In looking to make a fresh start in my career, I’ve discovered even more about the world that makes me unhappy. Prior to becoming a nurse, I was 17 years old, smart but extremely naïve, looking for the good in everything and thinking I found it. I graduated young, started working in cardiac and intensive care, scaring my patients with my youthful face but hopefully bringing them some comfort by the end of my shift. Fast forward almost 15 years from that innocent girl learning “Nursing 101”, and life has taught me that not everything is to be trusted. What we view as brilliance now will change tomorrow. What is “safe” today will be considered toxic by the next generation.
The reason for my feelings on this subject today is because I’ve been doing research on the scope of practice in nursing, especially as it relates to nutrition. What is legal and allowed varies from state to state. For example, in the state of Illinois, the only persons that can provide nutritional assessments are licensed dieticians and nutritionists. (You can find the laws in your state by clicking here)
Here is a summary of the current law in Illinois, found at the above link:
“This law is a Licensure with Exclusive Scope of Practice law. Only a licensed dietitian or a licensed nutritionist can provide therapeutic nutrition care including: assessment, goal setting, counseling, evaluating, and determining possible nutrient-drug interactions. IL licenses dietitians and MS level and above nutritionists. There are some limited exemptions for licensed acupuncturists, and employees of health food stores and retail businesses selling food and/or supplements that you would need to read and evaluate in light of your situation if you are not licensed. Other health professionals licensed in IL may practice the profession for which they are licensed. See exemptions for complete list of other standard exemptions.” (italics mine)
So, nurses may “practice the profession for which they are licensed”. Or, to specifically quote from the full copy of the Act, ” Exemptions. This Act does not prohibit or restrict: (a) Any person licensed in this State under any other Act from engaging in the practice for which he or she is licensed.”
What exactly does that mean?
When you think of nursing, it really is a comprehensive method of care covering many different avenues of healing. If you look in textbooks, this also covers nutrition. We encourage patients with congestive heart failure to watch their sodium intake, encourage cardiac patients to eat a low fat diet (yes, eat those egg beaters!), and encourage expectant mothers to eat a healthy diet. But does it go any further than that? According to law in Illinois, not really. And neither is education in nutrition for nurses really encouraged. We have yearly mandatory rallies at the hospital to encourage unity among coworkers, to remind us to speak to the patient when we draw their blood, and to watch our leadership team rock out with wild hair to their new theme song (I’m serious), but nutrition is sorely lacking.
I want to take a look at one population of patients: new mothers. At the hospital where I work, many are young, unemployed, and receiving aid from the state. Very likely, they’ve had little in the way of nutritional training. In extreme cases, they also abuse drugs, causing severe malnourishment. After they deliver, they order pizza or have a friend bring them McDonalds, and fill their 32 oz “water” pitcher with diet Coke. A nurse standing at their bedside at that moment, after their having been awake for several hours in labor and having just gone through the rigors of delivery, telling them, “You should really eat healthy, you know. How about something other than that pizza or that diet Coke?” Number one, they will laugh and go back to texting. Number two, the only “nutrition” that can be offered are juices filled with high fructose corn syrup and a bag lunch of a nitrate-filled turkey sandwich, Lays potato chips, and a box cookie. (At least the pizza includes cultured dairy in the form of cheese, right?)
Something needs to change. By tightly regulating nutrition, no one has access to nutrition. No one considers nutrition. When someone thinks of the word “diet”, they think of a weight-loss plan, not that it could be something healthy for you. And even when you have someone that’s looking to improve their health, will they really find it when they seek nutritional counseling? Perhaps. But perhaps not.
When my son was first diagnosed with autism, he was also diagnosed with gluten intolerance. We were referred by our primary physician to see a registered dietician. In the fifteen minutes we spent in her office, she gave me a list of a couple companies that offered gluten free packaged goods. She told me that Woodmans had some gluten free items in its natural aisle. And she told me that since my child was so skinny, he probably needed more protein, and Walmart carried a GREAT chocolate-and-peanut-butter spread. It didn’t really matter that I told her he ate all the time (plenty of protein too!) but never really seemed to absorb his food. I left the office with my handout, none-the-wiser as I already knew about Woodmans’ aisle (and I never did try that peanut butter, seeing that it contained another food allergen that I’d discussed with her – dairy).
Now, over 4 years after that appointment, I’ve finally found something that’s healing my son’s gut. He’s able to absorb his food, he’s putting on weight, and his physical therapist commented today that he looked good in his muscle shirt because he was finally gaining a little muscle! Was it a registered dietician that taught me this? No, it was moms. Parents were the first to advocate that something was wrong with their children’s guts. They were the first to say they responded well to diet changes. The GAPS protocol? Designed by a doctor who is a mom of a boy with autism. Some of them may now work in the field of nutrition, may have earned degrees, but it’s their passion that motivates them. They truly believe in the power of food to heal.
So, that 10 piece chicken nugget after you have a baby? How about some bone broth instead? 🙂
So, to go back to the initial question: can a nurse offer nutritional advice? The answer is yes … and no.
According to the above law, the nurse is allowed to practice “within her scope”. So, in terms of complementary therapies, what is a nurse allowed to do? I found the following very interesting: Article from the Online Journal of Issues in Nursing — Illinois allows nurses to practice complementary therapies
Here’s a chart that is included in the article:
Focused breathing Holistic Nursing
|Alternative medical system||Acupressure
Diet and nutrition (not herbs)
Deep muscle massage
Lympatic drainage Myotherapy/Myofascial
|Energy therapies||Healing Touch
You’ll notice under “alternative medical system” that “diet and nutrition” are mentioned. So, nutrition is considered within the scope of a nurse’s practice. However, the extent to which it is a part of the nurse’s practice gets a little fuzzy, and as the above article mentions, policies are starting to be made to regulate these complementary therapies. And as more laws against talking about healthy food are made, less and less people will be exposed to eating well and healing. Less education will be taking place.
What will be the outcome?
“The nurses, I have already learned, are the ones who give us the answers we’re desperate for. Unlike the doctors, who fidget like they need to be somewhere else, the nurses patiently answer us as if we are the first set of parents to ever have this kind of meeting with them, instead of the thousandth.”
― Jodi Picoult, My Sister’s Keeper
Exerpts from the Act quoted above:
— From Public Act 097-1141 SB2936 Enrolled LRB097 16902 CEL 62090 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Sec. 20. Exemptions. This Act does not prohibit or
(a) Any person licensed in this State under any other Act
from engaging in the practice for which he or she is licensed.
(j) A person from providing general nutrition information
or encouragement of general healthy eating choices that does
not include the development of a customized nutrition regimen
for a particular client or individual, or from providing
encouragement for compliance with a customized nutrition plan
prepared by a licensed dietitian nutritionist or any other
licensed professional whose scope of practice includes
nutrition assessment and counseling.
The provisions of this Act shall not be construed to
prohibit or limit any person from the free dissemination of
information, from conducting a class or seminar, or from giving
a speech related to nutrition if that person does not hold
himself or herself out as a licensed dietitian nutritionist
nutrition counselor or licensed dietitian in a manner
prohibited by Section 15.