Clinical nutritionists are responsible for planning dietary treatment programs for patients in hospitals, nursing homes, retirement communities, prisons and ambulatory facilities and providing therapeutic nutritional care, education and counseling in accordance with established procedures and regulatory requirements. States have specific laws regarding requirements for education, registration, certification and licensure to practice as a clinical nutritionist. You may specialize in enteral and parenteral nutrition, diabetes, cancer, kidney disease or other conditions.
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The primary role of a clinical nutritionist is to counsel patients on their nutritional health and advise them of dietary changes to make to manage their medical conditions. Clinical nutritionists are part of a health team and confer with physicians on the diagnosis and treatment protocol prescribed to determine what diet is most appropriate. Communication is a key skill required to provide services. Clinical nutritionists who can speak multiple languages, especially Spanish, are in biggest demand among health care organizations nationwide.
Nutritional assessment is a critical part of the job because morbidity and mortality increase when an ill patient is malnourished or has a deficiency or excess of one or more nutrients, impaired absorption of nutrients or imbalance of nutrients. A routine nutritional assessment involves determining the patient’s diet; medical and family history; and data such as height, weight, fat and lean muscle composition, and blood pressure. A more in-depth nutritional assessment involves performing a physical exam and conducting and evaluating a series of biological tests that may include blood sugar, cholesterol, fat, proteins, such as liver enzymes, vitamins and minerals. Clinical nutritionists may also review laboratory tests ordered by the physician.
After conducting and evaluating a nutritional assessment of the patient, the clinical nutritionist is able to identify nutritional problems and recommend a dietary meal plan to coincide with the physician’s treatment protocol. The dietary meal plan includes the amount of calories from proteins, carbohydrates and fats, the types and quantities of foods and portion sizes. The clinical nutritionist discusses these recommendations with the patient and physician before prescribing the diet and sharing the plan with the food service manager of the institution who is responsible for preparation and the meal service. The American Dietetic Association encourages clinical nutritionists, particularly those who provide care for the aging population, to implement an individualized nutrition intervention plan that balances the patient’s desires for food preferences with medical needs and focuses on patient quality of life, according to research by registered dietitian Kathleen Niedert, published in the "Journal of the American Dietetic Association" in 2005. Clinical nutritionists may adjust the diet plan as the patient’s health progresses or if certain foods may interfere with any prescribed drugs.
Clinical nutritionists may also prescribe nutritional supplements for patients who are deficient in a particular nutrient or who benefit from the supplement in the management of their condition. Clinical nutritionists discuss this with the physician and pharmacist to determine any potential adverse interactions with drug therapy. Patient response to supplements prescribed is monitored throughout the course of treatment.