What You Haven’t Been Told About Being A Dietetics Professional
Hello everyone! It’s Kelsey again, this time writing to you during the final few weeks of my clinical rotation. There are only seven weeks left of the internship year here at Cal Poly, and I cannot believe how much time has passed since my first rotation in September. Over the past nine months, I have been humbled by all that I have learned. It is immensely rewarding to look back and actually see how much I have grown through all the experience and work that has been done while earning the competencies necessary to move forward into entry-level practice (after that exam, of course).
Dietitians are resourceful investigators
What does that mean? A large part of the job of the dietitian is to investigate further into what is going on with our clients / patients nutritionally and how we can best help them. Often, the people we see especially in hospital and long-term care settings have multiple diagnoses. Good news! All the MNT notes you have been taking in class will serve you well. You will be able to serve your clients much more effectively if you are familiar with diagnoses that have nutrition implications, and you will see these over and over. Inevitably, you will come across less common disease states or conditions that you are not yet versed in, even as a seasoned dietitian. This is okay! What is important is that you know where to turn for credible information and can use your clinical judgement to educate and offer information to your patient (this comes with time and practice).
This is where your resources come into play. If you are anything like how I was in college, you may be renting your textbooks or waiting until the first day of class to find out if you really need that $185 textbook, or if it is more of a “suggestion” for the class. However, when it comes to your nutrition courses, I can tell you that you will truly be investing in your future RD-self if you secure your own copies of some solid nutrition textbooks. Since dietetics is a relatively new science and there is still so much we are learning, dietitians are constantly working to keep up with the latest research and recommendations (thank you CEUs). One of the BEST parts about going into this field is that it is evolving and there will always be new things to learn. For example, dietitians are performing Nutrition Focused Physical Exams (NFPE) in practice. This is a skill that both new as well as experienced dietitians have been encouraged to learn (hint: if you don’t know what this is yet, look into it!). Now that I have been working among multiple RDs in practice, I have seen firsthand how these resources continue to be used regularly. I have seen the Krause text on my colleagues’ desks, the ASPEN guidelines are never far away in the clinical setting, the Nutrition Care Manual (NCM) is accessed regularly, and many dietitians have copies of the Academy’s pocket guides on various topics.
It was crucial for me to know where to find information when a patient asked me a question unrelated to the reason why I was visiting him…“So what should I eat to help my gout?”
*patient proceeded to show me his swollen arthritic foot*
Excellent question.
That I did not know the answer to.
I recognized the patient for thinking about how he could use nutrition for healing and said, “I would love to get you some information about that topic, would you mind if I come right back?” I sped off to the nearest computer and pulled up the NCM. What can we do to help gout? A low-purine diet! I quickly educated myself and brought materials back to the room to go over with the patient and his wife. This was a topic I was unfamiliar with but was able to handle the situation independently and confidently because I knew my resources well.
Another crucial resource that dietitians have is each other. In many work settings, you may not be the lone dietitian. This is a beautiful thing and so important in my opinion, especially as a new dietitian. We all learn from each other and can use one another to talk things over, get opinions, and ask for reference suggestions.
The importance of using your colleagues as resources
So, what is your interaction like with everyone else working at your facility? This is something I started to pick up on in my first week as an intern. As only one part of the care team, it is incredibly valuable to communicate with other members of the team to collectively care for your patient. Some dietitians are part of an interdisciplinary team (IDT) who meet routinely; they may attend rounds with other members of the care team, or they may consistently work on a floor where they get to know the other staff (SLPs, nurses, physicians, diet office technicians, PT, OT, social workers, spiritual care, etc.).
Why is this so great? You will learn to utilize these relationships with other care providers to gather information you need for your patients (what an investigator you are!). For example, what if you have a patient who can’t answer your questions? In school we are given case studies to practice our MNT knowledge, but there are other complications that arise when you are actually doing this with a real person. Your patient may present with altered mental status (AMS) or dementia, or they may be a poor historian or asleep when you try to visit them, and sometimes there is no family available to provide information. What are you going to do? (Hint: it has to do with resources). You have an entire care team who is also working with this patient that you can reach out to. Use the electronic medical record (EMR) to see what other clinicians are noticing about the patient. Find the patient’s nurse to gather crucial information: How have they been eating? Do they need assistance ordering meals? Have they really not had a BM for 7 days? Has the physician mentioned starting them on a diet soon?
Another practical way that I have worked together with other disciplines is when I need a new weight on a patient. Nurses are BUSY and are appreciative when you take the time to do this yourself (this is not always feasible- dietitians are busy, too!). I have located the equipment storage closets on my floors, grabbed a standing scale, wheeled it down the hallway to my patient’s room (look out everyone, this thing is heavy), and worked with nurses and/or PT if the patient needs help getting out of bed. When you take initiative to get something done, other staff members will more than likely help you out. This facilitates teamwork and collaboration with your coworkers, which will ultimately best serve your patients.
These are just a few examples of the many ways that you will learn to be resourceful in your future career as a dietitian. This not only applies to work in the clinical world, but also extends into the realms of community, management, and all the new and fun places RDs are going (corporate wellness, humanitarian organizations, or maybe professional sports, anyone?). I encourage you to be open to the idea of not always being able to get something done by yourself, or not always knowing the answer (sorry Type As). ALL dietitians are life-long learners, which keeps us knowledgeable but also humble and grounded in our work. I think one thing all dietitians know is how to roll up their sleeves and use their resources. I hope these on-the-ground insights about being a dietetics professional help you make the connection between classroom learning and real world practice and that they inspire you even more as you prepare to bridge the gap between student and practitioner in this exciting field of work.