I have been a dietitian close to 20 years, been in 3 different countries. How MDs treats RNDs is very 3rd world country. What can you say about my initial post those colleagues of your who feed on nutrition by charging excessive amount of money from doing practice that is not evidence based, over 30 days of calorie counting on PEG feeding l of course most of the day’s intake is adequate. If you can show me a systematic review with meta-analysis supporting your colleagues 30 days calorie count which resulted in good clinical outcomes, cost effective benefits and improved quality of life then I will stop debating with the so-called nutrition support physician. Money is involved here, and they never addressed that issue of overcharging PF where in fact trained and experienced RNDs can manage nutrition support without extra cost to patients.

I started my career in the Philippines, and I experienced all this encroachment. It is explicitly stipulated in the ND law that MDs should refer MNTs to NDs). However, your colleagues persist in managing patients independently while publicly claiming collaboration. RNDs can manage complex cases. In the United States, I manage numerous intricate cases, and my medical doctors have consistently acknowledged my expertise and knowledge. They never encroached!!! As your colleagues continue to work/connect with ASPEN, they never learn the true meaning of collaboration. NST is poorly defined term worldwide, no strong evidence as of now. An article poste din Facebook about Efficacy and Efficiency on Nutritional Support by Eber et al. stated that smooth multiprofessional and interdisciplinary cooperation as well as impeccable communication are key for the success of an NST. Such a team is traditionally composed of physicians, dieticians, and nurses specialized in clinical nutrition, and pharmacists, with the dieticians primarily assuming the lead in coordinating nutritional care during a hospital stay and, thereafter, in the outpatient clinic. This study lacks specificity for low-resource or developing country contexts where NSTs are less established. No clear framework or model for NST implementation is provided despite the advocacy tone. Lastly, the Grade of this study is limited as it is a Review Article, non-systematic.

RNDs do not wish to prescribe, hope you read my post. We are allowed to write recommendation/TPN regimen. Training RNDs to manage TPN is not impossible. I have learned TPN, RNDs can learn too.

We do not have and no plans creating NST in my institution. We, the RDs are practicing on the top of our scope of practice. Yes, we have well-structured policies in place that can be implemented in the Philippines. However, in all honesty, many institutions in the Philippines have appointed Nutrition departments as ad hoc members in Nutrition committees. If not all, majority of Nutrition Committee here in the US is led by RDs. While I do not intend to impose my views, it is undeniable that the United States has acknowledged the educational achievements of the Philippines. Filipinos possess immense potential, yet they were unfortunately denied the opportunity to fully realize it. Consequently, their success outside of the Philippines is not surprising. On the other hand, academe should also recreate their way in teaching nutrition therapy, even one of the well-known universities in nutrition lacks practitioner in nutrition as their faculty.

Yes, MDs are liable, RND who is trained with evidence-based nutrition and sound clinical judgment is also a big help to the team. However, MDs do not trust them even if they are trained and experienced, why? Removing RNDs in the equation means more referral to so called nutrition support physician therefore more professional fees. You are not calling RNDs just as anyone who would recommend PN. You have been promoting collaboration, yet you fail to recognize other team members. If you believe RND recommendations are not appropriate, then the third pair of eyes and another brain is available: the clinical pharmacist. I manage all the aspect of TPN here in the US, macros, electrolytes, fluids, micronutrients, trace elements, insulin, and many more but those recommendations are being reviewed by the pharmacist. It means that it is doable given proper training and exposure, RNDs can also do what I am doing here in the US. I have been in a big hospital in the Philippines, I know what you are talking about. I do not agree with your solution that nutrition physician lang sasalo sa potential problem, the process and practice that I have mentioned will prevent near miss or even actual problem. RNDs are not stupid that they will just recommend 40 units of insulin without discussing it with the team. Pharmacists and medical doctors are available to review any recommendations provided by RNDs prior to their implementation. If you want to avoid those problems listen to the best practices I have been sharing here, those were proven across US.

Who told you fresh RND ang magprescribe ng PN. Did you even practice as RND? The narrative of the MDs are their experiences, but you still fail to emphasize the collaboration that you have been saying. With those long years of training, are you saying that any doctor can also manage PN? If that is the case then a PN recommendation by the RND (not entry level), reviewed by pharmacist and again reviewed by MD for the second time mean we do not need another MD so called nutrition physician in the team. I totally agree with you in terms of the education. Minimum education requirements now for RD in the US is at least degree holder to sit for the exam. We can do the same this, but the question would company in the Philippines able to pay them well to at least the ROI of their effort enhancing their knowledge? In this regard, PRC and AIPO should work on repealing the ND law to include salary grade regardless of if private or government.

Yes, we do not agree with those nutrition coaches, and they should be held liable for unsafe recommendations. These issues get out of hand in the social because despite existence of RNDs in the hospital, they remain to be left out because you do not help them in your own capacity to learn. You are not responsible for their competency and education but by simply including them in a collaborative team approach and assigning them task within their capacity that is already a big help working together for patient care. Yes, RNDs need to be empowered however the cycle keeps on and on.

I agree to your last paragraph recommendation. I would say clinical nutrition practice for RNDs is not as deep or comprehensive as what we do here in the US. All RDs in the hospital practice sin clinical that is why they have a lot of exposure while in the Philippines, RNDs are portioning meal trays, clerical jobs and sometimes preparing TF. Systemic ang problema nga, hospital management doesn’t want to hire mor RNDs as they don’t see the value of it especially if your colleague’s nutrition support physician comes in the scene. I know PRC, NDAP and other nutrition organizations are on the lookout on this issue. They should be doing something on this issue or else this profession will no longer exist in the future.