Clinical ladders are positively associated with job satisfaction and career advancement for registered dietitians in clinical nutrition management

Background:  Following a change in reporting structure, Registered Dietitian Nutritionists (RDNs) in a Virginia hospital system provided patients with better care, cost savings, and almost doubled clinical nutrition staff from 2008 to 2013.  Objective The study was conducted to determine if the administrative alignment of RDNs in their place of employment 1) allows them to perform to their greatest scope of practice and 2) influences job perceptions. Methods: A survey was developed and distributed nationally to CNMs and their coworkers.   Statistical analyses: Using SPSS 24, univariate descriptive statistics and bivariate analyses were conducted. Contingency tables were generated and Pearson Chi-square tests and as appropriate Fishers’ exact tests were used to draw statistical inferences. Results:  Respondents (n=508) represented four regions of the US with various job titles. Some reported to vice presidents of support services (34%) and others reported to vice presidents overseeing both clinical and support services (26%). Respondents, regardless of alignment, were either ‘satisfied’ (47%) or ‘very satisfied’ (36%) with their current positions. Most (74%) were in a nutrition department separate from food service. There was no difference in education (p=0.87) or pay (p=0.62) dependent on reporting structure. However, when RDNs reported to a clinical nutrition department, separate from food service, it was more likely that there was a clinical ladder for RDNs and there were more levels on the clinical ladder. Conclusion: This survey suggests alignment of a clinical nutrition department is associated with a higher likelihood that RDNs will have a clinical ladder to promote career advancement.