Dietetic Technicians, Registered Research Articles

Diversity demographics are needed to enhance accurate assessment of diversity in the nutrition and dietetics profession

A diverse workforce is vitally important to ensure that our nation has quality, affordable, and accessible health care. Diversity, equity, and inclusion are crucial to the nutrition/dietetics profession. As the Academy of Nutrition and Dietetics (Academy) strives to increase and better target its efforts in these areas, assessment will be required to measure progress. Evaluation of progress hinges on the cooperation of individual nutrition/dietetics practitioners — registered dietitians (RDs) or registered dietitian nutritionists (RDNs) and dietetic technicians registered (DTRs) and nutrition dietetics technicians, registered (NDTRs) to report race/ethnicity and/or gender to the Academy and/or the Commission on Dietetic Registration (CDR). Furthermore, accurate assessment and reporting of diversity demographics of the profession rely on the Academy and/or the CDR to use the full de-identified database of practitioners rather than smaller surveys. This article 1) summarizes reports on practitioners in health occupations by race/ethnicity and gender diversity from the CDR, U.S. government, and other professional organizations, 2) summarizes data collection standards issued by the U.S. government on race and ethnicity, 3) provides a recommended action step to encourage nutrition/dietetics practitioners to self-report race/ethnicity and gender to the Academy and/or the CDR, and 4) provides recommended action steps to encourage the Academy and/or the CDR to use the full de-identified database of nutrition/dietetics practitioners rather than smaller surveys to report diversity demographics of RDs/RDNs and DTRs/NDTRs by Academy groups, and to make several revisions to the CDR Registry Statistics and surveys to enhance future diversity and more accurate assessment of diversity in the profession.

Enhanced Bedside Manner Heals Patient–Practitioner Communication

C OLLECTING AND DOCUMENTing information, such as biochemical data, anthropometric measures, and food or nutrition-related history, are skills that health and nutrition practitioners perform as part of a client’s nutrition assessment. And then there are the less scientific skills—specifically a demonstrated proficiency in verbal and nonverbal communication—that are just as important to the Academy of Nutrition and Dietetics’ (the Academy ’s) Nutrition Care Process. Certainly, providing accurate and truthful information in communicating with the public is a priority for all registered dietitian nutritionists (RDNs) and dietetic technicians, registered (DTRs), and is, in fact, part of the Academy’s code of ethics, but how can this be accomplished effectively in an era marked by increased communication through online social media and less frequent in-person interactions? Simply stated, how can RDNs and DTRs present an engaging bedside manner when their clients or patients are more accustomed to communicating through Facebook or text messages than they are on a face-to-face nutrition counseling session? This communication conundrum is not limited to the nutrition anddietetics profession—other health care providers have been just as stymied by the prospect of improving patienteprovider interactions. To address this challenge, an innovative collaboration between Virginia Commonwealth University’s (VCU) theater and internal medicine departments is using a theater-based approach to teach empathy to medical students and physicians, one of the first programs in the country to form a partnership with theater faculty for this purpose. This article provides an overview of VCU’s Standardized Patient Program, suggestions for RDNs and DTRs to enhance verbal and nonverbal communication, and a self-assessment quiz to help RDNs and DTRs evaluate their bedside manner—and identify areas for improvement.

Compensation and Benefits Survey 2013: Education and Job Responsibility Key to Increased Compensation

Results are in for the sixth edition of the most comprehensive survey of dietetics compensation available, and the news for most dietetics practitioners is positive. The Compensation & Benefits Survey of the Dietetics Profession 2013, sponsored by the Academy of Nutrition and Dietetics, shows that registered dietitian nutritionists (RDNs) experienced wage gains in line with inflation since the 2011 survey, while pay for dietetic technicians, registered (DTRs) held steady. RDN median annualized wages are now at $60,000, up from $58,000 in 2011; DTR median annualized wages remain stable at $40,000. Wage gains varied by specific dietetics position. The importance of increased education and job responsibility to increased compensation is apparent. And dietetics practitioners continue to receive attractive benefits packages.

Working Together to Create a Healthier Eating Environment for All

Our nation’s health is in crisis, with overweight and obesity affecting two out of three adults and one out of three children in America. This in turn has led to rising mortality and morbidity rates. Poor eating patterns coupled with lack of physical activity are the primary culprits of declining health. With only 1% of Americans adhering to the 2010 Dietary Guidelines for Americans (DGAs) recommendation of three servings of whole grains per day, the collaborative effort of registered dietitians (RDs); dietetic technicians, registered (DTRs); food technologists; and scientists is essential to educate consumers and create whole grain products that are appealing for regular, daily consumption. As a registered dietitian, as an educator of dietetics students, and as the 2011–2012 President of the Academy of Nutrition and Dietetics, I see firsthand every day that change is needed. How do we make this change happen? First, we need to look at what Americans are eating. According to the U. S. Department of Agriculture’s Economic Research Service, in 2009, processed foods—including refined grains— topped the list of foods consumed in the United States at 63%, whereas plant foods like whole grains made up just 12% of the U.S. food consumption. How can we, collectively—RDs, DTRs, food scientists, and technologists—change American eating patterns? The answer lies in working together. The task of bringing healthful food to consumers is contingent upon integrating food and nutrition science by building a collaborative relationship between food scientists, technologists, manufacturers, and nutrition professionals. With America’s poor eating patterns in mind, a robust dialogue was undertaken in 2010 by scientists who formulate, innovate, and renovate food products and by nutrition professionals who counsel clients and communicate dietary guidance to the public, which resulted in the 2010 DGAs. The principal action themes in the DGAs are to: • Reduce overweight and obesity by reducing overall caloric intake • Shift food patterns to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruit, whole grains, nuts, and seeds • Reduce intake of foods containing solid fat and added sugars (“SoFAs”), refined grains, and sodium Ideally, the DGAs have paved the way for RDs to continue to work with foods scientists and technologists to create healthy food products that are practical, likeable, and affordable.

Practice Paper of the Academy of Nutrition and Dietetics Abstract: Promoting Ecological Sustainability within the Food System

Abstract Registered dietitians (RDs) and dietetic technicians, registered (DTRs) can implement environmentally responsible practices in their workplace and personal lives. RDs and DTRs who conserve natural resources while minimizing environmental degradation will help maintain sustainability of the food system, which requires knowledge of the external costs of operational and personal decisions. These external costs include energy to produce, transport, and process food; water for food production, preparation, and sanitation; removal of air pollutants; and waste management. As client and public educators, RDs and DTRs are uniquely positioned to meet the growing needs of those seeking guidance on food choices as they relate to ecological sustainability. In an effort to promote ecologically sustainable diets, it is important to consider natural resources as they relate to food production, transformation, distribution, access, and consumption. It is essential that the dietetics community takes a more active leadership role in support of ecological sustainability and social responsibility. RDs and DTRs can influence policy at the institutional, community, local, state, and national levels by presenting results of operational practices and science-based natural resource information. RDs and DTRs are encouraged to become educated and active in implementing sustainable practices and shaping policy in an effort to promote healthier individuals, communities, and the nation as a whole.

Nutrition Informatics Competencies across All Levels of Practice: A National Delphi Study

Nutrition Informatics Competencies across All Levels of Practice: A National Delphi Study

Dietetics Trends as Reflected in Various Primary Research Projects, 1995-2011

At the behest of the Commission on Dietetic Registration (CDR) Workforce Demand Task Force, a retrospective examination and reanalysis of 12 primary research projects (sponsored by CDR and/or the Academy of Nutrition and Dietetics between 1995 and 2011) was undertaken to identify trends in supply of and demand for registered dietitians (RDs) and dietetic technicians, registered (DTRs). The analysis suggests that supply of RDs (and possibly DTRs) lags slightly behind demand-although, in the case of DTRs, that does not necessarily imply that demand is growing (supply was shrinking throughout most of the study period). The population of both groups is aging, and the number of RDs and DTRs reporting expected retirement in the near future is sure to affect supply/demand relationships. Neither group reflects the US population as a whole in terms of either sex or racial/ethnic diversity, and the trend lines in these areas are essentially flat. RD practice is seen to be moving incrementally toward the clinical arena, in inpatient and (increasingly) outpatient settings. The proportion of RDs in clinical long-term-care, as well as in food/nutrition management and consultation/business practice, is decreasing; a longer-term trend away from foodservice is noted. There is small growth in both the prevalence and the compensation of clinical specialists in areas like renal, pediatrics, and weight management at the expense of more general clinical practitioners. In a trend likely related to the increase in clinical practice, RD positions are gradually losing managerial responsibility. DTRs have experienced a similar phenomenon. For almost all RD positions in the clinical arena, registration as an RD is a requirement for employment, suggesting that clinical employment should continue to grow along with the increasing health care demand from an aging population. The DTR credential is not required at similarly high rates. A major supply issue is the relative shortage of DTRs in certain parts of the country, particularly the South. Major effects from the June 2009 inauguration of the Pathway III route to registration as a DTR have been noted.

Population Risk Factors and Trends in Health Care and Public Policy

Many factors affect the current and future practice of dietetics in the United States. This article provides an overview of the most important population risk factors and trends in health care and public policy that are anticipated to affect the current dietetics workforce and future of dietetics training and practice. It concludes with an overview of the state of the current workforce, highlighting the opportunities and challenges it will face in the future. Demographic shifts in the age and racial/ethnic composition of the US population will be a major determinant of future the dietetics profession because a growing population of older adults with chronic health conditions will require additional medical nutrition therapy services. Dietetics practitioners will work with an increasingly diverse population, which will require the ability to adapt existing programs and services to culturally diverse individuals and communities. Economic factors will affect not only the type, quantity, and quality of food available in homes, but also how health care is delivered, influencing future roles of registered dietitians (RDs) and dietetic technicians, registered (DTRs). As health care services consume a larger percentage of federal and corporate expenditures, health care agencies will continue to look for ways to reduce costs. Health promotion and disease prevention efforts will likely play a larger role in health care services, thus creating many opportunities for RDs and DTRs in preventive care and wellness. Increasingly, dietetics services will be provided in more diverse settings, such as worksites, community health centers, and home-care agencies. To address population-based health care and nutrition priorities effectively, dietetics practice will need to focus on appropriate evidence-based intervention approaches and targets. The workforce needs to be skilled in the delivery of culturally competent interventions across the lifespan, for all population groups, and across all levels of the social-ecological model for primary, secondary, and tertiary prevention. Because there is an assumption that the dietetics profession will experience rates of attrition of 2% to 5% based on historical workforce data, an important consideration is that the current dietetics workforce is limited in terms of diversity. An increasingly diverse population will demand a more diverse dietetic workforce, which will only be achieved through a more focused effort to recruit, train, and retain practitioners from a variety of racial, ethnic, social, and cultural backgrounds. In addition, the geographic distribution of RDs and DTRs must be addressed through strategic planning efforts related to dietetics training to provide access to and delivery of services to meet population needs. Furthermore, the health care workforce is projected to bifurcate as a result of growth in demand for the "frontline workforce" that works in direct patient contact. This bifurcation will require the dietetics profession to consider new practice roles and the level of education and training required for these roles in relation to how much the health care delivery system is willing and able to pay for services. There are many challenges and opportunities for the dietetics workforce to address the changing population risk factors and trends in health care and public policy by working toward intervention targets across the social-ecological model to promote health, prevent disease, and eliminate health disparities. Addressing nutrition-related health needs, including controlling costs and improving health outcomes, and the demands of a changing population will require careful research and deliberation about new practice roles, integration in health care teams, workforce supply and demand, and best practices to recruit and retain a diverse workforce.

Dietetics Supply and Demand: 2010-2020

The Academy of Nutrition and Dietetics, in conjunction with the Commission on Dietetic Registration (CDR), invited The Lewin Group to undertake an analysis of the dietetics workforce. The purpose of the workforce study was to develop a model that can project the supply and demand for both registered dietitians (RDs) and dietetic technicians, registered (DTRs) (collectively referred to as CDR-credentialed dietetics practitioners) as the result of various key drivers of change. The research team was asked to quantify key market factors where possible and to project likely paths for the evolution of workforce supply and demand, as well as to assess the implications of the findings. This article drew on the survey research conducted by Readex Research and futurist organizations such as Signature i and Trend Spot Consulting. Furthermore, members of the Dietetics Workforce Demand Task Force were a source of institutional and clinical information relevant to the credentialed dietetics workforce--including their opinions and judgment of the current state of the health care market for dietetic services, its future state, and factors affecting it, which were useful and were integrated with the objective sources of data. The model is flexible and accommodates the variation in how RDs and DTRs function in diverse practice areas. For purposes of this study and model, the dietetics workforce is composed of RDs and DTRs. This report presents the results of this workforce study and the methodology used to calculate the projected dietetics workforce supply and demand. The projections are based on historical trends and estimated future changes. Key findings of the study included the following: • The average age of all CDR-credentialed dietetics practitioners in baseline supply (2010) is 44 years; approximately 96% are women. • Approximately 55% of CDR-credentialed dietetics practitioners work in clinical dietetics. • The annual growth rate of supply of CDR-credentialed dietetics practitioners declined from 3% in the early 1990s to 1.5% by 2010. • The net supply of CDR-credentialed dietetics practitioners is projected to grow by 1.1% annually. • Approximately 75% of the demand for the dietetics workforce will be met by the 2020 supply of CDR-credentialed dietetics practitioners. • The aging population, health care reform, increased prevalence of certain conditions (including obesity), and growth in the food industry are key factors affecting the demand.

Future Changes Driving Dietetics Workforce Supply and Demand: Future Scan 2012-2022

The dietetics profession faces many workforce challenges and opportunities to ensure that registered dietitians (RDs) and dietetic technicians, registered (DTRs) are at the forefront of health and nutrition. The profession must prepare for new public priorities, changes in population, and the restructuring of how people learn and work, as well as new advances in science and technology. In September 2010, the Dietetics Workforce Demand Task Force, in consultation with a panel of thought leaders, identified 10 change drivers that affect dietetics workforce supply and demand. This future scan report provides an overview of eight of these drivers. Two change drivers-health care reform and population risk factors/nutrition initiatives-are addressed in separate technical articles. A change matrix has been included at the end of this executive summary. The matrix contains a summary of each change driver and its expected impact and is designed to present the drivers in the context of a larger, dynamic system of change in the dietetics profession. The impact of any of these change drivers individually and collectively in a dynamic system is uncertain. The outcome of any change driver is also uncertain. The dietetics profession faces many choices within each change driver to meet the workforce challenges and seize the opportunities for leadership and growth.

Compensation and Benefits Survey 2011: Moderate Growth in Registered Dietitian and Dietetic Technician, Registered, Compensation in the Past 2 Years

Results are in for the fifth edition of the most comprehensive survey of dietetics compensation available, and the news for most dietetics practitioners is positive. The Compensation & Benefits Survey of the Dietetics Profession 2011, sponsored by the Academy of Nutrition and Dietetics, shows that registered dietitians (RDs) and dietetic technicians, registered (DTRs), experienced wage gains since the 2009 survey, although at rates lower than inflation. RD median annualized wages are now at $58,000, up from $56,700 in 2009; DTR median annualized wages are now $40,000, up from $39,000. Wage gains varied by specific dietetics position. The importance of increasing education, responsibility, and supervisory authority to increase compensation is apparent. And dietetics practitioners continue to receive attractive benefits packages.

The 2010 Commission on Dietetic Registration Entry-Level Dietetics Practice Audit: Distinguishing between Educational Attributes

The 2010 Entry-Level Dietetics Practice Audit determined the nature of entry-level practice for registered dietitians (RDs) and dietetic technicians, registered (DTRs). The primary goal of the audit was to provide the profession with quantitative insight about the level and frequency of involvement and perceived risk associated with activity statements of entry-level RDs (EL RDs) and DTRs (EL DTRs) in the first 3 years of practice. The Commission on Dietetic Registration uses the audit results to establish RD and DTR exam content domains while the Commission on Accreditation on Dietetics Education assesses the audit outcomes and accreditation standards for educators.

2011 Future Connections Summit on Dietetics Practice, Credentialing, and Education: The Summit at a Glance

The 21st century is one in which registered dietitians (RDs) and dietetic technicians, registered (DTRs) benefit from being technologically advanced, and the American Dietetic Association (ADA) put that into practice at its 2011 Future Connections Summit on Dietetics Practice, Credentialing, and Education conducted March 24–26, 2011. The Summit was a collaborative effort between the Council on Future Practice, Commission on Accreditation for Dietetics Education, Commission on Dietetics Registration, and the Education Committee.

Entry-Level Dietetics Practice Today: Results from the 2010 Commission on Dietetic Registration Entry-Level Dietetics Practice Audit

With responsibilities in the areas of credentialing, education, and practice standards, the Commission on Dietetic Registration (CDR), Commission on Accreditation for Dietetics Education (CADE), and the American Dietetic Association (ADA) have need of current, comprehensive information on dietetics practice. One response to this has been to periodically conduct empirical practice analyses to profile what registered dietitians (RDs) and dietetic technicians, registered (DTRs) actually do in practice ( 1 Role Delineation and Verification for Entry-Level Positions in Community Dietetics. American Dietetic Association, Chicago, IL1983 Google Scholar , 2 Role Delineation and Verification for Entry-Level Positions in Foodservice Systems Management. American Dietetic Association, Chicago, IL1983 Google Scholar , 3 Role Delineation and Verification for Entry-Level Positions in Clinical Dietetics. American Dietetic Association, Chicago, IL1984 Google Scholar , 4 Kane M. Estes C. Colton D. Eltoft C. Role delineation for dietetic practitioners: Empirical results. J Am Diet Assoc. 1990; 90: 1124-1133 Google Scholar , 5 Kane M. Cohen A. Smith E. Lewis C. Reidy C. 1995 Commission on Dietetic Registration Dietetics Practice Audit. J Am Diet Assoc. 1996; 96: 1292-1301 Google Scholar , 6 Rogers D. Leonberg B. Broadhurst C. 2000 Commission on Dietetic Registration Dietetics Practice Audit. J Am Diet Assoc. 2002; 102: 270-288 Google Scholar , 7 Rogers D. Fish J. 2005 Commission on Dietetic Registration Entry-Level Dietetics Practice Audit. J Am Diet Assoc. 2006; 106: 957-964 Google Scholar ). B. Ward is research manager, Readex Research, Stillwater, MN. D. Rogers is senior vice president, Readex Research, Stillwater, MN. C. Mueller is nutrition research manager, Clinical and Translational Science Center, Weill Cornell Medical College, New York, NY. R. Touger-Decker is professor and chair, Department of Nutritional Sciences, School of Health Related Professions, University of Medicine & Dentistry of New Jersey, and director, Division of Nutrition, New Jersey Dental School, University of Medicine & Dentistry of New Jersey, Newark. K. L. Sauer is assistant professor, Hospitality Management and Dietetics, Kansas State University, Manhattan.

American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Competent, Proficient, and Expert) in Extended Care Settings

American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Competent, Proficient, and Expert) in Extended Care Settings

A Decade of Work Coming Together: Nutrition Care, Electronic Health Records, and the HITECH Act

Ten years of strategic direction and resource development by the American Dietetic Association (ADA) has positioned the profession for nutrition care integration into health information technology (HIT), specifically electronic health records (EHRs) and personal health records (PHRs). New legislation included in the American Recovery and Reinvestment Act (ARRA) (1) creates an unprecedented opportunity to bring this work in to the spotlight, improve health care, and promote evidence-based decision-making for nutrition care using HIT. Registered dietitians (RDs) and dietetic technicians, registered (DTRs) are positioned to become leaders in this area. The purpose of this article is to identify ADA resources appropriate for use in EHR adoption and detail related elements of ADA’s Health Information Technology for Economic and Clinical Health (HITECH) Action Plan (2) that provide immediate opportunities for RDs, DTRs, and the profession.

Development of an Organic Gardening Workshop for Registered Dietitians, Dietetic Technicians Registered, Students, and Community Members in Rural, Appalachian Ohio

Development of an Organic Gardening Workshop for Registered Dietitians, Dietetic Technicians Registered, Students, and Community Members in Rural, Appalachian Ohio

2010 ADA Member Benefits Update

2010 ADA Member Benefits Update

Setting the Standard: Including the RD and DTR in State and Facility Policies

As with all health professions, dietetic practice is regulated. Health professionals from physicians to chiropractors are required to follow the letter of the law in every task they perform in order to protect the public by maintaining a minimum quality of service. The federal government dictates some of these standards through agencies within the US Department of Health and Human Services; however, states also regulate, and the states have the authority to implement higher standards than the federal government. This is a source of great opportunity for registered dietitians (RDs) and dietetic technicians, registered (DTRs) to be recognized as the qualified providers of nutrition and dietary services in programs and facilities in your state. Increasing the quality of nutrition and food services and supporting the employment of RDs and DTRs in health facilities nationwide must happen at the state administrative level, often through regulations.

Position of the American Dietetic Association: Providing Nutrition Services for People with Developmental Disabilities and Special Health Care Needs

It is the position of the American Dietetic Association that nutrition services provided by registered dietitians (RDs) and dietetic technicians, registered (DTRs), are essential components of comprehensive care for all people with developmental disabilities and special health care needs. Nutrition services should be provided throughout life in a manner that is interdisciplinary, family-centered, community-based, and culturally competent. People with developmental disabilities and special health care needs frequently have nutrition concerns, including growth alterations (failure to thrive, obesity, or growth retardation), metabolic disorders, poor feeding skills, medication–nutrient interactions, and sometimes partial or total dependence on enteral or parenteral nutrition. Individuals with special needs are also more likely to develop comorbid conditions such as obesity or endocrine disorders that require nutrition interventions. Poor health habits, limited access to services, and long-term use of multiple medications are considered health risk factors. Health maintenance and avoidance of complications can be promoted by timely and cost-effective nutrition interventions. Public policy for individuals with special needs has evolved over time, resulting in a transition from institutional facilities and programs to community living. The expansion of public access to technology and health information on the Internet challenges RDs and DTRs to provide accurate scientific information for those with developmental disabilities and special health care needs. Nationally credentialed RDs and DTRs are best prepared to provide appropriate nutrition information for wellness and quality of life.