Jurisprudence Guide for Dietitians in British Columbia Notes

Introduction

• The College of Health and Care Professionals (CHCPBC) regulates dietetics to protect the public in British Columbia.
• The Jurisprudence Guide is a reference tool for dietetic applicants and Registered Dietitians in B.C.
• It links dietetic practice with laws that protect public health and well-being.
• The guide and legislated enactments outline principles for competent, safe, and ethical practice.
• The Jurisprudence Examination tests knowledge in the Guide and must be passed by new applicants and Registered Dietitians every five years.

Regulation of Dietetic Practice in B.C.

• Chapter 1 focuses on legislation defining how the College regulates dietetic practice.
• Chapter 2 describes legal requirements for registration and different registration classes.
• Chapter 3 explores public protection through quality practice, performance expectations, and the Continuing Competence Program.
• Chapter 4 outlines the College’s oversight of professional conduct, the Patient Relations Program, and the Complaint Resolution Process.

Chapter 1: Regulation

• Dietitian title has a legal meaning with obligations and duties outlined in the Health Professions Act (HPA).
• The HPA's primary mandate is public protection through competent, safe, and ethical service delivery.
• Dietitians are regulated health professionals in all Canadian provinces except Northwest Territories, Yukon, and Nunavut.
• Regulation is granted when the profession involves risk of harm, is organized, and has resources to protect citizens.

The College of Health and Care Professionals of B.C.

• The College of Dietitians of British Columbia (CDBC) was established in 2002.
• In June 2024, CDBC amalgamated with six other health regulators to become the College of Health and Care Professions of B.C (CHCPBC).
• Only registrants of the College can use the reserved title “Dietitian” in B.C.
• The College’s mission is to safeguard public health by ensuring professionals have the competencies for safe and ethical care.

Regulatory Framework for Dietetic Practice in B.C.

• The College regulates dietitians using the Health Professions Act, Dietitians Regulation, and CHCPBC Bylaws.
• Enforceable Standards of Practice, policies, guidelines, and position statements further refine and support practice.
• The HPA is overarching legislation that sets terms for all health regulatory colleges in B.C.
• Section 16 of the HPA outlines the duties and objects of a college, including public protection and governance of registrants.

Dietitians Regulation

• It describes how the HPA is applied to dietetics.
• It specifies the college’s name, reserved title of “Dietitian”, scope of practice, restricted activities, and the requirement for a Patient Relations Program.

CHCPBC Bylaws

• They expand on the HPA and associated Health Profession Regulation, referring specifically to the CHCPBC organization and how it conducts its business.

Reserved Title

• Only practitioners registered with a college can use the reserved title, e.g., Dietitian.
• Registered Dietitian or RD assures the public, colleagues, and employers that an individual is a regulated health professional.

Interjurisdictional Considerations

• Dietitians must be registered in the province where they provide in-person professional dietetic services.

Scope of Practice

• Dietetics is defined as assessing, maintaining, restoring, and promoting health as it relates to nutrition; planning, implementing, and evaluating nutrition interventions; providing information and counselling with respect to nutrition.

Restricted Activities

• Restricted activities for dietitians are designing, compounding, dispensing, and administering enteral nutrition, and designing parenteral nutrition.

Certified Acts

• Tasks associated with enteral nutrition that require additional training (in force January 1, 2025).

Code of Ethics, Standards of Practice, Policies, Guidelines, Statements, and Procedures

• They outline the requirements for a minimum level of performance for safe, ethical, and competent dietetic care and are enforceable.

Meeting the HPA Mandate

• The duties and objectives have three main focuses: the college itself, registrants, and colleagues.

College Processes and Programs

• Licensure: Ensures dietitians are competent through required documentation, examinations, and fees.
• Quality Assurance: Ensures quality dietetic services through programs and initiatives.
• Professional Conduct and Complaints: Establishes standards of professional conduct and oversees practice.

Information and Privacy Legislation

• The College maintains accurate registrant information and keeps files secure in accordance with the Freedom of Information and Protection of Privacy Act (FIPPA).

Requirements of Registrants

• Registrants must provide access to health care records and inform individuals of their rights under the HPA and FIPPA.

Collaborations

• The College collaborates with registrants, B.C. Health Regulators, individual health regulatory colleges, and the provincial Ministry of Health, Program Director and faculty at UBC.

College Structure and Function

• The College is governed by a Board and various committees.

CHCPBC Register

• The CHCPBC register is a public document with information about registrants.

Chapter 2: Licensure

• CHCPBC has the responsibility to establish the conditions or requirements for registration of a person with the College.

Mandatory Registration to Practice in B.C.

• Registration with CHCPBC is required to practice dietetics in B.C. and use the reserved title “Dietitian”.

Currency

• Candidates for initial dietetics registration must provide proof that they have obtained dietetic education and training approved by the Board within the last three years, or proof that the candidate has been actively practicing dietetics within the past three years.

Classes of Registration, Requirements, and Reserved Titles

• Three classes of registration are currently available to CHCPBC dietetics applicants, plus one for provincial emergencies such as natural disasters and pandemics:
  -Dietetics: Full Registration
  -Dietetics: Temporary Registration
  -Dietetics: Emergency Registration
  -Dietetics: Non-Practicing Registration

“Substantial Equivalence” to Academic and Practical Training Requirements

• Optional route for applicants who do not meet academic and practical training requirements.
• The College’s assessment process involves a knowledge and practical evaluation designed to identify an applicant’s knowledge and skills relative to dietetic competencies.

Restricted Activities and Certified Acts

• Only competent healthcare professionals may perform Restricted Activities and Certified Acts.

Registration Renewal for Dietitians

• Annually by March 31.

Resigning from the CHCPBC

• Registrants who no longer practice dietetics or no longer wish to maintain their registration status are removed from the Register.

Reinstatement to the Register

• Former registrants who fail to renew registration by March 31st may be reinstated to the Register in the following circumstances:
  -Reinstatement for Non-Payment of Fees
  -Reinstatement Within Three Years
  -Reinstatement Within Six Years
  -Reinstatement After More than Six Years
  -Reinstatement Following Disciplinary Action

Practicing in Another Jurisdiction

• Chapter 7 of the agreement outlines measures to eliminate or reduce barriers to labour mobility across Canada.

Virtual Dietetic Practice in Canada

• Dietitians practicing across provincial borders must be aware of and abide by the registration requirements in the province where the client resides.

Professional Liability Insurance

• All practicing registrants carry professional liability insurance in an amount of not less than 2 million dollars per occurrence.

Chapter 3: Quality Practice

• Public protection is the primary mandate of the Health Professions Act (HPA).

Performance Expectations

• The CHCPBC establishes standards, educates registrants about them, monitors registrants’ compliance and enforce adherence to the standards.

Code of Ethics

• Ethical conduct is an integral part of the legal framework for dietetic practice in B.C.
• The Code of Ethics is a set of five standards that state the values, behaviours, and responsibilities.
• Ethical Standards:
  -Provide Services in the Best Interest of Clients.
  -Communicate Effectively.
  -Collaborate Effectively.
  -Practice Safely and Competently.
  -Be Honest and Responsible.

Ethical Problems

• Ethical violations are neglected ethical standards.
• Ethical dilemmas arise when two different courses of action may be supported by ethical reasons but neither option satisfies both sides of the dilemma.
• Ethical distress occurs when there are constraints or limitations on a dietitian’s practice that causes them to feel powerless.

Standards of Practice

• Standards of Practice outline requirements for the safe and competent practice of health professionals are an integral part of the legal and ethical framework for professional practice in B.C.

Indigenous Cultural Safety, Humility, and Anti-racism Practice Standard

• The In Plain Sight Report (2020) describes the widespread Indigenous- specific stereotyping, racism and discrimination in the B.C. health care system.
• This Standard is adopted to address healthcare disparities and foster a culturally safe healthcare environment.

Standards of Record Keeping

• Record keeping allows registrants to apply their analytical skills and professional judgment in an evidence-informed, accountable, and client-centered manner, allowing registrants to explain the rationale behind their decisions when providing clients with care.

Marketing Standards

• Advertisement and marketing are legal terms that should be interpreted together in the context of promoting dietetic services or products.

Continuing Competence Program

• The CHCPBC has the legislated responsibility “to establish and maintain a continuing competency program to promote high practice standards amongst registrants”.

Components of the Continuing Competence Program

• Self-assessment: Self-assessment provides registrants with a systematic way to compare their practice to the Dietetic Standards of Practice and identify areas where they perform well and other areas of practice they want to maintain, develop, or enhance.
• Professional Development Report (PDR): The Professional Development Report (PDR) addresses areas where a registrant identifies they may take action to address specific Standards and Indicators of Practice.
• Annual Declaration of Continuing Competence Program Participation: The Declaration of CCP Participation is a statement that all registrants are required to sign electronically during the online registration renewal process.

Quality Assurance: Monitoring, Reviews, and Remediation

-Section 26.1 of the HPA allows the CHCPBC to have a quality assurance program, if indicated in bylaws, to assess the professional performance of registrants.

Competence to Practice

• Dietitians have an obligation to ensure that they are competent in their practice throughout the course of their career.

Chapter 4: Professional Conduct

• All Registered Dietitians are expected and required to conduct themselves in a professional manner.
• The CHCPBC has the legislated authority, under the Health Professions Act (HPA), to establish standards and regulations to oversee the practice of its registrants and to establish procedures to handle occasions when registrants are found to have contravened professional conduct.

Defining Professional Conduct

• It is the expectation of the public, other professionals, employers, and government that Registered Dietitians will provide competent, safe, ethical services.

Top Ten Causes of Unprofessional Conduct

1. Failure to maintain current professional knowledge and competence
2. Failure to seek assistance or make appropriate referrals
3. Difficulties in a professional’s personal life affect their work-life
4. Alcohol and drug addictions
5. Poor communication
6. Failure to appropriately address client concerns
7. Environmental Factors
8. Personality conflicts escalate to unprofessional conduct
9. Complacency about professional standards
10. Professional documentation

Dietetic Patient Relations Program: “Where’s the Line?”

• To meet the requirement in the HPA and Dietitians Regulation for a patient relations program, the Interpretive Guideline “Where’s the Line?”, available on the Resources Page, was developed.
• This document discusses professional boundaries in therapeutic relationships.

The Professional-Client Relationship

• Every relationship has a foundation shaped by specific purposes and needs.
• The professional-client relationship is a working relationship that is established between a professional and a client (or substitute decision maker).

Understanding the Therapeutic Relationship

-Power: It is the responsibility of all dietitians to use their inherent power in an appropriate manner, ensuring that the needs of their clients are met in a safe and positive environment.
-Trust: A Registered Dietitian has a responsibility to act in the best interests of the client and to avoid any actions that would undermine the confidence and trust of clients.
-Respect: Respect for the client and their decisions are fundamental to a positive professional-client relationship.
-Personal Closeness: A Registered Dietitian needs to ensure that clients are informed of the care/ services that are being provided and that clients share in decisions relating to the care/services they receive.

Defining Boundaries

-Professional boundaries are intended to set limits and clearly define a safe, therapeutic connection between dietitians and their clients.

Managing Boundaries

-Registered Dietitians can most effectively establish and manage professional boundaries in the professional-client relationship by following the guidelines include in “Where’s the Line?”.

Boundary Crossings: Blurring and Violations

-A boundary crossing occurs when the behaviour of a Registered Dietitian deviates from the established boundaries of a professional-client relationship.

Blurred Boundaries

-Dietitians should be cautious in self-disclosure.
-There are potential risks to the professional-client relationship related to accepting or giving gifts.
-Registered Dietitians should avoid providing care/ services in any situation where a dual relationship exists.
-Dietitians should be cautious in developing social relationships with clients, their family members, or partners, and consider the impact the social relationship may have on the professional-client relationship.
-Prior to developing a social relationship with a former client, dietitians should carefully consider the following factors:
-The nature of the care/services that were provided (in any situations where psychosocial interventions were provided, it would not be appropriate to develop a social relationship with a former client).
-The duration for which the care/services were provided and the likelihood that care/services will be required in the future.
-The degree to which the client is emotionally dependent on the Registered Dietitian as a result of the previous professional-client relationship.
-The potential impact on the well-being of the client.

Boundary Violations

-A boundary violation on the part of a professional is deliberate behaviour that is inappropriate and violates the professional-client relationship.

A Boundary Has Been Crossed… Now What?

• It generally becomes only aware of boundaries once they have been crossed; however, it’s a dietitian’s duty to establish, maintain and monitor the boundaries of a therapeutic relationship and to act if a boundary has been crossed.

Consent to Nutrition Care Guidelines

• Under this Act, consent is required before any care or service can be provided.

Complaint Resolution Process

• The possible courses of action for resolving a complaint in compliance with the HPA are summarized in the BC Health Regulators video on the complaint process.

If a Complaint is Lodged Against You…

• There are some actions a registrant can and must take to ensure a full and fair investigative process: