To accomplish this goal, and expand his professional scope as a dietitian, Tom Stone McNees learned to place small bowel feeding tubes. Since that first placement more than five years ago, Tom has placed more than 1,000 tubes in high acuity medical, surgical and trauma patients.

Improving patient outcomes is what it's all about. "By placing the tubes myself, I feel I'm contributing to patient care in a measurable way," commented Tom. "Enabling earlier enteral feeding can go a long way toward speeding patients' recovery from critical illness."

Tom, considered a trailblazer by many, is leading by example. "I hope to increase awareness among dietitians that they can play a larger role in patient care," stated Tom. "Placing and helping to manage feeding tubes is an important and useful addition to the nutrition support dietitian's traditional role."

Like many trailblazers, Tom has encountered some resistance. "The nurses I work with, almost without exception, have welcomed my participation in patient care," Tom commented. "The limited resistance I have faced has come mostly from my most senior peers, dietitians with long experience in traditional practice who were initially reluctant to work outside their comfort zone. However, once they see that this is a safe practice that enables them to utilize their own extensive knowledge when learning how to perform this procedure, their reluctance often turns to enthusiasm."

Authorizing Tom to place tubes as a registered dietitian at Methodist Hospital required interdepartmental negotiation. In the end, it was determined that amending Tom's job description to include tube placement would clear the way for him to perform this procedure. The change to his job description was consistent with the ASPEN Standards of Practice for Nutrition Support Dietitians as well as the recommendations of the American Dietetic Association.

Being a dietitian is a second career for Tom who worked 10 years as a chef for hotels and restaurants in Atlanta, including a five-star restaurant. His culinary career was rewarding, but left Tom wanting more. A series of aptitude tests at Georgia State University identified strengths in people and instrumentation, suggesting possible careers as a jet pilot, espionage agent or dietitian. His food background and an innate interest in behavior with an undergraduate psychology major made dietetics a natural choice. He now has a Masters degree in Health Sciences.

At a state association meeting in Georgia, Tom heard Gail Cresci, M.S., R.D., C.N.S.D. speak about her experience placing feeding tubes in her position at the Medical College of Georgia. Upon joining the staff at Methodist Hospital several years later, Tom expressed interest in learning to place tubes.  The PICC nurses, who performed the placements at Methodist, learned of Tom's interest in placing small bowel feeding tubes and encouraged him to train with them. Tom followed whenever he could, keeping a log of each observation. After a few months, he began doing the placements under their supervision.  Once the PICC R.N.s were confident Tom could do the job, he demonstrated his skills for the nutrition support team medical doctor and Tom was "checked off" to do the procedure without supervision.

Within a few years Tom was doing more placements than any other individual in the large Clarian system. After a lot of practice he became the "go-to" specialist for difficult enteral access problems. Tom is often called in when others have been unsuccessful in placing a transpyloric tube, or when a R.N. is having trouble placing a simple nasogastric tube.

"Professionally, learning to place feeding tubes has made it easier for me to help the nurses with other patient care issues," explained Tom. "The skill has also provided me the opportunity to play a greater role in the patient-care teams, and increased my overall job satisfaction tremendously."

Now, Tom is hoping other dietitians will be intrigued by his results. He travels to other hospitals, demonstrating his technique and teaching physicians, nurses, and other dietitians about feeding tube placement. Hospitals need more people who can place tubes and he's doing everything he can to spread the word about this very teachable procedure.

"I know I am not the only dietitian placing feeding tubes," he said. "But I hope increasing awareness of the benefits may encourage others to follow my lead. I believe the nutrition support dietitian is the perfect individual to carry out this procedure in many clinical settings."