Public health RDs are at the forefront of local, provincial, national and global campaigns to reduce the burden of chronic disease, improve health equity and enhance the sustainability of food systems.32 These RDs experienced the most change in their work-lives during the COVID-19 pandemic, with most being deployed away from their regular role for more than three months while their work remained undone (see Table 2). Undoubtedly, there will be long lasting impacts on the health of populations as the sustainability of healthcare systems is dependent on the effective implementation of public health strategies that specifically target food environments and their impacts on the health of communities.32,33
We know that feeling undervalued in the workplace is a reason AHPs, including dietitians, may leave their jobs and/or employers.34, 35 It is concerning that public health RDs in Canada, on average, had negative experiences in their first (typically lengthy) redeployment of the COVID-19 pandemic and that most felt underprepared to perform the duties in their new role. It is also unsurprising, knowing this, that Canadian public health RDs felt that the organizations they worked for considered their contributions to be nonessential and of only moderate value. Considering that close to 90% of public health RDs in our sample had been redeployed, it will be particularly important that Canadian healthcare organizations give public health RDs: i) the space, time and resources to debrief and recover from a potentially traumatic redeployment experience,20,23,36,37 and ii) demonstrate widely and loudly their appreciation, respect and support for the initiatives and “outputs” of public health RDs working within their organizations.23,38−40 Otherwise, there may be significant attrition from this workforce,35,41 which will have long-lasting, far-reaching, negative impacts on population health.42
More than half of our respondents had been absent from work for more than three weeks during the pandemic period. Respondents were able to select more than one reason for their absence and more than half indicated that anxiety about contracting COVID-19 contributed to their absence from work. The impacts of concerns about contracting COVID-19 on the work-lives of allied health professionals, including dietitians, have been reported in studies globally.24, 43, 44 For example, fear of contracting COVID-19 led some Canadian dietitians to relocate out of high-risk regions.24 It was interesting to see that, despite the prevalence of COVID-19 related anxiety, only 5% of our respondents reported contracting COVID-19 at work. This may indicate that mandatory training in proper use of PPE was effective in preventing transmission of COVID-19 in healthcare settings.
Limited child care availability and school closures were also frequently reported by our respondents as reasons for lengthy absences from work; this aligns with the findings of other, related studies.1,24 In a study conducted pre-pandemic in the United States and Puerto Rico, Williams et al.7 found that approximately 65% of RDs had care responsibilities, with 9.1% of those reporting care responsibilities for both dependent children and elders. It would be interesting to explore whether similar proportions of respondents in more gender-equal professions reported absences related to child care responsibilities. Gupta et al.10 noted a gap in evidence relating to health professional absenteeism resulting from caregiving responsibilities in their systematic review of health workforce surge capacity during outbreaks of respiratory diseases. They hypothesized that this may be the result of a lack of consideration for sex and gender in existing research.10
Coates et al.1 identified attrition in the supply of healthcare workers during the COVID-19 pandemic as one of three key pressures on the health system. The findings of their scoping review of health workforce strategies in response to major health events indicate that increased supports are one way of alleviating this pressure. For example, the provision of child care services for employed healthcare staff. For the majority of studies included in the review, nurses and physicians were the professions of interest.1 The development of flexible arrangements for staff has also been reported as a strategy to better ensure adequate staffing for surging needs in the intensive care setting.45 More research is needed to better understand strategies that work best for other health professionals, such as AHPs.
The findings of this study can now be employed by health administrators and managers of RDs seeking to better prepare for a future pandemic (or a resurgence of COVID-19). It is clear that it is not ideal to redeploy the vast majority of the public health nutrition workforce for an extended time, particularly when redeploying into roles that may not draw on their specialized expertise and experience. Public health nutritionists play a key role in maximizing population level nutrition, primarily through their advocacy and policy work. For example, type 2 diabetes is known to increase the risk of severe COVID-19 infections.46,47 At the same time, we know that the contributions of public health RDs, such as the adoption of health-promoting agricultural and nutritional policies and modifications to infrastructure and environments that support nutritional health, contribute to the prevention of diabetes.48 In this way, ensuring that public health nutrition work is ongoing lessens the potential burdens (economic, social etc.) of future pandemics. Preventing this from re-occurring may be best accomplished by identifying and building a pool of less specialized staff, who can be called upon to fill roles in call centres and contact tracing centres.
Additionally, to reduce lengthy absences from work among health professionals in a future pandemic(s), there will need to be: i) more effective and/or timely communication of risk and of rates of healthcare workers contracting the infection,49,50 and ii) better provision for healthcare workers responsible for dependents, whether children or elders.1,51
Strengths and Limitations
More than 200 dietitians completed our survey, with representation from RDs of varied ages, years as an RD, education levels, location of work, employment statuses, work settings and provinces/territories of residence. Our data was collected in June of 2022, which is much further into the COVID-19 pandemic than most other studies exploring allied health professionals’ work experiences. Our survey was designed to capture the breadth and depth of RD experiences (e.g., knowing not only whether someone was re-deployed but where, for how long, how many times, etc.).
All data collected was self-reported. If, in a future study, it were possible to access and analyze data from administrative databases (e.g., internal databases recording absence timing/duration and details of training), then we may be able to establish the convergent validity of our findings. Our data were collected at a single time point, which for some may have been many months following their most recent redeployment. It is possible that this introduced recall bias.