Future Dimensions - Wendy Phillips MS, RD, CNSC, CLE, NWCC ...wendyphillips.weebly.com › uploads › 1 › 2 › 3 › 7 › 12375533 › ... · gained real wisdom (AKA my “aha”

VOLUME XXXVI, NUMBER 42011 - 2012

Managing EditorCourtney Spurlock, MS, RDPhone: 407/880-6708Fax # 407/880-6962E-mail:[email protected]

Lead Features EditorLisa Trombley, MA, RD, CNSDPhone: 310/903-2900E-mail: [email protected]

Features EditorsJennifer Doley, MBA, RD, CNSDPhone: 520/872-6109E-mail: [email protected]

Robin Aufdenkampe, MS, RDPhone: 734/936-5920Email:[email protected]

Future DimensionsIN CLINICAL NUTRITION MANAGEMENT

Viewpoints and statements in thesematerials do not necessarily reflectpolicies and/or official positions ofthe Clinical Nutrition ManagementDietetic Practice Group or theAcademy of Nutrition and Dietetics.

© 2011 Clinical Nutrition Manage-ment Dietetic Practice Group of theAcademy of Nutrition and Dietetics.

All rights reserved.

Publication of an advertisementin FUTURE DIMENSIONS inClinical Nutrition Managementshould not be construed asendorsement of the advertiseror the product by the CNM Dietetic PracticeGroup or the Academy ofNutrition and Dietetics.

Employee and Organizational Effectiveness: Influencing Thinking Styles

By Deborah Wildish BHEc, MA, RD

This article is the culmination of over twenty years of clinical nutrition managementexperience and the application of reflexive practice (1) that transformed my reflectionsinto pivotal learning experiences. Three intertwined themes mark my learning jour-ney:

1. understanding how people think to promote effective individual and team behav-iors

2. leading and coaching business skill development3. fostering an advanced practice environment that invites out-of-the-box thinking.

This article will highlight my experiences, their connections to these three themes andfinally, their convergence along with a personal epiphany.

Understanding How People Think

When I enrolled in a graduate program in education, I believed education couldchange human behavior. However, while analyzing results for my master’s thesis, Irealized that self-directed and adult learning theory did not provide an adequate expla-nation for my observations of different human behaviors (2). When my focus shiftedto educational psychology, I becameintrigued by Pask’s ConversationTheory which describes intellectu-al activities as dialogue and behav-ior. This theory captures three dif-ferent learning strategies: holist,serialist and versatile, which link tothinking and behavioral styles (3,4).

My first illumination, when Igained real wisdom (AKA my “aha”moment), was realizing that noteveryone thinks the same way I do!To be an effective manager, I hadto better understand each of myemployees. My effectiveness as aleader advocating, motivating andsustaining change hinge on align-ing our collective thinking andbehavior(s).

My simplistic application of Pask’s

IN THIS ISSUE• Farewell Message From The Chair• Featured Articles

• Employee and OrganizationalEffectiveness: Influencing Thinking Styles

• Getting the Job and Keeping It: Makinga Difference in Your Organization

• A Call to Action - Shining the Spot Lighton Advocacy

• Spring HOD Fact Sheet - Continuum ofProfessional Progression and Growth

• New Release! Critical Illness Guidelines• New Release! Food and Nutrition for

Older Adults Guideline

• FNCE 2012

Future DimensionsIn Clinical Nutrition Management

Conversation Theory to healthcare isas follows: those in management posi-tions tend to be holists; that is, bigpicture, and bottom-line thinkers. Amajor pitfall of being an extremeholist is omitting important details,which can be very problematic whenimplementing initiatives. Clinicians(i.e. direct care providers) lean towardbeing serialists, driven by the need tounderstand and address all the detailsand favoring a step-wise or task-ori-ented approach to complete their jobresponsibilities. Extreme serialistsneed specific rules or methods, havedifficulty tolerating ambiguity and arereluctant to rely upon professionaljudgment. The versatile thinker is ablend of both styles and thus has theability to maintain a big picture focuswhile capturing only the essentialdetails.

Three applications of Pask’sConversation Theory follow:

1. Working Groups that go on andon…

I was a member of one workinggroup that went on for 6 years! I real-ized the group was populated withextreme serialists who had to “rehash”everything at each meeting. I was inanguish, felt helpless and thought theonly way to get off that workinggroup was to quit my job (or die).However, my belief that I couldn’tinfluence the group was erroneous; Icould have worked through or aroundthe chair. Now I understand.

2. Projects that keep expanding …While coaching and mentoring clini-cal dietitians in practice-basedresearch projects, I’ve observed thatthey are fabulous information gather-ers but then get swamped. My role isto help clinical dietitians maintaintheir project focus while sortingthrough endless detail (5-8). I helpidentify key details and assist withevidence synthesis, organizing andcombining details. The last step

requires a final push and is mostimportant: knowledge translation intoclear (bottom-line) guidelines forinter-professional practice.

3. Getting air time withsenior managers…

For every clinical dieti-tian project, we designan inter-professionalengagement plan toinvolve stakeholders andproject partners. The firststep is condensing volu-minous information intoa one page projectdescription that focuseson key details. During a short meet-ing with each stakeholder, this infor-mation is verbally tailored to fit thethinking style of senior managers.The added bonus is that no matterhow busy the person, their adminis-trative assistant can find you a 15minute time slot!

Leading and Coaching BusinessSkill Development

The Rotman School of Managementat the University of Toronto isredesigning business education for the21st century, drawing upon conceptssuch as Integrative ThinkingTM (9,10). Integrative thinkers build newmodels that consider numerous vari-ables such as clients, employees, inter-professional and senior managementteams, resources, funding, policies,processes, health structures, govern-ment, health care law, professionalassociations and the regulatory envi-ronment. Integrative ThinkingTM

captures complexity, opposing viewsand perspectives to creatively solveproblems without making costlytrade-offs. The goal is to retain andcombine the best ideas to achieve bigideas, faster.

There are four iterative steps to theIntegrative ThinkingTM process,described as the choice cascade (9,

10):

1. Salience: Identifying information,factors and variables that are highly

relevant or of notable sig-nificance to the decisionor choice. Busy managersmay respond to complex-ity by short-cutting theprocess and over-simpli-fying the issue. This ren-ders the solution incom-plete and less effective.

2. Causality: Mappingout multidirectionalcausal relationships and

patterns between the salient variables.Mysterious elements are embraced(not ignored) and judgments aboutcausality are open to revision.

3. Sequencing or Architecture:Isolating key foreground variables (towork on parts of a system) whileretaining the entire causal picture.Other variables move to the back-ground but their relationships to thekey variables are not lost during activeproblem solving.

4. Resolution: Tolerating ambiguity,uncertainty and tension betweenopposing variables to flexibly and cre-atively manage choices. Rather thanfocusing on closure, continuous opti-mization toward perfection is thegoal.

How does Integrative ThinkingTM

fit with the business of clinical nutri-tion management?

Clinical nutrition managers applycurrent best evidence to

o maximize inter-professionalcollaboration &

o implement quality care &o strengthen connections to

food/food services &o promote patient safety &o improve patient satisfaction & o balance or reduce cost.

FUTURE DIMENSIONS IN CLINICAL NUTRITION MANAGEMENT Vol. XXXVI, No. 4, 2011-2012

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“The versatilethinker is a blendof both styles andthus has the abilityto maintain a bigpicture focus whilecapturing only theessential details.”


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The ampersand between each of thesefactors symbolizes the challenge ofclinical nutrition management.However, causality between these fac-tors and their sub-factors reveals thecomplexity of IntegrativeThinkingTM. Clinical nutrition man-agers are charged with promotingquality care and services while pro-moting safety and balancing or reduc-ing cost. Today’s reality is that healthcare providers and systems have limit-ed resources. To ensure viability ofany service, including food or clinicalnutrition services, judicious use ofhealth care dollars is necessary.Layering a business perspective to themanagement of clinical nutrition isimperative. The clinical nutritionmanager has the opportunity to pro-mote shared accountability withinand beyond their clinical dieteticteam (dietitians, diettechnicians, diet clerks).Two examples follow:

1. Clinical nutritionmanagers lead withbusiness skills…While training tobecome a dietitian, Ihad difficulty under-standing why practicevaried between clinicaldietitians. For example: I observedthat dietitians recommend differentnutrition support strategies (e.g. dif-ferent oral formula, modular supple-ments, or foods) for patients with thesame diagnosis. This inconsistency inpractice was perplexing to me, so Ideveloped an algorithm to assist dieti-tians in clinical decision-making inmanaging enteral nutrition support(11). This algorithm ensures that themost cost-effective alternatives areconsidered first. The underlying con-cept is that various nutrition supportstrategies may yield similar clinicaloutcomes but the cost of each strategycan vary immensely. Through ongo-ing revision of enteral formulary

strategies, we have promoted qualitycare while sustaining an annual sav-ings of over $100,000 for more than20 years.

2. Clinical nutrition managers arepositioned as business skill coach-es…I noticed a trend after years of observ-ing and reviewing clinical dietitianperformance: experience in food serv-ice operations or managementenhances performance in clinicaldietetics. These dietitians often pres-ent with stronger planning, organiza-tion, time management and financialskills. They understand the impor-tance of balancing quality with cost.Therefore, my attention has beenredirected to dietitians who lack expe-rience in food service operations. Icoach these dietitians to consider andcompare costs of various clinical

dietetic approaches, andto encourage them tothink more broadlyabout impact acrossprofessions, depart-ments, programs, andthe health system.Sometimes clinicaldietitians working inhospitals forget thatwithout food and food

services, clinical nutrition practice isnot possible. The clinical nutritionmanager wears two hats and acts as abridge to promote communicationbetween clinical dietitians and foodservices to realize goals that promotebest practices, resulting in coordinat-ed care and service delivery.

Fostering an advanced practiceenvironment

My latest research focused onadvanced practice across the diversityof dietetic practice roles and settings.I conducted a two phase national sur-vey research project which resulted inan evidence-based framework, dividedinto four dimensions (12). A skeletal

summary follows coupled with strate-gies for clinical nutrition managers:

Depth: Digging deeper….Expertise in a given area of dieteticpractice, specialization (e.g. food serv-ice management, clinical nutritionpractice and sub-specialties) is cap-tured within this dimension.

Strategy: Clinical nutrition managerscan facilitate the development ofexpertise (depth) in a given area ofpractice. In my experience, it takesclinical dietitians at least 5 years ofspecialization in an area of practicebefore they can become an expert.The clinical nutrition manager pro-motes engagement through brain-storming creative and stimulatingchallenges, to encourage the dietitianto remain in one area and maximizegrowth before moving on.

Breadth: Reaching beyond…Applies a big picture perspective,establishes links within dietetics andacross professions, networks broadly.

Strategy: Clinical nutrition managerscan encourage a broad, big pictureperspective that spans practice sectorsand professions. A clinical dietitian’sworld view can be stretched byencouraging strong partnerships withfood services, dietitians in other prac-tice sectors such as the community,food industry, academia and govern-ment; and other health professionsand related fields such as engineeringand computer science. Rich and inno-vative solutions result from harnessingdiverse perspectives.

Enablers: Approach to practice…Harnesses innovation and creativity,enters unknown territory and takesrisks, leads transformational change.

Strategy: Clinical nutrition managersmust take an active role in not pre-serving the status quo because this isa major barrier to innovation. Theycan cultivate a safe environment to

“Clinical nutritionmanagers are chargedwith a leadership rolewhich encompassesmentoring staff andexerting positive andstrategic influence...”


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raise new ideas which might appearradical to some, and to try newapproaches. The climate must permitfailure; otherwise, fear of failure willthwart innovation. Clinical nutritionmanagers ensure that the appropriatechecks and balances are strategicallyin place to prevent any risk to patientsafety, promote cost-containment,and align with other requirements.

Outcomes: For the dietitian, theclients, the organization, the pro-fession…Central themes include: inspiring,mentoring, influencing or increasingprofessional autonomy.

Strategy: Clinical nutrition managersmust maintain the focus on goals andoutcomes (there must be a definedoutcome). In clinical nutrition, westruggle with outcome measures. Ittakes time before a change can bemeasured (i.e. nutritional status) andoutcome measures are often convolut-ed and attributed to other factorssuch as medications and diseasecourse. However, the clinical nutri-tion manager must lead by measuringeffectiveness and achievement of goalsand outcomes.

The following thought-provokingquotations are responses from myadvanced practice survey research:

“I think an extremely importantpart of advance dietetic practice isto be able to look more globally atissues from more than anutrition/dietetics perspective. Ithink that having that ‘bigger’ pic-ture perspective is an important partof gaining respect from other healthcare disciplines.”

“I am not sure if you can teachAdvanced Practice the way I see it.It has more to do with the personal-ity and the motivation of the dieti-tian. I see everyday opportunity tomove forward in our practice but itseems that some dietitians will never

embrace that or are just not gettingit.”

The concepts of versatile thinking,Integrative ThinkingTM andadvanced practice are all interrelated.Versatile thinking is similar to flip-ping between the dimensions ofdepth (serialist) and breadth (holist)in advanced practice. IntegrativeThinkingTM fits with advanced prac-tice as it captures the complexity andinterrelationships with a primaryfocus on results and outcomes.

I recently attended the CanadianAssociation of Professional Speakersannual convention in Toronto (2011)and was inspired by Sid Ridgley’spresentation entitled: Further, Faster,Better. He believes that it is not possi-ble to change a person’s personality,but you can change thinking styles tochange your results. The sequence fol-lows: influencing thoughts & beliefs? changes relationships & actions ?changes your results!

Clinical nutrition managers arecharged with a leadership role whichencompasses mentoring staff andexerting positive and strategic influ-ence to change thinking, relation-ships, actions and results. For me, thisis a very powerful message.

Deborah works as a Manager,Clinical Nutrition and CorporateProfessional Leader, Dietetics forARAMARK Canada Ltd. at theToronto Rehabilitation Institute inOntario Canada and she can bereached at:[email protected]

References1. Bleakley A. From reflective practice

to holistic reflexivity, Studies inHigher Education, 1999; 24(3):315-330.

2. Wildish DE. Interpreting the expe-rience of adults engaged in self-directed learning of the internet.

Ottawa: National Library ofCanada, Canadian Theses. Thesis(M.A.) University of Toronto,1995.

3. Pask G. Styles and strategies oflearning, British Journal ofEducational Psychology, 1976;46:128-148.

4. Pask G. Learning Strategies,Teaching Strategies, andConceptual or Learning Style. In:Schmeck, R, ed. LearningStrategies and Learning Styles.New York: Plenum PublishingCorp.; 1988.Chapter 4: 83-100.

5. Wilk, H. Exploring osteoporosis:How my quest for evidencebecame my personal journey.Practice, Dietitians of Canada.2010;51:7.

6. Ricupero, M. Supplemental alpha-tocopherol: A perspective onapproaching an evidence-basedproject. Practice, Dietitians ofCanada. 2009;48:7.

7. Whitelaw J. Questioning existingpractices: vitamin C supplementa-tion for wound healing. Practice,Dietitians of Canada. 2009;46:2.

8. Wilk H. Researching the role ofvitamin D in the elderly as a PENpathway. Practice, Dietitians ofCanada. 2005;32:3.

9.http://www.rotman.utoronto.ca/integrativethinking/definition.htm

10. Martin, R., Austen, H. The art ofintegrative thinking. RotmanManagement Fall 1999:2-5.

11. Wildish DE. Enteral formularymanagement: A cost-effectiveapproach. Can J Diet Prac Res2006;67:193-198.

12. Wildish DE, Evers SA. A defini-tion, description and frameworkfor advanced practice in dietetics.Can J Diet Prac Res [online],2010;71:4-11.


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In the era of universal healthcareand “Obamacare”, getting a job inthe healthcare industry is frequent-ly seen as the ticket to job security.Much thought and preparationgoes into securing a job in thisindustry. Applicants considerwhere they might like to work, thelocation of potential job sites, whothey might know in the nutritiondepartment, and the prerequisitesfor the position. Once the officialcall is made offering the applicant ajob, is the same thought and prepa-ration given to keeping the job andmaking a difference in the organi-zation where the dietitian is nowbecoming an employee? This arti-cle will discuss how employees,specifically dietitians in healthcareorganizations, can best presentthemselves at the pre-hire inter-view, give tips for keeping the joband increasing the chances for pro-motional opportunities, andremind the reader of the impor-tance of making a difference in theworkplace.

The Pre-Hire ProcessInterview Preparation

An applicant receives the await-ed phone call from a recruiter orpersonnel director from an organi-zation where he or she applied andan interview is scheduled. Beforethe interview, the applicant isstrongly advised to do some home-work on the facility where theinterview has been granted. If thefacility contracts with a foodservicecompany, or if the facility is part ofa larger healthcare organization,

those should be researched as well.It is important to understand themission and vision/purpose of thehealthcare organization. For exam-ple, is this a community healthcenter dedicated to serving thelow-income population, or is this adialysis center focusing on end-stage renal patients? What isunique about the facility and whatskills are needed to match theirneeds?

The InterviewDuring the actual interview,

the applicant needs to be him orherself, communicating stronglywith good eye contactin a practiced but notoverly-rehearsed pres-entation of personalskills and accomplish-ments. Interviewtechniques to remem-ber are to know andpromote one’s ownstrengths and to beready with specificexamples of goingabove and beyondone’s job or schoolresponsibilities previ-ously. If the applicantdoes not have much work experi-ence to tout, other accomplish-ments that can be accentuatedinclude internships, education, andvolunteer work.

A recent informal survey ofClinical Nutrition Managers(CNMs) showed that length oftime in the dietetics field, special-ization in a certain area, and a vari-

ety of experiences have a varyingdegree of importance depending onthe position. Many CNMs arewilling to hire a registered dietitian(RD) who is relatively new to thefield, or a newly graduating intern,if they have a variety of experiencesthat are applicable to that positionin addition to excellent communi-cation and interpersonal skills.Highlighting experiences, even vol-unteer experiences which aredirectly related to the dieteticsfield, can be beneficial.Community involvement, such aspresenting nutrition talks at

schools and communi-ty groups, demon-strates an ability tointeract well with thepublic and a desire touse nutrition knowl-edge to educate oth-ers.

For newly graduat-ing interns, it is veryappropriate to discussprojects completedand skills learned dur-ing the internship.While all interns haveto meet basic compe-

tencies, each internship program isunique and offers different experi-ences. Interns should maximizetheir efforts during their internshiptowards areas of dietetics they wantto pursue for their career and high-light these projects during inter-views. However, after the first 1-2years of being in the workforce,internship projects should rarely be

Getting the Job and Keeping it:Making a Difference in Your Organization

By Wendy Phillips, MS, RD, CNSC, CLE and Janelle Webb, MBA

“A recent informalsurvey of ClinicalNutrition Managersshowed that lengthof time in the dietet-ics field, specializa-tion in a certain area,and a variety of expe-riences have a vary-ing degree of impor-tance depending onthe position.”


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used as examples for answeringinterview questions. Doing sosuggests that activities of signifi-cance will only be completed in thenew workplace if absolutelyrequired. RDs who take initiativeto complete projects, give presenta-tions and expand their knowledgeof nutrition without being instruct-ed to do so by an InternshipDirector are much more desirablethan those who do not.

CNMs want to hire RDs who arepassionate about what they do.Passion is difficult to fake, and truepassion is easy to spot by an experi-enced CNM. Sometimes RDsapply for jobs because of location,salary, or even the reputation of theinstitution where they are applying,not because they are particularlypassionate about that area of dietet-ics. It is better to be honest abouttrue interests and highlight howthose passions can be used in theposition.

Since healthcare jobs involvequality management, every CNMis responsible for producing qualityresults within their department.Applicants can bolster their inter-view by focusing on quality man-agement during their interview.Specific examples from previousjobs or internships where perform-ance improvement projects or qual-ity management activities wereinvolved are helpful and questionsrelated to quality management arebecoming more common in thedecision-making process. It is fur-ther essential to be able to speakabout regulatory agencies and howto meet those requirements.

Promotional Opportunity toCNM

RDs who are interested in

management would be wise tospeak to CNMs or other managersto get a realistic idea of what isinvolved. The old saying “youdon’t know what a person doesuntil you’ve walked a mile in theirshoes” is true; most RDs do notrealize everything a CNM does oris responsible for, so the RD needsto be sure this is something theywant to do. Many companies pro-vide management developmentplans and/or career developmentladders with specific activities andspecific reading recommendations.Since each facility, and thereforeeach management position, isunique, the development plansshould be customized to the facilityand the individual candidate.Many contemporary managementbooks are available for preparationand self-education.

Additionally, there is nothingthat can replace “hands on experi-ence”. When applying for a man-agement position, a greater varietyof experiences enhances a candi-date’s viability as a candidate.Employees respect managers, andare frequently more productiveworking for those, who can speaktheir language and have at leastsome experience in their area ofexpertise. For example, a CNMwho is a certified lactation educatorwill be able to work closely withand support a NICU RD who ispassionate about breastfeeding, andthe two will be able to collaborateon important patient-related activi-ties such as breastfeeding networksand outreach opportunities.

If the CNM candidate knows sheor he will be applying for a man-agement position that will haveresponsibilities over a specialty area

that they are not familiar with,they would benefit from creating apersonal development plan tobecome at least moderately profi-cient in that area. This educationdoes not need to be formal, butcan be obtained through industryjournals, attending medical in-serv-ices, or by working alongside anRD with the specialty knowledge.For example, a potential CNM canspend several days working with arenal RD in a dialysis center togain knowledge related to renalnutrition Of course, professionalcertifications, continuing educationmodules, and advanced degrees areexcellent ways to obtain the knowl-edge necessary to manage RDs in awide variety of settings.

For RDs who are interested inpromoting to a CNM position,desirable traits include many of thesame qualities one would look forwhen hiring an RD: passion,enthusiasm, and the ability tomotivate others. Demonstration offlexibility is important, as managersare the ones who must respond inemergency situations. An effectivemanager needs to be open-mindedand willing to look at one problemor issue in multiple ways and frommultiple viewpoints. CNM candi-dates are able to prioritize tasks andresponsibilities efficiently to stayon deadlines and can recognizewhat can or cannot be delegated.

CNMs need to know how toutilize available resources, whetherpersonal, processes, technologyservices, etc. to accomplish goals.CNM candidates are RDs who cansee the “big picture”, but also knowthe specific daily details that arenecessary to complete in order toaccomplish the larger goals.

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Creating successful action planstakes time and experience, butCNM candidates show potentialfor identifying procedural stepsthat are necessary to achieve suc-cess.

All employees, but especiallythose interested in promotions,must realize that the modern jobmarket is one of constant changeand innovation, especially in thehealthcare industry where researchleads to improved patient care,treatments and outcomes.Employees that thrive in this sortof job market are those who realizethat continuing education, improv-ing their job related skills, andbeing an adaptable, fast-learningemployee are basic job require-ments. These employees attenddietetics-related conferences, readnutrition-related journals and arti-cles to remain abreast of the newestresearch information in the field,and complete research projects andpublish themselves. They also areinterested in learning by doing,collaborating with their co-work-ers, subordinates, and superiors infinding more efficient or new waysof doing “old” procedures orprocesses.

Keeping the Job andDemonstrating Value

A report in the HarvardBusiness Review (2004) states thatemployees are more likely to pur-sue job mobility within the samecompany rather than jumpbetween different companies. Thisis “in striking contrast to the late1990s, when young people flittedfrom company to company insearch of new skills, contacts, andexperiences” (1). This retention ofemployees for healthcare organiza-

tions is especially beneficial, sincethe costs associated with employeeturnover can be substantial.Identifying RDs who have theabove characteristics for advancedpractice or management is a corefunction of the CNM, as providinggrowth opportunities will assist inmaintaining a satisfied and engagedworkforce.

To demonstrate true value inthe workplace, it is critical to pro-vide tangible evidence of positiveoutcomes. This is often accom-plished through quality improve-ment initiatives (QI). Valuableemployees focus on QI that seeksto improve both organizational rev-enue and patient/customer satisfac-tion. Once opportunities forimprovement are identified, CNMscan benefit from having their RDsparticipate in all phases of thePDCA cycle:

Plan: help create the data collec-tion tool

Do: collect dataCheck: analyze resultsAct: write action plans; train oth-

ers to implement actionplans; re-check results

RDs should also report the projectto appropriate committees andsuperiors within the healthcareorganization to be sure the nutri-tion department activities alignwith the overall mission of theorganization. This helps todemonstrate project managementskills, teamwork, and the ability tomeet deadlines for effective change.

ConclusionThis article has shown that

while the thought and preparationdevoted to getting a job is impor-tant, it is the actions of the

employee after the interviewprocess that can ensure the personstays a valued, integral part of thehealthcare organization for manyyears. Recognizing where onemight make a difference in theorganization, focusing on QI stan-dards to improve organizationalrevenue and patient satisfactionwhile also remembering to focuson personal growth will maximizethe ability of the employee to makea personal and professional differ-ence.

Wendy Phillips has worked in nutri-tion management for 10 years in avariety of roles and is currently theClinical Nutrition Director forMorrison Healthcare at theUniversity of Virginia Health Systemin Charlottesville, VA. She has pre-cept Dietetic Interns for 13 yearsduring Nutrition Support andClinical Management rotations andenjoys mentoring students andinterns. Wendy can be reached [email protected]

Co-Author, Janelle Webb holds abachelor’s degree in OrganizationalLeadership as well as an MBA. Sheworks for Kaiser Permanente as aLifestyle Educator in Bakersfield,CA. Previously, she was involved inWIC Worksite Wellness initiativesthrough Clinical Sierra Vista WIC.Janelle can be reached [email protected]

ReferenceBuchanan, L. The young and therestful. Harvard Business Review.2004;82(11):25.

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CNM members…It is hard to believe an entire year has gone by and I am writing my final message as your Chair. I am sothankful to have served as your CNM Chair this year. I believe CNM to be one of the premier DPGs (I’m a little biased, orcourse). And, serving as the Chair of this impressive group has been a highlight of my dietetics career. However, I would beremiss if I did not take the time to express my appreciation to all those who contributed to a successful year for our DPG.“Feeling gratitude and not expressing it is like wrapping a present and not giving it.” -William Arthur Ward

First and foremost, I wish to personally thank the CNM Executive Committee (EC) for their support and all of their hardwork. At the beginning of the year, I conveyed to the EC that my theme for the year was the Nike, Inc. motto…“Just DoIt”...and they did! It was with the executive committee’s commitment and perseverance that we were able to accomplishmany great things this year on our member’s behalf.

“Kudos” to the CNM Professional Development Team (Sara Bakert, Jennifer Wilson, and Sharron Lent), FundraisingCommittee (led by Janet Barcroft), and Chair-Elect (Kim Brenkus) who did a fabulous job planning and executing thisyear’s CNM symposium. The 2012 CNM annual educational symposium “Executing Change” took place March 24-27,2012 at the Savannah Marriott Riverfront in Savannah, Georgia. The symposium was attended by 253 participants includ-ing our numerous sponsors. The event would not have been a success if not for the generous financial contributions of oursponsors. Our platinum level sponsors included: Nestle Health Science and Abbott Nutrition. And our bronze level spon-sors included: Aramark Healthcare, the CBORD Group, Inc., Columbus State Community College, Computrition,Inc., Diamond Crystal Sales/Hormel Health Labs, Dole Packaged Foods Company, Kellogg, Morrison ManagementSpecialists, Nature’s One, Inc., nutritionDay in the U.S., Provide Nutrition, and Sodexo Healthcare Services.

A “job well done” to the CNM Standards of Professional Performance (SOPP) workgroup (Krista Clark, Cindy Moore,Mary Jane Rogalski, Marsha Schofeld, Janet Skates, Lisa Trombley, and Janel Welsh). They worked tirelessly over thepast few years to create a very comprehensive set of SOPPs. This year they finished and submitted the CNM SOPPs to theAcademy. Where in turn, the Academy’s Quality Management Committee and Scope of Practice Sub-committee reviewedthe documents and officially approved them with comments. We anticipate they will be published this coming year in thejournal. It was a huge accomplishment and will prove beneficial for all CNMs.

A big “Thanks” goes out to Terese Scollard, Informatics Sub-Unit Chair, and the CNM website workgroup members(Cathy Welsh, Krista Clark, Mary Jane Rogalski, Deb Hutsler, and Marcelle Karustis). They were instrumental in get-ting our “new and improved” CNM website up and running. It is still a work in progress, but after many years of hopingfor a more robust website, these ladies made it happen! Check out the new website at www.cnmdpg.org. Follow the direc-tions on the homepage to register and login as a CNM member. In addition, I wish to “thank” Deb Hutsler and YoungHee Kim for their help in making the transition to our new electronic mailing list (EML) and eBlast provider seamless.

Other acknowledgment and thanks goes out to our CNM Newsletter Committee (Courtney Spurlock, Managing Editor,and Robin Aufdenkampe, Jennifer Doley, and Lisa Trombley). They continued to provide informative and educationalnewsletters. The Research Committee led by co-chairs, Barbara Isaacs Jordan and Susan DeHoog, continued to work onthe development of productivity tracking forms we hope to make available this upcoming year. Frances Suen and theLegislative & Reimbursement Committee kept us informed of important legal issues and solicited input from CNM mem-bers to share with the Academy. Kathy Allen and the Member Services Committee put together an awesome CNM display

Message from the ChairSherri Jones, MS, MBA, RD, LDN

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at the FNCE DPG Showcase and created catchy CNM T-shirts for both FNCE and the symposium. Kerry Scott and theCNM Nominating Committee produced a great slate of candidates for our ballot and continues to recruit CNM membersat FNCE and the symposium who are interested in getting more actively involved in the executive committee. And lastly, aspecial “shout out” to our new Academy DPG Relations Manager, Mya Jones. This was Mya’s first year with the Academyin her role. She did a great job supporting CNM and looking out for our best interest.

In addition, I want to thank those EC members who will be ending their terms on the EC. I greatly appreciate all that youcontributed over the year(s). There is no greater contribution than that of giving your time and talents. You should be veryproud. I apologize if I may have forgotten to acknowledge anyone who contributed to our successful year. As you can tell, it“took a village” to accomplish everything for CNM this year, and I was merely one of the villagers.

In closing, I wish Kim Brenkus, the incoming CNM Chair, and the 2012-2013 Executive Committee much luck and suc-cess. I know Kim will do a great job as leader, and will continue to advance the interests of our DPG and its members.Again, thank you for letting me serve you. It has truly been my pleasure. If I can ever be of help to any of you please don’thesitate to contact me.

My continued best,

Sherri

Sherri Jones, MS, MBA, RD, LDNChair, Clinical Nutrition Management DPG (2011-2012)Office: 412-623-1629; Mobile: [email protected]

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Advocacy promotes the value of foodand nutrition issues and shines a spot-light on the benefits of what registereddietitians do every single day. Hereare some of the ways you can getinvolved!

• WRITE a letter to your represen-tative in support of The DrugShortage Prevention Act, ThePreventing Diabetes in MedicareAct, The Older American Act, andthe Farm Bill. Your representa-tive's vote directly affects yourwork and benefits as a registereddietitian.

• ATTEND a town hall meeting inthe district to show your supportand voice your opinion on thebenefits of the work of registereddietitians.

• ACT and alert others to act bysending an action alert throughthe Academy’s website. E-mailyour member of Congress usingthe Grassroots Manager on theAcademy’s website.

• READ “Eat Right Weekly” to staycurrent on what’s happening inWashington D.C. What happensthere can affect what you can do inyour local district!

• CONTRIBUTE any amount, bigor small. If every member donatedjust $10 each year, ANDPACwould be one of the largesthealthcare professional PACs inthe country. You can easily add adonation when you renew yourmembership online.

• INVITE your congressman/woman to your place of work,along with a few other registereddietitians and show them the ben-efits of your profession.

If dietetics is your profession, thenadvocacy is your business. Below arefour pieces of legislation that willdirectly affect dietitians in the com-ing vote:

#1. The Preventing Diabetes inMedicare Act (H.R. 2741)Economic Impact and Cost Benefit

• Diabetes costs US $174 billioneach year.

• Costs to treat a person with dia-betes = $11,744 per year.

• Lifestyle interventions (such asMNT) for pre-diabetes can savethe insurance provider moneywithin three years.

Outcomes • 50%-70% of Medicare participants

with pre-diabetes can avoid dia-betes with lifestyle intervention.

• Lifestyle interventions that includediet therapy showed a 71%decrease in new diabetes casesamong persons over 60.

• RDs provide effective, evidence-based MNT that result in weightloss and obesity prevention.

#2. The Preserving Access to Life-Saving Medication Act (H.R.2245)/(S. 296)The Drug Shortage Prevention Act(H.R. 3839)

Reasons for the urgency • Drug shortages sidetrack the recov-

ery process for patients and inhibitthe registered dietitian’s ability tomanage the patient’s recovery withnutrition therapy.

• A record 211 medications becamescarce in 2010; three times asmany as in 2006.

• Registered dietitians, pharmacistsand doctors are not notified ofdrug, or vitamin or mineral short-age in advance. If a company sim-ply stops manufacturing a drug, ahealthcare provider may not knowuntil they try to place an order.

• The FDA investigates the short-ages, but its authority needs to beexpanded in order to develop aprocess and solution.

Please support these bills-houseH.R. 2245 and H.R. 3839 and forthe Senate S. 296 By Supporting you will help:

• Registered dietitians, doctors, phar-macists, and nurses provide qualitysafe patient care.

• Allow the FDA to work with othermanufacturers, both domestic andinternational, to find new sourcesand ensure that the supply chain isnot interrupted in the case of ashortage.

#3. The Older Americans Act (S.2037)Economic Impact and CostEffectiveness

• $1,300 = one year of home-deliv-ered meals/congregate dining OR6 days in a nursing home

• State, local and private funds payfor 78% of costs of home-deliv-ered meals.

The benefits of the OAA NutritionPrograms for Older Adults

• Fewer healthcare acquired infec-tions: Older adults with strongnutritional status are less likely toacquire infections if they requirehospitalization or other facilitycare, which means shorter hospital

Shining the Spotlight on AdvocacyBy Frances Suen, MS, RD

Chair, Legislative and Reimbursement


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stays and lower healthcare costs. iii

• Less Falls: Proper nutrition,including adequate intake of pro-tein, vitamin D, and calcium, helpsprevent brittle bones that can easilybe broken during a fall.

• Less hospitalization and health-care: Older adults who follow adiet of healthy food and adequatefluids are less likely to have healthcomplications that require hospi-talization.

• Help stretch money for medica-tions: Many older Americans areforced to choose between medica-tions and food, and often theychoose to purchase food instead ofmedications.

#4. 2012 Farm Bill Six Key Components of the FarmBill We Support

1. The Supplemental NutritionAssistance Program (SNAP).SNAP provides monthly benefitsto eligible low-income familiesused to purchase food. The goalof the program is “to alleviatehunger and malnutrition…byincreasing food purchasingpower...”

2. SNAP-Ed. The goal of SNAP-Edis to provide nutrition and healtheducation to SNAP participants.The economic return of nutritioneducation far exceeds the cost,with a return on investment of$9.58 in health care and produc-tivity savings for every $1 spent.iii

3. The Commodity SupplementalFood Program (CSFP). This pro-gram primarily serves homeboundseniors. The USDA purchasesnutrient-rich foods at wholesaleprices for distribution. Thesefoods are sent to state agenciesthat contract with local communi-ty and faith-based organizations towarehouse and distribute foodand educate participants.

4. The Emergency Food AssistanceProgram (TEFAP). TEFAP helpssupplement the diets of low-income Americans. USDA pro-vides commodity foods to stateagencies, usually food banks, fordistribution at food pantries, soupkitchens, and homeless shelters tofamilies in need of emergencyassistance.

5. The Fresh Fruit and VegetableProgram (FFVP). FFVP providesfree fresh fruits and vegetables tostudents in elementary schoolswhere 50% or more studentsreceive free or reduced-pricelunch. The goal of the FFVP is toimprove children’s overall diet andcreate healthier eating habits toimpact their present and futurehealth.

6. Nutrition Research. Researchperformed in the AgriculturalResearch Service and the sevenHuman Nutrition ResearchCenters focuses uniquely onhuman nutrition. Additionally,the National Institute of Food andAgriculture (NIFA) supportsresearch, education, and extensionprograms to advance nutrition,agriculture and other importantknowledge.

Why a Productive Farm Bill MakesSense for Communities

• SNAP-Ed provides evidence-basednutrition education that improvesthe food choices and lifestyle ofSNAP participants.

• The economy increases by $1.73for every $1.00 put into theSupplemental Nutrition AssistanceProgram (SNAP).i

• Jobs are created and the economyis strengthened when local retailersand farmers directly market theirproducts at local farmers marketsand community “food hubs.”

• The Fresh Fruit and VegetableProgram increases children’s fruitand vegetable consumption by15%, without increasing theirenergy intake. This means kids areeating fruits and vegetables insteadof other, potentially less healthyfoods.ii

• Federal investment in food, nutri-tion, agriculture and environmentresearch is vital in order to guidesound environmental, agriculture, eco-nomic and social decisions.

If you need further information as youget involved in the advocacy process,please reach out to Ben Timmins,Director of Public Policy Academy ofNutrition and [email protected] or FrancesSuen, MS, RD, Chair, Legislative andReimbursement --------

ADVERTISING POLICY

CNM accepts advertising for publication in FUTURE DIMENSIONS in ClincialNutrition Management. All ads are subject to approval by the Review Committee andmust meet established guidelines. All ads must be camera ready, and must be received bythe Editor by copy deadlines. Fees must accompany the ad at the time of submissions.

20% discount for CNM members.

Send all inquiries to the Editor, FUTURE DIMENSIONS in Clinical Nutrition Management.

The following rates apply:Full Page $1000Half Page $ 750Quarter Page $ 500Eighth Page $ 250


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CNM DPG, Ann Childers, MS, RD, MHA, LD, [email protected]


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ChairSherri L. Jones, MS, MBA, RD, [email protected]

Chair-ElectKim Brenkus MBA, RD, [email protected]

Immediate Past ChairKrista Clark, MBA, RD, LD, [email protected]

SecretaryYoung Hee Kim, MS, RD, LDN, [email protected]

TreasurerMonica Milonovich, MS, RD, [email protected]

Newsletter Managing EditorCourtney Spurlock, MS, [email protected]

Nominating Committee ChairKerry R. Scott RD, [email protected]

CNM DPG Delegate to the HODAnn Childers, MS, RD, MHA, [email protected]

Nutrition Informatics ChairTerese Scollard MBA, RD, [email protected]

Vice-ChairCathy Welsh, MS, [email protected]

Administrator, CNM Electronic Mailing List (EML)Deb Hutsler, MS, RD, [email protected]

WebMasterMarcelle Karustis, MS, RD, RN, [email protected]

Newsletter Features EditorsLisa E. Trombley, MA, RD, [email protected]

Jennifer Doley, MBA, RD, [email protected]

Robin Aufdenkampe, MS, [email protected]

Nominating Committee Chair ElectCaroline Steele, MS, RD, CSP, [email protected]

Donna Quirk, MBA, RD, [email protected]

Legislative & Reimbursement ChairFrances Suen, MS, [email protected]

Committee MemberJane Nuckolls, MA, RD, [email protected]

Member Services ChairKathryn [email protected]

Committee MembersJanel [email protected]

Linda Markiewicz, MBA, RD, [email protected]

Professional Development ChairSara Bakers, MD, RD, [email protected]

Immediate Past ChairSharron Lent, RD, [email protected]

Committee MemberJennifer Wilson, MS, RD, [email protected]

Research/Quality Management Co-ChairSusan DeHoog, [email protected]

Co-ChairBarbara Isaacs Jordan, MS, RD, [email protected]

Committee MembersDebby Kasper, RD, [email protected]

Jessie Pavlinac, MS, RD, CSR, [email protected]

Young Hee Kim, MS, RD, LDN, [email protected]

Mary Jane Rogalski, MBA, RD, [email protected]

Ida [email protected]

ADA Quality LiaisonSharon McCauley, MS, MB, RD, LDN, [email protected]

Fundraising ChairJanet Barcroft, RD, [email protected]

Immediate Past ChairKim Brenkus, MBA, RD, [email protected]

Committee MembersSky Joiner, [email protected]

Megal O’Donnell, RD, [email protected]

ACADEMY OF NUTRITION AND DIETETICSManager, Relations TeamMya Jones, MPH, MBAManager, DPG/MIG/Affiliae [email protected]

CLINICAL NUTRITION MANAGEMENT DIETETIC PRACTICE GROUP2011 - 2012 EXECUTIVE COMMITTEE

FUTURE DIMENSIONSIN CLINICAL NUTRITION MANAGEMENT

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and follow instructions.If you have any questions contact Deb Hutsler,MS, Rd, LD at [email protected]

CNM DPG Web siteYour source of information for the currentExecutive Committee, updates on AND andCNM issues, past issues of Future Dimensions,plus other information about the DPG.

Visit us at:www.cnmdpg.org.

For more information, contact the web site coordinator:

Marcelle Karustis, MS, RD, RN, LDN at:[email protected]

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