NUTR EXAM 2

• - Most powerful influence on health care quality
• - independent, non-profit voluntary accrediting agency
• - Develops standards for a variety of health care institutions

Accreditation is for a 3 year period --> if don't pass have 1 year to come up with standards

1=1 substantial compliance --> going above and beyond (want 1 or 2)

5 = 5 noncompliance --> not following the standard at all

age 65+

below perverty level

diagnosis determines how long the patient can stay in hospital

codiagnosis can allow person to stay longer

ex. malnutrition

Direct and assist employees to the work necessary to achieve the organization’s goals

• Policies:
• - Framework for future decisions
• - Guides employees toward best action in a given situation

• Procedures:
• - Determines step by step how an activity is done
• - Expresses standards of time, quality, etc.

Flexible and adaptable to a variety of situations

Broad enough to allow supervisors to use some judgment and decision making

Past experience

Similar organizations

Attitudes of top level managers as well as other managers

Day to day experiences

Must be specific

Should be guides for action, not thinking

Training employees

• Has supervisor carefully analyze the job
• Leads to uniform performance

Help in decision making

• Who is responsible for the job?
• What?
• When?
• Under what circumstances?

Policies and Procedures must be updated regularly

Several copies should be available

Policies and Procedures must be shared with employees

Purpose of the food service department

• Organizational design
• General and therapeutic menus

Ordering, receiving and storing food

Meal and nourishment service

Cost control, budget and records

Housekeeping, sanitation and safety

Personnel: hiring, orientation, discipline, firing, staff development and training.

Statements of what can be done and not done

Do not allow for freedom or flexibility

Do not have any time sequence and set of steps

Can be part of a procedure or stand alone

Check for potential conflicts with present job requirements

Be sure there is available staff time for implementation

Ex. Transfer from other departments

Ex. Employment agencies

Hotlines: Monster. Com

Job banks -> NH dietetic association has one

Head hunters -> look for people to fill managerial positions

- Regulates employment practices

- The Equal Employment Opportunity Act is part of this act

-It is illegal for employers to discriminate based on race, color , religion, sex, or national origin in hiring, firing, promoting, compensating or in terms , conditions or privileges of employment

Protects people 40 years and older from age discrimination

Prohibits employers from replacing older employees with younger workers regardless of whether the purpose is to save money or to give the company a more youthful image

Affects all companies that hold federal contracts

They must seek out, hire and advance reasonably well qualified individuals whose groups have been discriminated in the past

• Also protects individuals with physical and mental challenges
• Usually called affirmative action

Prohibits discrimination against disabled veterans but specifically Vietnam Vets

Added amendment to the 1964 Civil Rights Act

Prohibits discrimination against workers on the basis of pregnancy, recent childbirth or related medical conditions

Employers must maintain a workplace free from sexual harassment and intimidation

Sexual harassment is defined as subjecting a person to unwelcome sexual advances, requests for sexual favors and any verbal or physical conduct of a sexual nature

• Any verbal or physical conduct that denigrates or shows hostility or aversion towards an individual because of race, color, religion, gender, national origin, age, disability or to their friends and relatives
• Examples: racial slurs, ethnic jokes etc

Amendment to the Civil Right Act of 1964

Prohibited quotas and allowed for collection of damages if a person is found to have been discriminated against

The term “glass ceiling” came out of this legislation

glass ceiling - barriers that prevents women and minorities from achieving managerial positions

It is an invisible barrier which often prevents women and minorities from achieving management positions

Changed the word creed to religion when considering types of discrimination and rather than say gender discrimination changed it to sex discrimination

Employees of the US Government have the privacy of their personal files as well as lockers , background investigations and other matters

Personnel can copy and correct info in their files and can appeal over disputed material in their files

Prohibits discrimination against disabled individuals

Employers are required to make reasonable accommodations or modifications that help impaired individuals to function in their jobs

example: having computer technology and brail for blind

You cannot ask when interviewing for a job whether a person has a disability but you can ask if a person can perform the job with or wit

advertisements in ADA Journal, Today's dietician, the news paper

• • Birth place • Marital Status
• • Date of birth • Citizenship -> can ask isf is a citizen or has green card just not from where
• - Religion
• - Nationality
• - Race
• - Inquiry on arrests -> can ask if convicted for anything
• - Photograph
• - Clubs, societies etc

• - Intelligence Tests
• - Aptitude Tests -> to tell what best suits a person
• - Achievement Tests --> can person achieve what job entails
• - Personality Tests
• - Civil Service Tests

• Detailed study of the job
• Answer the following

What is the job?

What kind of tasks are involved?

• What employee behavior is required:
• How can it help in the selection process?

Interview person doing the job

Record a daily diary

• Complete a checklist
• Hire a consultant

Visit a facility that has the job

To plan work activities during non-peak periods

To determine work simplification

• To determine work methods and procedures
• For training purposes
• To determine performance standards
• To aid in better supervision
• To provide facts for union negotiations and job classifications

To discover related and overlapping jobs that can be combined

To determine workload when new equipment or new work methods are introduced

To provide safety precautions

To provide data on time constraints

Minimum requirements that must be met by the applicant

Based on the job analysis

• - Experience
• - Education
• - Special training
• - Personal requirements --> must be able to lift 50lbs
• - Working conditions
• - Hours of work
• - Job classification
• - Promotional opportunities
• - Tests required
• - Need for license or certification

Organized list of routine duties and responsibilities

Compiled from job analysis

Avoid occasional tasks

• Be precise but flexible
• One needed for each position on the organizational chart

• - Match applicants to the job
• - Establish orientation and training programs
• - Establish performance appraisal forms
• - Establish job classification and pay
• - Determine limits of responsibility and authority
• - Clarify chain of command

Helps determine the fitness of the applicant for the job

Provides information to help applicant determine interest in the job

Goal of the interview --> hire the best person use either job analysis or job description

Review job description and specification

Contact references if necessary

Prepare questions or not

• - Be neutral to answers given
• - Use open ended questions when possible
• - Ask follow up questions for clarification
• - Ask simple questions first
• - Explore ability first
• - Do only approximately 20% of the talking (they do 80%)
• - Maintain control
• - Take only brief notes
• - Treat everyone equally

• - avoid making snap judgement
• - avoid yes and no questions
• - don't ask leading questions

-Holiday Pay-> 5-10 days determined by employer

-Personal Days

-Vacation Days ->Often lumped w/ personal days and called paid time off

Sick Leave

Bereavement Leave or Jury Duty --> suppose to get paid

-bereavement for immediate family

• - Selecting someone completely opposite from the former employee or vice versa
• - Selecting someone who has similar characteristics to the interviewer
• - Being influenced by candidate order (judging the last persons interview on the 1st persons)
• - Allowing one absolutely glowing recommendation to influence decision
• - Need to hire quickly
• - Basing decision on feelings and emotions

• - How long employee worked for them
• - Type of employee the applicant was
• - How applicant got along with others
• - Was applicant promoted or demoted
• - Would you rehire this applicant

• - Personal qualities
• - Intellectual qualifications
• - Work capacity
• - Interpersonal relationships
• - Physical qualities
• -like a person with a good clear voice to answer phones
• - Experience

• - Inform applicant when the final decision will be made
• - Reflect on all information available
• - Compare with application information
• - Make selection and notify applicants of decision

Philosophies and goals of the organization

Provides an understanding of the organization

Provide a handbook to keep for future reference

• - When to report to work
• - How to keep track of hours
• - Meals, uniforms an other benefits
• - Payroll procedures
• - Disciplinary procedures
• - How to do the job

• - Introduces new worker to the job
• - Assists in the adjustment period
• - Prevents learning policies through rumor mill
• - Reduces dissatisfaction and turnover (people stay at job longer)
• - Eliminates fears of the unknown

• - Creates a favorable attitude
• - Establishes a sense of belonging
• - Breaks down barriers
• - Promotes self confidence

• - Upgrades workforce
• - Promotes job competence
• - Reduces future grievances
• - Reduces employee turnover

• - Have extensive academic training
• - Commitment to public service - willing to provide services in facility and community
• - Ability to make independent judgments
• - May be generalists or specialists
• - Often prefer participative management

- Oversees the work of one or more individuals

- Are accountable for their work as well as the work of others

- Possess authority and responsibility for what happens in the workplace

• - Require special technical training
• Know the “how to” but not always “why”
• - Do not require close supervision
• - Examples: cooks, secretaries, exterminators, equipment repairman

• - Bring no marketable skills to the job
• - Usually are trained on the job
• - Commonly earn minimum wage

Examples: receptionists, cashiers and foodservice workers

• - Usually 37½ to 40 hours – total 2,080 hours/year
• - Typical shift is 8 hours/day – 5 days a week
• - Some hospitals do 12 hr shifts 3 days/ week

• - Number of hours less than full time
• - Typical is 20-24 hours a week
• - May or may not get benefits

• - Less than half time (<20hrs/wk)
• Do not have any benefits
• - May receive a higher pay scale in lieu of benefits

• - Also called casual or on call employee
• - Not guaranteed any number of hours
• Scheduled as needed
• - Usually fills in for other workers on leave

• - Two individuals sharing one position
• - Can lead to decreased productivity if not managed properly
• - Can result in duplication of effort or in omission of essential elements

Newly hired – lasts a period of 60-90 days

Employee can be dismissed without cause

• - Hired to work on a special project or
• May cover an absence or Hired to cover increased need

-Often may not be on the payroll of the organization but hired through an employment agency

- Usually hired for several weeks/months.Often has a skill that another employee in the organization cannot fill

• - A temp receives no benefits
• - Can be expensive (wages+fees) but may be worth it to maintain quality and standards

• - Hired to do a job that is finite in nature
• - Can be paid hourly, monthly or by the project
• - Receives no benefits
• - Usually provides special services
• - Usually called a consultant
• great for people that want to have a family make $50-100 per hour

• - base
• - holiday (time and 1/2)
• - overtime - (time and 1/2)
• - double time
• - shift differential (more for working nights and evenings)
• - hazard pay
• - split hsift
• - doubleback - more money made in 2nd shift when 2 shifts back to back

• - Paid for doing a job no matter how many hours it takes to get the job done
• - Usually a minimum of 40 hours but may fluctuate from week to week
• - Burnout can occur due to stress, fatigue and dissatisfaction if not managed properly

• - When salaried workers work more than 40 hours, some institutions allow those hours as time off. --> comp day
• - Usually must be used within 60 days
• - Can also be redeemed for wages
• - Must be clear policies to prevent abuse

• -Ethnicity
• - Race
• - Gender
• - Xenophobia (Fear of strangers/foreigners)

Women managers in the workforce

Older Americans working longer

• Multiculturalism
• Disabilities

• -Broader variety of viewpoints
• -Extends the marketplace
• - Ability to satisfy the needs of a diverse community

• - Xenophobia (fear of strangers or cultures)
• - Takes time and money to help
• workers overcome biases

If all groups of workers can do the task with similar or acceptable level of proficiency, the task should be given to the least skilled

• - Based on work activity
• -Criteria – to meet the needs of 100% of patients on modified diets and 25% of other patients at risk (ex. cancer patients eat normal diet)

Service time

Instruction Time

Routine Support Service Time

Nutritional Assessment Time

Available Staff Time

• - Reviewing the medical record
• - Obtaining the diet history from the patient
• - Communicating with team members (put likes and dislikes so patient doesn't get food they won't eat)
• - Preparing materials for diet instruction
• - Developing the care plan
• - Recording in the chart

This can be computed from the Client Learning Study

Time spent on activities that are performed for ALL patient

• - Anthropometric measurements
• - Parenteral and enteral nutrition

Hours each professional is available

1 FTE has 33.75 hrs available (taking out breaks, lunch and vacation time)

when benefits are calculated in

• - out patient group classes make up for less 1 on 1 dietitian client interaction
• - videos are also used to teach diets

• - Goals and objectives of the organization
• - Standards of performance
• - Efficiency of the workforce
• - Type of establishment
• - Menu – number and types of diets
• - Kitchen layout and design
• - Location of kitchen
• - Sanitation requirements
• - Responsibility for distribution of trays - Hours of operation

• - Considers hours of work per day
• - Time the worker is to be scheduled
• - Number of days per week to be scheduled

employee scheduled for 40 hr/wk in less than 5 days

• - Permits flexibility
• - Working less than 8 hours some days and more than 8 on other days

• - Record keeping
• - Extra supervisory staff
• - Difficult to meet needs of foodservice - Delays interdependent tasks
• - Many jobs cannot be delayed to the next day

• master schedule - all shifts
• shift schedule - staggered
• production schedule

No more than 7 consecutive days and no less than 2 consecutive days off

Most institutions have formulas for scheduling weekends

• - Try to honor employee preferences if possible
• - Do not use scheduling to reward or punish. This will undermine your
• credibility

• - Teens must be 14 to work in food service
• - Teens 16 and under cannot work more than 8 hrs/day and 40 hrs/wk
• - When school is in session, they cannot work before 7 a.m. or after 9 p.m.
• - Teens under 18 cannot repair or maintain equipment; cook or bake; load or unload trucks; use a food slicer

Don’t use seniority as a factor

Do ask for volunteers --> can help by doing small tasks or visiting people

Develop a holiday cycle

• - Have a policy for asking for time off
• - Have employees responsible for finding a replacement if it is short notice

Eliminates having to start from scratch every time – saves time

• Two week cycles are the most common
• Provides consistency, more equitable, easier to develop

• 1. Know how many (total) Workers are needed each day
• 2. Know which positions are cross-trained
• 3. Use a grid – names along the side, dates at the top
• 4. Use a legend to indicate positions when people are crossed-trained
• 5. Enter all days off; regularly scheduled, holidays, vacation, special requests, extended sick leave
• 6. Write in work days assuring the guaranteed number of hours for each worker
• 7. Look for gaps and fill in with part-time employees
• 8. Use per diem employees if needed
• 9. Check and cross check to be sure hours are accurate – overtime COSTS! 10. Also check for cost effectiveness

• - Each employee has different needs, desires, prejudices, IQ’s, beliefs and skills
• - Everyone learns at a different rate
• - Training must be tailored to the individual
• determined by amount employee needs and how fast employee learns

• - Adults do not learn just for the sake of learning
• - Adults learn in order to perform and solve some immediate problems
• - Adults want learning that is relevant

• - Adults do not learn just for the sake of learning
• - Adults learn in order to perform and solve some immediate problems
• - Adults want learning that is relevant

• - Adults resist situations where they are treated with disrespect
• - Adults like to help plan and conduct their own learning experiences
• - Adults require practical results from learning --> like seeing a finished product
• - Adults perceive learning experiences that are organized around life problems

• - Determine Performance deficiency
• - Determine desired performance and steps to get there
• - Determine ideal end results
• - Determine the skills that must be taught
• - Determine the feasibility of training

• Put the employee at ease
• Explain the operation

TELL - SHOW - ILLUSTRATE

Not all training runs smoothly

Learning is faster at first then slows down

Learners get discouraged and may regress (plateaus discourage learners)

Learning plateaus often occur

• - Gives the employee the opportunity to acquire a broad perspective and diversified skills
• - Helps the employee see the BIG PICTURE
• - Each rotation could be 2-3 months
• more proficient workforce

• - Oldest technique
• - Purpose is to inform
• - Saves time, inexpensive
• - Passive – can be boring
• - Must be supplemented by AV’s

• - Allow for the exchange of ideas, discussion of problems, finding solutions to issues
• - Opportunity to express views and opinions
• - Great for networking with others, learning teamwork

• - Acting out situations
• - Used to train for interviewing, counseling, managing
• - Gain insight from their own performance and comments from observers

• - Widens perspective
• - Experience situations involving resolution of different ideas
• - Learn to adjust to other people’s viewpoint
• - Gives opportunity to assume a position of leadership

• - Solve problems under simulated conditions
• - Requires active involvement in problem solving
• - Use pertinent situations with immediate application