High Turnover in Clinical Dietetics: A Descriptive Analysis

Purpose: To identify key attributes of Canadian clinical registered dietitian (RD) jobs associated with high rates of turnover. Methods: Managers of clinical RDs in Canada were eligible to complete a survey on the topic of turnover in clinical RD positions. Specifically, key details were sought regarding positions with the highest and lowest turnover in each manager’s portfolio. Results: High turnover (HT) positions turned over an average of 4.0 times in a 5-year period in contrast to 0.3 times in low turnover (LT) positions. Resignation was the top reason for turnover in both HT and LT positions. HT and LT positions were of analogous full-time equivalent, had comparable caseloads, and served clients/patients with similar diagnoses including diabetes and neurological conditions. Conclusions: There is significant variation in the frequency of turnover across positions in clinical dietetics in Canada. What differentiates HT positions from LT positions remains unclear. More research is required to guide managers seeking to balance turnover and preclude uneven nutrition care quality across units and programs.

High turnover in clinical dietetics: A qualitative analysis

Background: Relationships between dietitians and other healthcare providers can impact the degree to which patient care is collaborative; inefficient communication can lead to suboptimal care. It takes time for multidisciplinary team members to build collaborative, trusting relationships. For this reason, frequent dietitian turnover (or “churn”) is of concern. Consequences include fewer referrals to clinical dietetic services and limited provider continuity. The characteristics of clinical dietetic jobs associated with churn have not been identified. The principal investigator’s professional experience and a review of the literature led us to predict that managers would identify disease prestige as having an impact on churn. In this article, we report the qualitative results of a multi-method study that we conducted to explore: 1) characteristics of clinical dietetic jobs in the public sector associated with the most churn, and 2) consequences of churn on patients and managers of clinical dietitians. Methods: We conducted semi-structured interviews with ten managers of clinical dietitians in the Canadian public health care system. We conducted a thematic analysis that was both inductive and deductive. Results: We identified four themes: i) Avoidable factors that contribute to churn often reflect intersecting human resource management issues; ii) Unavoidable factors that contribute to church frequently result from a decision made by the departing dietitian; iii) High churn in select positions has a disproportionately negative impact on patients served by dietitians in those high churn positions, and iv) Consequences of churn can be long-lasting and result in less efficient dietetic practice and reduced access to medical nutrition therapy. As predicted, prestige was perceived as playing a role in triggering dietitian turnover – however, prestige was more commonly attributed to employment in a respected institution than to providing treatment for a particular disease or condition. Conclusions: Managers of publicly-employed dietitians identified many factors as contributing to churn. Managers observed churn resulting in low provider continuity and limiting patient access to dietitians. More research is needed to better understand factors contributing to churn among Canadian clinical dietitians.Trial Registration: Not applicable.

Implementing a Clinical Practice Change: Adopting the Nutrition Care Process

The Nutrition Care Process (NCP), created by the Academy of Nutrition and Dietetics, provides a framework that encourages critical thinking and promotes uniform documentation by Registered Dietitians (RD). Additionally, it creates a link between the nutrition assessment, nutrition intervention, and the predicted or actual nutrition outcome. NCP has been integrated into a number of institutions in Canada and internationally. A committee of nonmanagement RDs at the Hospital for Sick Children led the Department of Clinical Dietetics in adopting the NCP. The committee developed and consecutively delivered a tailored education plan to 5 groups of RDs within the department. Additional resources were developed to complement the learning plan. The committee administered informal pre- and post-education surveys to measure outcomes. RDs reported receiving adequate training and felt confident implementing NCP into their practice. Adopting the NCP was well-received and RDs within the department continue to integrate it into their current practice.

Selected determinants of the professional identity of dietitian in the context of legal regulations on the practice of dietitian in Poland and the European Union

The subject of the article is the present status of the profession of dietitian in the Polish healthcare system, taking into account the analysis of the current legislation in force that defines the principles of employment of dietitians and the practice of the dietitian in Poland in the context of relevant provisions of the EU law, with emphasis on the position of dieticians in the health-care systems of selected European Union countries. The study advances the thesis that the current status of the profession of dietitian in Poland reflects its incomplete professionalization manifested in the lack of legal regulations on the principles of its practice that are applied in the case of other medical professions. A consequence of the present, comparatively low status of the profession of dietitian in Poland is, inter alia, the hindered availability of professional clinical dietetics counseling under public health insurance, as well as the practice of the profession as a business activity by individuals whose professional qualifications are not subject to verification by professional regulatory bodies. This produces a risk to patients, arising from the fact that interventions not verified by the EBM paradigm are nevertheless implemented as part of dietary counseling.