1. Week4 Day2 Chapters 6-13 Roles for Registered Dietitians

2. Early Roles / Positions
In the early years, dietitians worked primarily in hospitals or were associated with food assistance programs and the war effort.
“Therapeutic Dietitian” was used to describe the person who provided food for medical reasons such as prevention of nutrient deficiency or help with the treatment of disease.

3. Employment Settings
In 2011, 56% of RDs and 58% of DTRs were employed in clinical practice.
The primary practice areas for clinical dietitians are:
Acute care—inpatient
Ambulatory care—outpatient and home care
Long term care as in residential facilities

4. Organization of Clinical Nutrition Services
Clinical Nutrition Manager
Chief Clinical Dietitians
Clinical Dietitians / Medical Nutrition Therapists
Dietetic Technicians
Dietetic Assistants

5. Medical Nutrition Therapy (MNT)
MNT is “the assessment of the nutritional status of patients with a condition, illness or injury that puts them at risk.”
Review and analysis of the medical and diet history, lab values, and anthropometric measurements.
Nutrition treatment is then based on the findings.

6. The Clinical Nutrition Manager
Primarily responsible for directing activities of others on the team.
Personnel responsibilities: hiring, evaluating performance, providing in-service or on the job training, reviewing productivity reports.
Communication with staff, other departments, administration.
Ensure performance achieves the goals and objectives of the department.

7. The Clinical Dietitian
Provides nutritional care for patients.
Nutritional screening of patients.
Consult and collaborate with physicians and allied personnel.
Current on MNT knowledge and patient education.

8. The Clinical Dietetic Technician
Assists the clinical dietitian.
Gathers data for nutritional screening.
Assist with nutritional assessment and anthropometric data.
May administer nourishment and dietary supplements and monitor patient tolerance.
Supervise dietetic assistants.

9. The Clinical Dietetic Assistant
Assists in routine aspects of nutritional care.
Process diet orders, check menus against standards.
Distribute patient menus; pass and collect trays.
Evaluate patient food satisfaction and gather food records for nutrient intake.

10. Clinical Privileging
A process to develop and implement good patient care. In most hospitals, physicians are responsible for overall patient care and assume the risk and legal responsibility for the care including diet prescribing. If the dietitian assumes diet prescribing, competence must be demonstrated, must be licensed by the state and approved by the hospital.

11. Authority for Diet Prescribing
Dependent authority: the RD can order diets, nutritional supplements, and nutrition-related test according to pre-approved criteria.
Independent authority: the RD may perform these tasks with more autonomy.

12. Dietitians in Management
Food service in hospitals was the primary focus of the first dietitians who were considered nutritional experts.
Food Service is prominent in the history of the profession.
Management roles have expanded into all areas of practice

13. The Manager
A person responsible for people and organizational resources and who possesses management skills including technical, human, and conceptual.

14. Areas of Employment
In the 2011 membership survey, the following was shown:
12 percent of RDs were in food and nutrition management
18 percent of DTRs were in food and nutrition management
22 percent are executives, directors, or managers
19 percent are supervisors or coordinators
Similar results for dietetic technicians.

15. Titles of Positions
Director and Associate Director of Food and Nutrition Services.
Clinical Nutrition Director of multi-unit services.
Food and Nutrition Consultant.
Director/Chief Administrator in hospitals,
school nutrition, food companies and related businesses.
Nutrition Program Director

16. Salaries
The food and nutrition manager earns athe highest level of salary among other areas of practice. Work experience, geographic location, and advanced degrees account for many of the differences.

17. Foodservice in Noninstitutional Settings
Colleges and universities—cafeterias, vending, catering, restaurant style.
Employee cafeterias or dining facilities.
Business and commercial enterprises.
Each may be profit or non-profit depending on the sponsoring organization.

18. School Nutrition Programs
Lunch and breakfast meals are offered.
31 million pre-school to 12th grade are fed daily.
Average of 11 million children participate in breakfast programs.

19. School Nutrition
Dietitians in the programs need both managerial and nutrition education skills.
The National Food Service Management Institute conducts research regarding the functions and tasks of school nutrition managers.
Comprehensive nutrition service must be provided to all pre-school to grade 12 students.
Nutrition service integrated with school health program and implemented through a school nutrition policy.
Nutrition education linked to promotion of nutritious meals and snacks.
Family, community, and health services partnerships support health outcomes for all children.

20. Clinical Nutrition Management
Refers to activities of practitioners in hospitals and health care in institutions who develop and operate systems that meet the nutritional needs of patients.
The clinical manager performs many management functions and supervises other professionals in clinical areas.
Often has responsibility for multiple units.

21. Commercial Food Services
`Retail and hospitality food service establishments that prepare food for immediate consumption on or off site.
Types:
Restaurant, café, cafeteria
Hotel and hotel chains
Supermarket, delicatessen
Limited service chains

22. Public Health Program Managers
Federal, State, and County government levels
Performs many management functions depending on program and funding source
Supervises other professionals and staff
May serve in non-traditional areas (media, marketing, health promotion)

23. Characteristics of Successful Managers
Ability to manage personnel and financial resources, produce quality products and services, communicate effectively.
The “transformational” leader helps others function at a high level, master change, and plan futuristically.

24. Additional Training Needed
Public relations
Communications
Marketing
Purchasing
Financial management

25. Areas of Management Opportunity
Food corporations:
Research and development
Consumer affairs
Communications
Government liaison
Disaster planning
Military base
Homeless shelters
Food distribution centers
Worldwide religious companies/programs
Government food programs
Contract food service companies

26. Community Nutrition
Community nutrition addresses the entire range of food and nutrition issues relating to individuals, families, and special groups with a common bond such as place of residence, language, culture, and health.
2011 Report: 11% of RDs and 12% of DTRs work in community nutrition.

27. Public Health Nutrition
Defined as a component of community nutrition that is publicly funded and provided through a state or local health agency. Public health includes all aspects of health including prevention of disease and the provision of primary care.
6 % of RDs and 9% of DTRs work in Women’s, Infants and Children’s (WIC) programs

28. Community Nutrition Professionals
Establish links with other professionals involved with a broad range of human services, including:
Child care
Services for the elderly
Educational institutions
Community-based research

29. Work Settings Federal, state, local health agencies.
Neighborhood/community health centers.
Industry.
Ambulatory care clinics.
Home health agencies.
Specialized community projects.
Institutions and hospitals.
Private practice.
Nonprofit and for-profit private centers.

30. Additional Work Settings
Native American health services
Health and Human Services or Welfare
School nutrition programs
Area Agencies on Aging
Cooperative Extension
Food Banks / Commodity food programs

31. The Public Health Approach
Uses intervention to promote health and prevent disease.
Promotes a healthy lifestyle.
Directs money and energy to problems affecting the largest number of people.
Targets the un-and under-served.
Collaborates with the public, consumers, leaders, legislators.
Monitors health of people in the community.

32. Levels of Prevention Primary: prevention of the disease itself.
Secondary: detection, diagnosis, and intervention early in the disease process.
Tertiary: treating and rehabilitating persons with diagnosed health conditions.

33. Consultation and Private Practice
In 2011, 8%of RDs and 3%of DTRs work in consultation and private practice.

34. Keys for Success Personal characteristics:
Confidence and determination
perseverance
self-directed
energetic
action-oriented
motivated
seeks assistance from mentors

35. Characteristics of the Consultant in Business
Risk taker
High level of energy
Versatile
Innovative and motivated
Can work independently
Practices good public relations

36. The Consultant in Health Care and Extended Care
Important legislation established the role of the RD as consultant in health care:
1960s Medicare regulations
1987 Omnibus Reconciliation Act
The demand for consultant dietitians increased rapidly when nursing homes were required to hire an RD. Many dietitians responded needed to obtain continuing education to practice in long term care and meet regulations.

37. Federal and State Regulations
A minimum of 8 hours per month is often specified although the amount of time will vary in different institutions. The consultant in long-term care needs to be familiar with:
Federal and state regulations
Policies and goals of the facility
HIPPA or privacy regulations
Patient’s rights

38. Areas of Practice in Long-Term Care
Nursing homes
Skilled nursing facilities
Sub-acute care facilities
Alcohol and Drug rehabilitation
Retirement facilities

39. Further Health Care programs
Developmentally disabled clients and group homes
Home health care
Congregate feeding sites
Senior citizen centers
Correctional facilities
Hospice
Small, rural hospitals

40. Typical Activities of the Consultant
Confer with on-site dietary manager.
Perform nutritional assessments and follow-up.
Check at-risk residents and make recommendations for nutritional care.
Observe meal service and eat a meal to evaluate quality.
Make rounds during meal service.
Conduct in-service education for employees.
Document all activities with recommendations for follow-up.

41. The Consultant in Business Practice
Practice areas identified by the Nutrition Entrepreneurs practice group:
1. Services for individuals, corporations and media.
2. Restaurants, food companies, catering
3. Internet and business technology
4. Sports and health facilities
5. Coaching

42. Practice Areas--Continued
Pharmaceutical Sales
Medical and institutional equipment sales
Chef’s schools
Specialized clinics and spas

43. The Dietitian in Business
The latest survey shows that 31 percent of dietitians work in the for-profit sector including contract management, managed care organizations and others.

44. For-Profit Category
A wide range of positions including private practice and working with corporations, trade associations, hotels, and restaurants.

45. Expanded Opportunities
As employers realize the contributions of dietitians and add more positions, the benefits are:
Increases the company’s credibility.
Promotes health and nutrition of customers.
Increases the understanding of customer needs.

46. The Dietitian in Health and Wellness Programs
Sports and dietetics as a profession have existed for centuries but the combination of the two as a career specialty is relatively recent.
The growth of wellness and fitness programs has been rapid as the relationship between nutritional status and maintenance of health and prevention of disease becomes more evident.

47. Sports Nutrition Work settings: Sports medicine clinic
Professional football and other sports teams
Universities and fitness centers
Gyms and exercise centers
Supervision of food production and training tables in college athletic residence halls
Coaching of athletes in good nutrition practices
Preparation of training materials in programs

48. Cardiovascular Nutrition
Cardiac rehabilitation is an area of need in post-surgery recovery. This may occur in both inpatient and outpatient settings. Nutrition counseling is a vital part of the care provided by multidisciplinary teams along with education of the patient and the family.

49. Areas of Employment Lipid research clinics University research
Pharmaceutical companies that market products to cardiovascular patients.
Preparation of educational materials.
Private practice

50. Wellness and Health Promotion
Dietitians in private practice and consultation often contract with industry groups, health clubs, gyms, medical centers, rehabilitation units, and communications as in media contacts and educational materials.

51. Further Areas of Practice
Programs for smoking cessation
Programs in meditation and yoga
Stress management
Exercise programs
Employee relations

52. Wellness and Fitness Programs
Classes in group settings are common and may include the aging and retired population in home settings or in institutions.
Several national organizations provide excellent information for those working in these areas.

53. Disordered Eating
In this specialty area, nutrition, physical, and psychological issues are often intertwined with eating behavior such as overeating, chronic dieting, compulsive eating, and binge eating disorders. Anorexia nervosa and bulimia nervosa are the usual diagnoses.

54. Career Settings Dietitians working in this area may work in:
Residential treatment centers
Medical and psychiatric hospitals
Outpatient clinics
Managed care organizations
University health centers
Private practice

55. The Dietitian in Education and Research
Every dietitian is an educator at least some of the time. Specific teaching areas:
Inservice education for food service employees, nurses, clients and families
Medical nutrition education
Head Start and WIC programs
Preceptor for students and interns
Education efforts during National Nutrition month
The media: in print, and for the public.

56. Formal Educational Roles
Elementary and Secondary schools including child nutrition programs and in school-based health centers.
Colleges and universities including culinary institutes and technical schools
Medical and Dental Education
Nursing programs
Allied Health programs

57. Industry-Based Education
Companies that manufacture medical nutrition products use dietitians to provide technical and clinical information to the sales force, clinicians, retail pharmacists, and educators of healthcare professionals.
Others promote and demonstrate the use of equipment and food product.

58. Dietitians in Research
Students and faculty conduct much of the research in nutrition and dietetics. Some researchers are RDs, others are food and nutrition scientist, food scientists, biochemists and others. Many hospitals also conduct research and hire dietitians in clinical research centers as well as working directly with medical staff.

59. Clinical Research
Dietitians specializing in nutrition support, pediatrics, renal dietetics. Oncology, diabetes and other clinical specialties conduct research as a part of their work. This may be in collaboration with physicians and others in the medical team or for the purpose of collecting clinical information for professional uses and sharing with other dietitians.

60. Careers
Food and Industry Companies. Research is conducted relevant to product or recipe development, translation of research into meaningful information for the public and others. Nutrition products, properties of foods, outcomes research and cost-effectiveness are research examples.

61. Government Careers
Nutrition science at U.S. Department of Agriculture, U.S. Army Natick Research center, and Centers for Disease Control. Extension specialist, National Aeronautical and Space Administration.

62. Community and Public Health Careers
Public health initiatives that document the value of nutrition and the dietitian’s role in chronic disease intervention.
University collaboration with public health practitioners to promote healthy behaviors.
Nutrition research in developing countries for food and agriculture production, nutritional assessment, and intervention.