The Certified Nutrition Support Clinician (CNSC) directs acute nutrition therapy by: performing a comprehensive nutrition assessment, determining nutrition diagnosis, writing orders for appropriate nutrition therapy and monitoring medical status to adjust interventions. The CNSC directs therapy to achieve positive patient outcomes of maximal nutrition status, reduced length of stay and reduced readmissions.
The CNSC practices within their scope of practice at an advanced level. Order writing privileges granted by the hospital medical staff and the hospital board as well as collaboration with physicians and other health care team members ensures the provision of appropriate acute nutrition therapy to patients. These privileges include initiating, changing and discontinuing enteral and parenteral nutrition, supplements, diet orders, and education to treat disease states. The dietitian performs duties and responsibilities in a manner consistent with our mission and values.
Principle Accountablilities: % of Time Spent
1 Directs the provision of acute medical nutrition therapy for hospitalized patients including writing orders for consult patients, tube feedings and Daily TPN and all associated TPN additives, electrolytes and insulin. 50%
- Assesses nutrition status utilizing Nutrition Focused Physical Exam (NFPE), patient interview, diagnoses, medication and lab review.
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Determines nutrition diagnosis utilizing knowledge of disease states, biochemical indices, fluid and electrolytes, diagnostic tests, drug/nutrient interactions and nutrition.
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Orders appropriate nutrition interventions including labs based on nutritional diagnosis, medical diagnosis, medical interventions, and prognosis.
- Practices at an advanced level through order writing for all aspects of parenteral nutrition including ordering daily TPN including macronutrients, electrolytes, fluid and insulin.
- Orders enteral prescriptions as appropriate for advancement of enteral feeding.
2. Manages medical, surgical and nutrition progress to treat/prevent malnutrition; maximize nutritional status; reduce length of stay and readmissions.
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Advises physicians and other health care givers including pharmacy and nursing to ensure appropriate early interventions are initiated including proper mode of feeding, appropriate route of feeding, tube or line selection, writing of the enteral and/or parenteral orders, fluid and electrolyte adjustments.
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Monitors and changes as nutrition interventions as needed based on patient medical/surgical status.
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Provides nutrition education for acute disease management and refers to outpatient areas for ongoing comprehensive education and management.
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Impacts malnutrition, readmissions and length of stay through early and appropriate interventions.
- Actively participates in admission and discharge process of patients on home nutrition support through communications with home care providers to ensure appropriate orders are written.
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Utilizes community resources and programs to assist patients after discharge.
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Contacts other healthcare agencies, home care agencies and family members as needed to gather information and/or disseminate information regarding patient care.
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Follows all HIPAA guidelines.
3. Quality Management 15%
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Participates in outcome studies,
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Participates on clinical committees to assure clinical goals are achieved.
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Ensures practice is consistent with department and regulatory agencies policies for provision of patient care.
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Completes quality monitors as determined by the hospital, department and staff. Is cognizant of hospital and department Balanced Score Card quality monitors and works to ensure goals are met.
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Works with Case Management for appropriate documentation to maximize financial reimbursement to the hospital.
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Identifies areas of concern and works to implement changes to improve quality of service provided to patients.
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Strives to ensure positive patient experience
4. Critical Thinking and Application of Nutrition Expertise and Knowledge 35%
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Interprets literature and applies to patient interventions. Is able to interpret research for applicability to current practice and incorporate evidence-based guidelines into practice.
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Promotes advancement of practice through communication of sound scientific principles and theory when planning patient care with physicians, other disciplines and department staff.
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Educates healthcare team including physicians, residents, nurses, other ancillary services and dietetic interns. Develops and implements educational strategies to meet education needs including lectures, literature development, classes, etc. Provides nutrition education to Medical Residents through Residents’ Report and resident nutrition service rotations.
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Mentors dietetic interns.
5. Personal Management
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Meets the needs of all areas that utilize nutrition services. Exhibits FACES behaviors in interactions. Is courteous, helpful, and responsive to requests from patients and hospital staff.
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Utilizes leadership skills to influence appropriate practice changes and accomplish goals.
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Manages time to complete assigned duties and meet deadlines.
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Computer literate
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Develops and maintains positive relationships.
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Self-directed learner. Always looking forward for new areas of growth and development both individually and for the hospital.
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Appraises performance to identify areas of strength and areas for improvement. Develops and implements plans based upon appraisals.
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Develops working relationships with physicians, clients and other support areas.
6. Performs other work duties as assigned.
Employee is required to sit occasionally and walk frequently. Employee must lift/carry a light (1-20 lbs.) load frequently. Employee may be required to lift over 100 lbs. with assistance. Employee is occasionally required to reach forward and reach overhead. For repetitive action, employee is required to use both hands for simple grasping and pushing/pulling. Employee is occasionally exposed to electrical hazards and frequently exposed to CRT terminal work.
(Occasionally: 1-33%, Frequently: 34-66%, Continuously: 67-100%)
The most significant of duties are included but this does not exclude occasional work assignments not mentioned or developmental duties.
Job Relationships: Brief descriptions of the types of interactions that occur for this job.
Takes direction from: Director, Clinical Nutrition Manager
Provides direction to: Room Service Assistants
Supervised by: Clinical Nutrition Manager
Master’s degree or minimum 2 years of Clinical Experience
Licensure in the State of Missouri and Registration with the Commission on Dietetic Registration.
Certified Nutrition Support Clinician required.
Membership with the Academy of Nutrition and Dietetics or American Society of Parenteral and Enteral Nutrition is required within one year of hire.
