How work and family caregiving responsibilities interplay and affect registered dietitian nutritionists and their work: A national survey

Investigation of Precepting-Related Burnout in Dietetics Preceptors

BACKGROUND

Dietetics preceptors are at risk of abandoning their role because of potential burnout. Identifying factors associated with greater and lesser burnout can help key stakeholders identify and implement strategies to prevent or mitigate burnout in dietetics preceptors.

OBJECTIVE

The purpose of this study was to identify factors associated with the burnout preceptors attribute specifically to the work of precepting.

DESIGN

This study used a cross-sectional study design. A survey instrument including burnout measures, precepting measures, and items querying personal and work characteristics was distributed via e-mail to a random sample of 10 000 credentialed nutrition and dietetics practitioners.

PARTICIPANTS SETTING

Respondents who lived in the United States, were currently practicing, and had precepted during the past year were included in the sample (n = 310). The survey was conducted in October and November of 2022.

MAIN OUTCOME MEASURES

Precepting-related burnout was measured using scores on the Copenhagen Burnout Inventory; scores ranged from 0 to 100 and higher numbers indicated greater burnout.

STATISTICAL ANALYSES PERFORMED

Factors associated with precepting-related burnout were identified using an analysis of covariance. Pairwise comparisons with Tukey adjustments were done to determine differences across categories for the categorical variable in the model (ie, percent of interns requiring additional coaching). A stepwise variable selection process was performed to determine the best analytic models.

RESULTS

Factors associated with lower precepting-related burnout in dietetics preceptors included higher Commitment to the Preceptor Role scores, lower percentages of interns requiring additional coaching, feeling appreciated by the dietetic interns, and higher Preceptors' Perceptions of Support scores. A factor associated with higher precepting-related burnout was precepting a greater number of dietetic interns in the past year. For every 1-point change in each variable, the degree of change in precepting-related burnout was -7.9 for Commitment to the Preceptor Role, -3.2 for feeling appreciated by dietetic interns, -4.5 for Preceptors' Perceptions of Support, and +1.2 for number of dietetic interns per year. The mean ± SE difference in precepting-related burnout scores between preceptors who reported < 10% of dietetic interns requiring additional coaching and those who reported > 50% of dietetic interns requiring additional coaching was -13.7 ± 3.7.

CONCLUSIONS

The factors found to be associated with precepting-related burnout scores in dietetics preceptors are potentially modifiable, suggesting this burnout might be prevented or mitigated to some degree.

Prevalence of emotional burnout among dietitians and nutritionists: a systematic review, meta-analysis, meta-regression, and a call for action

BACKGROUND AND OBJECTIVES

Despite anecdotal evidence pointing to the high prevalence of job stress and burnout among dietitians and nutritionists, few studies have been conducted on this topic. Moreover, most studies are from Western countries. The objective of the current study, based on systematic review, meta-analysis, and meta-regression, is aimed to provide systematically graded evidence to assess the prevalence of emotional burnout among dietitians and nutritionists across age, sex, and cultural backgrounds.

METHODS

Two reviewers independently conducted a systematic search from 1 January 2000, to 1 April 2024 and was later updated to 15 November 2024, across seven databases: EBSCOhost Research Platform, EMBASE, PubMed/MEDLINE, ProQuest, ScienceDirect, Scopus, and Web of Science. The DerSimonian-Laird method was utilized to pool the data in this meta-analysis. Data from a total of 12,166 dietitians and nutritionists were extracted from 16 datasets (published in twelve research reports) covering a period of approximately 25 years. We measured the pooled prevalence of global burnout syndrome and its individual symptoms among dietitians and nutritionists. Subgroup meta-analyses were also conducted to identify a comprehensive set of moderators, including participants' age and sex.

RESULTS

The prevalence of global burnout syndrome in dietitians and nutritionists (K = 10, N = 10,081) showed an overall prevalence rate of 40.43% [23.69; 59.74], I² = 99.3%, τ [95% CI] = 1.18 [0.84; 1.97], τ² [95% CI] = 1.38 [0.71; 3.89], H [95% CI] = 12.68 [11.70; 13.74]. The prevalence of burnout dimensions/individual symptoms in dietitians and nutritionists (K = 2, N = 695) is summarized as follows: emotional exhaustion (EE) at 26.11% [15.14; 41.17], I² = 84.0%, τ = 0.21, τ² = 0.46, Q = 6.25, p < 0.001; depersonalization (DP) at 6.59% [1.08; 31.22], I² = 95.0%, τ = 1.72, τ² = 1.31, Q = 20.18, p < 0.001; and personal accomplishment (PA) at 59.29% [39.81; 76.23], I² = 89.3%, τ = 0.29, τ² = 0.54, Q = 9.36, p < 0.001. Meta-regression showed no difference by age or sex, p = 0.80, and p = 0.20, respectively.

CONCLUSION

This meta-analysis revealed that the prevalence of burnout among dietitians and nutritionists is as high as in other medical professionals. Furthermore, age and sex were not significantly associated with emotional burnout among dietitians and nutritionists. This study provides the impetus for policy changes to improve dietitians' and nutritionists' working conditions, as well as the overall quality of nutrition care.

Amant O, Ward-Griffin C, Anderson S. Double-duty caregivers enduring COVID-19 pandemic to endemic: "It's just wearing me down"

The COVID-19 pandemic has considerably strained health care providers and family caregivers. Double-duty caregivers give unpaid care at home and are employed as care providers. This sequential mixed-method study, a survey followed by qualitative interviews, aimed to comprehensively understand the experiences of these Canadian double-duty caregivers amidst the pandemic and the transition to the endemic phase. The multi-section survey included standardized assessments such as the Double-duty Caregiver Scale and the State Anxiety Scale, along with demographic, employment-related, and care work questions. Data analysis employed descriptive and linear regression modeling statistics, and content analysis of the qualitative data. Out of the 415 respondents, the majority were female (92.5%) and married (77.3%), with 54.9% aged 35 to 54 years and 29.2% 55 to 64 years. 68.9% reported mental health decline over the past year, while 60.7% noted physical health deteriorated. 75.9% of participants self-rated their anxiety as moderate to high. The final regression model explained 36.8% of the variance in participants' anxiety levels. Factors contributing to lower anxiety included more personal supports, awareness of limits, younger age, and fewer weekly employment hours. Increased anxiety was linked to poorer self-rated health, and both perceptions and consequences of blurred boundaries. The eighteen interviewees highlighted the stress of managing additional work and home care during the pandemic. They highlighted the difficulty navigating systems and coordinating care. Double-duty caregivers form a significant portion of the healthcare workforce. Despite the spotlight on care and caregiving during the COVID-19 pandemic, the vital contributions and well-being of double-duty caregivers and family caregivers have remained unnoticed. Prioritizing their welfare is crucial for health systems as they make up the largest care workforce, particularly evident during the ongoing healthcare workforce shortage.

Opting In and Out: A Qualitative Study Exploring Career Break Experiences of Registered Dietitian Nutritionists

BACKGROUND

Since 2002, an average of 17.5% of registered dietitian nutritionists (RDNs) have reported being out of the paid dietetics workforce, and approximately half of those report intention to return. With the Academy of Nutrition and Dietetics' focus on expanding workforce demand and capacity, understanding why and how dietitians opt in and out of the dietetics workforce may provide insights into how to potentially reduce the number of career breaks or expedite and enhance the reentry process.

OBJECTIVE

To explore the lived experiences and perspectives of dietitians who were taking (with intention to return) or had taken a career break and returned to the paid dietetics' workforce.

DESIGN

A qualitative study with semistructured interviews was conducted.

PARTICIPANTS/SETTING

Participants (n = 22) were recruited through purposive sampling over social media. They were required to be credentialed as RDNs, reside in the United States, and have either previously or currently (with intent to return) taken a break from the dietetics workforce. Interviews were conducted using Zoom videoconferencing technology during September 2021.

DATA ANALYSIS

Data were analyzed using a Coding Reliability Thematic Analysis approach.

RESULTS

The data are summarized in four themes: (1) motivations to leave and return, (2) staying connected with dietetics, (3) preparing to return and returning to the dietetics workforce, and (4) desired resources for career breaks and reentry.

CONCLUSIONS

Understanding the experiences of dietitians who take career breaks may help inform career reentry and help the profession meet the current and future workforce demand.

Factors Associated With Intent to Leave the Profession for the Allied Health Workforce: A Rapid Review

Shortages of satisfied and well-trained health care professionals are an urgent threat for health systems worldwide. Although numerous studies have focused on retention issues for nurses and physicians, the situation for the allied health workforce remains understudied. We conducted a rapid review of the literature on allied health workers to investigate the main reasons for leaving their profession. 1,305 original research articles were retrieved from databases MEDLINE, CINAHL, PsycInfo, and Epistemonikos, of which 29 were eligible for data extraction. Reviewed studies featured mainly pharmacists, psychologists, dietitians, physical therapists, emergency medical professionals, and occupational therapists. We categorized 17 typical factors of the intent to leave as organizational, psychological, team and management, and job characteristics. The relative importance of each factor was assessed by measuring its prevalence in the selected literature. By revealing common themes across allied health professions, our work suggests actionable insights to improve retention in these vital services.

Telenutrition: Changes in Professional Practice and in the Nutritional Assessments of Italian Dietitian Nutritionists in the COVID-19 Era

The COVID-19 pandemic has brought about various restrictions around the world, and its impact on healthcare has been enormous: RDNs have had to shift from in-person interactions with clients to telenutrition consultations, encountering obstacles. We designed the first survey to investigate the changes in RDN practices related to telenutrition provision after the onset of the pandemic through an online survey in Italy. Four hundred and thirty-six responses were analyzed. Before the pandemic, only 16% of Italian RDNs provided telenutrition; this percentage increased significantly up to 63% (p < 0.001). Among patients, the lack of interest in accessing telenutrition (30.9%) and the Internet (16.7%) were the most frequently reported barriers. Among RDNs, one of the main obstacles was their inability to conduct nutritional evaluation or monitoring activities (24.4%). Our survey indicated that increased adoption of telenutrition can be a valid, safe alternative to face-to-face visits. Telenutrition was mainly used by young RDNs (20−39 years) with fewer years of professional experience (0−20 years) and master’s degrees. Remote nutrition can enable RDNs to maintain normal workloads and provide patients with uninterrupted access to nutritional healthcare. It is important that RDNs using telemedicine resources possess the ability to provide high-quality, efficient, and secure services using evidence-based guidance.

Practices and resilience of dieticians during the COVID-19 pandemic: a national survey in the United Arab Emirates

BACKGROUND

The COVID-19 pandemic impacted the practices and resilience of most healthcare workers, including dieticians. In addition to offering critical care to COVID-19 patients, dieticians play a major role in preventing and managing conditions known to affect COVID-19, such as obesity and metabolic disorders. The objective of this study was to examine the conditions and changes in the work environment as well as resilience and its correlates among dieticians during the COVID-19 pandemic in the United Arab Emirates (UAE).

METHODS

A cross-sectional national survey was conducted among dieticians practicing in the UAE (n = 371), using a web-based questionnaire. The questionnaire addressed, in addition to the sociodemographic information, the practice-related characteristics and resilience of participants. For the latter the Connor-Davidson Resilience Scale© was used. Descriptive statistics as well as simple and multiple linear regressions were used in the statistical analysis.

RESULTS

Of participants, 26.4% reported not having access to personal protective equipment and 50% indicated being concerned for their safety and health. Furthermore, considerable proportions of participants were not satisfied (45%) with the support nor with the appreciation (37.7%) they received during the pandemic. One in four dieticians considered quitting his/her job. While 65.8% of participants reported counseling COVID-19 patients, a third did not use any online platform for counseling. The most cited challenge to dietetic practice during the pandemic was 'maintaining work-life balance' (43.1%). The mean CD-RISC score was 72.0 ± 14.0. After adjustment, working in a hospital or public clinic (as opposed to private clinic), having a condition preventing face-to-face counseling, considering quitting job and feeling neutral or dissatisfied with the appreciation were associated with lower resilience scores, while counseling COVID-19 patients was associated with higher scores.

CONCLUSIONS

Despite the fairly high resilience among dieticians practicing in the UAE during the COVID-19 pandemic, the findings of this study highlighted a few challenges, mainly related to safe practice environment, support for online counseling, and maintaining work-life balance. Concerted efforts of policy and decision makers ought to develop targeted programs for dieticians to ensure their retention and wellbeing during the COVID-19 pandemic.