Hi, are you _________? Great! My name is Clara and I’m a Registered Dietitian here at the hospital…”
How I start most of my conversations at work ^^^
Some people are surprised to find out that aside from this blog/IG passion project I keep up with, I actually work as a full time Clinical Dietitian at a hospital! Yep, I’ve been at it for almost 3 and a half years, which is INSANE to think about.
During my relatively short tenure as an RD, I’ve fielded a number of questions regarding my job at the hospital, questions ranging from how satisfied I am at my current position, how valued I feel, to simply, what my typical day looks like!
In an effort to be efficient and create more of a long term reference/resource, I took to IG to compile some of the most common questions y’all have had about my job as a dietitian at a hospital. I think it’ll be really eye opening! Even when I talk to dietitians that work at other hospitals, it’s always intriguing to hear how they run things and operate. While it is a fairly regulated field, each facility has their own criteria, policies and procedures that dictate how they work.
Working in a clinical setting has been extremely eye opening, especially as I compare it to current health/wellness trends and interests on instagram and social media. The patient population is VASTLY different than the average person that follows me. A needed reminder that I must meet each individual as just that — an individual.
The beauty of the dietetics field is that there are SO MANY JOB OPTIONS. While working as a clinical RD is one of the larger sectors, it’s definitely NOT the only option, which I think many new grads are surprised to hear.
ANYWAY, let’s dive into the questions, shall we?! Hope these give you a better glimpse into the word of clinical dietetics!
Any advice to an aspiring clinical RD that can’t seem to pass the exam? Don’t give up!! Continue to work at it, studying your weakest areas. Remind yourself that you’ve been going to school for this stuff for over 5 years — you KNOW it!
Do you have a favorite patient population and/or disease state to work with, and why? In general, I just LOVE working with older adults/geriatrics. I love being able to work to optimize their nutrition to extend their quality of life — hopefully allowing them to eat well enough to support them in their daily activities of living, food enjoyment, and disease management. And on a more personal reason, it’s just a joy to hear some of the stories they share! They are often so kind and respectful, it makes work more enjoyable.
I don’t really have a specific disease state that I love to work with honestly! Any time that I can provide education and guidance in making healthy changes to facilitate improvements in health is my favorite!
Do you feel like you’re able to build relationships with your patients or is it more fleeting? The nature of a clinical dietitian/hospital job in itself is very fleeting — we really only have just a few minutes. Sometimes after providing diet education at one visit we also have the chance to follow up with them once or twice more before they leave the hospital, but after that, I don’t personally see them again….unless they are admitted to the hospital again (which is never good!).
What % of your time are you with patients v charting, etc…? The majority of my time is definitely spent charting — whether it’s looking up and taking down info from a patients medical record, or later typing up a note after my assessment of the patient. Time spent with patients can vary, sometimes patients are short and uninterested in conversation and conversations are short (it can be like pulling teeth sometime!), but other times I can spend upwards of 15-30 minutes at a patients bedside…this of course is also dependent on my overall patient load for the day, patient interest in conversation, and content to cover.
Do you feel respected in your role by the nurses, doctors, etc…? For the most part, yes! I like to remind myself that we all have different personalities, but if we both focus on having the patient’s best interest at the top of our priority list, then we can all respect each other. Collaboration is key!!! Though I have learned how to turn the other cheek from time to time 😉
What is your favorite thing about being a clinical dietitian and the greatest challenge? What do you enjoy most about the work you do? My FAVORITE thing is being able to “plant the seed” and introduce (or encourage) patients to start making changes to how they eat to improve their health. Hearing someone take an interest to healthy eating patterns seriously lights up my world like nothing else. I really enjoy being able to connect with patients and learn more about their way of living, view on food/nutrition, and just being able to talk with them!!
The greatest challenge is without a doubt patient compliance and interest. Our patient population mainly consists of older adults and individuals that are used to eating very ahem, “southern” foods, as well as packaged and processed foods and beverages. Many are hesitant to listen or make changes, which can be frustrating over time.
Did you always want to work as a clinical dietitian? What this your first choice of jobs out of the internship? Did you want to be in the clinical setting before you got the job? Nope! I thought it was interesting during my internship, but it wasn’t something I thought I wanted to pursue. I started out as a PRN position but shortly after transitioned to full time because, ya girl had to pay the bills! So yes, this was my first choice of job out of the internship — the RD market is slim in Asheville, so I honestly took what I could get.
Are you enjoying it? I enjoy my coworkers/other RD I work with, which makes up a large part of my job satisfaction.
Do you ever work with patients who have dysphagia? Yep! For those that aren’t in the healthcare field, “dysphagia” essentially means someone has trouble swallowing properly. This might cause them to swallow in a way that is unsafe and could lead to aspiration, if not eating foods and beverages with the appropriate modifications (cut up, ground, pureed, thickened) and working with a speech therapist.
I work with patients after they’ve been evaluated by a speech therapist to ensure they are consuming adequate nutrition if they have been deemed to have dysphagia. Our kitchen can provide foods that are mechanically altered (cut up, ground, pureed, thickened, etc). I also work with them to provide diet education, when needed, to help them select appropriate food and drink choices at home within their diet modification. If their dyspaghia deems them too unsafe to eat or drink anything by mouth, then they would be assessed for a feeding tube placement, and then the RDs step in to provide tube feed recommendations to meet their nutrient needs! That’s about the extent of our work with them, though!
Most challenging nutrition assessment and consult situation? Tough question! One challenging nutrition assessment is when patients absolutely DO NOT want to talk to you — it really is like pulling teeth, so painful to get a patient to even carry on normal conversation, even after explaining why I’m there and trying to build rapport. I think they automatically think I’m going to judge them, which is NOT the case.
Working with alcoholics can also be difficult because I find they often underreport their usual intake, giving me a skewed outlook on their typical intake.
What’s the most common reason you are consulted? We have an automatic trigger for decreased appetite or unintentional weight loss that brings in a fair amount of consults. All hospital RDs have this in some way, shape or form — it’s a way to screen for malnutrition. The other most common reasons we are consulted are either obesity or some type of disease-specific diet education (DM, heart failure, cirrhosis).
How do you think your internship prepared you for full time job? In dietetic internships, you are required to complete a certain number of hours of supervised practice in a real life setting. So during my internship, I spent 3 months shadowing and working under a clinical dietitian at another local hospital, so I was fairly well prepared for my full time job, since I had essentially worked the position (ahem, for free), for 3 months prior! Of course every hospital system works a little different with medical records and charting and what not, but for the most part I knew what to expect, knew how to perform assessment and conduct patient interviews, etc…
How many patients are you expected to see per day? Is your day full of back to back patients or do you have down time? We aren’t expected to see a certain number, we are just expected to see the patients that require an initial assessment or follow-up, based on established criteria! I work in a 170-something bed hospital, so we aren’t terribly huge. My patient load can range considerably, some days I may have as few as 3, other days I’ve had upwards of 17. On “slower” days, we work on clinical projects, continuing education courses, or work on educational posters for the cafeteria, etc…filling in “down time”!
Which patients do you get to work with? Do you work with all age groups? Do you work with adults or children? Do you work with tube-fed kids? Do you cover a specific area/medical service in the hospital? I work with pretty much any patient that has been admitted to the hospital. We don’t see EVERY patient, though. I specifically cover a med/surg floor and a progressive care unit. Our patient population is predominantly adults and geriatrics, but we also have people in their 20-40s. I don’t work with tube-fed kids, but I do work with tube-fed adults! I see patients with a wide variety of conditions: diabetes, heart failure, heart disease, cirrhosis, pancreatitis, cancer, overweight/obese, underweight, malnutrition, tube feeding and nutrition support, COPD, to name a few! We have patients with pneumonia, respiratory failure, renal failure, COPD exacerbations, urinary tract infections (those really get the older population!), broken hips and surgical patients, etc.
What is the range of patients you see? What is the ratio of nutrition ed. v counseling? Range in terms of age: mostly 30s-90 year olds. Range in terms of conditions: all across the board!! Diabetes, heart failure, cirrhosis, overweight/obese, underweight, cancer, tube feeding, COPD, unintended weight loss and decreased appetite.
I tie nutrition education in with counseling most of the time. If I’m educating for the first time, then I might weave counseling/motivational interviewing in throughout the talk, and follow up with more counseling and goal setting with the patient.
Do you work with anyone with eating disorders? We don’t work with eating disorder patients at our facility, so nope! While all RDs are technically qualified to work with EDs, it is certainly a higher acuity part of the field that really requires more intensive education and training.
Do you see all patients or just patients who need a diet change due to health conditions? We don’t see all patients in the hospital! We go by certain criteria set up to determine which patients we see. That criteria includes: any consult we get from a doctor or nurse for nutrition-related education/assessment, underweight classification, prolonged length of stay, lack of solid food diet for >/=5 days. Usually when we assess a patient, based on their past medical history or current medical problem, some type of diet education/counseling is given or reviewed.
What is your favorite story from your time working at the hospital so far? So many! Most involve cute little old patients 🙂 Most recently, I had a patient the other day direct my attention to the cutest 8×11” print out of him and his dog hanging by his bed; the pride on his face was infectious….I literally had tears welling up in my eyes! HA!
I’ve also had a patient kiss my forehead (okay, that was a little weird), and countless patients that just say silly things that make me smile or giggle. Sometimes nutrition is involved, but other times its just the human-ness of connecting with someone else.
How many lives would you say you change every day?? Ha!!!! This is a joke my coworker and I say to each other almost daily…especially on the days when NO ONE wants to talk to us! One of our past interns submitted this question, and it gave me a little chuckle!
What does a day of work look like? Typical day usually goes something like: get into work, print out floor sheets and tally up the patients I need to see for the day. Drink coffee, cut up with my coworker, look up patient info on the computer, write down pertinent info….go up to medical floors and talk to patients, assessing, providing education, etc…then come back down to the office (NO WINDOWS, BTW) and chart/type up notes from my patient encounters!
How many days a week do you work? 5 days a week 8-4:30ish, and then every other weekend, I am on call. We are fortunate to be able to work remotely on the weekends and don’t have to actually go in — but not all facilities have this flexibility! On weekends I work, I will have a half day off one day the following week.
Are you able to practice the way you’d like to in the hospital setting? For the most part yes, however there are of course some things I don’t totally agree with. I wish we could offer more local, organic foods, and I wish we had better options that the current nutrition supplement drinks that we do, BUT in the grand scheme of things, I’m able to practice relatively close to how I’d like, since I try to focus on a more patient-centered approach!
What got you into studying and working in health/wellness? I initially grew interested in health and nutrition my junior year of high school, but didn’t start actually studying it in college until my junior year! I got into it because I loved the power that food and movement both have to improve our health. It was what I felt most passionate about, and really couldn’t picture myself doing anything else!
Have you worked anywhere else besides acute as an RD? Pros and Cons? Not as an RD, but I had a brief stint working as a WIC Nutritionist right out of college, prior to my internship!
Pros: routine and always knowing what you will walk into, being able to talk face to face with people and often be the one to walk them through nutrition for the first time. Steady paycheck and benefits. More PTO than most jobs (at least in my position). Great experience and you get to see a lot.
Cons: limited, short interactions with patients with little or no follow up. It’s hard to build relationships with patients in the hospital since they aren’t there to see you and continue to follow up with you. Most times, nutrition is the last thing on their mind. Tired, cranky, sick, demented — so conversation isn’t always productive. Sitting at a desk for most of the day. No windows in our office. Have to work most holidays and weekend coverage.
Do you want to continue working at a hospital? Not long term 🙂 It really is a great learning experience and exposes you to SO many different aspects of health, which I’m thankful for. My eyes have been opened to how other populations view and prioritize nutrition and health based on how/where they grew up, financial situations, and other lifestyle factors. It’s been a reminder that not everyone in the world cares about nutrition as much as I do.
That being said, it’s not my long term goal to stay there. I crave connecting with clients in more intimate settings, building deeper relationships and being able to walk alongside patients/clients during their health journey, vs. just giving information one time and sending them on their way. I truly believe it is a collaborative relationship between RD and patient, and that’s hard to manifest in a hospital setting.
How do you make time for all that you do? Work, IG, working out, trying recipes, etc…Ha!! I don’t, simple as that. Something ALWAYS gets pushed to the back burner. I really don’t believe in “balance”, but rather it’s all about priorities. With my current role at the hospital being my full time gig, it will get most of my attention during the day. Outside of that, my real life relationships will get poured into next. I usually work out in the morning before work, so most of the people that know me know that I go to bed early, ha! I LOVE showing up for y’all on Instagram, but sometimes my days are so packed that I just can’t. It breaks my heart, but I’m hopeful that maybe one day it will change!
How long is the schooling after a bachelors? This depends on the internship program you are matched with. They can range from 6 months all the way up to 2-3 years. Shorter if you do just the internship, and longer if you pair it with a masters degree!
What is the school like? To keep it short, you start off with a 4 year undergrad program in an accredited dietetics program. That qualifies you to apply to internships. If matched to an internship, you begin that — usually lasting from 6 months to up to 2 years — and complete extensive supervised rotations and additional course work, which THEN qualifies you to sit for the national registration exam.
School was A LOT of work. Science heavy for sure, which can be intimidating, but so so worth it in the end, especially if you want to really understand the science behind nutrition. We also had classes on counseling technique, food service, management, medical nutrition, life cycle nutrition, and SO much more. I thoroughly enjoyed going to class and learning the material!!
What was your undergrad degree? And is there only one option before going to RD school? Dietetics was my undergrad degree! From my understanding, you have to complete an ACEND-accredited undergrad program to be eligible to apply for internships which then qualifies you to sit for the exam.
For those that are considering dietetics as a second career and are out of college, there are some combined programs, where you can combine class work and the internship at the same time.
For a more comprehensive breakdown, visit eatright.org!!!!