Abstract
BackgroundRelationships 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 is of concern. Consequences include fewer referrals to clinical dietetic services and limited provider continuity. The characteristics of clinical dietetic jobs associated with high turnover have not been identified. We predicted that managers would identify disease prestige as having an impact. In this study, we aimed to explore: 1) characteristics of clinical dietetic jobs associated with the highest turnover, and 2) consequences of high turnover on patients and managers of clinical dietitians.MethodsResearch assistants conducted semi-structured interviews with ten managers of clinical dietitians in the Canadian public healthcare system. We employed a constant comparative approach to thematic analysis. We classified themes related to turnover as either avoidable or unavoidable.ResultsSub-themes under avoidable turnover included lack of manager support, growth opportunities, burnout/workload, tension/conflict and hours of work. Sub-themes under unavoidable turnover included life-stage/life-events and geography. We also identified themes related to consequences of turnover, including: burnout/workload, client/patient impact, tension/conflict, cost and gap-specific. As predicted, prestige was perceived as playing a role in triggering dietitian turnover. Managers observed high turnover resulting in low provider continuity and limiting patient access to dietitians.ConclusionsManagers of publicly-employed dietitians identified many factors as contributing to high turnover. Future prospective research, incorporating the objective measure of turnover and multi-method analysis of work characteristics and work setting, would be of value in the identification of characteristics of clinical dietetic jobs associated with high turnover and the consequences of high turnover on patients and managers of these staff.
Highlights
Relationships between dietitians and other healthcare providers can impact the degree to which patient care is collaborative; inefficient communication can lead to suboptimal care
Few have explored the impact of workforce instability on the performance of healthcare providers [3] and the peer-reviewed literature reveals little about how characteristics of work settings affect Registered Dietitian (RD) [4]
Turnover is defined as movement of an RD out of a job followed by a search for a temporary or permanent replacement (referred to by Burgess et al (2000) as worker flow [7])
Summary
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. Relationships between RDs and other healthcare providers can impact the extent to which patient care is collaborative and the relative efficiency of interprofessional communication; inefficient and ineffective communication can lead to suboptimal patient care [2]. For this reason, healthcare leaders should be concerned when there is frequent turnover in an RD position serving a unit or unit(s). We are considering turnover in relative terms — high turnover positions are those with the most frequent turnover in a clinical RD manager’s portfolio
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