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A Day in the Life of a Clinical Dietitian

Posted Mar 15 2011 6:32pm

Happy mid-March to all of you! Peter and I are in the midst of enjoying some skiing at an “undisclosed location” … but if you’re clever (and/or a longtime reader), you can find out where we are. Let the hunt begin!

I recall that in my last post I promised you all a day in the life of a clinical registered dietitian/RD. Jessie promises, Jessie delivers! First, however, a little about what dietitians DO in general. In my experiences talking to the random (wo)man-on-the-street, I have discovered that most people think RDs do one of the following: (A) Tell people what they CAN’T eat (i.e. “yummy” foods), (B) Tell people what they CAN eat (i.e. “healthy rabbit food” ), or (C) A combination of the above. C’mon, raise you hand if you think the above is true.  Yes, you! winking

As you can probably guess from my rather subjective verbiage, (A) (B) and (C) does NOT encompass the scope of what an RD can do.  The title “registered dietitian” is protected because of the science-heavy education, supervised practice, and ongoing training that a registered dietitian must complete and maintain.  The title “registered dietitian” distinguishes a trained and certified RD from a “nutritionist” or “nutritional expert” or one of the other many permutations of “nutrition” that require little or no formal training.  You can read more about what an RD does on ADA’s website here .

So, where DO registered dietitians work? Just for you, my dear readers, I made up this handy little pie chart based on the American Dietetic Association ‘s most recent survey of where its members work:

Snazzy, eh?

As you can see, more than a third (34%) of RDs work in hospitals, in inpatient and acute care.  I’ll be sharing my experience in inpatient care below.  A significant percentage of RDs work in clinics (12%) and community and public health programs (11%) – I wrote about my experience in community nutrition here . 11% work in extended care facilities (which was one of my first clinical dietetic experiences). RDs can work as consultants to health-care facilities (6%) or other organizations (2%). RDs can work in private practice (4%) – in which I’ll be working for my next supervised practice rotation.  And, of course, RDs can work in school foodservice (3% – I wrote about my experience in school foodservice here ), or in education (5%).  RDs work in very diverse areas!

Still, the piechart is vague.  What exactly do those 34% of RDs who work inpatient actually DO? For the past six weeks, I have worked as an inpatient dietitian at a VA hospital (this experience is part of the 1200 hours of supervised practice that I need to complete before I can take the registration exam to become a registered dietitian). On a day when one of the dietitians was out and I sat on her floor, I wrote down everything I did that day (with the exception of the  TPN order, which another RD put in and I observed). Also, I moved the timing of some events around to help with flow.

7:45 am: Arrival at the hospital. The parking lot is already crammed full of cars.

The VA hospital is that tall, rather imposing gray building in the back. That’s only one of the buildings.

8 am: Arrive on the floor, check computer to see how many patients have been admitted and how many nutrition consults have come in.  Prioritize patients based on time of arrival (all new inpatient admissions to the floors must be seen within 72 hours and all consults must be seen within 48 hours – yes, RDs do work weekends!).

8:15 am: Walk around the floor and check on patients’ breakfasts. Note errors and patient concerns with their trays. Correct errors if needed.  On this particular day, I also asked each patient if they wanted a non-meat option for lunch, as it was Ash Wednesday.

8:25 am: Reported which patients wanted a non-meat lunch to the kitchen in time for them to make changes to the lunch service.

8:45 am: A nurse stops me in the hall and says that a patient wants to talk to me about his trays.  I quickly review patient’s chart on the VA’s award winning computerized medical records.  Note the patient has severe ascites and is therefore on a sodium and fluid restriction. Visit pt and discuss the rationale of why he cannot have extra salt and water. After some conversation, the patient is calmer. I write down the patient’s food preferences and have one of the RDs enter his preferences into the computer system (I can’t change diets or preferences myself because I’m still a student).

9:30 am: Hop on the computer to finally start charting on my patients for the day, only to be interrupted …

9:45 am: … by a dietetic technician, registered (DTR – an essential part of the dietetics team!) calling from the kitchen about a patient whose diet order keeps changing back and forth. Review patient’s chart and recommend the correct diet for this patient. Have RD change diet.

10 am: Finally! Some time to chart on patients. I review their current diagnoses and prior medical history, as well as height, weight, blood pressure, labs, and subjective information such as appetite and nausea/diarrhea/constipation/chewing or swallowing problems. I talk to the patient to find out this subjective information, as well as make a note of how they appear (malnourished, nourished, etc., and how likely the patient will comply with diet recommendations). All this information, plus other information not mentioned, must be recorded in a professional manner in the computer charting system. The RD will make diet recommendations based on all this information. The diet may be simple if the patient has no nutritional problems, but most patients at the VA hospital must have some kind of special diet. For example, sodium-restricted diets are common due to high blood pressure or liver disease, and renal disease and failure without dialysis may require a protein restriction. There are disease-related needs for low fat diets, low protein diets, high protein diets, fluid-restricted diets, consistent carbohydrate diets, and on and on. Those diets don’t even count the tube feeds and parenteral nutrition needed for some patients.

10:45 am: As I walk to my next patient, I pause to be inspired by the posters on the wall (sorry for the glare – at least I’m still getting inspired!):

12:15 pm: Walk around the floor checking on patients’ lunch trays. A patient is irate because she received the wrong lunch tray. Talk with patient for a few minutes, then have RD call down to kitchen for late tray.

1 pm: Time for lunch! Admire roses on clinical RD manager’s desk for RD Day .

Jumping ahead a few days … at lunch, we were able to enjoy some chocolate brownies baked by one of the dietitians, Laurie, for our last day at the hospital (“our” meaning me and Brianna, another University of Connecticut student who was working in outpatient counseling at the same hospital). Here we are:

I just adore Brianna! We’ve done a lot of our supervised practice in dietetics together, and let me tell you: this girl is going to be an awesome registered dietitian!

Closeup of the goods:

Yes, it definitely tasted as good as it looks. Thanks, Laurie!

1:30 pm: Back to work! Need to make sure we get see all the patients before the day is over.

2:30 pm: Check on a TPN patient.  I won’t get into all the technicalities of nutrition support, but I will say that RDs have an important role in making sure someone who can’t eat (enough or at all) gets the nutrition he or she needs.  For example, an advanced head and neck cancer patient who can no longer safely swallow and therefore get enough oral nutrition may get a PEG placed (actually got to see one of those procedures!) – this person will get nourishment directly into the stomach. Or, a person may develop a postsurgical ileus and eventually need TPN – this person will receive nutrition intravenously. Dietetics is cool, folks.

3 pm: Keep at it! Gotta see all those patients!

Here I am with Elizabeth, one of the dietitians at the VA, who I coerced into taking a picture with me:

Thanks, Elizabeth! big grin

4:30 pm: Done for the day! … as long as I’ve seen all my patients, of course …

So, what do you think? I hope you’ll agree that a registered dietitian does more than (A) (B) and (C). happy  I will miss my time at the VA hospital, but I am excited to start my next rotation with a private practice dietitian!

Please feel free to ask me any questions you have about dietetics, nutrition, whatever, and I will be happy to answer! ‘Til next time, dear reader …

Q: Have you ever met a registered dietitian? What was your experience like?

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