Supervised Practice Experience Overview
1. A minimum of 1,000 hours of supervised practice in the personalized nutrition care model which addresses the CNS SPE competencies is an essential component of the CNS credential. The program is structured to ensure each candidate obtains the in-depth knowledge and skills expected of an advanced-level nutrition professional while maintaining the flexibility required to achieve individual career goals. As such, candidates are responsible for working with BCNS-approved supervisors and in appropriate practice settings to complete a practice experience that meets all program requirements outlined herein. We encourage you to go into the SPE with the mindset that more than one supervisor will most likely be needed to provide supervision in a broad range of conditions and MNT competencies.
2. BCNS approval of SPE does not guarantee that the candidate will meet the experience requirement in a given state. We work hard toward the end that the CNS SPE requirements will meet those of most state licensing boards that license or certify CNSs. Requirements vary from state to state and are changing over time. Most states individually evaluate the education, examination, and SPE components of each candidate. The CNS SPE requirements are flexible to allow candidates to meet career goals and objectives and state licensing statutes and regulations in the state(s) in which they intend to practice.
For best outcomes, BCNS strongly recommends that each candidate review the current licensing statute and regulations in their state before beginning the SPE so that it may be designed to meet the state’s requirements for record-keeping, supervisor qualifications, supervisor-candidate interaction, competencies and skills, practice facilities, etc. We leave this responsibility to each candidate. This should not be difficult but planning and record-keeping is essential. We highly recommend 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, which contains links to each regulatory board’s website, if available.
3. Although the Supervised Experience Program 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 experience has been approved by the BCNS Credentials Council. Some states do offer a provisional license for candidates who have completed the education and experience portion and are waiting to take the exam. These provisional licenses are typically good for a year and sometimes have an option for extension. Provisional licenses may have different rights and responsibilities than full licenses.
4. It is expected that candidates will 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. Observational experience may be part of a degree program or may occur post degree. Observational experience means a planned learning situation that is not direct client care, does not require intervention by the candidate, meets pre-planned stated outcomes, and provides for candidate evaluation. Some examples of Observational experience are: watching videos of client and practitioner interaction, sitting in on a consultation conducted by another practitioner, participating in a virtual clinic, role playing with colleagues, conducting research for a particular client, participating in simulation exercises, writing and reviewing case studies, shadowing an experienced clinician, and creating client handouts for a particular client.
5. 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. This is referred to as direct experience. Some examples of Direct experience are: counseling individuals and groups directly; researching and developing client treatment plans for particular current clients; researching, preparing and presenting client workshops; participating in an approved supervision program; and reviewing cases with approved supervisors.
6. Both observational and direct activities must be categorized into Category A, Category B, and Category C, and candidates are required to record them in the SPE Tracking Tool. 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. For detailed information on activities for each category, please contact Certifications@NutritionSpecialists.org.
7. Supervised practice experience settings may be any that facilitate the above requirements, including but not limited to: Internship*, residency, or clinical rotation Clinical practice Institutional setting Community setting *Internships must comply with state labor laws. NOTE: Retail stores are not an appropriate setting.
8. In order to address the CNS SPE competencies, the 1,000 hours will likely come from multiple venues and supervisors. Supervisors may supervise a candidate in multiple settings as long as the supervisor has the demonstrated experience and qualifications for the skills needed for the setting. Each supervisor must meet the eligibility requirements and be approved by the BCNS prior to supervising candidates for eligible practice hours.
9. To be eligible, all supervised experience must be gained after the candidate matriculates into the qualifying degree program. However, both candidates and supervisors should be aware if a particular state law mandates the SPE begins only after completion of the education program.
10. BCNS allows supervision to be done in person, remotely, or a combination of the two. Candidates should review guidelines for supervision of the state in which you are residing and the state(s) in which you plan to be licensed, if different than where you reside. An increasing number of states will require that in cases of remote supervision, there be occasional direct observation of candidate-client interactions whether by viewing a recorded session or by sitting in a live session via teleconference or on site.
1. Each candidate is responsible for securing the setting(s) and qualified supervisor(s) for the experience and for working with the supervisor(s) to tailor the experience in accordance with CNS Supervised Practice Experience Requirements and CNS Supervised Practice Experience Competencies. Note: to meet all the competencies, it is recommended that candidates work with multiple supervisors in multiple settings (such as a practicum or internship, clinical practice, community, institutional or home health care setting.)
2. For best outcomes, BCNS strongly recommends that each candidate 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. To ensure that candidates are working with a BCNS-approved supervisor, each candidate is responsible for verifying the completion and submission of the CNS Supervisor Approval Application for each supervisor they will work with. Note: Candidates are encouraged to have their supervisor(s) approved by BCNS prior to beginning the practice experience with the specific supervisor. The approval of the candidate’s supervisor does not mean the candidate’s experience is approved. Candidates are required to submit a Candidate’s Report upon the completion of the SPE, which will be reviewed for approval along with their completed BCNS Tracking tool covering the entire SPE.
4. It is required that candidates coordinate their SPE program with their supervisor(s) to support and address each of the competencies while allowing it to be tailored to each candidate’s individual career goals.
5. Each CNS candidate must document and attest to the completion of 1,000 hours, by completing on an ongoing basis, and submitting up completion, the following documentation to the BCNS: CNS Candidate’s Report CNS SPE Tracking Tool We encourage thorough, complete and timely record-keeping throughout the SPE to ensure your records are complete both for BCNS review and state licensing.
6. To ensure that candidates understand the PN Care process, BCNS encourages candidates to use the PN Case Data Collection, either separately or embedded in the EMR or other similar form, with each client and to review them when discussing each case with the supervisor(s).
7. To document competency in all aspects of the PN care process, one comprehensive PN Case Data Collection form and one PN Case Report must be approved by a supervisor at the end of the SPE hours. The supervisor will document approval of both reports on the Supervisor’s Report. These forms are NOT to be submitted to the BCNS.
8. Candidates and supervisors must meet 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 will be higher in the beginning of the SPE and may be reduced as the candidate progresses through experience. States vary in their requirements on this so be sure, once again, that you are familiar with state laws relevant to you.
9. Candidates are responsible for making 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.
10. Candidates are required to disclose to their clients that they are under supervision as part of the requirements to earn the CNS credential and are required to use a title in any promotional material that indicates the individual's status as a student, trainee, or supervisee, if they are not licensed. You can however, use any degrees or certifications you have earned as long as they do not violated titles that are restricted in the state(s) in which you are practicing, to use by licensees only. Remember this covers the state in which you provide from, as well any states in which your clients reside.
11. Candidates are required to have student or professional commercial general liability insurance while under supervision.
Supervisors must meet the following criteria:
1. Must have a minimum of three (3) full-time years of clinical experience in nutrition care completed after obtaining the required credential or degree.
2. Must have one of the following degrees (from a regionally accredited institution) or certifications: Certified Nutrition Specialist (CNS) in good standing; Master of Science or Doctoral Degree in a field of nutrition 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. Doctors of Chiropractic (DCs) must also be a CNS or MS, Nutrition.
3. Supervisors must meet state requirements to practice MNT in their home states and the state in which the client resides. Candidates need to be aware of this in deciding which clients they work with. (Note: This includes licensure and telehealth requirements if/when applicable.)
1. 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.
2. Approved supervisors may supervise multiple candidates on an ongoing basis.
3. Supervisors may not be married to, related to or domestic partners with the supervisee(s).
4. 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.
5. All supervisors must demonstrate training and experience in nutrition assessment, nutrition intervention including medical nutrition therapy and evaluation.
1. Each supervisor is required to attend a pre-recorded ANA Personalized Nutrition SPE training session.
2. The supervisor is assuming professional responsibility for work done by the supervisee and is required to implement a system that reflects they have authorized, verified, and directed the work of the supervisee while under supervision. Degree of monitoring can reflect the supervisor’s assessment of the candidate’s evolving skill level.
3. Supervisors are responsible for completing the BCNS Supervisor Approval Application and submitting 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.
4. Supervisors are responsible for assisting each candidate in tailoring 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. Each supervisor must provide adequate, active, and continuing oversite of a supervisee's activities including the review of a supervisee's practice on a regular basis via regularly scheduled conferences between the qualified supervisor and the supervisee.
6. Supervisors must have access to all client records of the supervisee and should review them at regular intervals. Supervisors should keep notes on their candidates’ work and progress.
7. Supervisors are required to review PN Case Data Collection Reports for each of their candidate’s clients. This is a tool provided by the BCNS for supervisors to evaluate a candidate’s work on an ongoing basis to ensure they are competent in all aspects of the PN care process.
8. The supervisor is expected to 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 of time, a backup BCNS-approved supervisor should be designated.)
9. Upon completion of the supervision experience, each supervisor is responsible for verifying the completion of the hours reported on the CNS Supervised Practice Experience 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. Supervisors are required to have liability insurance.
11. The supervisor shall review performance by periodic observation, either in real time (on site or remotely) or by having access to a recording of the nutrition service