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Research article
High turnover in clinical dietetics: A qualitative analysis
Sarah J Hewko
University of Prince Edward Island Faculty of Science
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8804-4686
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Health Services Research.
Background: Relationships between dietitians and other healthcare providers can impact the degree to which patient care is collaborative; inefficient communication can lead to suboptimal care. It takes time for multidisciplinary team members to build collaborative, trusting relationships. For this reason, frequent dietitian turnover (or “churn”) is of concern. Consequences include fewer referrals to clinical dietetic services and limited provider continuity. The characteristics of clinical dietetic jobs associated with churn have not been identified. The principal investigator’s professional experience and a review of the literature led us to predict that managers would identify disease prestige as having an impact on churn. In this article, we report the qualitative results of a multi-method study that we conducted to explore: 1) characteristics of clinical dietetic jobs in the public sector associated with the most churn, and 2) consequences of churn on patients and managers of clinical dietitians.
Methods: We conducted semi-structured interviews with ten managers of clinical dietitians in the Canadian public health care system. We conducted a thematic analysis that was both inductive and deductive.
Results: We identified four themes: i) Avoidable factors that contribute to churn often reflect intersecting human resource management issues; ii) Unavoidable factors that contribute to church frequently result from a decision made by the departing dietitian; iii) High churn in select positions has a disproportionately negative impact on patients served by dietitians in those high churn positions, and iv) Consequences of churn can be long-lasting and result in less efficient dietetic practice and reduced access to medical nutrition therapy. As predicted, prestige was perceived as playing a role in triggering dietitian turnover – however, prestige was more commonly attributed to employment in a respected institution than to providing treatment for a particular disease or condition.
Conclusions: Managers of publicly-employed dietitians identified many factors as contributing to churn. Managers observed churn resulting in low provider continuity and limiting patient access to dietitians. More research is needed to better understand factors contributing to churn among Canadian clinical dietitians.
Trial Registration: Not applicable.
Keywords
Canada; Health workforce; Hospital administration; Nutritionists; Personnel administration, hospital; Personnel turnover
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On 02 Dec, 2020
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On 29 Nov, 2020
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On 29 Nov, 2020
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Received 11 Oct, 2020
Editorial decision: Minor revision
On 11 Oct, 2020
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Received 21 Sep, 2020
Reviewer #2 agreed
On 10 Sep, 2020
Reviewer #1 agreed
On 31 Aug, 2020
Editor assigned
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This preprint is under consideration at BMC Health Services Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
High turnover in clinical dietetics: A qualitative analysis
Sarah J Hewko
University of Prince Edward Island Faculty of Science
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8804-4686
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Published
On 06 Jan, 2021
No community comments so far
Submission checks complete
On 08 Dec, 2020
Editorial decision: Accept
On 07 Dec, 2020
No comments provided
Editorial decision: Minor revision
On 02 Dec, 2020
Editor assigned
On 29 Nov, 2020
Submission checks complete
On 29 Nov, 2020
Editor invited
On 29 Nov, 2020
Version 1
Posted 06 Aug, 2020
No comments provided
Review #2 received
Received 11 Oct, 2020
Editorial decision: Minor revision
On 11 Oct, 2020
Review #1 received
Received 21 Sep, 2020
Reviewer #2 agreed
On 10 Sep, 2020
Reviewer #1 agreed
On 31 Aug, 2020
Editor assigned
On 06 Aug, 2020
Reviewers invited
Invitations sent on 06 Aug, 2020
Submission checks complete
On 05 Aug, 2020
Editor invited
On 03 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Health Services Research.
Background: Relationships between dietitians and other healthcare providers can impact the degree to which patient care is collaborative; inefficient communication can lead to suboptimal care. It takes time for multidisciplinary team members to build collaborative, trusting relationships. For this reason, frequent dietitian turnover (or “churn”) is of concern. Consequences include fewer referrals to clinical dietetic services and limited provider continuity. The characteristics of clinical dietetic jobs associated with churn have not been identified. The principal investigator’s professional experience and a review of the literature led us to predict that managers would identify disease prestige as having an impact on churn. In this article, we report the qualitative results of a multi-method study that we conducted to explore: 1) characteristics of clinical dietetic jobs in the public sector associated with the most churn, and 2) consequences of churn on patients and managers of clinical dietitians.
Methods: We conducted semi-structured interviews with ten managers of clinical dietitians in the Canadian public health care system. We conducted a thematic analysis that was both inductive and deductive.
Results: We identified four themes: i) Avoidable factors that contribute to churn often reflect intersecting human resource management issues; ii) Unavoidable factors that contribute to church frequently result from a decision made by the departing dietitian; iii) High churn in select positions has a disproportionately negative impact on patients served by dietitians in those high churn positions, and iv) Consequences of churn can be long-lasting and result in less efficient dietetic practice and reduced access to medical nutrition therapy. As predicted, prestige was perceived as playing a role in triggering dietitian turnover – however, prestige was more commonly attributed to employment in a respected institution than to providing treatment for a particular disease or condition.
Conclusions: Managers of publicly-employed dietitians identified many factors as contributing to churn. Managers observed churn resulting in low provider continuity and limiting patient access to dietitians. More research is needed to better understand factors contributing to churn among Canadian clinical dietitians.
Trial Registration: Not applicable.