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Professional development for the RD: What does the future of our profession look like?

Issue: April 2018

ByRosa K. Hand, PhD, RDN, LD, FAND

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This topic will be presented during the session, “Professional development for the RD: What does the future of our profession look like?” being held on Thursday, April 12, from 10:30 a.m. to 12:00 p.m. in the Austin Convention Center.

The Commission on Dietetic Registration requires registered dietitians to complete 75 hours of approved continuing professional education every 5 years in order to maintain their credential.¹ CMS requires that every patient on dialysis has access to a qualified dietitian, which is defined as a registered dietitians with at least 1 year of clinical experience, ^2,3 but beyond these statutes, what is the future of the dietetics profession, specifically for renal registered dietitians?

The Academy of Nutrition and Dietetics and the National Kidney Foundation jointly developed focus area standards for nephrology nutrition, which can be used to expand practice and identify areas for professional development.⁴ There are opportunities now and in the future for renal registered dietitians (RDs) working in chronic kidney disease (CKD), in-center and home dialysis, transplant and in the hospital.

In CKD, CMS offers coverage for medical nutrition therapy provided by a RD for patients with a glomerular filtration rate of less than 50 mL/minute 4 that is woefully underutilized. Renal RDs can be the leaders in raising awareness and usage of this important benefit through their connections with nephrologists and other RDs.

In dialysis, RDs are mandated as a member of the quality assurance performance improvement (QPAI) team and manage many components relevant to incentive-based payments.³ RDs have the opportunity to become QAPI leaders by viewing the process as a real chance for improvement, not just a form to be filled out every month. QAPI also has the potential to open doors to research; RD observations of individual patients plus insights from QAPI when systematically collected and combined, have the potential to answer questions and improve patient lives.

Across practice settings, RDs can reshape the profession by focusing on patient important/patient-oriented outcomes. The close relationships built between renal RDs and their patients and frequent follow up represent an opportunity to lead in this area. RDs influence many of the outcomes recently identified as important through a consensus process of providers and patients/caregivers.⁵

Interdisciplinary team staffing levels have been a hot topic and have been covered in this publication.⁶ As RDs continue to advance the profession, we must determine whether staffing ratios for dialysis RDs are in the best interest of patients and the profession. Research demonstrates that patient:staff ratios are lower at non-profit facilities,⁷ and independently that non-profit facilities have better patient outcomes.⁸

Do staffing ratios explain these differences in outcomes? Staffing is poorly explored in many professions and mandated ratios have the potential for unintended consequences, but this topic represents an opportunity for renal RDs to lead in data collection. Again, the level of follow-up and contact between renal RDs and their patients presents opportunities for answering important questions about best use of constrained time, including identification of technique, such as motivational interviewing, and interventions that make a difference in patient lives, and job satisfaction/prevention of burnout.⁹

These are just a sampling of roles for the renal RD of the future. All are powered by adoption of the nutrition care process terminology and advocating for structured nutrition data within your practice setting.

References:

1. Commission on Dietetic Registration. CPEU Rollover. www.cdrnet.org/pdp-cpeu-rollover. Accessed Nov. 30, 2017.
2. CMS, HHS, et al. Medicare and Medicaid programs; Conditions for coverage for end-stage renal disease facilities. Final rule. Fed Regist. 2008;73(73):20369-20484.
3. Blankschaen SM, et al. Am J Kidney Dis. 2016;doi:10.1053/j.ajkd.2016.03.417.
4. Kent PS, et al. J Acad Nutr Diet. 2014;doi:10.1016/j.jand.2014.05.006.
5. Evangelidis N, et al. Am J Kidney Dis. 2017;doi:10.1053/j.ajkd.2016.11.029.
6. Zurnoff R. California Dialysis clinic staff ratio bill passes assembly health committee. NN&I. www.nephrologynews.com/california-dialysis-clinic-staff-ratio-bill-passes-assembly-health-committee. Published June 28, 2017. Accessed Sept. 6, 2017.
7. Yoder LA, et al. Am J Kidney Dis. 2013;doi:10.1053/j.ajkd.2013.05.007.
8. Dalrymple LS, et al. Clin J Am Soc Nephrol. 2014;doi:10.2215/CJN.042000413.
9. Sullivan C, et al. J Ren Nutr. 2006;doi:10.1053/j.jrn.2006.07.005.

• For more information:
• Rosa K. Hand, MS, RDN, LD, FAND, is an instructor in the department of nutrition and is completing PhD research on the topic of dialysis RD staffing at Case Western Reserve University in Cleveland.