Perspective: Improving Neonatal Registered Dietitian Nutritionist Staffing, Utilization, and Compensation

Neonatal registered dietitian nutritionists (RDNs) are vital members of the multidisciplinary neonatal intensive care unit team due to their professional nutrition expertise and the critical role of nutrition for high-risk infants. The neonatal RDN is the only health care team member who is continually focused on infants' nutrition status and nutrition care. They advocate for nutrition care at medical rounds and effectively improve nutrition and growth rates of critically ill infants, which helps to reduce health care costs. The purpose of this article is to describe how inadequate staffing, utilization, and compensation are contributing to neonatal RDNs leaving their clinical roles and to suggest solutions to the identified issues. Dedicated neonatal RDNs are recommended by the American Academy of Pediatrics; additionally, increased staffing of neonatal RDNs is desired within the profession to support best practices and to fill gaps with anticipated neonatal provider shortages. Research into ideal neonatal RDN staffing ratios to support improved patient care, professional development, and hospital cost savings are recommended. Utilization of neonatal RDNs at their full scope of practice can be achieved with increased staffing dedicated solely to infant/pediatric services and not in combination with adult services. RDN responsibilities, including ordering parenteral and enteral nutrition and managing infant nutrition preparation areas, improve patient care and provides opportunities for career advancement for neonatal RDNs. With the increasing costs for professional entry, adequate compensation for neonatal RDNs will likely be required to continue to attract and retain skilled practitioners in the field. Incorporation of RDNs in collective bargaining efforts, creation of career ladders, and establishment of billable services are strategies that could improve compensation. These changes should be solved by the collective efforts of dietitians, neonatologists, clinical nutrition managers, and hospital administration.