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Special Features 1994 Council on Renal Nutrition Membership Salary and Employment Benefit Survey Council on Renal Nutrition Executive and Quality Assurance Committees* I N 1992, THE COUNCIL on Renal Nutrition (CRN) Executrve Committee identified the need for a membership salary and employ- ment benefit survey. The CRN QualityAssur- ante Committee, in conjunction with the CRN Executive Committee, undertook the planning and development of the survey. The objectives of the survey were to obtain current information on the salary and em- ployment benefits of renal dietitians as represented by the CRN membership. METHODOLOGY The survey was developed in consulta- tion with a statistician and practicing renal dietitians. The survey consrsted of a 7-page document wrth separate sections to collect information on patient population, facility description, clinical responsibilities, experi- ence and credentials, and compensation. A total of 41 questions were presented in a predominantly multiple-choice format. A copy of the survey can be obtained by contacting the National Kidney Foundation. The survey was mailed to 1,309 CRN members representing the total member- ship at the time of the summer 1994 mail- ing. Participatron was voluntary. No partici- pation Incentive or follow-up reminder was *Count/I on Renal Nutnbon, National Kidney Foun- datlon, New York, NY. Address reprints requests to Council on Renal Nutr/t/on, National Kidney Foundation, 30 E 33rd St, New York, NY 10016. o 1995 by the Natlonal Kidney Foundat/on, Inc 1051.2276/95/0504-0007$03.00/O used. Data collection ended in September 1994. STATISTICAL ANALYSIS The data were numerically coded and analyzed by Cor Corn Research (Pitts- burgh, PA) using Statistical Package for the Social Sciences software (SPSS, Inc, Chi- cago, IL). Descriptive statistics were used for demographic and facility information. Reported percentages totaling less than 100% indicated missing responses. Ques- tion analysis included count, mean, mode, range, standard error, and deviation. Lev- ene’s test for equality of variances and unpaired student’s t test was used to com- pare yes/no responses. Analysis of vari- ance was used for multiple comparisons within groups. RESULTS Six hundred thirteen surveys were re- turned, for a return rate of 47%. This rate was considered an acceptable data rate return to produce a viable statistical analy- sis Incomplete surveys (n = 16) resulted in 597 surveys available for analysis. The com- pleted surveys represented 49 states, the District of Columbia, and six foreign coun- tries (Canada, Greece, Guam, United King- dom, Malta, and France). Demographics Respondents were 98.2% female and 90.5% white, with Afro-American (1.3%), Asian (5 4%), Hispanic (1.7%), and other Journal of Renal Nutrition, Vol 5, No 4 (October), 1995: pp 223-227 223

1994 Council on Renal Nutrition membership salary and employment benefit survey

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Special Features

1994 Council on Renal Nutrition Membership Salary and Employment Benefit Survey Council on Renal Nutrition Executive and Quality Assurance Committees*

I N 1992, THE COUNCIL on Renal Nutrition (CRN) Executrve Committee identified the

need for a membership salary and employ- ment benefit survey. The CRN QualityAssur- ante Committee, in conjunction with the CRN Executive Committee, undertook the planning and development of the survey. The objectives of the survey were to obtain current information on the salary and em- ployment benefits of renal dietitians as represented by the CRN membership.

METHODOLOGY

The survey was developed in consulta- tion with a statistician and practicing renal dietitians. The survey consrsted of a 7-page document wrth separate sections to collect information on patient population, facility description, clinical responsibilities, experi- ence and credentials, and compensation. A total of 41 questions were presented in a predominantly multiple-choice format. A copy of the survey can be obtained by contacting the National Kidney Foundation.

The survey was mailed to 1,309 CRN members representing the total member- ship at the time of the summer 1994 mail- ing. Participatron was voluntary. No partici- pation Incentive or follow-up reminder was

*Count/I on Renal Nutnbon, National Kidney Foun- datlon, New York, NY.

Address reprints requests to Council on Renal Nutr/t/on, National Kidney Foundation, 30 E 33rd St, New York, NY 10016.

o 1995 by the Natlonal Kidney Foundat/on, Inc 1051.2276/95/0504-0007$03.00/O

used. Data collection ended in September 1994.

STATISTICAL ANALYSIS

The data were numerically coded and analyzed by Cor Corn Research (Pitts- burgh, PA) using Statistical Package for the Social Sciences software (SPSS, Inc, Chi- cago, IL). Descriptive statistics were used for demographic and facility information. Reported percentages totaling less than 100% indicated missing responses. Ques- tion analysis included count, mean, mode, range, standard error, and deviation. Lev- ene’s test for equality of variances and unpaired student’s t test was used to com- pare yes/no responses. Analysis of vari- ance was used for multiple comparisons within groups.

RESULTS

Six hundred thirteen surveys were re- turned, for a return rate of 47%. This rate was considered an acceptable data rate return to produce a viable statistical analy- sis Incomplete surveys (n = 16) resulted in 597 surveys available for analysis. The com- pleted surveys represented 49 states, the District of Columbia, and six foreign coun- tries (Canada, Greece, Guam, United King- dom, Malta, and France).

Demographics

Respondents were 98.2% female and 90.5% white, with Afro-American (1.3%), Asian (5 4%), Hispanic (1.7%), and other

Journal of Renal Nutrition, Vol 5, No 4 (October), 1995: pp 223-227 223

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224 COUNCIL ON RENAL NUTRITION

TABLE 1. Current Age of Respondents at Time of Survey Expressed As a Percentage of the Sample

Current Age Percentage W of Sample

<20 0 20-25 2.2 36-30 15.2 31-35 12.7 36-40 25.5 41-45 20.6 46-50 11.1 51-55 7.2 56-60 3.9 >60 1.7

Percent by total sample 100.0

(0.8%) comprising the remainder of the sample. Table 1 shows the age distribution. Thirty-one percent had a master’s or other advanced educational degree. Forty-one percent had state licensure; 6.7% (n = 40) attained American Dietetic Association Board Certified renal nutrition specialist cer- tification. Fifteen percent reported having specialized language skills (8% Spanish speaking, 6% other foreign language, 1% sign language). Table 2 illustrates total years of the sample’s clinical experience as dietitians, renal dietitians, and in present positions.

Facility/Employer Description

Employment status was as follows: 44.4% full-time employment as renal dietitians, 14.1% full-time as dietitians with renal re- sponsibilities, 3.9% full-time as consulting

TABLE 2. Total Years of Clinical Experience by Dietitian Category Expressed As a Percentage of the Sample*

Renal Present Years of Experience Dietitian Dietitian Positron

<l 03 3.9 7.0 l-5 16.8 40.5 49.7 6-10 21.1 27.5 23 3 11-15 22.9 147 106 >15 38.2 129 9.2 No response 07 0.5 0.2 Percent by total sample 100 0 1000 1000

*No differentiation was made for full- or part-time employment years

renal dietitians, 27.8% part-time as renal dietitians, and less than 1% employed by parenteral nutrition or pharmaceutical com- panies. The area of employment was 57.6% urban, 315% suburban, and 9.9% rural. The type of facility in which respondents were employed included 58% free-standing and 36% hospital based; 48% for profit and 35% not for profit. Employer description included 41% as staff members with ne- phrology or dialysis facilities, 28% as for staff members with a food service or dietary department, and 3% as employees for con- tract food services companies.

Patient Ratio

The number of patients per full-time equivalent (FTE) employee (40-hour work week) is shown as Table 3. No data were available on characteristics of patient popu- lation representing this ratio, ie, type of treatment modality (hemodialysis, perito- neal, prerenal, or transplant) or patient char- acteristics (education level, treatment years or history, degree of independence or com- pliance).

Compensation

The amount of compensation paid annu- ally was paid as salaries in 48.2% and calculated hourly in 50.3%. Tables 4 and 5 show gross hourly wages by employer and employment categories expressed as a percentage of the sample. No significant difference was found in reported hourly

TABLE 3. Patient-to-Registered Dietitian Ratio per Full-Time Equivalent Employee Expressed As a Percentage of the Sample*

Number of Patrents per One Full Trme Percentage

Equivalent Employee of Sample

O-50 1.8 51-100 16.9 101-150 34.8 151-200 32.5 > 200 127

No response 13 Percent by total sample 1000

NOTE No informatron is known regarding the characteristics of the patients represented

*Data are as reported, not as recommended

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SALARY AND BENEFIT SURVEY 225

TABLE 4. Gross Hourly Wage by Employer Categories Expressed As a Percentage of the Sample*

By Hospital Entire Sample By Profrt Status Based Status

Hourly All For Not For Hospital Not Hospital Rate ($) Respondents Profit Profit Based Based

<lOOO 02 0 0.2 0.2 0 10.01-l 2.00 05 0.3 02 02 03 12 01-14.00 6.0 23 37 1.8 42 14 01-16.00 21 .o 9.9 112 79 132 16.01-18 00 23 7 104 13.2 89 147 1801-2000 158 74 8.5 57 102 20 01-22.00 7.9 34 45 39 40 22 01-24 00 87 45 4.2 2.7 6.0 24.01-26 00 65 50 1.5 08 57 26 01-28 00 2.2 1.7 05 03 18 28.01-30 00 18 13 0.5 0 1.8 30 01-32 00 0.3 0.2 02 0 03 32.01-34 00 0 0 0 0 0 34 01-36 00 0.3 0.3 0 0 0.3 36.01-38 00 0.2 02 0 0 02 38.01-40.00 02 0.2 0 0.2 0 >4001 0.5 0 05 02 03

Percent of total sample 1000 47.6 52.4 35.8 64.2

*Full and part time merged; 596 respondents

salary by CRN membership region. There For all employment categories (full time was a direct correlation between experi- and part time), employers paid the following ence and salary. As years of experience as benefits: 66% medical, 54% dental, 28% a dietitian increased, salaries also in- vision care, 57% life insurance, 48% disabil- creased. ity insurance, 53% retirement plan, and 28%

TABLE 5. Gross Hourly Wage by Employment Categories Expressed As a Percentage of the Sample*

Hourly Rate (9

Full-Time Full-Time Employed by a Full-Time Dietitian Consulting Part-Time Parenteral

Renal Covers Renal Renal Nutrition Dretrtran Renal Dietitian Dietitian Company Other

< 10.00 0 02 0 0 10 01-12 00 02 03 0 0 12 01-14.00 34 12 0 13 14.01-l 6 00 109 49 03 42 16 01-18.00 109 30 0 86 18.01-20 00 81 12 03 47 20.01-22 00 39 08 03 17 22.01-24 00 34 05 10 29 24.01-26 00 05 03 12 29 26.01-28 00 03 03 05 0.3 28.01-30 00 03 0.2 0 08 30.01-32 00 0 0 0 0.2 32 01-34 00 0 0 0 0 34.01-36 00 0 0 02 0 36 01-38 00 0 0 0 0 38 01-40.00 0 0 0 0.2 >4001 0 0.2 0 0

Percent of total sample 44.5 14 1 39 27.9

0 0 0 0.2 0 0 0 0 0 0 02 0 0 0 0 0 0 03

0 0 02 0.7 12 15 12 10 17 07 0.3 0.2 0 0.2 02 0 03 9.4

*All employers merged, 596 respondents,

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226 COUNCIL ON RENAL NUTRITION

malpractice or liability insurance. Other ben- efits received included 72% professional seminar reimbursement, 56% tuition reim- bursement, 47% free or discounted park- ing, and 22% professional membership or credential reimbursement. The amount of coverage and contribution ratio varied greatly among the respondents.

Clinical Responsibilities

The nutrition care functions that the clini- cian performed on a regular basis included the following: perform initial assessment and development of nutrition care plans, conduct follow-up assessment and deter- mine future goals treatment, document in the medical record, educate patient and caregivers, participation in care plan confer- ences, and develop educational materials. Other nutrition care functions reported by the respondents included participate on bedside rounds or team meetings (85%), provide documentation of continuous qual- ity improvement (74%), complete needs assessment or liaison between intradialytic nutrition company and renal facility (71%), evaluate or calculate urea kinetic modeling data (66%), and represent the facility or discipline to renal groups (50%). Less fre- quently reported nutrition care functions included educate student interns (48%), edit or contribute to patient newsletter (43%), participate in research study involving nutri- tional aspects (25%), and give in-service presentations to staff (15%). All other nutri- tion functions listed on the survey repre- sented less than 10% of the respondents.

Nutrition care activities reported by the respondents are shown in Table 6.

DISCUSSION

The purpose of the survey was to provide information to the CRN membership for use by the individual renal dietitian. All data are presented in raw form and should be inter- preted with caution. All data were self- reported. No attempt was made to validate the data or cross-check the data with any other data base. Selected specific ques- tions on the survey were not reported be-

cause of uncertainty of the validity or relabil- ity of the data.

Limitations

The profile of the renal practitioner pre- sented by this survey is one of significant clinical experience. Because each CRN region can potentially combine geographi- cally (urban, rural) and demographically (density of renal facilities available), compari- son within a region may have been statisti- cally diverse, but this diversity was not seen between regions. Because of missing data and assurance of confidentiality, the data could be presented only in this abstract manner.

Gross annual and hourly salary data are difficult to present in an objective manner. The majority of employers provide benefits as part of the salary package, which cannot be easily separated or compared between facilities because of wide variation. Each ESRD Network office has specific informa- tion on the federal composite rate level paid. Comparison between the composite rate and regional salaries/benefits may help interpret the data presented here.

The patient ratio data presented per FTE employee do not address the diversity of the renal population served. Guidelines to estimate renal dietitian staffing ratios have been published but are currently under revision.’ These guidelines can be used to estimate staffing needs within an individual facility or employment situation. Similarly, guidelines for maintaining the quality of nutrition care exist for renal patients and should be used when examining the time

TABLE 6. Nutrition Care Activities Reported

Actwlty Prescribe Recommend

W) w=4

Oral nutntlon supple- ments

Diet orders Vitamins Phosphate binders Over-the-counter fiber or

laxative products Minerals Calcitriol Oral vitamin D analogues

64 47 62 52 24 70 23 75

23 53 19 70

6 63 4 64

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SALARY AND BENEFIT SURVEY 227

factors and resources needed to achieve minimum and optimal standards of care.2

ACKNOWLEDGMENT Appreciation IS expressed to the CRN mem-

bers who partrcrpated in the survey

REFERENCES

1 Council on Renal Nutrition of the Natronal Kid- ney Foundation Gurdelines for estimating renal dietr- tran staffing levels. J Renal Nutr 3 84-93, 1993

2 Medford S, McCann L. Maintaining quality nutn- tron care for the end-stage renal disease patient. J Renal Nutr 3 94-99, 1993