Staffing Mix


CNMs can use their organization’s nutrition acuity profile and other services pro- vided by the clinical nutrition team to assist with determining the appropriate staffing mix. The budget for clinical staff salaries and FTE count allowance should also be considered. The staffing mix refers to the type of clinical nutrition staff in place (eg, full-time, part-time, as-needed RDNs and NDTRs). After analyzing these elements, the CNM can determine if the staffing should only include RDNs; whether RDNs are full-time, part-time, or working on an as-needed basis; and if NDTRs can fulfill some patient care duties.


Nutrition and Dietetics Technicians, Registered


Depending on the organization’s size and needs, the addition of NDTRs to the clinical staff can allow RDNs to focus more on higher-acuity patients and tasks such as par- ticipating in interdisciplinary collaboration, placing feeding tubes, and managing EN and PN. NDTRs work under the supervision of the RDN when providing direct patient care.7


NDTRs can assist RDNs with gathering information for evaluating


low-risk patients, implement and monitor nutrition interventions, provide nutrition education per institution guidelines, and complete nutritional analyses of menus. They may also participate in responsibilities related to monitoring the quality and accuracy of food service to patients.8


Pro Re Nata Registered Dietitian Nutritionists


Utilization of pro re nata (PRN) RDNs (which usually means working only when needed) can be a creative way to provide patient care coverage and improve job sat- isfaction of the full-time staff. The PRN RDN schedule can vary greatly depending on the organization’s needs. Some PRN RDNs may work a set schedule each week, whereas others may work on an as-needed basis only. PRN RDNs can provide pa- tient care when full-time staff take time off during the usual workweek or on the weekends. While full-time staff often cover weekends in many organizations, the obligatory days off during the week may lessen the continuity of care supported by having the same RDN FTEs Monday through Friday. It is important to note that not all organizations have the ability to provide full weekend coverage with PRN or full-time RDNs and may need to provide coverage on just one weekend day or follow an on-call protocol in order to comply with policy. Another benefit of utilizing PRN RDNs is that they are often ideal candidates when full-time openings arise. There are also advantages for the PRN RDN. Those who are new to the profession can enhance their confidence and skills as well as obtain more exposure to different patient populations. The PRN role is also a good opportunity for experienced RDNs who desire part-time hours and the ability to maintain their clinical skills. Determining the best staffing mix for an organization may involve some trial


and error. Ongoing evaluation of the staffing model may be necessary, as what works best for one time period may not work best in the future, especially if the variables that impact clinical nutrition staffing needs change. For example,


if


the current staffing mix is based on physicians writing nutrition support orders and the RDNs are going to take on this responsibility, the CNM will need to evaluate whether additional RDNs are needed, if RDNs with different skills or credentials


74 EFFECTIVE LEADERSHIP & MANAGEMENT IN NUTRITION & DIETETICS


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