Actual and Ideal Tasks of Nutrition Support Dietitians: A Survey of Nutrition Support and Chief Clinical Dietitians

Abstract

Two questionnaires were sent to the “Chief Clinical Dietitian” at 300 randomly selected, general medical/surgical hospitals, with 300 or more beds in the United States and Puerto Rico. One questionnaire was to be completed by the chief clinical dietitian (CC); the other was to be given to a nutrition support dietitian (NSD) who spends at least 50% of her/his time managing patients receiving enteral and/or parenteral nutrition. The questionnaires consisted of 3 parts: a list of 15 tasks of nutrition support dietitians, questions regarding preparation for the practice of nutrition support, and demographic data. Twenty experts in nutrition support validated the list of 15 tasks using the Delphi method. The NSDs were asked to indicate how often they perform each task and would ideally perform each task (5 point scale, 5 = always, 1 = never). Likewise, the CCs were asked to indicate their perception of how often each task is currently and would ideally be performed by the NSD at their hospital. The total response rate among the CC group was 42.6% (N=128); 118 of the questionnaires were usable. The total response rate among the NSD group was 40% (N=120); 111 of the questionnaires were usable. The Wilcoxon Matched-Pairs Signed-Ranks Test was used to determine differences between NSD actual and ideal frequencies, between CC actual and ideal frequencies, between NSD and CC actual frequencies, and between NSD and CC ideal frequencies. The differences between NSD actual and ideal frequencies and CC actual and ideal frequencies for all 15 tasks were significant (p < 0.0001). Both the NSDs and CCs wanted increased involvement of NSDs in tasks such as fluid and electrolyte management, parenteral nutrition order writing, and feeding tube placement. No other comparisons between NSD and CC responses reached significance except the ideal frequency for “Determines macronutrient composition of parenteral nutrition.” The difference between CC and NSD ideal was significant (p < 0.0005) with the NSDs wanting to ideally perform this task more often than the CCs wanted die NSDs to perform it. According to 94.6% of the NSDs, post-R.D. qualifying experiences are needed to provide nutrition support dietitians with specialized clinical skills. In summary, NSDs desire increased involvement in patient care and this desire is largely supported by CCs. NSDs also seek post-R.D. qualifying experiences to increase their skills in nutrition support.