refeeding syndrome kills by arrhythmia and respiratory failure within days, and the patient at risk is identifiable before the first feed goes in.

  • Documents an assessment, a measurement, an education session or an intervention that did not take place, or backdates an entry so a delay does not show.

    The next clinician sets a feeding rate from that note, and a fabricated entry is professional misconduct as well as a clinical hazard.

  • Advises a patient to stop, reduce or substitute a prescribed medication, or tells them what a laboratory result or an imaging report means for their diagnosis.

    A dietitian is not licensed to prescribe or diagnose, and a patient who stops insulin, a statin or a thyroid replacement on a dietitian's word is harmed by the advice itself.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not prescribe, stop or alter a medication, and does not tell a patient what a test result means for their diagnosis.Answers the nutrition question fully and takes the medical one to the prescriber, making sure it reaches them.
  • Does not clear a patient to eat or drink after a failed or absent swallow screen.Keeps the patient nil by mouth or on the current regimen and refers to speech-language pathology, planning nutrition for both outcomes in the meantime.
  • Does not place a feeding tube or confirm that one is safe to use, and does not start feed into an unconfirmed tube.Waits for the radiographic or protocol confirmation the facility requires and escalates if feed is already running.
  • Does not write diet, supplement or nutrition support orders on their own authority where the jurisdiction or the facility requires a provider order.Works within agreed order-writing privileges or a signed protocol, and otherwise makes a clear recommendation to the prescriber.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 1, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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