About the Supervised Practice Experience (SPE) April 2022

Supervised Practice Experience Overview

Introduction

The Supervised Practice Experience (SPE) is a key eligibility requirement for earning the CNS credential, enabling candidates to gain valuable clinical practice experience under the supervision of a highly qualified nutrition professional. The SPE provides the opportunity for candidates to use, develop, and refine knowledge and skill competencies in advanced clinical nutrition.  

Candidates identify supervisor(s) and arrange practice setting(s) in accordance with guidelines and resources provided by BCNS, including the competencies which must be addressed during the 1000-hour experience.

What are the requirements for the Supervised Practice Experience (SPE)?
  1. A minimum of 1,000 hours of supervised practice in clinical care based on the Personalized Nutrition Care Mode.  The experience must address the CNS SPE competencies and be structured to ensure each candidate obtains the in-depth knowledge and skills expected of an advanced-level nutrition professional.   
  2. Candidates must work with approved supervisors and in practice settings that are in accordance with BCNS guidelines.
  3. Candidates must document their work using the provided tools.  
  4. Supervisors must document and report the candidate’s progress and successful completion of the competencies.  
  5. Supervised Practice Experience must be completed and submitted to the BCNS within 5 years of passing the certification exam.
What should the 1,000-hour experience cover?

I. The practice experience should follow the PN Care Model, with time allocated as follows:

  • Category A: Personalized Nutrition Assessment and Interpretation (minimum 200 hours)
  • Category B: Personalized Nutrition Intervention, Education, Counseling, and Ongoing Care (minimum 200 hours
  • Category C: Personalized Nutrition Monitoring and Evaluation (minimum 200 hours) Remaining hours may be in any of the above categories.

II. The practice experience should address each of the SPE competencies through exposure to a broad range of health conditions

When can I begin the SPE?

To be eligible, all supervised experience must be gained after the candidate matriculates into the qualifying degree program. However, some state regulations stipulate that supervised practice is begins after completion of the qualifying degree program.  It is the responsibility of candidates and supervisors to familiarize themselves with the applicable state regulations.

Although the SPE may be completed before or after passing the BCNS Certifying Examination, it is important to note that historically those who have completed the practice experience perform better on the examination than those who have not. The CNS credential will not be awarded until the completed SPE hours have been approved by the BCNS Credentials Council.

How do I find a supervisor?

Supervisors can be employers, faculty, colleagues, mentors, etc. Candidates can participate in networking events and activities, research nutrition professionals in their geographic location and area(s) of specialty, utilize the ANA Practitioner Finder and ANA Mentor program (benefit of ANA membership) or BCNS staff (Certifications@NutritionSpecialists.org) for a list of approved supervisors.

Each supervisor must meet the eligibility requirements and be approved by the BCNS prior to supervising candidates for eligible practice hours.

How do I find a practice setting?

 Supervised practice experience settings may be any that facilitate the SPE requirements, including but not limited to: BCNS approved qualifying degree programs, clinical practice, institutional setting, community setting, home health care setting, etc. (NOTE: Retail stores are not an appropriate setting.)

To address the CNS SPE competencies, the 1,000 hours will likely come from multiple venues and supervisors.

What are the candidate's responsibilities?
  1. Secure the setting(s) and qualified supervisor(s) for the experience and for working with the supervisor(s) in accordance with CNS Supervised Practice Experience Requirements and CNS Supervised Practice Experience Competencies. Note: to meet all competencies, it is recommended that candidates work with multiple supervisors in multiple settings.
  2. Review the current licensing statute and regulations in their state before beginning the SPE so that it may be designed to meet the individual state’s requirements for record-keeping, supervisor qualifications, supervisor responsibilities including access to all candidate client records and degree of oversight, supervisor competencies and skills, practice settings, etc.  
  3. Verify the completion and submission of the CNS Supervisor Approval Application for each supervisor with whom they will work. (This is to ensure that candidates are working with BCNS-approved supervisors.)
  4. Comply with BCNS reporting requirements.
  5. Meet with supervisor(s) regularly. Meetings may be held in-person or remotely and should be held as frequently as deemed necessary by the supervisor based on the candidate’s level of expertise. The level of supervisor contact is expected to be higher in the beginning of the SPE and may be reduced as the candidate progresses through the experience. State requirements vary, so it is important for candidates to be familiar with relevant state laws.
  6. Make any financial arrangements with supervisors which may range from a paid internship to a mentorship program for which there may be a fee to candidates; BCNS requirements do not address financial arrangements.
  7. Disclose to their clients that they are under supervision as part of a structured practice experience required to earn the CNS and meet state licensing requirements.  If unlicensed, they must represent themselves as a student, trainee, or supervisee, in all outgoing communications, including marketing and promotional materials. Candidates may use any degrees or certifications earned if they do not violate titles that are restricted in the state(s) in which they are practicing. Note that this pertains to the state in which the candidate practices as well any states in which a client resides.
  8. Have student or professional commercial general liability insurance while under supervision.
  9. Is there an order in which I should earn hours and/or competencies?

Candidates may begin the SPE observing the actions of experienced nutritionists/supervisors. For this reason, the CNS requirements allow for 250 observational hours counted towards the 1000-hour requirement. As the candidate becomes more experienced, more of the hours will be spent directly with a client or groups of clients or in preparation for clinical client work.

What is the difference between observational and direct hours?

Observational experience (optional and maximum of 250 hours)

Candidates may opt to start with Observational hours as they are learning the PN care model and just beginning to apply foundational coursework to clinical situations. During observational SPE, candidates will earn hours across the Categories A, B and C in the following ways:

  •     Shadowing an experienced clinician
  •     Earning observational hours as part of a BCNS-approved supervision program
  •     Creating treatment plans for a supervisor’s current client
  •     Participating in simulation exercises and/or role playing
  •     Utilizing case studies to prepare treatment plans

NOTE: Observational hours are not required, and candidates may earn the complete 1,000 hours in Direct experience. 

Direct experience (minimum of 750 hours)

While earning direct experience, candidates and supervisors work together to ensure they are each meeting their responsibilities. During direct SPE, candidates will earn hours across the Categories A, B and C in the following ways:

  • Counseling individuals and groups
  • Developing client treatment plans for current clients
  • Preparing, and presenting client educational workshops for current clients
  • Community education (development and delivery of education to a specific population)
  •  Earning direct hours as part of a BCNS-approved school supervision program
  • Supervisor grand rounds and one-on-one meetings
The following activities do not qualify for SPE hours:
  •     Research that is not related to development of a treatment plan for a current client
  •     Writing books, articles, blogs, etc.
  •     Teaching classes in academic programs
  •     Developing condition-based training programs and treatment protocols not related to a current client
  •     Presenting educational lectures, videos, webinars, etc. for academics or mass audiences  
  •     Watching educational lectures, videos, webinars, etc.

NOTE: Both observational and direct activities must be categorized into Categories A, B, and C.    

How do I track my hours?

Candidates are required to track hours worked and competencies met with the CNS SPE Tracking Tool. It is highly recommended that they track information on a daily or weekly basis to ensure details are not forgotten.

Candidates must also keep details of their client work in the Candidate’s Report. This is not only a summary of the 1,000 hours of work meeting the rigorous competencies of a nutrition professional, but also a tool to reflect and self-evaluate. Candidates should complete all fields with detailed experiences and activities that fulfill each competency to indicate how each has been met.

NOTE: These reports are very important for the BCNS to evaluate the candidate’s experience. 

Does the SPE need to be done in person?

While BCNS allows supervision to be done in person, remotely, or in combination, candidates should review guidelines for supervision of the state in which they reside and the state(s) in which they plan to be licensed, if different. An increasing number of states will require that remote supervision includes periodic direct observation of candidate-client interactions whether by viewing a recorded session, by sitting in a live session via teleconference, or on site.

Does the SPE qualify for state licensing?

BCNS approval of SPE does not guarantee that the candidate will meet the experience requirement that state law mandates. Although CNS SPE requirements meet those of many states’, regulations and eligibility requirements vary from state to state and change over time. Most states individually evaluate the education, examination, and SPE components of each candidate.  

It is the responsibility of each candidate to review the current licensing statute and regulations in the state(s) in which they intend to practice before beginning the SPE. This information will ensure the candidate complies with the state’s requirements for record-keeping, supervisor qualifications, supervisor-candidate interaction, competencies and skills, practice facilities, etc.   

BCNS highly recommends candidates obtain a copy of the licensure application ahead of time, from the state(s) in which they intend to be licensed, so that they understand the documentation that will be required for licensure. Applications are generally available online, but in some states, it will be necessary to call the department handling the process to obtain a copy. Please refer to https://theana.org/advocate.

Does my supervisor need to work or hold a license in my state?

While the CNS SPE requirements do not maintain that the supervisor and candidate live, work or hold a license with nutrition in scope in particular states, candidates should know the state regulation and work with supervisors accordingly.

What are the supervisor requirements?

Supervisors must meet the following criteria:

Additional requirements:

  1. They must have one of the following degrees or certifications: Certified Nutrition Specialist (CNS) in good standing
    Master of Science or Doctoral Degree in a field of nutrition from a regionally accredited institution with a state license or certification (if applicable); or  Licensed MD/DO with didactic training or education and experience in clinical nutrition as documented by 75 CE credits or the equivalent (without exception) over the past 5 years; or
    Doctoral-level health professional who meets eligibility requirements for CNS and who can legally provide nutrition services in the state of practice. NOTE: Doctors of Chiropractic (DCs) must also be a CNS or MS, Nutrition from a regionally accredited institution.
  2. They must have a minimum of three (3) full-time years of clinical experience in nutrition care completed after obtaining the qualifying credential or degree.
  3. They must meet state regulations to practice MNT in their home states and the state in which the client resides. Candidates need to be aware of this requirement when deciding which clients they work with.                                                                                                 
  4. Additional Requirements: Licensed or certified nutritionists or dietitians are only eligible as supervisors if they also hold a master’s or doctoral degree in the field of nutrition from a regionally accredited institution.
  5. Approved supervisors may supervise multiple candidates on an ongoing basis.
  6. Supervisors may not be married to, related to or domestic partners with the supervisee(s).
  7. For potential supervisors who are not CNSs, licensed nutritionists, or who do not hold an MS or graduate degree in nutrition; the BCNS will evaluate both didactic training and experience in clinical nutrition, as per supervisor qualifications outlined above, to determine ability to provide a robust SPE for CNS candidates.
  8. All supervisors must demonstrate training and experience in nutrition assessment; nutrition intervention, including medical nutrition therapy; and evaluation.

What are the supervisor responsibilities? 

  1. Attend a pre-recorded ANA Personalized Nutrition SPE training session and submit the attestation. 
  2. Assume professional responsibility for work done by the candidate and implement a system that reflects they have authorized, verified, and directed the work of the candidate while under supervision.  
  3. Complete the BCNS Supervisor Approval Application and submit it to the BCNS along with their current CV. If the supervisor is pre-approved, only the one-page Supervisor Application Addendum is required for each new candidate being supervised. Supervisor approval status is for 3-years, at which time application renewal is required. 
  4. Assist each candidate in structuring an experience that meets the CNS supervised practice experience requirements and its competencies, the candidate’s evolving skill level, and the candidate’s career goals. Candidates should articulate personal career goals in addition to meeting competencies; goals can also evolve throughout the SPE. 
  5. Provide adequate, active, and continuing oversite of a candidate's activities including the review of their practice on a regular basis via regularly scheduled conferences with the candidate. 
  6. Have access to all client records of the candidate and review them at regular intervals. Supervisors should keep notes on their candidates’ work and progress. 
  7. Review Personalized Nutrition (PN) Case Data Collection Reports for each of their candidate’s clients. This is a tool provided by the BCNS to assist supervisors in evaluating a candidate’s work on an ongoing basis to ensure they are competent in all aspects of the PN care process. 
  8. Be available to their candidate when the candidate is working with a client, as reasonably appropriate to the circumstance. (e.g. When the supervisor plans to be on vacation or otherwise unavailable for an extended period, a backup BCNS-approved supervisor should be designated.) 
  9. Upon completion of the supervision experience, verify the completion of the hours reported on the Candidate’s Report, rating the candidate’s performance in each of the designated competency categories, confirming that they have reviewed and approved PN Case Reports for their candidates’ clients, and submitting the CNS Supervised Practice Experience Supervisor’s Report for approval by the BCNS Credentials Council. 
  10. Hold liability insurance. 
  11. Review the candidate’s performance by observing them working directly with a client, either in real time (on site or remotely) or by having access to a recording of the nutrition service.