Effect of Hospital Restructuring on Registered Dietitian Staffing in a Large Metropolitan Area.

Abstract

LEARNING OUTCOME: To review the effects of restructuring on management and non-management staffing in hospital food and nutrition services departments.The Nutrition Administrators of Chicagoland (NAC), a professional group composed of clinical nutrition managers (CNMs), conducted a survey in April, 1995 to study the effect of restructuring in its member hospitals. Questionnaires were mailed to 85 hospital based CNMs in Chicago and neighboring suburbs. This tool was designed to investigate how management and non-management registered dietitian (RD) staffing had been affected by hospital restructuring. Specifically, respondents were asked to provide information regarding: 1) facility description (urban (U) vs. suburban (S) and teaching/university (TU) vs. community (C); 2) size/census; 3) restructuring history (number of phases and time frame); 4) change in management RD, non-management RD and overall food and nutrition staff full-time equivalents (FTEs) post restructuring; and (5) changes in managerial span of control.Results: Forty (40) questionnaires were returned and the data was analyzed using Student's t-tests and ANOVA. The average hospital occupancy was 60%. At least one restructuring phase within the past three years occurred in 82.5% of the hospitals. The main impact of restructuring trends fell on the managerial RDs, with an average 21.2% decline in FTEs. Non-management RDs and total food and nutrition staff FTEs evidenced a smaller decrease of 5.4% and 8.3%, respectively. Of the hospitals retaining the CNM position (n=34), 35.2% reported a change in the title of the CNM position and increased responsibilities in 23.5%. Title retention with additional responsibilities was reported by 11.8%. There was no statistically significant difference in this data when it was analyzed by hospital type (TU vs. C), location (U vs. S), or size/census.Conclusions: In this metropolitan area, hospital restructuring has had a measurable effect on RD staffing, irrespective of hospital type, location, or size/census. Management RDs, in particular, have been impacted by the current restructuring environment When CNMs are retained, their span of control frequently increases, with the assignment of additional duties and responsibilities. Reimbursement trends suggest that CNMs should anticipate continued downsizing and be proactive in the process underway in their particular facility.