by Bridget Storm, MA, RD, LDN, CNSC
The field of clinical nutrition is undergoing significant shifts, driven by increasing demand and evolving clinical practice requirements. According to recent data, the demand for Registered Dietitians (RDs) is predicted to grow by 7% over the next decade, while the number of clinical RDs has decreased by 9% in just three years. This mismatch between supply and demand has placed many healthcare facilities in a challenging position, struggling to meet staffing needs. The situation calls for a renewed focus on competency development, especially as new and incoming Registered Dietitian Nutritionists (RDNs) find themselves in increasingly complex clinical environments in their early careers. The increased complexity of patient cases highlights the necessity for robust clinical training, which has often shifted to being done on the job.
Dietetic interns and newly credentialed RDNs may face a significant gap between their medical nutrition therapy (MNT) education and real-world clinical practice. This gap can be attributed to changes in supervised practice requirements and academic credentials. Notably, the total required supervised practice hours for dietetic certification were recently reduced from 1200 to 1000 hours, with a minimum of 700 hours spent in onsite clinical settings. Moreover, while a Master’s degree is now required to take the RD exam, this degree does not necessarily have to be in dietetics, as long as the Didactic Program in Dietetics (DPD) requirements are met. Adding to this complexity, the recency of DPD education is left to the discretion of individual programs, leading to variability in readiness for clinical practice.
This evolving landscape means that many new RDNs may not meet the same clinical competency standards as those entering the field before these changes. Despite this, new professionals are often tasked with providing care that exceeds the Accreditation Council for Education in Nutrition and Dietetics (ACEND) entry-level competency expectations. Consequently, there is an increasing reliance on on-the-job training to bridge these gaps, although the quality and consistency of such training can vary based on the availability of qualified mentors and leaders in each facility.
Competency in nutrition support requires much more than simply meeting the minimum standards of clinical education. New and practicing RDNs alike must continually hone their skills and stay current with evidence-based practices. Key areas of competency include:
· Practicing within an individual scope of practice: It is crucial for RDNs to understand the limits of their scope and to know when to seek additional expertise or refer a patient to another specialist.
· Staying current with evidence-based practice: Continuous professional development ensures that RDNs maintain the knowledge, skills, and judgment necessary to provide high-quality care.
· Utilizing data-driven decision-making: Effective patient care relies on gathering and interpreting appropriate data to guide treatment plans.
· Engagement in quality improvement: RDNs should participate in both self-evaluation and broader quality improvement efforts within their practice settings. Applying feedback from these efforts is essential for professional growth and ensuring that care standards are met.
Looking Ahead: Solutions for Future Competency
To address these challenges, healthcare facilities should consider implementing more structured competency development programs and offering clear guidelines for clinical orientation duration. Investing in experienced mentors who can guide new RDNs through the intricacies of high-acuity patient care will also be critical. Additionally, creating formal competency evaluation frameworks will ensure that new professionals are adequately prepared for the demands of clinical practice. The field of nutrition and dietetics is at a crossroads, with staffing shortages and increasing patient complexity requiring creative solutions. By focusing on competency development and supporting new RDNs with proper training, the profession can continue to grow and meet the needs of the healthcare system while ensuring the highest standards of patient care.
References:
- Dietitian and Nutritionist. US Bureau of Labor Statistics, United States Department of Labor. Accessed 6/18/24. Dietitians and Nutritionists : Occupational Outlook Handbook: : U.S. Bureau of Labor Statistics (bls.gov).
- RD Examination – Eligibility Requirements. Accessed 7/29/24. https://www.cdrnet.org/RDNeligibility.
- ACEND Accreditation Standards for Nutrition and Dietetics Graduate Degree Programs. June 2022. Accreditation Council for Education in Nutrition and Dietetics; 1-45.
- Doley J. Dietetics Education: Will Enough RDs Enter the Workforce? Today’s Dietitian 2024, Vol 26 (2); 14.
- Revised 2024 Scope and Standards of Practice for the Registered Dietitian Nutritionist. Commission on Dietetic Registration Scope and Standards of Practice Task Force. Pg 1-58.
- Stein K and Rops M. The Commission on Dietetic Registration: Ahead of the Trends for a Competent 21st Century Workforce. J Acad Nutr and Diet 2016 Dec; Vol 116 (12): 1981-1997.e7. https://doi.org/10.1016/j.jand.2016.09.019.
- Corrigan ML et al Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: Revised 2021 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nutrition Support. J Acad Nutr and Diet 2021 Oct; 121 (10): P2071-2086.E59. https://doi.org/10.1016/j.jand.2021.05.026.
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