Developing a Dual Career Ladder for Registered Dietitians in a Large Health System

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         Career ladders are ways to categorize employee based on their development and promotions. A career ladder can be classified into two subsets:
·         Traditional career ladder: when the employee has certain skills, he/she can be promoted to a higher (managerial) position.
·         Dual career ladder: when the employee has certain skills, he/she will be specializing in that skill, rather that pursuing managerial role.

         The dual career ladder began to be used in the nutrition field in the early 1990s and continue to develop by providing programs for RDs to grow and specialized without necessarily going to the managerial route. Examples are Specialist in Renal Nutrition (CSR) and Board Certified Specialist in Pediatric Nutrition (CSP) in the early 1990s, and later on many specialty certifications were created such as: Certified Specialist in Sports Dietetics (CSSD, the Certified Specialist in Geriatrics (CSG), and the Certified Specialist in Oncology (CSO).
         This article talks about the experience of modifying the RD career ladder from one that depends on the degrees and/or certifications and years of experience as a standard for development and promotion, to one that focuses on dual career ladder and classify RDs into 4 categories (RD I: competent, RD II: proficient, RD III: advanced practice, and RD IV: expert). Promoting the RD to advance category depends on measuring several criteria “advanced attributes”for advanced practice and the Dietetics Career Development Guide defined by the Academy. The adapted career ladder was tested on 83 RDs at 10 health care facilities. Each year, RDs nee to submit their performance documentation to a subcommittee that is an extension of the MHHS system Clinical Nutrition Council to review it. After the first year of implementing this career ladder, the following results were found that he lowest criteria for RDs participation were: (Obtaining specialty certification, external contribution to the dietetics profession, and demonstrating active membership within a dietetics professional organization). On the other hand, the following criteria have the highest participation level: (Committee or task force participation, fellowship/advanced education, continuing education, continuous quality improvement, years of experience).
         In conclusion, according to Johnson & McHenry, 2014 “We advise benchmarking with standards established by other ancillary disciplines and respective governing bodies when creating a dual career ladder. In addition, It is paramount that the developer of the career ladder is regularly accessible to clarify concerns expressed by staff, and edits the requirements when deemed appropriate to allow and encourage employee engagement”


Johnson, M., & McHenry, M. (2014). Developing a Dual Career Ladder for Registered Dietitians in a Large Health System. Future Dimensions in Clinical Nutrition Practice.

A.K.A

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