Managing A New Task In Dietetic Practice

Scenario

Jenny is a Public Health Dietitian who works in a school health program. Part of her assignment with the schools this year will be to conduct short anaphylaxis training during school staff meetings. The training will include a presentation on anaphylaxis reactions, common allergenic foods and a demonstration of Epi-Pen use. Considering the dietetic scope of practice, are there any concerns for Jenny to provide this training and demonstrate usage of the Epi-Pen?

Evaluating a New Task

It is important to recognize that the job responsibilities of RDs are evolving due to changes in technology, changes in the dietetic body of knowledge as well as the changes in programs and policies relating to the health care delivery system. In Jenny's scenario and other similar cases, RDs need to exercise professional judgment to evaluate new tasks and the conditions under which they should perform them.

When considering the addition of new tasks to their workload, RDs should ask themselves these five questions:

  1. Is the task within the dietetic scope of practice or intrinsically related to it?
  2. Will performing the task improve client-centred care?
  3. Given all of the local circumstances, who is the most appropriate person(s) to perform the task (e.g., an RD, or another health care provider/team member)?
  4. Are there any legal barriers restricting an RD from performing the task (e.g., performing a Controlled Act)? For example, would an authority mechanism be needed for an RD to perform the task?
  5. Do I have the appropriate skills and competence to perform the task? If not, how can I obtain what is necessary to become competent?

Applying the questions to the Scenario

1. Is the new task within Jenny’s scope of practice or intrinsically related to it?

The Dietetic Scope of Practice Statement states, "The practice of dietetics is the assessment of nutrition and nutritional conditions and the treatment and prevention of nutrition related disorders by nutritional means". According to this statement, anaphylaxis training is within the dietetic scope of practice as it involves nutrition and nutritional conditions relating to a physiological reaction to food.

2. Will performing the task improve client-centred care? 

Jenny’s clients are the students at the school. Jenny's teaching will improve their care as school staff will be more informed about anaphylaxis reactions and be able to improve overall school safety for in managing allergic reactions to food.

3. Is Jenny the best person to perform the task? 

Because Jenny provides other nutrition services within her role as a Public Health Dietitian at the school, her regular presence within the facility results in her being an appropriate person to deliver the anaphylaxis training.

4. Are there any legal barriers restricting Jenny from performing the task? Is this task a controlled act? 

Teaching school staff about anaphylaxis reactions and even demonstrating the use of an Epi-Pen on a piece of fruit, sponge ball, or pillow, showing a video demonstration, or simply explaining the mechanism of the Epi-pen is not a controlled act. Therefore, there are no legal barriers for performing anaphylaxis training.

While injecting a substance is a Controlled Act, RDs may administer an Epi-Pen in an emergency situation where a client is experiencing an anaphylactic reaction. According to the Regulated Health Professions Act, 1991, performing a controlled act in emergency situations is not prohibited. 

5. Does Jenny have the appropriate skills and competence to perform the task? 

Having determined that anaphylaxis training is within the dietetic scope of practice, Jenny needs to assess whether she has the skills and competence to deliver the training to the school staff. Jenny recently attended a training session on Epi-Pen use with a group of Public Health Nurses and along with her current nutrition knowledge of allergic reactions, she feels she is competent to provide anaphylaxis training. Therefore, it would be appropriate for Jenny to provide such education and training to the school staff.

What to do when the task is not appropriate

If an employer asks a dietitian to perform a task that is not appropriate, they may express their concerns with their employer. Such discussions provide opportunities for RDs to educate their employers about the dietetic scope of practice. If in doubt, RDs can certainly call the College with their inquiry and we can provide additional perspective.