City/State:

New Rochelle, New York

Department:

MNR Clinical Nutrition

Work Days:

DAYS VARY

Scheduled Hours:

Hours Vary

Scheduled Daily Hours:

7.5 HOURS

 

Montefiore is a premier academic health system and the University Hospital for Albert Einstein College of Medicine, serving the more than 3 million people living in the New York City region and the Hudson Valley. Montefiore is doing more to deliver science-driven care where, when and how patients need it most. With our new member and affiliate locations in Westchester, Rockland and Orange counties, Montefiore offers patients state-of-the-art healthcare close to home.

We have a fantastic opportunity for a Full-Time Registered Dietitian at our Montefiore New Rochelle Hospital.

Job Summary

Provide in-depth nutritional assessment of nutritional status and needs and develops appropriate care plan to meet nutritional goals
for patients at high nutritional risk or per policy. Assessment includes nutrition focused physical examination and identification of nutrition diagnosis(es) and etiology. Determines appropriate interventions and specific goals. Develops medical nutrition therapy care plan including discharge recommendations. Provide instructions on appropriate diet therapies to patients/family. Monitors progress towards resolution of nutrition diagnosis and achievement of goals. Actively participates as core team member in interdisciplinary coordinated patient care program and on committees for the development and revision of nutrition related policies and procedures. Acts as a source of nutrition care expertise to MMC staff and associates.

Essential Functions

• Triage assigned units daily to identify and prioritize patients requiring nutrition visit as per department standards (CBORD /Epic review)
  * Determines consults to be seen that day and patients due for follow up care, and identifies unconsulted patients that may need to be seen. Tallies appropriate on daily Log.
  * Logs reflect appropriate priorization of daily load. Communicates with team (nursing/provider) to encourage ordering of a consult when appropriate and identified during triage.
• Completes nutrition consults within policy time frames.
  * Documented evidence in medical record and productivity log of timely completion of consults.
  * Timely intervention of all consults by policy or best practice time frames; no patients missed.
  * Documents reason for any untimely interventions on Productivity Log.
• Assesses nutritional status and needs, and develops appropriate interventions and care plan through review of the medical record, medical diagnosis and history, labs/ medications, patient/family/caregiver interview, nutrition focused physical exam, diet history, fluid balance, weight status/changes, adequacy of diet to meet needs, tolerance to EN/PN, and input from health care team. Integrates all available information to calculate estimated nutritional needs for calories, protein, fluids, micronutrients.
  Calculates estimated nutrition needs based on age, weight status, injury factors including wound healing needs, medical diagnoses and histories, current and past intake, tolerance to oral/enteral/parenteral diet order, including evaluation of EN residuals. Calculates the degree to which these needs are met by patient.
  * Completed Comprehensive Assessment as evidenced in the medical record in adherence to policies and procedures, departmental and professional standards of practice, and time frames.
  * Assessment of needs, status, choices for care plan and interventions are quantified, evident, and clear to the reader.
  * Determines level of care in adherence to policies. Determines appropriateness of diet order, nutritional supplements, and/or nutrition support and communicates recommendations for change when indicated.
  * Accurate calculation of all nutritional needs appropriate for each patient, to include but not limited to calorie, protein, fluid, and micronutrient needs, and weight status. Nutrition Focused Physical Exam performed on all appropriate patients, and results documented.
  * Documents reason for variation of calculations when outside of standards of care/policy.
• Performs accurate Nutrition Focused Physcial Exam to identify signs of nutritional deficiency or malnutrition on all patients determined by departmental policy.
  * Physically examines appropriate patients to determine presence of and severity of muscle loss and/or loss of subcutaneous fat stores in all areas of the body as listed by the Academy of Nutrition & Dietetics.
  * To include:
  * Muscle or grip strength.
  * Scalp, hair, mouth, skin and nail health.
  * Appearance and feeling of different body parts, including the arms, legs, chest, back and face.
  * Signs of fluid retention or dehydration. Documentation is accurate and specific in EMR.
• Identifies patients meeting ASPEN/AND criteria for malnutrition or at high risk for malnutrition and communicates assessment and plan with the interdisciplinary team as needed.
  * Identifies and documents ASPEN/AND criteria met to identify malnutrition in both the nutrition note(s) and the Evaluation of Malnutrition Note in EMR.
  * Uses appropriate ASPEN/AND terminology including severity and type of malnutrition.
  * Quantifies percentage of intake, needs and weight loss per policy.
  * Lists all criteria in the PES statement.
  * Adheres to all related documentation policy of undernutrition and malnutrition.
  * Documents progress in all subsequent follow up notes until resolved or patient is discharged.
• Determines appropriate nutrition diagnosis(es) and identifies the corresponding etiology and evidence; formulates appropriate PES statement(s) for each patient seen. Chooses the appropriate number of nutrition diagnoses based on patient assessment (1-3).
  * Adheres to Academy of Nutrition & Dietetics Nutrition Care Process Terminology standards for selection of Nutrition diagnosis and PES statements.
  * Makes appropriate choices of nutrition diagnoses. Etiology is consistent with the cause of the main nutritional problem.
  * Symptomalogy listed is inclusive, specific and quantifiable when appropriate.
• Formulates appropriate plan of care and goals of care, listing interventions and recommendations through continuum of care to alleviate the signs and symptoms of the nutritional diagnosis, and ultimately resolve the identified problem.
  
  Recommendations include, but are not limited to, modification of diet order, enteral and/or parenteral orders, oral supplements, fluids, micronutrient supplementation, snacks, suggested labs & referrals (food supply, homecare, SW, out pt RDs) . EN/PN to include appropriate formula, rate, route of delivery, flushes, addition of modulars, electrolytes, micronutrients, feeding precautions, and methods for optimal transition in between feeding modes.
  * Completes Comprehensive Assessment in EMR (or on downtime paper form) including goals and care plan that are realistic, appropriate and in conformance with professional and departmental policies and procedures and professional standards of practice.
  * Documents reason for interventions when outside of standards of care/policy.
  
  * Provides referrals to other members of interdisciplinary team as appropriate to optimize patient care.
  
  * Pends diet orders (PO, EN, PN, oral supplements) appropriately, accurately and timely in EMR.
• When appropriate, designs a parenteral solution prescription for a patient using the types of amino acid/ dextrose solutions, lipid emulsions, electrolytes and other compounds available.
  * Adheres to professional, departmental and hospital standards of care, ASPEN /AND guidelines. Accurate calculations, appropriate for age and condition.
  * List indications for use of parenteral nutrition. Enters prescription accurately into Epic. Note and prescription to include:
  * Calculate protein, calorie, and fluid, requirements for the patient
  * Calculate protein, carbohydrate, and fat content of parenteral solutions and ensure appropriate distribution. Monitor non-protein calorie to nitrogen ratio of a parenteral solution
  * Include appropriate amounts of micronutrient, trace element and electrolyte components into the solution. Adjust electrolyte and zinc content by taking into account salt based or ion based electrolytes of the entire Rx.
  * Explain procedures for the termination of a parenteral feeding as appropriate.
  * Meets Pharmacy time deadline for PN orders; communicates to TPN Pharmacist with relevant problems to meet timeline.
  * Monitor per policy, preferably by best practice guidelines.
• Monitors implementation of and evaluates efficacy of nutrition care plan to determine if patient has achieved or is making progress toward the established goals. Monitors progress toward resolution of nutrition diagnosis. Modifies care plan and/or goals appropriately if necessary.
  Monitoring includes, but is not limited to: patient compliance, diet/supplement/EN/PN intake and tolerance, anthropometric measurements, laboratory data, and psychosocial issues.
  * Completes follow up and progress notes in EMR according to departmental standards and time frames.
  * Determines and documents clearly if each nutrition diagnosis or goal remains appropriate, making revisions as needed.
  * Determines and documents clearly in EMR the progress toward resolution of nutrition diagnosis and goals.
  * Revises interventions, care plan, and goals accordingly.
  * Documented evidence in medical record of recommendations for change in conformance with departmental policies, procedures, and time frames. Additional evidence when recommendations and/or implemented by health care team.
  * Monitors pended orders have been activated or declined by Physicians/providers.
• Evaluates patient/caregiver need for nutrition counseling. Provides appropriate counseling/education using method/materials to maximize comprehension and achieve desired outcomes including adherence to nutrition recommendations and enhanced quality of life.
  * Documented evidence of evaluating need for nutrition counseling, counseling provided or reason to defer, comprehension/motivation level/anticipated compliance according to hospital, departmental and regulatory agency protocols, standards and time frames. Refers to other and ambulatory RDs as appropriate.
  * Uses interpretative services as appropriate.
• Documents consults, comprehensive/initial assessments, care plans, calorie counts, malnutrition assessments, follow-up/progress notes, and counseling in medical record to provide record of intervention and recommendations.
  * Evidence of all pertinent information including intervention and recommendations and rationale of choices, in medical record.
  * Evidence that each section of EMR is completed per policy for each note (e.g. notes, CPG, education section).
• Completes all sections of the monthly Productivity Log.
  * 100% accuracy, no error.
  * Turned in timely as per protocol or request.
• Updates CBORD computerized patient files or EMR on a daily basis for dates of interventions, assignment of care level, follow up dates, interventions, recommendations, and patient preferences/special requests as needed.
  * Documented evidence of adherence to departmental standards of practice in CBORD & EMR computer file. Includes date/type of note and next follow up date per policy or best practice. Covering RDs are able to provide timely follow up based on the unit's patient list.
  * Creates spreadsheet diet for patients with complex needs above CBORD's capabilities.
• Provides dietitian coverage as staffing necessitates to insure timely response to nutrition consults and continuity of nutritional care.
  * Provides coverage as needed according to policy, procedures, and departmental standards. Uses sound judgment in prioritizing consults and communicating coverage issues to dietitians and manager/Director.
• Acts as a resource/source of nutrition expertise to other healthcare professionals including physicians and nurses by providing in-services, lectures, guidance and instruction as needed/requested.
  * Documented evidence of in-services/lectures provided. Provision of inservices or informal education to staff upon request or identification of need.
  * Evaluation by units' health care professionals as to quality of nutrition information provided and availability of RD.
• Instruct, precept, and provide feedback to dietetic students and interns, in keeping with departmental and institutional standards.
  * Measure performance of students in terms of standards, providing ongoing feedback to student and Clinical Nutrition Manager/Director of Clinical Nutrition.
  * Completes all intern evaluations for each rotation and summary in a timely manner according to the specific originating institution.
• Retains and expands knowledge base through appropriate continuing education to maintain credentialing, and professional expertise.
  * Maintains active R.D. credentialing, plus NYS C.D.N. for ambulatory positions, and other as appropriate.
  * Attain average 15 continuing education credits per year (or 75 over 5 year period).
• Actively participates as core team member including participating in interdisciplinary/departmental meetings to enhance patient care, performance improvement measures, staff training or education, and communicate implementation of nutrition goals, progress, and outcomes with team members.
  * Evidence through Productivity Logs, sign in sheets of attendance, on-line transcripts and active participation in interdisciplinary conferences or meetings as scheduled. Attendance at rounds when appropriate.
  * Provision of in services or informal education to staff upon request or identification of need.
  * Assists in development and revision of diet manual, nutrition care guidelines, standards of practice and instructional materials. Participation may be by request or own initiative.
  * Documents accurate data on productivity log and submits log in timely manner. Completes performance improvement data/assignments as requested.
• Is responsible and accountable for own actions and actively participates, practices and promotes Montefiore excellence.
  * Conforms to Medical Center’s human resource policies and procedures, contributes to problems identification and resolution in work environment. Supports the mission, vision, critical success factors and goals of Montefiore Medical Center and the standards of care.
• Other duties as assigned.
  * As determined by manager/director.

Qualifications

• BS Required
• MS Preferred
• Registered Dietitian/Nutritionist Required

 

Montefiore New Rochelle Hospital is an equal employment opportunity employer. Montefiore New Rochelle Hospital will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.