Survey of Current Job Functions of Renal Dietitians

doi:10.1053/j.jrn.2009.05.009

Journal of Renal Nutrition

Volume 19, Issue 6, November 2009, Pages 450-461

https://doi.org/10.1053/j.jrn.2009.05.009 Get rights and content

Objective

This cross-sectional study examined the current job functions of renal dietitians in relation to their demographic characteristics.

Setting and Participants

Seven hundred and forty-seven dietitians of the Renal Dietitians Dietetic Practice Group of the American Dietetic Association and Council on Renal Nutrition of the National Kidney Foundation completed an electronic survey. Of 2566 surveys distributed, 29.1% (n = 747) were returned and useable.

Main Outcome Measure

Descriptive and inferential statistics were used. We performed χ² tests to identify relationships between reported job functions and demographic characteristics. Fisher's exact tests were used when greater than 20% of cells had an expected frequency of less than five.

Results

Dietitians' job functions were related to demographic characteristics. Dietitians with greater than 10 years of renal-dietitian experience were more likely to evaluate urea kinetic modeling frequently (χ² = 32.95, P < .0005), or evaluate dialysis adequacy (χ² = 24.16, P < .0005), than those with less renal-dietetics experience. Dietitians who worked in an outpatient facility were more likely to prescribe a renal diet frequently (χ² = 13.39, P < .0005), recommend renal vitamins (χ² = 9.81, P = .002), or evaluate interdialytic weight gain, or IDWG (χ² = 32.24, P < .0005), versus those who did not work in an outpatient facility.

Conclusions

This study documented the frequency of dietitians performing job functions related to renal dietetics. The results of this study document the variability in the role of renal dietitian, and suggest differing levels of practice within renal dietetics.

Section snippets

Sample

This study was limited to RD members of the CRN of the NKF, or the RPG of the ADA, who were practicing in the United States for the 2006-2007 membership year. Approximately 1600 CRN members and about 2200 RPG members received the survey. The lists were cross-referenced so that individuals who were members of both organizations did not receive the survey twice. Upon removal of those who were members of both professional organizations, and accounting for unavailable or invalid e-mail addresses,

Results

The total response rate on Survey Monkey was 923 (35.9%). Of those, 107 (4.1%) indicated they were not currently practicing renal dietetics. Surveys with greater than 10% of questions unanswered were deleted (n = 24, 2.9%). One respondent did not see patients, and one dietitian indicated seeing fewer than 1.0% renal patients (n = 2, 0.2%), and thus they were excluded. International respondents were also removed from the database (n = 43, 5.2%). Of the remaining 816 survey responses, 29.1% (n = 747)

Discussion

This cross-sectional study sought to examine the relationship of current practice patterns of renal dietitians with their demographic characteristics. The useable response rate of 29.1% in our electronic survey was considered sufficiently powered to detect statistical differences between groups. This response rate differed from that in recent surveys of renal dietitians.7, 8 A survey of NKF-CRN members in 2003 to determine the application and use of NKF KDOQI Adult Nutrition Guidelines elicited

Conclusions

This study documented the frequency and percentage of dietitians performing job functions related to renal dietetics. Several job functions were significantly related to demographic characteristics. Dietitians with more years of renal experience were more likely to perform a greater number of job functions, as were older dietitians and those who practiced in an outpatient setting. The results of this study document variability in the role of renal dietitian, and strongly suggest that differing

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Cited by (10)

Renal Dietitians' Perceptions of the Value of Subjective Global Assessment: A Mixed Methods Study
2020, Journal of Renal Nutrition
Citation Excerpt :
In this study, participants' use of SGA often (16%) was comparable to the 14% (n = 59) noted by the Canadian McKnight et al. study27; however, they did not differentiate between often and occasional use. If we combine often and occasional use in this study (47%), it is comparable to data from the Australia28 and US29-31 studies as well the 34% use noted in a Canadian acute care center.44 Given renal RD's support for having a standardized process to assess nutrition status and a tool to direct the process, it may be beneficial to include a brief discussion during SGA training about the validation and reliability studies in the CKD population.9,10,12,14
The objective of this study is to assess how renal registered dietitians (RDs) in Canada perceive the value of Subjective Global Assessment (SGA) to assess protein-energy wasting for clients with chronic kidney disease.
A sequential exploratory mixed method approach included 2 focus groups (n = 6 and 8) and a national survey (n = 54). Two online focus groups were conducted 1 month apart followed by an online survey. Participants included renal RDs working with Stage 5 chronic kidney disease (dialysis and non-dialysis) patients.
Five main themes (consistency, organizational/environment, confidence, interpretation, and education) emerged. Renal RDs support using a tool to provide a standardized process for nutrition assessment and feel SGA is an effective educational tool; however, barriers such as time, privacy, confidence in the tool, as well as ability to perform physical assessment, interpretation, and subjectivity limit the use of SGA. Renal RDs feel that it is important to examine nutrition interventions in conjunction with SGA results.
The main results of the study describing the limitations to the clinical use of the SGA tool revolve around RDs' time, confidence, ability to interpret the SGA tool, and how SGA is used by administration. The results support the need for educators and administrators to communicate the use of SGA results and provide education opportunities focusing on the use of validated, reliable, responsive tools to assess nutrition status as well as hands-on physical assessment. In some situations, an alternative validated version of SGA or screening tool may be appropriate.
Quantifying the Time Used for Renal Dietitian's Responsibilities: A Pilot Study
2019, Journal of Renal Nutrition
Citation Excerpt :
Research over a period of 10 years suggests that these high patient-to-FTE staff ratios leave dietitians without the time to follow the KDOQI guidelines for nutrition assessment and intervention.2,6 In the dialysis units, dietitians see patients at least once a month to review their laboratory values7 and spend time on Centers for Medicare and Medicaid Services mandates including plans of care,8,9 documenting quality measures, and participating in Quality Assurance Performance Improvement activities.10 Many dietitians assist the interdisciplinary team to manage anemia, metabolic bone disease (MBD), and kinetic (adequacy) modeling, as well as providing nutrition counseling or education and monitoring the response.7,9,10
The purpose of this study was to quantify how dialysis dietitians spend their time and whether the activities that were most frequent varied based on the ratio of patient to full-time equivalent (FTE) dietitian.
This study is a cross-sectional, observational, time-and-motion study carried out using the Work Activity Measurement by Activity Timing software/method for time recording.
This study was carried out in 14 dialysis centers in and around Cleveland, Ohio.
Fourteen registered dietitian nutritionists participated in this study. The mean time/experience of these nutritionists in dietetics was 26.6 ± 8.5 years.
Percent of time in direct care (e.g., patient interaction) versus indirect care (e.g., documentation and plans of care, professional communication) versus other responsibilities (e.g., administrative work, education of self or others).
The mean number of tasks recorded per 3-hour observation session was 38.3 ± 14.0, including 18.5 ± 7.7 indirect care tasks, 7.7 ± 6.2 direct care tasks, and 9.7 ± 5.4 other tasks. The mean number of unique patients seen per observation session was 6.9 ± 5.4; the mean direct care time per patient encounter was 6.95 ± 4.05 minutes. Indirect care took the highest proportion of observed time, 56.0 ± 22.2%, followed by direct care, 24.9 ± 18.8%. Increasing the ratio of patient to FTE had a moderate negative correlation with the percent of time spent in direct patient care (r = −0.35, P = .21), but there was no relationship between the ratio of patient to FTE and direct care time per patient (r = 0.02, P = .94).
About 25% of dietitians' time was available for direct patient care. This is much less than that reported in previous studies and may not be sufficient to improve the nutritional status. Limitations of our study include a small sample size from a single region. Further work is needed to understand the balance of responsibilities among renal dietitians and their impact on patient outcomes.
Renal Dietitians' Perceptions of Roles and Responsibilities in Outpatient Dialysis Facilities
2015, Journal of Renal Nutrition
This study was designed to determine what job responsibilities renal dietitians working in outpatient dialysis facilities consider as most important and most time-consuming. We hypothesized that more time-consuming activities would not always be considered most important.
An online survey was sent to 3,382 renal dietitians via professional organization e-mail lists. The survey included 30 activities that renal dietitians perform, grouped into 3 categories (general responsibilities, assessments, and interventions) and based on the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative nutrition guidelines. For each category of activities, respondents were asked to rank the 10 activities from 1 (most important or time-consuming) to 10 (least important or time-consuming). For analysis, the rankings were combined into 3 groups: 1 to 3 = most; 4 to 6 = mid; and 7 to 10 = least important or time-consuming. Demographic and professional questions were also included.
Four hundred sixty six renal dietitians responded, and represented a broad range of experience in renal dietetics and type of dialysis facility. The mean number of patients per 40 hours full-time equivalent dietitian was 115.5 ± 38.4. There was good agreement between the respondents' ranking of importance and time consumed. Those activities identified as most important were traditional dietitian roles such as diet assessment and nutrition education. Many respondents provided write-in response of other activities they considered important and time-consuming such as communicating with family members or caregivers, enrolling and managing patients in the in-house pharmacy program, and serving as a care coordinator.
It appears that the renal dietitian's role of providing nutrition assessments and counseling in outpatient dialysis facilities is being expanded to include administrative and coordination responsibilities. The impact of these changes on patient outcomes is unclear; however, previous research has indicated that administrative responsibilities take away from patient care time and decrease dietitian job satisfaction.
Dietary Trends and Management of Hyperphosphatemia Among Patients With Chronic Kidney Disease: An International Survey of Renal Care Professionals
2014, Journal of Renal Nutrition
Citation Excerpt :
To explore trends in phosphorus consumption among patients with CKD and to examine the problems associated with the clinical management of hyperphosphatemia, we conducted a survey of renal care professionals in 4 European countries. Although there have been numerous surveys that have examined the attitudes and practices of renal care professionals,14-18 to our knowledge this survey is the first to investigate their experiences relating to dietary trends and restriction of dietary phosphorus intake in patients with CKD before and during dialysis. The survey was developed as part of a collaboration between the European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) and Shire Development LLC.
The objective of this study was to review the opinions and experiences of renal care professionals to examine dietary trends among patients with chronic kidney disease (CKD) and problems associated with the clinical management of hyperphosphatemia.
This was an online survey comprising open and closed questions requesting information on patient dietary trends and the clinical management of hyperphosphatemia. The study was conducted in 4 European countries (the Netherlands, Spain, Sweden, and the United Kingdom).
Participants were 84 renal care professionals.
This was an online survey.
Responder-reported experiences and perceptions of patient dietary trends and hyperphosphatemia management were assessed.
Most survey responders (56%) observed an increase in the consumption of processed convenience food, 48% noticed an increase in the consumption of foods rich in phosphorus-containing additives, and 60% believed that there has been a trend of increasing patient awareness of the phosphorus content of food. Patients undergoing hemodialysis (HD) were most likely to experience difficulties in following advice on dietary phosphorus restriction (38% of responders estimated that 25-50% of their patients experienced difficulties, and 29% estimated that 51-75% experienced difficulties). Maintaining protein intake and restricting dietary phosphorus were perceived as being equally important by at least half of responders for predialysis patients (56%) and for those undergoing peritoneal dialysis and HD (54% and 50%, respectively). There were international variations in dietary trends and hyperphosphatemia management.
Although most responders have observed a trend of increasing awareness of the phosphorus content of food among patients with CKD, the survey results indicate that many patients continue to experience difficulties when attempting to restrict dietary phosphorus. The survey responses reflect the global trend of increasing consumption of processed convenience foods and phosphorus-containing additives, which has implications for the management of hyperphosphatemia in patients with CKD.
Moving the Issue of Renal Dietitian Staffing Forward
2012, Journal of Renal Nutrition
Citation Excerpt :
Finally, there are 2 additional surveys of dietitians that did not focus on K/DOQI guidelines per se, but the results of which reflect implementation inconsistencies as well. First, a survey of renal dietitians published in 2009 (n = 734) found that 57.9% the dietitians always used evidence-based protocols, 26.8% sometimes did so, 5.4% occasionally used them, and 5.4% never used protocols.24 Second, there are the results of a survey published in 2011,25 which examined the extent to which dietitians had adopted EBGs issued by the American Dietetic Association for the treatment of adults with chronic kidney disease stages 1 to 5.
The day-to-day pragmatic work realities of dietitians who cover dialysis clinics are rarely the focus of discussion. This article highlights the points of convergence between these realities and the research literature. Focusing on the National Kidney Foundation Kidney Disease Outcomes Quality Initiative clinical practice guidelines for nutrition and the difficulties encountered with their full implementation, a seemingly pervasive problem of limited time is revealed. Given the evidence that renal dietitians can positively impact morbidity and mortality risks, when protein–energy malnutrition is primarily the byproduct of insufficient nutrient intake, it suggests that progress with enhancing the nutritional status of patients may be fundamentally contingent on increasing the time they have available, through improved staffing.
Comparison of diet quality tools to assess nutritional adequacy for adults living with kidney disease
2022, Canadian Journal of Dietetic Practice and Research

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Original ResearchSurvey of Current Job Functions of Renal Dietitians

Objective

Setting and Participants

Main Outcome Measure

Results

Conclusions

Section snippets

Sample

Results

Discussion

Conclusions

J Am Diet Assoc

J Renal Nutr

J Renal Nutr

J Renal Nutr

J Am Diet Assoc

J Renal Nutr

J Renal Nutr

Nutrition care process and model part I: the 2008 update

J Am Diet Assoc

Renal Dietitian Standards for Clinical Practice

Nutritional assessment and support of kidney transplant recipients

J Infus Nurs

Original Research
Survey of Current Job Functions of Renal Dietitians