Leadership in clinical dietetics: meeting the challenge to roles in nutritional support.

The success of efforts to improve nutrition training of other health professionals poses a threat to the position of clinical dietitians as authorities in nutrition. In situations in which no dietitians are present or dietitians' skills are not recognized, pharmacists and nurses are especially likely to take over nutritional support roles traditionally assigned to the clinical dietitian. At the University of California, San Francisco, where dietitians are included in nutrition education and patient care programs and where understanding of the role of the dietitian is a stated educational goal, a preliminary survey suggests that conflicts occur in roles that are shared by members of nutritional support teams. Factors contributing to role conflicts include not only inadequate education of other health professionals but also problems of job expectations, education, training, and self-image among dietitians. Improved training in clinical nutrition, acquisition of better team and patient care skills, documentation of the effectiveness of dietetic services, and efforts to improve status and visibility would help alleviate role conflicts and ensure clinical dietitians a more rewarding place in the health care system.