Job Summary:

In accordance with the Purpose, Vision, Values and Coast Salish Teachings, and strategic direction of PHSA, safety, including both patient and employee safety, is a priority and a responsibility shared by everyone at PHSA. As such, the requirement to continuously improve quality and safety is inherent in all aspects of this position.

In collaboration with the Program Manager, and Professional Practice Leader, Nutrition, and working within an interprofessional collaborative environment, the Dietitian, Gastroenterology, Hepatology and, Nutrition’s primary function is to support the nutritional management of gastroenterology and hepatology patients using advance knowledge and skill to assess, plan, implement and evaluate nutrition goals and care plans according to best practices at BC Children’s Hospital.  The dietitian works collaboratively with patients, families and the health care team to identify patients at risk for nutritional sequelea; develop evidence based protocols, provide teaching and develop education resources. The dietitian acts as a resource to community health care professionals, participates in research and in ongoing quality assurance and risk management programs as necessary.

Duties/Accountabilities:

1.    As a primary focus, provides nutrition care to patients, conducts nutrition screening and assessment of patients based on established standards and best practice guidelines, physical nutrition assessment, identification of relevant laboratory and other data.  Identifies relevant data through interviews with patient and/or family, collects anthropometrics data, conducts chart review, and participates in patient care rounds.  Uses advanced knowledge of disease processes to identify specific vitamin and mineral deficiencies.  Uses advanced clinical techniques such as body composition analysis, and measurement of additional anthropometric parameters including Triceps Skin Folds (TSF), Mid-Arm Muscle Circumference (MAMC), and abdominal girth to interpret body composition as part of a comprehensive growth assessment.  Identifies nutrition diagnosis as appropriate.

2.    Based on assessment and using a patient centred approach, develops disease specific and age-appropriate nutrition goals.  Calculates requirements for infant formula, modified oral diets, enteral and parenteral nutrition support, as appropriate.  Makes recommendations to the healthcare team regarding the nutrition support modality: oral, enteral, or parenteral, including time and rate of feeding.  Makes recommendations regarding diet order, formula selection, macronutrient adjustments, micronutrient supplementation and laboratory monitoring to the healthcare team.  

3.    In consultation with the patient/family, physician and other health care professionals as appropriate, monitors and evaluates patient response to the comprehensive nutrition care plan, including ability to achieve nutrition goals, tolerance to nutrition support through methods such as performing and reviewing additional anthropometric parameters, nutrient intake records, growth and gastrointestinal function.  Adjusts care plans including diet orders, macronutrient composition, micronutrient supplementation, infant formula, enteral and parenteral nutrition orders as required.  Consults with physicians, health care professionals and family as appropriate regarding the patient’s response to the nutrition care plan and ability to meet goals.  Makes recommendations to the team and/or family for changes or adjustments as required.

4.    Documents the comprehensive nutrition care plan and recommendations at each stage of the nutrition care process in the patient health record according to established format and policy, time-lines, and legal requirements.  Documents nutrition support/diet order changes.

5.    Provides comprehensive education, nutrition counseling, and follow up to individuals or groups of patients, families and/or caregivers associated with assigned inpatient units,  clinics or programs, on specific disease conditions,  nutrition care plans, including route and method of feeding, formula selections and supporting continuation of lactation as appropriate. Considers quality of life, expected growth and development, and treatment modality.  Adapts the education session for the patient and family based on their learning style and readiness for change.  Services are also provided to registered patients by telephone, e-mail, outreach or other means such as telehealth as required.    Includes the patient/family in implementing the care plan, including providing education that incorporates individual patient needs e.g. cultural, religious, learning, social, and economic factors.

6.    Communicates with interdisciplinary team and participates in rounds to provide input regarding nutritional status, response to the nutritional care plan, modifications to the plan and discharge planning needs.  Attends education events and program meetings as required.

7.    Acts as a resource person to the interdisciplinary team, and other health care professionals throughout the hospital, as well as community hospitals and community health care professionals and agencies or societies on the nutritional management of the assigned patient population to enhance continuity of care.

8.    In collaboration with the healthcare team, initiates and  leads the development, implementation and revision of evidence based nutrition management  guidelines, treatment protocols, and clinical pathways for assigned patient population using current literature.  Collaborates with Program Manager,  Professional Practice Leader, other pediatric centres/agencies as appropriate, to inform, develop and measure best practice;   Provides input into menu planning, diet writing guidelines for the assigned patient population based on clinical evidence.

9.    Participates in hospital, department and university programs related to teaching. Provides students/interns with the opportunity to observe and take an active role in the assessment, nutrition diagnosis, monitoring, implementation and evaluation of nutrition care of patients in the assigned population.

10.    Provides input to the Professional Practice Leader (PPL) and UBC Dietetics Program Staff on the practicum component of the UBC Dietetic Internship Program for the assigned patient population, as applicable.  Participates in the development/revision of area specific intern placements for submission to PPL.  Provides input related to intern performance evaluation in accordance with established guidelines.

11.    Communicates nutrition care principles to health care professionals, colleagues, peers and students through in-service education and orientation/training sessions, rounds and continuing education programs.  Serves on discipline/program committees or represents the discipline/program in external committees as required.

12.    Provides input to department and program meetings; participates in relevant and related hospital and community based committees, activities and projects.

13.    Provides input and feedback to discipline and/or program regarding strategic planning initiatives and effective use of resources.  Collects and submits workload measurement and other data according to established guidelines.

14.    Participates in discipline or program based quality assurance/improvement initiatives by methods such as collecting data, monitoring variances to expected outcomes, and patient/family satisfaction surveys.  Makes recommendations to the team, Program Manager, Medical Director and or Professional Practice Leader for change based on results.
  
15.    Performs other related duties as assigned.

Qualifications:

Education, Training and Experience

• Bachelor’s degree in Dietetics or Nutritional Sciences from an accredited university.  Graduate of an accredited Dietetic Internship Program, or equivalent education, training and experience as approved by the College of Health and Care Professionals of BC.   
• Current full registration as a Dietitian with the College of Health and Care Professionals of BC, with Restricted Activity A, B, and C as appropriate for designated patient/client population.
• Certification as a Nutrition Support Clinician by the National Board of Nutrition Support Certification, Inc.
• Completion of an advanced anthropometrics workshop or an equivalent combination of education training and experience
• A minimum of two years recent related pediatric clinical experience including nutrition support in an acute pediatric health care setting focusing on gastrointestinal disorders or an equivalent combination of education training and experience

Knowledge, Skills and Abilities

• Advanced knowledge of nutrition management principles and medical nutrition therapy for acute and chronic disease states and clinical conditions relating to the designated patient/client population, including gastroenterology and hepatologic diseases, the macronutrient and micronutrient sequelae of disease and associated nutrition treatment therapies and modalities.
• Demonstrated ability to apply advanced clinical techniques such as advanced anthropometrics including TSF, MAMC for monitoring of patient body composition.    
• Advanced knowledge of pediatric clinical nutrition theory and practice within a patient/client/family centered model of care for designated patient/client population.  
• Advanced knowledge of ASPEN Standards of Care for Pediatric Nutrition Support and nutrition support practice guidelines, including knowledge of oral, enteral nutrition and parenteral nutrition as appropriate for designated patient/client population, and macronutrient and micronutrient manipulations for gastrointestinal and hepatological disease.  
• Demonstrated ability to design, implement and monitor pediatric nutrition care plans including therapeutic diets delivered via oral , enteral and parenteral routes.  
• Broad knowledge of the standards of practice established by the College of Health and Care Professionals of BC.
• Broad knowledge of normal nutrition and health promotion/disease prevention strategies to improve the health of designated patient/resident population.
• Broad knowledge of pediatric feeding practices, including normal infant feeding practices, breast feeding, and breast feeding promotion.
• Demonstrated competency in research  processes and methodology
• Effective interpersonal, verbal and written communication skills with patients/residents, families, staff and students/interns.
• Demonstrated ability to work collaboratively and effectively in an interprofessional environment.
• Demonstrated ability to plan, organize and prioritize workload.
• Demonstrated ability to counsel and teach in individual and group settings.
• Demonstrated ability to problem-solve and think critically.
• Demonstrated ability to evaluate and apply current literature.
• Demonstrated ability to  plan, implement and evaluate programs
• Ability to initiate quality assurance initiatives to evaluate the effectiveness of nutrition care plans
• Demonstrated skill and ability to operate related equipment and techniques appropriate to clinical areas.
• Basic computer literacy to operate a personal computer, word processing applications and patient care information system.
• Physical ability to perform duties of the position