NDTR Leadership - Why Not Us?

How an NDTR can confidently lead while managing imposter syndrome in a director role.

Kelly Homer

Director of Nutritional Services

Windom Area Health

Overcoming Imposter Syndrome as an NDTR in Leadership

The Oxford English Dictionary defines imposter syndrome as “the persistent inability to believe that one’s success is deserved or has been legitimately achieved as a result of one’s own efforts or skills.”

As an NDTR working under the title Director of Nutritional Services at a critical-access hospital, imposter syndrome has often crept into my thoughts. Am I truly qualified to be in this position? What rules might I be breaking by managing the hospital’s registered dietitian?

These questions became even louder when I searched for resources for NDTRs in director or managerial roles and found very little information beyond the Scope of Practice documents from the Commission on Dietetic Registration.

Stepping Into the Director Role

As the Director of Nutritional Services, my responsibilities include directing the day-to-day operations of the Nutritional Services department; managing the department’s budget and long-range planning; supervising staff using effective employment practices, training, and policy adherence; and collaborating with the Registered Dietitian to complete inpatient assessments and provide education for patients and their families.

Before I stepped into this role, the positions of Director and Registered Dietitian were combined. When our RD chose to step back from her management duties, the organization restructured the department and redistributed responsibilities. My title as manager changed to Director, which placed me above the RD on the organizational chart.

And once again, imposter syndrome appeared.

How could I, an NDTR, be placed above the hospital’s RD?

Lessons That Helped Me Reframe My Role

Since stepping into this position, several realizations have helped strengthen my confidence.

Leadership extends beyond nutrition expertise.

Before the restructuring, the RD reported directly to the CEO. Now, our department reports to the hospital’s CFO. This shift reminded me that I am not in this leadership position solely because of my nutrition knowledge—I am also here because of my leadership skills and ability to manage a department.

Supporting colleagues is a hallmark of good leadership.

I have always believed that a great leader supports their employees. Because of my NDTR credential, I am able to assist the RD within my own professional scope and in areas where she has documented that I am competent to practice.

Understanding supervision within the NDTR–RDN team.

The Commission on Dietetic Registration recently updated its Scope of Practice documents for NDTRs and clarified an important distinction:

“This description of ‘supervision’ as it relates to the RDN/NDTR team is not the same as managerial supervision.”

This clarification helped ease my concerns. Within our organization, the RD can request assistance with tasks she believes I am competent to perform. She can supervise my direct patient-care practice without needing to hold a managerial role over me.

Recognizing the Value of the NDTR Credential

When I first stepped into the role of Director of Nutritional Services, I frequently asked myself, Why was I chosen for this position? Why me?

Now, a little more than six months into the role, my confidence has grown—and I have found my answer.

I am a natural leader. I enjoy sharing my expertise, supporting my team, and contributing wherever I can.

I also bring both educational and professional experience in foodservice operations and nutrition care, which are essential components of this position.

Sometimes NDTRs are viewed as “less than” within the nutrition profession—and sometimes we internalize that perception ourselves. But it is important to remember what it takes to earn and maintain the NDTR credential:

• Completing an associate’s or bachelor’s degree program
• Completing at least 450 supervised practice hours
• Passing a national registration exam
• Maintaining the credential through 50 hours of continuing education every five years

In fact, according to the Commission on Dietetic Registration’s 2023 Pass/Fail Statistics, the NDTR exam had a 49.7% pass rate.

While Registered Dietitian Nutritionists are experts in the field of nutrition, NDTRs are experts as well.

And in the areas where we feel less confident, we have both the opportunity and the responsibility to grow through continuing education and professional development.

Why Not Me?

Stepping into leadership can challenge our confidence, especially when there are few examples to guide us.

But leadership is not defined solely by title or credentials. It is defined by the ability to guide teams, support colleagues, and serve patients effectively.

Today, I remind myself:

I am a leader.

I am an expert in my field.

So the question is no longer “Why me?”

The question is “Why not me?”