DPG11 Healthy Aging (HA)

This message was posted by a user wishing to remain anonymous

Hello all,

This week a concern was brought to my attention with regard to me working in the scope of my practice in my LTC/SNF. It was delivered via email with the ADONs cc'd by the nurse practitioner. She has no idea that we do NFPEs, can assess edema/fluid status, palpitate abdomen's, ask questions about insulin's effectiveness in brittle diabetics, and look at medication side effects leading to poor PO intake. She took offense to my doing my job thoroughly and suggested that I should stay in my lane, even if I was well-intentioned. I intend to sit down with the team and discuss the scope in depth. I am newer to the facility, in person, whereas the previous RD was remote only. They are simply not aware of what we do. But this is obviously a delicate situation now. Any suggestions on how to handle this? 

This is a problem around the world: people don't know what RDs do, including the medical community, so don't take their message personally. You are rocking your job!!! This is an opportunity to educate people on what RDs do. Maybe the DPG will give you free access to the PowerPoint slides used to review for the CSG exam which you could select several slides to create a presentation for educating your team in a meeting. This is a great opportunity! You're a dietitian working at the top of your field: stay positive and grateful for this opportunity!

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Jean M. Copeland, RDN
Cardiovascular Medicine Dietitian Nutritionist
Dartmouth-Hitchcock Medical Center
Lebanon N.H. jean.m.copeland@hitchcock.org
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This message was posted by a user wishing to remain anonymous

See if the department has policies/procedures on nutrition assessment on admission, quarterly/annuals high risk etc. If there's something you'd like to change set a meeting with the facility Administrator and discuss your intentions.

Most actions in LTC should be guided by facility policies and procedures so even if a Dietitian is trained in certain specialties the facility may not operate that way until it's discussed and reviewed by the administrator/Medical Director and Director of nursing. Just keep in mind what you develop for the nutrition department would have to be carried out by every dietitian and not doing so would make the department and facility out of compliance with the policy, so be realistic. 

Good evening, 

I just read the anonymous thread concerning NFPE's. My suggestion is to print an evidenced based document on why RD's are trained to do that assessment. Ask if you could do a inservice for all nurses not just the one who was a little offended. Also, try to speak directly with the person of interest and explain that you didn't mean to offend them. Explain to them that you are supporting their medical assessment but only from the nutrition lense. This assessment helps you identify nutritional deficiencies so collaboration with the entire medical team can be achieved on behalf of the patient first and then everyone concerned for the patient. The goal is to enlighten other medical modalities on how the profession of the Registered Dietitian has changed and is a collaborative profession when it pertains to complete and holistic approach to health and wellness. I say use wisdom and use a polite professional approach. You got this, don't fret. 

Tammie S. Brown, MPH, RDN, LD

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Tammie Brown
Harvest AL
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