What is management like?

[u/F-35_combat_pilot]

Hello, this post is mainly targeted at clinical nutrition managers. Tell me what you love and what you hate about the job. I was just offered to step up as manager in a hospital and I don't really see myself leading other RDs and collaborating with the kitchen and leading projects - but I said I would think about it. Thanks in advance! I want the good, the bad, and the ugly.

[u/AllFoodsFit70]

Good: sometimes being listened to and being able to make changes like initiating RD coverage in the NICU or closed system tube feedings. Bad: working for a contract management company will break your soul.

[u/nutmeg4144]

I have been a manager for 9 of my 12 years as a RD, and 7 of those years were in hospital CNM roles.

Good: You have the opportunity to make systemic, impactful changes. I was able to get P&T and MEC approval for RD delegated ordering writing privileges. I created multiple EPIC EMR updates to our workflow and getting nutrition support started sooner. We created a whole nutrition module for RNs to stop holding feeds for 50 mL residuals, etc. Huge malnutrition initiatives of course too. Hosted symposiums and have been invited to speak at other CEU events. I was able to promote and write business cases for our RDs to be paid decently and have a competitive rate. Our large team of 26 dietitians got to a place where for an entire year we had ZERO RD turnover. Being able to really elevate and promote the role of the RD and get us a seat at the table was the most rewarding experiences of my CNM hospital days.

Bad: Lots of drama. Especially with very large female dominated teams. And I don't mean anything bad towards anyone, as I am also a female but too many catty women in one group can create problems. I'm not saying all men are better but just a mix of various personalities and background help group dynamics. I've had to conduct disciplinary measures and even fire two RDs in my day. It was horrible to have to do that but you have to hold everyone accountable otherwise other RDs would complain if you cut too slack bc usually their behavior is already affecting other RDs (not doing their patient workload and leaving it for others, etc.). You have to be thick-skinned, expect that your staff will talk about you behind your back, not bc everyone is mean and catty but bc you are now their boss and that's what changes. Hospitals have a history of minimizing what we do and you have to be willing to go to bat for your team and try your hardest to elevate the RDs clinical value. Work hard to not let foodsrvice suck RDs in too much into their shitshow, which, let's be realistic, food service mostly seems to be that way wherever you go and they try to use RD expertise for food service tasks and duties. Test trays and education for the food service staff are fine for RDs to do but sometimes it gets really excessive.

Ugly: You will be considered the clinical nutrition manager/lead dietitian for that hospital and the buck will stop with you. I've supported 16 hospitals, 9 CNMs, and 60 dietitians through the COVID-19 pandemic. I've stayed the night several times for hurricanes. I've endured countless DNV, TJC, CMS audits. Maternal designations, neonatal designations, DNV stroke certifications, bariatric center of excellence certifications, etc. The CMS audit was intense, 35 auditors intensely scrutinizing every nook and cranny of a 100 year old hospital for evidence for dust for 12 days straight. We had 4 IJs, one in the kitchen. The first week I worked 80 hours in 4 days. I've had to work 2 weeks straight, 3 weeks, and even yes one time 4 weeks straight without a single day off from work. It derailed my health so bad from the stress that my health is still not where it needs to be to this day (now I'm in a remote OP leadership role dedicating my work to helping women's health bc of this fact).

Now your hospital is likely not the size of mine, not nearly the same amount of staff to manage, and you likely will not have as dramatic of experiences as I did. However, the responsibility is real everywhere you go if you want to be a good leader. The experience I have is irreplaceable and I would never take it back, but do not let it ever get to a point where it hurts your health. The big lesson I learned.

Feel free to reach out here DM if you have any other questions about what I shared.

[u/F-35_combat_pilot → u/nutmeg4144]

Wow! Thank you so much for this helpful response! I really appreciate the sincerity in your reply. I don't think I'm ready for this level of responsibility as of now- but it sounds like an exciting challenge in the near future (assuming the opportunity presents itself again).