Perceived job importance and job performance satisfaction of selected clinical nutrition management responsibilities

In almost all hospital organizations, clinical nutrition managers are responsible for managing human and material resources for the delivery of nutrition care. The constantly changing health care environment forces clinical nutrition managers to decide how to provide an effective and professional atmosphere for their clinical and foodservice staff. Regulatory agencies, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), continue to change performance standards and demand a higher level of clinical accountability. For example, during the last few decades, health care organizations have established stricter standards in many areas, including the timeliness of nutrition screening and assessments, interdisciplinary care planning, maintenance of staff competency, and quality improvement activities. Standards have increasingly focused on patient care outcomes, and therefore hospital administrators have directed their improvement efforts toward performance outcomes instead of written standards. In this challenging environment, it has become imperative that clinical nutrition managers have and use strong leadership and strategic planning skills. In response to financial demands, health care administrators have cut budgets, yet at the same time demanded top-quality care. Use of contract management companies for clinical nutrition and food services may have also affected clinical nutrition managers' job responsibilities. In many cases, foodservice responsibilities, such as tray-line management have been added to clinical nutrition managers' job duties. At the same time, more intense quantitative performance evaluation processes, such as productivity and patient acuity studies are required to justify staffing levels. The purpose of this study was to assess how clinical nutrition managers perceive the importance of selected job responsibilities and their performance satisfaction with the same.

A questionnaire was developed to measure clinical nutrition managers' perceptions of job importance and satisfaction with performance. The questionnaire included demographic information about clinical nutrition managers and their facilities and a list of responsibilities in which clinical nutrition managers were most likely engaged. A 4-point Likert-type scale was used to rate the perceived importance of each item (that is, 4=very important, 3=important, 2=undecided/neutral, and 1=not important). For those who thought that the job responsibility did not apply to them, a 'not applicable' option was provided. Clinical nutrition managers were also asked to rate how satisfied they were with their performance of each responsibility using a 3-point Likert-type scale (that is, 3=satisfactory, 2=somewhat satisfactory, and 1=not satisfactory).

The questionnaire and a cover letter were mailed to each member of the ADA Clinical Nutrition Management DPG in the United States in July 2000 (N= 1688). Approximately 3 weeks later, follow-up postcards were mailed to all participants, and an e-mail reminder was sent to members of the ADA Clinical Nutrition Management DPG electronic mailing list to increase participation. Of 1688 questionnaires sent, 485 were returned (28.7%), and 431 questionnaires (25.5%) were usable for data analyses. The 54 excluded questionnaires were from members who were not working in the clinical dietetics field at the time of data collection.

Respondents rated compliance with JCAHO and other regulatory agencies as the most important job responsibility of a clinical nutrition manager, followed by ensuring adequate screening and assessment utilization. Adequate screening and assessment are also required for JCAHO and are essential in developing daily nutrition care plans. Assessment and improvement of patient/client satisfaction was rated as one of the most important responsibilities. This finding may indicate that clinical nutrition managers are constantly looking for ways to improve patient satisfaction and are concerned about how clinical staff and services are perceived during a patient's hospital stay. It may also suggest that many clinical nutrition management responsibilities have broadened to include not only clinical nutrition services, but also patient foodservices. Aside from patient satisfaction, staff retention was the only other nonregulatory-related responsibility that was ranked as one of the top five most important responsibilities.

Findings from this study revealed that clinical nutrition managers consider many aspects of their job responsibilities to be important to the overall success of their departments and organizations. Most respondents, however, indicated that regulatory job responsibilities were most important, which is likely, due to clinical nutrition managers being required to have adequately structured systems for JCAHO accreditation and other state/local regulations. Assessing and improving patient satisfaction was also perceived as one of the top five most important job responsibilities, indicating that clinical nutrition managers want to provide quality care to patients and other clients. Furthermore, performance satisfaction ratings were the highest for regulatory-related job responsibilities. Such results are not unexpected because clinical nutrition managers traditionally receive more organizational support for these regulatory-related functions due to the direct effect on a hospital's reputation and profitability.

In general, clinical nutrition managers rated performance satisfaction ratings for most regulatory-related job responsibilities highly and were satisfied with responsibilities that were considered to be important. However, clinical nutrition managers were not as satisfied with their performance of some responsibilities, such as ensuring competitive salary levels, securing reimbursement, and outcome/cost-benefit issues. This may be due to a lack of knowledge or experience, time constraints, and/or insufficient support from the organization.

By understanding what responsibilities clinical nutrition managers perceive as important, practitioners may compare their perception of importance with results of this study, to explore and identify the responsibilities that may need more time, commitment and improvement. Performing and developing outcome studies and securing reimbursement for clinical services were not perceived to be as important, as were other responsibilities.

As the health care environment changes, so will the responsibilities of clinical nutrition managers. This study provided a guideline for areas of possible improvement in clinical nutrition management in this ever-changing environment. In addition, data suggested that clinical nutrition managers generally perceived more satisfaction with performance of responsibilities that they believe are most important. Therefore, to increase awareness of important clinical nutrition management responsibilities, clinical nutrition managers need to continue networking and supporting one another to identify important issues, challenges, and possible resolutions.