Advanced nutrition support therapy practices of registered dietitian nutritionists: A survey of the Academy of Nutrition and Dietetics' Dietitians in Nutrition Support Dietetics Practice Group and the American Society for Parenteral and Enteral Nutri

Nutrition support therapy (NST) requires continuous monitoring and interdisciplinary collaboration to optimize nutrition status and prevent complications. Registered dietitian nutritionists (RDNs) are pivotal in managing NST, using their expertise to assess malnutrition risk, evaluate suitable nutrition routes, and lead teams in evidence-based nutrition care. However, not all RDNs operate at an expert level owing to varying education, training, and clinical experiences. A survey to determine expert-level RDN NST practices was created and distributed through the Dietitians in Nutrition Support Dietetic Practice Group of the Academy of Nutrition and Dietetics and the Dietetics Practice Section of the American Society for Parenteral and Enteral Nutrition. The survey gathered data on demographics, practice characteristics, and frequency of and barriers to performing select expert-level practice indicators using the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: Revised 2021 Standards of Practice and Standards of Professional Performance for RDNs (competent, proficient, and expert) in Nutrition Support. A total of 668 RDNs completed the survey (12.4% response). Findings revealed that RDNs frequently performed nutrition-focused physical examinations (83%) and determined micronutrient supplementation (59%). RDNs performed the following activities less frequently: evaluating body composition using diagnostic results (9%), inserting nasogastric/nasoenteric tubes (19%), and leading quality-improvement initiatives (30%). Key barriers identified included lack of training/experience and institutional support, and regulatory constraints. These results underscore the need for enhanced professional development, including training programs and interprofessional collaboration, to promote RDN expert-level NST practice and advance the dietetics profession.