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CPE (1) Article: Developing a Dual Career Ladder for RDs in a Large Health System
3-7
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One free CPEU available to CNM DPG members!
1. Read the article titled “Developing a Dual Career Ladder for Registered Dietitians in a Large Health System” by Marie Johnson and Megan McHenry
2. Log on to the CNM DPG website at cnmdpg.org 3. Go to the member’s only section and click on the link for the CPE Exam 4. Take the exam; your CPE certificate will be emailed to you within one week
This article has been approved for 1 CPE, Level 2; Learning Needs Codes 1010, 7090 . The
test will remain available for three years after the publication date of this edition of Future
Dimensions in Clinical Nutrition Practice (August 4th, 2014).
3
Developing a Dual Career Ladder for Registered
Dietitians in a Large Health System Marie Johnson, MS, RD, CSG, LD and Megan McHenry, MS, RD, LD, CNSC
Background and Definition
ciplines and businesses to provide a framework
for individuals seeking professional advance-
ment, career development, continual learning, or
promotion. By definition, a career ladder can be
categorized into two subsets: traditional and
dual. A traditional career ladder is typically used
in technical based occupations to promote em-
ployees into a supervisory role based on skill set.
Conversely, a dual career ladder is namely used
in scientific or medical-based professions. Its pur-
pose is to promote em-
ployees who have special-
ized and/or advanced skill
pursue a management
employee obtains a pro-
motion, they become a
skill or duty. In contrast, in a dual career ladder
setting, an employee who obtains a promotion
does not supervise others but becomes more
specialized in their skill or trade. Various profes-
sions in the healthcare sector utilize dual career
ladders. For instance, respiratory therapy, phar-
macy, substance abuse disorder counseling,
physical therapy, and nursing professionals use
dual career ladders to document and promote
advancements in their careers.
The dietetics profession has adopted the same
ideology to foster the career growth of current
and future practitioners. In the early 1990s, sev-
eral publications highlighted the use of career
ladders within the registered dietitian (RD) com-
munity. 2-4
versity Medical Center Nutrition Services Depart-
ment created a Professional Growth Program
that utilized the dual career ladder concept. The
program emphasized activities that extended
beyond a performance appraisal and basic clini-
cal duties to encourage growth of advanced
practice skill sets without the intent of adopting
a management role. The Professional Growth
Program had a positive impact by reducing the
rate of turnover among the clinical dietitians by
11%. 3
Dietetic Registration created two advanced certi-
fications, the Board Certi-
tified Specialist in Pediatric Nutrition (CSP). Almost a
decade later, from 2006 to
2008, three more specialty
tering a management position.
proved the Dietetics Career Development Guide
developed by the Council on Future Practice,
which became a structured guide for the RDs
professional development track. In March 2011
the Summit Oversight Workgroup convened a
group of educators, practitioners, and students
to address mechanisms in which future creden-
tialed dietetics professionals could carve innova-
tive avenues to practice within emerging roles,
define specialist and advance practice, and func-
tion across a career ladder. This group devel-
oped the vision and guiding principles for the fu-
ture of dietetics. 5
is to promote employees who
have specialized and/or advanced
pursue a management track”
Development of RD Career Ladder
Due to the these new career development guide-
lines set forth by the Academy, the Memorial
Hermann Health System (MHHS) Clinical Nutrition
Council embarked upon the process of updating
our existing dual career ladder for RDs. The initial
MHHS RD Career Ladder was driven by stringent
standards that relied solely on advanced degrees
and/or certifications and years of experience.
This led to the general dissatisfaction of clinical
dietitians and poor retention rates of otherwise
high performing RDs who had no means of recog-
nition. We developed a subcommittee to update
and revise the dual career ladder. The subcommit-
tee utilized the following resources to create the
dual career ladder: the Academy’s Dietetics Ca-
reer Development Guide 6 , recommendations from
the House of Delegates, Benner’s “From Novice to Expert” to assess level of proficiency
7 , and MHHS
macy, and nursing departments. In 2012, our ca-
reer ladder was presented to all 83 RDs at 10 fa-
cilities within our health system. Staff provided
feedback during meetings where the career lad-
der was presented and discussed, and adjust-
ments and/or clarifications were implemented.
Structure of MHHS RD Career Ladder
In order to progress through the levels, a point
system was developed to allow for the RDs to
grow from Level I – IV using 12 criteria that our
system calls “advanced attributes”. The corre-
sponding point ranges for each RD level was de-
termined by utilizing the criteria for advanced
practice RDs and the Dietetics Career Develop-
ment Guide defined by the Academy in order to
identify key characteristics of competent to expert
level RDs. 8 With this, CNMs piloted mock point
assignments for each level and developed the fol-
lowing ranges (Table 1).
was weighted in relation to the Dietetics Career
Development Guide and was assigned a cap value.
A cap was placed on each criterion in an effort to
promote a well-rounded practitioner. A specific
project, presentation, and/or accomplishment can
only be used in one advanced attribute category
(Table 2).
For RD Level I and II, competent and proficient
RDs, respectively, a binder with documentation
regarding involvement in any of the criteria is
submitted to the local campus Clinical Nutrition
Manager (CNM) for review. A scorecard is util-
ized to record points, and the CNM can review
and make notes alongside each criterion in tan-
dem. During the end of each fiscal year, ad-
vanced practice (RD III) and expert RDs (RD IV)
and those wishing to be promoted to an ad-
vanced practice level submit the dual career lad-
der documentation to the Career Ladder Sub-
committee. The subcommittee is an extension of
the MHHS system Clinical Nutrition Council. The
review process is designed to ensure that each
submission is scored uniformly by an unbiased
body. The valid review period covers MHHS’ fis-
cal year, July 1 through June 30. With the excep-
tion of criteria one and two, all activities must
take place during the valid time period. All activi-
ties not occurring within the specified time
frame will not be considered.
Implementation of MHHS RD Career Ladder
As with most large scale process change, anxi-
ety, anticipation, and concerns were expressed
by staff. Consequently, it was essential to clearly
and concisely explain the impetus behind the
career ladder while also soliciting staff feedback
to ensure employee engagement and accep-
tance. The main concerns were as follows: the
intent behind the career ladder, how to obtain a
promotion, demotion guidelines, documentation
Intent. Explaining intent behind the career lad-
der was extremely important during the
Summer 2014
Registered Dietitian Level Point Range
RD I (Competent) 3-8 points
RD II (Proficient) 9-13 points
RD III (Advanced Practice) 14-18 points
RD IV (Expert) ≥ 19
ess. Requiring yearly qualifications and documen-
tation for maintaining advanced practice and ex-
pert level status is a way to elevate and expand the
role of the RD but could be misunderstood if not
properly explained.
taining a specified point level does not automati-
cally qualify a staff member for promotion. The
career ladder is used in conjunction with the
performance appraisal and there are specific
recommended prerequisites for each level. For
example, if a corrective action has been given to
an employee over the fiscal year, a promotion is
not merited. Furthermore, in order to reach
Level III or IV, a clinician must have a specialty
certification and sufficient experience in his or
her practice area.
Table 2. RD Career Ladder Criteria
Criteria / Advanced Attributes Point Value Cap
Specialty Certification 1 = Active certification
2 = Active certification plus renewal cycle 2
Fellowship / Advanced
6
1 = Conduct and develop food service based educational programs and/or
in-services biannually
3 = Invited higher education institution/symposium/conference or
presentation for MD/residents/nurse practitioner
Preceptor, Intern Coordinator
or Mentor Role
1 = Preceptor 10 days (collectively regardless of the quantity of interns)
2 = Preceptor for 20 days (collectively regardless of the quantity of interns)
3 = Intern coordinator
8
1 = Participant in hospital or unit based committee/council/ task force
2 = Acting as a participant in a system wide committee/council/task force
3 = Leading (i.e. chair) or co-leading (i.e. co-chair) a system and/or
hospital committee/council/task force
2 = Lead or Co-Lead for CQI project
3 = CQI project leading to a major clinical or operational improvement in
which the participant lead or co-lead the project
6
2 = Conducting poster presentation or invited presentation at a local,
regional or national level
3 = Published work in a professional journal; published book chapter;
platform presentation
1 = Membership and active participation in local, state, or national
professional organization/s
2 = Serve as a committee member in one or more state or local professional
organization/ or national professional organization/s
3 = Acting in leadership role as appointed or elected officer in professional
organization/s
6
5
2 = ≥ 16 years 2
6
the career ladder does allow for a onetime grace
period in which the CNM will meet with the em-
ployee to develop an action plan. Typically, when
an employee does not obtain the number of
points required at their specific level, it is reflected
in their performance appraisal. If the employee
fails to meet the expected number of points for a
second year, they will be demoted by one level –
regardless of the point level they achieved. No
reduction in pay occurs; however, this fact will
likely affect the performance appraisal and may
result in no merit increase.
Supporting Documentation. Documentation is
vanced attribute. For each criterion, a list of re-
quired documentation is described in detail.
Revisions. Creation of an additional criterion,
“Special Considerations”, was added due to poten-
tial unforeseen missed categories. After the an-
nual review of submission, feedback is given to
the Clinical Nutrition Council and updates may be
added at that time. An example of this is under
the category “Professional Contribution.” Specific
avenues to achieve 1 to 3 points in this category
were community presentations, regional media
spots, and/or published work. With the rise in
marketing using Facebook, Pinterest, Instagram,
and other social media in our system, we recently
added “social media spot” to this section of the
dual career ladder.
Human Resource Considerations
the implementation of the career ladder. The Hu-
man Resources department was consulted regard-
ing the dual career ladder for input and additional
perspective. Furthermore, the MHHS Compensa-
tion Department was consulted in order to modify
job descriptions and review compensation struc-
ture. Job descriptions from other disciplines along
with the Standards of Professional Practice were
utilized as resources to update the RDs job de-
scriptions (8). Additionally, market analysis by the
Compensation Department was utilized to ensure
salary grades were appropriately aligned with
annual inflation rates and economic growth
within the dietetics profession.
MHHS RD Career Ladder, we reviewed high-
lights, employee feedback, and any improve-
ments that could be made. The criteria ful-
filled were examined and tallied at the conclu-
sion of the review period for those eligible for
promotion to an advanced practice or expert
level focus or those who sought maintenance
of their position (Table 3). The lowest participa-
tion was realized within the following three cri-
teria: obtaining specialty certification, external
contribution to the dietetics profession, and
demonstrating active membership within a die-
tetics professional organization. Conversely,
following five criteria: committee or task force participation, fellowship/advanced education,
continuing education, continuous quality im-
provement, and years of experience. Compar-
Future Dimensions in Clinical Nutrition Practice Summer 2014
Table 3. Percent of Level III and IV RDs Meet-
ing Criteria
Preceptor, Intern Coordinator or
Continuous Quality Improvement
advanced practice RD by the Academy, the MHHS
Career Ladder Subcommittee identified an inte-
gral pitfall in our basic requirements for ad-
vanced level practitioners. Consequently, a basic
requirement of obtaining and maintaining a spe-
cialty certification was included within job de- scriptions for level III and IV RDs for fiscal year
2015.
◊ The Academy of Nutrition and Dietetics has
developed many resources that will aid health systems in creating career ladders.
◊ We advise benchmarking with standards es-
tablished by other ancillary disciplines and
respective governing bodies when creating a
dual career ladder.
supporting a career ladder and the expecta-
tions of the advanced practice or expert level
RD as defined by the Academy.
◊ It is paramount that the developer and
‘owner’ of the career ladder is regularly ac-
cessible to clarify concerns expressed by staff,
and edits the requirements when deemed
appropriate to allow and encourage em-
ployee engagement.
with the system Compensation Department
to fully assess employee retention and satis-
faction in relation to the implementation of
the career ladder.
ladder”? (2012) Retrieved March 7, 2014,
from http://www.shrm.org/templatestools/
opportunity for advancement. Top Clin Nutr.
1993. 8(3):13-18.
3. Watkins L, Blue L, Cator K, et al. Dietitians and
a clinical ladder program: a successful combi-
nation. J Am Diet Assoc. 94(9):1038.
4. Smith AE. Improving career outlook in clinical
dietetics. CNM Newsletter. 1993. 12(3):1-2.
5. Spring 2012 HOD Meeting Update: Academy
President. Academy of Nutrition and Dietetics
Website. http://www.eatright.org/Members/
May 28, 2014.
6. The Academy of Nutrition and Dietetics. The Career Development Guide. http://
www.eatright.org/Members/content.aspx?
id=7665. Accessed on May 28, 2014.
7. Benner P, Hall P. From Novice to Expert. Am J
Nurs. 1982. 82(3):402-407.
Dietetic Association: Standards of Practice in
Nutrition Care and Updated Standards of Pro-
fessional Performance. J Am Diet Assoc. 105
(4):641-645e10.
Manager at Memorial Hermann Northeast. Prior
to her current position, she worked at Memorial
Hermann’s The Institute for Rehabilitation and
Research as well as the Rehabilitation Hospital-
Katy. She has eight years of experience in clinical
dietetics and earned her Master’s Degree at
Texas Woman’s University-Houston.
Master’s in Clinical Nutrition at the University of
Memphis. Prior to her current position, Megan
worked as a Nutrition Support and Critical Care
Dietitian in the adult, pediatric, and neonatal
populations for five years.
8
As Registered Dietitians, we value the importance
of eating healthier, especially in the hospital set-
ting. However, do our customers feel the same
way? As the Corporate Director of Wellness for a
national foodservice provider, this is a VERY im-
portant topic in my everyday work. In my line of
business, I am charged with controlling the
swinging pendulum between what our patients
and customers should eat, while also providing
what they “want to eat” - even if it doesn’t al-
ways meet our definition of healthy. Another
conundrum - we support our hospital administra-
tors with growing the bottom line through in-
creases in retail revenue (usually through sales of
“traditional” foods such as burgers and pizza), while also promoting better health outcomes of
both patients AND hospital staff.
Are these goals mutually exclusive? Sometimes,
but they do not have to be.
In recent years we have experienced growing cus-
tomer requests for better-for-you foods in the
healthcare communities that we serve. Meeting
the consumer demands in today’s technically
savvy world is a tall order for any foodservice
provider. Today’s well-informed customer has a
growing awareness of food that has fewer calo-
ries, the right kinds of fat and less sugar. Not
only do they clamor for higher nutrient quality
but they also express interest in foods that sup-
port functional claims such as ‘better gut or brain
function’ or foods that support American Family
Farms or are raised with fewer antibiotics.
In 2012, Morrison Healthcare launched its broad-
based Mindful Choices ® platform which includes
everything from supply chain changes to wellness
and sustainability commitments. This has been a
labor of love many years in the making. We have
been working with our client hospitals and health
systems to implement standards for healthy food
marketing, wellness meal offerings, nutrition la-
beling, food preparation, healthy beverages, and
fruit and vegetable offerings. We nurtured
strong relationships with prominent wellness or-
ganizations, Partnership for a Healthier America
and Healthier Hospitals Initiative, which have
helped
Choices ® easy
tomer responses and behaviors related to
healthy eating initiatives.
about encouraging our communities to choose
healthier foods.
As dietitians, we think it’s brilliant when restau-
rants do the work for us in finding and highlight-
ing the healthy foods on a menu. However, we
have learned that the typical consumer sees
“healthy” food labels as a roadmap for foods to
avoid. A recent survey by the National Restau-
rant Association shows that only half of the res-
taurants polled mark the healthy items on their
menus. 1 So, what works?
Does Healthy Food Really Sell? Promoting healthier eating in hospitals can actually work. Here’s how.
By Lisa Roberson, RD and April Rascoe, MS, RD
Mindful Choices Wellness meal
served in hospital cafes
Healthy, enticing food descriptions. Describe
healthy food attributes by using words such as
“fresh” or “guiltless” to invite guests to eat tasty,
better-for-you options. Our chefs describe food
in such a way that makes the smallest appetite
hungrier with each word, such as “fragrant
aroma”, “mouthwatering freshness”, “crunchy
you get the idea.
nell Food and Brand Lab has seen great results
using catchy names to win over school-aged chil-
dren to eat more carrots. 2
Combining this strategy
average hospital café may
as the vegetarian option,
selling around 6-8 black
bean burgers daily. When
loaded with sriracha-
toasted whole grain bun
Burger”, it then becomes a culinary masterpiece
to the typical consumer, including non-
vegetarians, selling upwards of 20-30 burgers per
day.
or purpose-based marketing, wins over customers
by highlighting the values and beliefs of the com-
pany selling the product. Panera Bread Company
is a great example of this with their “Baked Be-
fore Sunrise, Donated After Sunset” campaign. 3
In the hospitals we serve, we have also seen in-
creased purchases of vegetarian menu items
when they are advertised through our Be A Flexi- tarian campaign, which encourages the customer
to reduce meat consumption one meal per week
by choosing a ‘flexitarian’ or non-meat meal. This
campaign advertises our ef-
through fewer greenhouse
animal proteins, AND im-
prove health by reducing
saturated fat intake. Our
Eat Local campaign, which
advertises fruits and vegeta-
our salad bar items by up to
55%, as compared to salad
bar sales without this pro-
motion.
with the Stars, Project Runway…the list goes on.
This same makeover concept also works excep-
tionally well in promoting acceptance of healthier
food. In a study that observed the decisions peo-
ple make while under significant restrictions, con-
sumers will react more favorably to restrictions
that they perceive are not that different from
their initial goals. 4
For example, if a
fried chicken fingers. This is where our Culinary
Research & Development Team creates healthier versions of comfort foods to meet that demand,
such as crunchy baked quinoa-breaded chicken
fingers with sweet strawberry ketchup. Along
Reinventing typical healthy menu items can
attract customers to pur- chase healthier foods
The Be A Flexitarian campaign enhances sales
of healthy food by featuring purpose-based
marketing
Quinoa-breaded chicken fingers with strawberry ketchup is popular on our children’s menu, and is served in the
cafe to adults
call this concept ‘stealth health’.
Other examples of successful culinary makeovers
include our black bean cupcakes, where we re-
place butter and oil with blended black beans,
and our cream of broccoli soup which uses vege-
table broth and quinoa
flakes instead of cream
soup.
steamed tilapia (read as boring) into one that de-
livers flavor and texture,
such as the Southwest-
ern Tortilla Tilapia with
jicama relish. The tilapia is given extra crunch by
breading it in 100% stone ground corn tortilla
chips before baking.
changes to food items or the food environment
which may be transparent to customers can pro-
mote healthier eating. Examples of stealth
health changes include:
other side dishes
lean ground beef and turkey
• Create sauces with low sodium stocks and
fresh herbs instead of high sodium bases
• Serve smaller portions of regular (non-diet)
desserts as “small bites”
and flavor
• Use flaxseed in pancakes and granola parfaits • Add wheat germ to oatmeal
• Blend leafy greens such as spinach and basil
into soups and pesto
otic-fortified items when possible
our customers towards acceptance of healthier
menu options.
Healthy choice architecture describes the way
that consumer decisions may be influenced by
how choices are presented. As an example, if
you want the customer to buy bottled water in-
stead of sugar-sweetened soft drinks, then the
water should be placed at eye level and in easy
reach of the beverage cooler, while the sugary soft drinks are placed out of direct line of sight -
at the bottom of the cooler. Healthy choice ar-
chitecture can also include reducing the price of
healthier foods over traditional items so that the
healthy item is more desirable.
Does healthy choice architecture help promote
the sales of healthy foods? Absolutely! Here’s
an example of using healthy choice architecture
to drive retail sales.
remove low-nutrient dense impulse buys from
the cash register and replace them with better-
for-you options. Statistics show that the majority
of customers make impulse buys at the cash reg-
ister, and offering items such as candy bars, fried
chips and desserts can be considered a hidden
risk factor for obesity and heart disease. 5 Our
Healthy food reinvented - Southwestern Tortilla
Tilapia
architecture
architecture
11
new cash register standards include placing fresh
fruit, bottled water and snacks with less than 200
calories within 5 feet of the register. By replacing
junk food impulse buys with bottled water, we
increased the sales of bottled water by 144%
over the previous year! Selecting the right loca-
tion to promote healthier items can make a
HUGE impact on sales.
This last lesson is critical to the success of pro-
moting healthy eating. As a Registered Dietitian,
I have had many years of experience in educat-
ing, instructing, advising and preaching to our
customers the benefits of healthy eating. No matter how much I encourage my customers to
eat healthier foods, this magical experience
never happens until we DELIVER on FLAVOR.
When a customer is able to enjoy great-tasting
foods that are also healthier, they have an epiph-
any that can be life-changing for the better. How
does this happen? Here are some tips:
• Engage your chefs. Dietitians are great at
planning healthy menus, but chefs can trans-
form a healthy menu into a delectable experi-
ence. Chefs who are also credentialed as die-
titians are transforming healthcare foodser-
vice.
No one tells a better story to customers than
the experts. Capitalize on this unique rela-
tionship to create a Food Network-like experi-
ence.
and fresh, great-tasting foods prepared at
their peak.
has to be equivalent to the pursuit of the Holy
Grail. Applying these basic principles to your
foodservice strategy can help not only promote
healthier eating, but also drive retail sales.
Acceptance of Healthy Foods on Patient Menus
Gaining acceptance of healthier foods can also be
a challenge in the patient population. The Cen-
ters for Medicare and Medicaid Services (CMS)
has also implemented a new survey tool which is
causing a renewed focus on hospitals menus nu-
trition analysis. One of the first questions you
will likely be asked by a CMS surveyor is, “can I
see your nutrient analysis for all menus?” If you
are not able to produce this information in a
quick manner, and be able to explain it, this auto-
matically raises red flags in the surveyor’s mind.
If you do not have your analysis in place, then it is
highly advised that you develop a Quality Assess-
ment and Performance Improvement plan to
show how you intend to achieve this regulation.
The next task is assuring that each diet is Dietary Reference Intake (DRI) compliant. What does
that mean exactly? Surveyors are expecting to
see that all nutrients are meeting 100% of the
DRI for patients who receive a non-select menu.
For condition specific diets that require certain
nutrient restrictions, you must be able to explain
each of these circumstances. It is a great best
practice to have each diet explanation included
with the nutrient analysis so anyone speaking to
the surveyor about DRIs that are < 100% will eas-
ily be able to do so.
When working with patient menus, you can over-
come the challenges of meeting BOTH the regula-
tory requirements and patient satisfaction stan-
dards while still offering healthier choices for all
diets. Here are some insights.
Desserts For All? That’s the million dollar ques-
tion that dietitians are
vide desserts in smaller
portions as a teaching
tool for showing how
unrealistic to believe
so why not show them how to make better
choices and keep their sweet tooth under con-
trol? By providing portion controlled desserts,
Peach Yogurt Burst. Healthy desserts that are seemingly
indulgent help patients accept a diet restriction.
12
it’s a slice of happiness for patients while they
are not feeling well and under added stress.
Flavor, Appeal and Presentation. It doesn’t mat-
ter what a meal includes or how nutritious it is—
if it doesn’t have good flavor, appeal and presen-
tation, then the patient will not be satisfied. This
is a key reason why, as dietitians, we need to be
in the kitchen working with chefs. If the chef and
dietitian are not communicating on a daily basis
with each other, then it is likely your menu is
lacking and you are not reaching your full patient
satisfaction potential.
Building the
Chef / Dietitian
someone else’s
shoes to improve
result in improvement. So take the initiative and
ask your chef if you can spend a day with them.
Challenges in Meeting DRIs For Inpatient Menus
Step 1—Know your patient population. Access
hospital statistics to learn what predominate
population, by age and gender, is served at your
facility. Your menu nutrient analysis should then
be compared to the Dietary Reference Intakes
(DRI) for this group. It is also necessary to deter-
mine what ethnicities you serve, as this should be
one of the key factors to consider when choosing
menu items.
nutrient information. Most nutrient analysis
software programs are based on USDA informa-
tion. It is important to understand that some nu-
trients are not included, therefore it is impossible
to conduct a complete and accurate nutrient
analysis. Those nutrients include: Molybdenum, Chromium, Chloride, Iodine, Fluoride, and Biotin.
Step 3—Become a nutrient investigator. Manu-
facturers by law only have to provide informa-
tion on 14 nutrients; however, a surveyor’s ex-
pectation is that you meet the DRIs for all 43 nu-
trients. So what do you do when there are gaps
in your information? You can use a reference
such as Bowes and Church’s Food Values to find
comparison data to support your analysis with-
out having to add unnecessary additional foods.
Step 4—Balance your nutrient requirements
with real food. Begin your focus on the chal-
lenging nutrients:
• Fiber—You will not come close to meeting
any DRI for fiber without having your default
grain options set as whole grains. That does- n’t mean you can’t have a piece of white
bread in the kitchen, but if a patient is unable
to make a selection, then the default options
need to be whole grains.
• Potassium—Upon a first run of an analysis
for a new menu, it is likely you will be defi-
cient in a handful of micronutrients. Start
with bringing your potassium up, and most
other nutrients will in turn increase as well.
• Choline—Finding a balance between choline
and cholesterol can be challenging, but it is
possible. One idea is to offer scrambled eggs
that are made with a mix of egg substitute
and real eggs. You are then able to increase
your choline and keep your cholesterol < 200
mg for the day.
team. It’s necessary to understand what works
realistically for production purposes. Do your
menu items match your culinary team’s skill set?
When you hear negative feedback about a spe-
cific food item, get in the kitchen and talk to your
chef. Discuss ideas on how the menu item can
be improved both from a flavor and nutritional
aspect.
Conclusion
It is imperative that everyone in the food service
department be aware and able to speak confi- dentially to the patient population your hospital
serves, the nutritional content and compliance of
your menus, and your actions for taking your pa-
Summer 2014
Managing Editor:
310-903-2900
ltrombley@dhs.lacounty.gov
704-355-6660
leighannewooten@yahoo.com
(801) 662-5303
amanda.nederostek@imail.org
Interested in contributing an article to the newsletter? Topics of interest in-
clude leadership, management, inno-
and outcomes, nutrition legislation
coding, informatics, healthcare re-
please contact an editor.
the development of our menus a priority, both
patient and retail menus, and work together to
capitalize on all skill sets within the Food & Nutri-
tion Department, our patient and customer satis-
faction scores have only one place to go….
up! Promoting healthier eating in our hospitals
may actually be easier than we think. Our call to
action is for each of you to take your inherent
passion for promoting healthier eating in your
hospital communities and apply some of these
guidelines. At the end of the day, we hope to
blur the lines of our customers and patients so
that what they WANT to eat, and what they
SHOULD eat, start to remarkably look like one and the same.
References
fessional, 2008. http://
, 2014.
2. Wansink B, Just DR, Payne CR, et al. Attrac-
tive Names Sustain Increased Vegetable In-
take in Schools. Preventive Medicine.2012:55
(4): 330-332.
Values. New York Times. February 13, 2013.
http://www.nytimes.com/2013/02/14/
business/media/panera-to-advertise-its-
, 2014.
4. Botti S, Broniarczyk S, et al. Choice Under Re-
strictions. Marketing Letters. 2009:19:3–4,
183–199. DOI: 10.1007/s11002–008–9035–4.
5. Cohen DA, Babey SH. Candy at the Cash Reg-
ister-A Risk Factor for Obesity and Chronic
Disease. N Engl J Med. 2012:367:1381-1383.
DOI: 10.1056/NEJMp1209443.
personal passion for wellness and sustainability
and is the Corporate Director of Wellness for
Morrison Healthcare. After completing her die-
tetic internship at Vanderbilt University Medical
Center in Nashville, TN, she served as CNM and
Regional CNM for Morrison Healthcare in several
hospitals for over 10 years. Lisa has led her com-
pany to achieve awards in employee wellness
such as the Kaiser Permanente Most Fit Company
Award for three consecutive years and recogni-
tion as one of the top 10 Healthiest Employers by
the Atlanta Business Chronicle.
ness Programs for Morrison Healthcare and has
served in this role for 9 years. Prior to this posi-
tion, April was a CNM for 4 years and has experi-
ence as the Director of Patient Programs, in
which she was responsible for hospital adherence
to patient services standards. April is the Presi-
dent-elect of the Georgia Academy of Nutrition
and Dietetics and also serves as the secretary of
the Georgia Dietetic Foundation. April completed
both her Master’s degree and dietetic internship
at East Tennessee State University.
14
Commission on Dietetic Registration (CDR) cur-
rently has five established board certified specialist
credentials to offer:
• Certified Specialist in Gerontological Nutrition
(CSG)
Obesity and Weight Management specialist creden-
tial application was approved by the Council on Fu-
ture Practice in 2013, and is now in development as
CDR’s first interdisciplinary credential.
This first article will explore the specialist credential
in oncology nutrition. The oncology nutrition cre-
dential was approved for development in 2006, and
the first examination was administered in 2008. All
specialist exams are offered twice a year, and the
oncology examination windows are in March and
September. Because this is a practice-based exam,
interested applicants must meet the eligibility crite-
ria, which are:
status with CDR
nation date
Documentation of 2,000 hours of practice experi-
ence as an RDN in the specialty area within the past
five years.
CDR website at www.cdrnet.org.
tested in the specialist exams. A new audit is per-
formed every five years to ensure the exams reflect
current practice. Specialists are required to suc-
cessfully pass the exam every five years to maintain
their credential. The content outline, reference list,
candidate handbook, and other pertinent exam in-
formation can be found on the CDR website under
the Specialist Certification tab, or at
www.cdrnet.org/certifications/board-certified-
specialist.
to achieve recognition for the CSO in the clinical
oncology practice area. Employment opportunities
in healthcare facilities and cancer centers around
the country are including the CSO credential in
their position descriptions for dietitians in oncology
nutrition. The CSO credential is often stated as pre-
ferred, or it is indicated that new hires are encour-
aged and/or required to obtain certification when
eligible.
specialist credential can be found in the American
College of Surgeons: Commission on Cancer’s Pa-
tient Centered Standards 2012 for Accreditation,
and in the Association of Community Cancer Cen-
ters’ published works. Doctors, nurses, social work-
ers, and pharmacists working in oncology are also
able to obtain specialty certification through their
professional organizations. This shows the medical
oncology community’s support for CDR’s Board
Certification in Oncology Nutrition.
application can be directed to CDR at 800-877-
1600, extension 5500, or specialists@eatright.org.
The second article in the fall newsletter will high-
light the Board Certified Specialist in Pediatric Nu-
trition (CSP) credential.
Commission on Dietetic Registration Specialist
Credentials: Taking Practice to the Next Level By Kathryn Hamilton, MA, RDN, CSO, LD
15
Quality and Process Improvement
Sub-Unit Update By Sherri Jones, MS, MBA, RDN, LDN, FAND—QPI Sub-Unit Chair
Hope you are all enjoying your summer. The CNM QPI Sub-Unit is still going strong and continues to
progress over time. It’s hard to believe it has been over a year now that the “not so new” sub-unit has
been in existence. We hope you have been taking advantage of the information and resources the
QPI Sub-unit has to offer.
We also hope you are aware of the special QPI electronic mailing list (EML). We have managed to
recruit > 75 subscribers to this EML. Cindy and I have tried to share postings of quality and process
improvement related CEUs, resources, etc. on a weekly basis. The QPI EML is not yet as robust as our
general CNM EML. But, I am hopeful we will begin to see our subscribers posting questions and re-
sources over time. As a way to generate more dialogue on the QPI EML, I may begin to post questions
or a “call for quality/process improvement resources” for members to share. Let’s take full advantage
of the knowledge and tools our CNM members have to share. There is so much we have to learn from
one another… If you are not currently subscribed to the special QPI EML and wish to do so, you can
subscribe to the EML through the QPI Sub-Unit webpage or enter the following URL directly: http://
www.cnmdpg.org/members/page/qpi-sub-unit-member-info.
Do you have a Quality Improvement project you’d like to share? Submit to our QPI Project Contest: The sub-unit is in the process of developing a Quality/Process Improvement Project Award Contest.
We are asking interested CNM members and their teams to submit successful projects you’d like to
showcase. There are so many impressive projects and initiatives our CNM members have imple-
mented. We will be posting the guidelines and directions on the CNM website shortly. All submissions
will be judged by a panel of five judges from the CNM Executive Committee. One winner will be se-
lected to receive a free registration to the 2015 CNM Symposium. In addition, the top ten projects will
be showcased at the Symposium as posters. We will be sending an announcement for QI project sub-
missions as an eBlast to all members. Look for the announcement soon to come!
Topic/Ideas for Annual Symposium – April 2015:
The QPI Sub-Unit will present a session each year at the CNM Symposium. This past year, Cindy and I
gave a brief overview on Value-Based Purchasing and introduced the QPI sub-unit components to at-
tendees. We are now looking for QPI topics to include in the 2015 session. Please let us know if there
is a specific topic you’d like to hear about.
And as always, if you have any questions or suggestions for the new Quality and Process Improve-
ment Sub-Unit feel free to contact the sub-unit Chair and/or Vice-Chair. The sub-unit is a member
benefit, and thus, we want to be sure to meet your needs and expectations. Continue to visit the QPI
Sub-Unit section of the website for updates.
QPI Sub-Unit Chair: Sherri Jones, MS, MBA, RDN, LDN, FAND jonessl@upmc.edu
QPI Sub-Unit Vice-Chair: Cindy Hamilton, MS, RD, LD hamiltoc@ccf.org
CNM DPG Announcements
Treasurer Report By Janet Barcroft, RD, LDN
Investment Reserve: $312,387
Informatics Sub-Unit Update By Janel Welch MS, MPA, RD, CDN
The Informatics sub-unit has been working on the CNM website. There have been many enhance-
ments and updates over the past few months. If you have not had a chance to check it out, be sure
to take a moment and visit www.cnmdpg.org.
To log in, all you need is your Academy user ID and password. There have been several additions to
the Resource Library, which is a collection of documents shared amongst the DPG members. In addi-
tion, you can find archived newsletters, information on upcoming events and ways you can partici-
pate with the CNM DPG!
Research Committee Report By Susan DeHoog, RD
The data collection phase has concluded for the Dietetic Practice Based Research Network RDN Pro-
ductivity/Staffing study. The data is presently being analyzed, and results will be presented at FNCE
in October, as well as in an article in the Journal of the Academy of Nutrition and Dietetics later this
fall.
CNM accepts advertising for publication in Future Dimensions in Clinical Nutrition Management. All ads are
subject to approval by the Review Committee and must meet established guidelines. All ads must be camera
ready and received by the Editor by copy deadlines. Fees must accompany the ad at the time of submission.
CNM members receive a 20% discount. Send all inquiries to the Managing Editor, Future Dimensions in Clinical
Nutrition Management. Publication of an advertisement in Future Dimensions in Clinical Nutrition Manage-
ment should not be construed as endorsement of the advertiser or the product by the CNM DPG or the Acad-
emy of Nutrition and Dietetics.
Future Dimensions In Clinical Nutrition Management
Viewpoints and statements in these materials do not necessarily reflect policies and/or official positions of the
Clinical Nutrition Management Dietetic Practice Group or the Academy of Nutrition and Dietetics. © 2014
Clinical Nutrition Management Dietetic Practice Group of the Academy of Nutrition and Dietetics. All rights re-
served.
17
How long have
you been a
Currently, I supervise 20 dietitians at the Massa-
chusetts General Hospital (MGH). I manage the
inpatient side and my counterpart manages out-
patient, with the exception of dialysis and trans-
plant. Mass General has 1001 licensed beds, in-
cluding the MGH for Children.
What do you love most about your job?
The people… encouraging my staff, seeing them
grow. Working on ways to expand our services
and roles, developing relationships throughout
the hospital. I find interacting with a new genera-
tion of enthusiastic and dynamic young profes-
sionals, and fostering dietetic interns, the most
rewarding part of my job.
What is the most challenging part of your job?
Undoubtedly, the budget is the most challenging
part of my job. We are all trying to do more with
less, to find ways to be more efficient, and to
stand our ground to not take on additional areas
without compensation.
What advice do you have for new CNMs?
The best advice I can give is to know your people.
Make it a point to know the people who help
your staff, network. I think most everyone knows
this, however, be nice and be fair. Involve your
staff by asking for their input and encourage
them to help you problem-solve. Participate in
research, both quality/process improvement and
quantitative, and support your staff in this as
well.
Describe what you think the ideal role of the RD
should be 30 years from now. What do you
think we need to do as a profession to get to
that point?
In 30 years… we need to be extremely tech savvy
- technology will be ubiquitous. Global warming
will have occurred, and preventative medicine
will lead to an even larger aging population. Tak-
ing all of that into account, I think that there will
be a relationship between technology and the
basics, i.e. having your own garden.
I believe that hospitals will be for emergent and
acute events, and the dietitians there will be
highly trained and specialized members of the
fully integrated medical team. I think the medi-
cal home will actually become your own inte-
grated medical home, where the home health-
care company will deliver your medical equip-
ment/devices, while you are connected to the
local network eHospital. It’s possible that your
TF/TPN will be genetically modified specifically
for you, and your consultation with the dietitian
will be via video-chat.
As a profession, we need to be thinking ahead
and planning for the future so that we will be an
integral part of it; this means cutting edge tech-
nology, specialized practice, preventative medi-
cine and not staying complacent as we see
healthcare change.
Take a poll of your own staff— you may be sur-
prised at what you hear regarding the future.
If you couldn’t be a dietitian anymore, what
profession would you choose?
nail polish color namer?
Summer 2014
Kathryn.allen@coramhc.com
Chair-Elect
csteele@choc.org
YoungHee.Kim@baystatehealth.org
Secretary
wilsonjs@ph.upmc.edu
Treasurer
jdoley@carondelet.org
ltrombley@dhs.lacounty.gov
leighannewooten@yahoo.com
Amanda.nederostek@imail.org
lisacherry@gmail.com
Wp4b@virginia.edu
mrogard@charter.net
jwelch02@unityhealth.org
ann.childers@palmettohealth.org
kristaclark72@gmail.com
dhutsler@chmca.org
Julie.Haase@wfhc.org
mmkrd@aol.com
Clinical Nutrition Management Dietetic Practice Group
2014—2015 Executive Committee
Cathy Montgomery, RD, LD
Research Co-Chairs
CDN
jordanb@mskcc.org
pavlinac@ohsu.edu
debby_kasper@premierinc.com
jonessl@upmc.edu
hamiltoc@ccf.org
mmilonov@yahoo.com