Category Archives: Uncategorized

RD? Check. Job? Check. What Now?

For the past nine months or so I have been enjoying my job as a clinical dietitian.  Although initially I felt pretty green as a new dietitian, my patients and coworkers have taught me so much!  I’m enjoying the work and feeling confident in what I do each day as I complete my assessments, respond to consults, and sign orders as an RD, LD.

Maybe it’s just because I’m straight out of school, but part of me feels a little restless.  I’m used to doing a million things at once in college or in my internship.  Having a predictable, steady job was my goal, and I am very happy. But as silly as this seems, I sort of feel like everything I’ve worked for has led up to this point, and now I need to set new goals for myself.

Admittedly, I’ve been keeping pretty busy with my involvement in the outpatient cardiac rehab at the medical center where I work.  In addition to my inpatient duties, I provide one-on-one nutritional counseling and will start teaching classes next month.  Also (thanks to web presence!) I have been doing some freelance writing.  Most recently I was contacted by an editor at Military.com‘s SpouseBuzz Blog for a guest entry.  I was really excited to contribute to a blog that reaches out to fellow military spouses!  My post was on healthy eating while your spouse is deployed –  read it here.

So what’s the next step?  Well…

bachelor's degree graduation

Currently contemplating: Am I ready to upgrade my Bachelors degree to an MS or MPH?

…I have started browsing through online graduate schools.  Honestly, I’m not sure what kind of program I want, such as a Masters in Public Health (MPH) versus a Masters in Science (MS).  Then, do I take the thesis option or the paper/coursework option?  Researching all the options has been, at times,  overwhelming.  I know I will need a 100% online graduate program, however, because my husband serves in the Army and we are required to move around.

But then I think…do I really want to take classes?  I mean really, it’s only been a year since I finished my internship.  Plus that means I’d have to study, take exams, write papers, and pay a LOT of money.  Is now the right time to do so?  We haven’t had any kids yet so that’s ideal, and the more I put it off the less likely I’ll be to actually do it.  However my husband’s job is making for big changes so maybe now isn’t the best time.  Is there a best time?  My internal debate rages on…

Has anyone out there completed online degrees in nutrition that would like to share their experience?  I’d love to hear your feedback about the program you chose and how it fit into your life!

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The Interdisciplinary Team: How an RD Fits

One of the things that drew me to become a Registered Dietitian was working directly with other people and helping patients live healthier lives.  Clinical nutrition wasn’t my dream career while I was still in college; I always thought clinical dietitians worked independently on their patients, who they only saw for a few minutes for assessment anyways.

After completing my clinical rotation, however, I quickly saw that I could still enjoy face-to-face contact with not only my patients, but also my co-workers.  I loved being part of the interdisciplinary medical team, going on rounds and discussing the patients’ plan of care.  It feels really good to contribute to someone’s recovery, especially in such a specialized field as nutrition.

Here are a few members of the medical team that I work with on a daily basis:

Nurses & CNAs: These individuals are my number one allies.  They are the ones that spend the most time with the patient.  They can see how well the patient is eating, if they have GI issues, or if they have wounds that require extra nutrition to heal.  They are also the ones administering tube feeds and checking residuals.  Additionally, they are much easier to get in touch with than the doctors, and can be a valuable advocate for my recommendations when the doctor does come around!  Every time I respond to a consult, finish an education, or drop off tube feed orders, I let the nurse of that patient know.  He or she starts to recognize and trust me.  In fact, I seem to get more consults and calls now that I have established professional relationships with the nurses on my floors, which is great!  (Plus it’s always nice to have people smiling and saying hello to you, instead of “who are you?”)  The only thing I’ve had to really push for them is at what residual level you need to stop a tube feed (ie please do not stop a 65 ml/hr tube feed when you get a residual of 40 ml! Check the nursing manual! This person needs their calories & protein to heal!) However I have the utmost respect for nurses and everything they do.  My own mother was a nurse!

Speech: Speech Language Pathologists aka Speech Therapists do not always teach people how to speak; they assess everything in the vicinity of the throat.  They are a dietitian’s best friend when it comes to determining patients’ ability to swallow.  This is mainly for older adults, those with a stroke, or certain other medical issues.  Sometimes I have to delay my nutritional assessment until Speech comes through with their recommendations; I can’t recommend extra protein or a particular diet order if the patient can’t even swallow! (And in that case, they’d probably need a tube feed.)  Also, they are the ones that recommend modified textured diets; for example, it is easier for people to swallow pureed foods and thickened liquids than dry foods and watery liquids.

PT/OT: Physical and Occupational Therapists are vital for anyone needing any sort of rehabilitation after an operation, trauma, stroke, etc.  Learning from PT that my patient on a continuous tube feed is ambulating in the hallways and doing exercise regularly tells me perhaps I should switch them to bolus feeds.  Learning from OT that my stroke patient can feed themselves with utensils tells me to monitor their meal intake closely now that they are eating without assistance.

Social Workers & Case Managers: When a patient cannot afford the food they need to keep them healthy after discharge, social workers can recommend food assistance programs, community meals, and other resources.  They can also coordinate home care, nursing home referrals, home tube feeds/TPN care, transportation for follow-up appointments, etc.  I’ve had to work with these individuals on several occasions to make sure the patients have a smooth transfer out of the facility in regards to supplements, education, and tube feed orders.

Doctors: In my experiences, the doctor has always needed to sign off my orders, so they have the ultimate say in what happens.  For the most part, they take the dietitian into consideration.  I especially enjoyed clinical rotations in teaching hospitals – students and interns were quick to listen and go with what the dietitian had to say.  On the other hand, some doctors are less receptive to the input of a dietitian, which any RD will tell you.   Also some doctors have crazy schedules that have them visit patients at 6 am or 8 pm, making them hard to get a hold of.

Throughout my internship and beyond, I’ve had to push my way through in a few patients – namely ones on total parenteral nutrition (TPN, which is basically a nutrition IV) – to give them optimal nutritional status (ie- if the gut works, use it!)*  What the doctor says goes, but I’ve had a few instances where I had to be pretty convincing in my charting, as well as verbally defend my recommendations.

*Going with this example, some people (nurses, patients/families, and doctors alike) think TPN is an easy fix if someone cannot eat by mouth.  However, it can be detrimental to use TPN if the person has sepsis (you’re pumping sugar straight into infected blood, feeding the bacteria!) or diabetes (you’re pumping sugar straight into diabetic blood, making it difficult to control blood sugars!).  Also the intestines actually function as part of the immune system, so by eliminating use of the gut, you may be decreasing their immunity.  Not to mention potential overgrowth of intestinal bacteria, sky-high healthcare costs associated with TPN, risks associated with placing a central line, etc.  Ok, enough with my TPN rant….

What I’m getting at is this: RDs are the nutrition experts, and we are a valuable asset to the medical team.  Working with these other professionals is extremely rewarding, and you can learn so much from everyone else.  At times you have to stand up for yourself, but you also have to step back and see the big picture.  Nutrition may not be as important as say, SURGERY.  Nutrition alone CANNOT FIX EVERYTHING.  And very importantly: you can’t make it personal if a doctor decides to ignore your advice.  That’s when the issue becomes about YOU and not the interest of the PATIENT.

The medical team, not to mention the patients, rely on us to convey cutting-edge, research-based nutritional interventions.  Contributing patient care recommendations in the specialized field of nutrition is interesting and rewarding.  It’s so gratifying when you can work together with the other disciplines for the patient’s benefit!

Life is Taking Me WHERE? Learning to Fit In

I grew up as a Coast Guard brat, moving around the country every few years. I ended up spending my entire high school years in Maryland, where I also ended up attending the University of Maryland, College Park as well as my dietetic internship.  Watching my mom deal with all the moves when I was growing up made me decide that I would never want to marry into the military life, and I loved Maryland.

Fast forward: in college I met an Army ROTC cadet who I ended up marrying during my internship in 2011.  (Guess you can’t really help who you fall in love with, right? And turns out he’s worth it to deal with the whole Army thing 🙂 )  And now, here I am, an Army wife who last summer had to relocate to a strange new place, leave all my friends and family behind, adjust to married life, and…oh yeah, pass the RD exam and start my career

El Paso Juarez Exit

Careful you don't take a wrong turn and end up in Juarez by accident!

Last summer I moved to El Paso, TX, which is a sprawling city (pop ~650,000) in west Texas that immediately borders Juarez, Mexico.  Before you jump to conclusions about what it’s like to border one of the most dangerous, “murder capitals” of the world, El Paso has recently been named one of the safest cities of over 500,000 people, which I can agree with.  Plus our neighbor has some WONDERFUL influences on us, not to be forgotten – Juarez contributes a lot of beautiful art, delicious cuisine, and citizens from both sides of the border are the friendliest population group I have ever been among.  Bordering Mexico does have challenges, however, such as a HUGE cultural shift from the East Coast, including the language, food, and lifestyle.

**Note: I really enjoy living here! Of course adjusting was difficult but El Paso really is a wonderful place.  I encourage anyone to visit before they judge it!**

I decided early on that finding a job working in clinical nutrition was probably my best bet in this locale:

  1. It would be a good experience to work in clinical right out of my internship to continue sharpening my skills in assessing, interviewing, educating, and intervening in a variety of patients and conditions.
  2. All the community nutrition jobs (primarily for low-income El Pasoans) required you know Spanish, and for good reason. Hospitals have staff that could help translate – I only know a small amount of conversational Spanish. (¡qué lástima!)
  3. Many organizations such as dialysis centers required at least 1 year of experience outside of the internship.  I had 0.
  4. Working for a national hospital company may benefit me in the long run by allowing me to relocate within their system as I need to move around with my husband.
  5. I like clinical!

My internship provided me with so many rotations in so many different places, and as a result that experience REALLY helped.  As I interviewed for jobs, I had a lot of insight on how various facilities can differ in terms of management style, workplace culture, RD job duties, and patient population.

I was thrilled when I found an RD position for a medical center nearby, working alongside a few other dietitians, only one of whom is Hispanic and Spanish-speaking.  Not to say it hasn’t had its challenges!

I’d say about half of my patients do not speak ANY English.  Some of them don’t even live in El Paso – they came from across the border.  I’ve learned that in my facility, asking nurses to help translate is the best option, if they’re available to help.  Most of the nurses are from around here and are fluent in Spanish.  One time I made the mistake of having a patients grandson help to translate what was supposed to be a brief, simple education, and boy was that a mess.  He didn’t understand what I was trying to say, so the patient ended up even more confused; I ended up having to wait for the nurse to come help anyways!  Plus the nurses are usually familiar with the educational content I provide, so they know exactly what I’m trying to say as well as how to explain it, unlike a family member.

Often times I also ask for assistance from the Spanish-speaking RD on staff, who has been extremely helpful!  She’s also helped teach me about common food items and other cultural differences in El Paso that I’m not used to.

Here’s my main point: My advice to any dietitians (or even nurses, doctors, or other healthcare workers) who must move to an unfamiliar place…immerse yourself in their culture, and find a local to enlighten you on how people live.  Joining the local dietetic association was also really helpful- you’ll meet RDs who have lived there forever.  I realize El Paso is a pretty extreme example, but the same advice applies.

The bottom line is if you don’t know your patient population, you can’t do your job well.  This is especially crucial when you’re dealing with their eating and lifestyle habits – I can’t tell a person of Mexican descent to stop eating tortillas, that would just be loco.  Number one rule of nutrition counseling is to work with the patient to make small changes to gradually lead to big improvements.  I need to know the baseline diet of the average person here in order to meet them on their level.  To do that, I’ve visited the grocery stores (including the Mexican markets), read the local paper for specials and restaurant reviews, explored menus, grilled my coworker who is a born and bred El Pasoan, and even sampled the local delicacy – Chico’s Tacos (the locals love it but I had a hard time stomaching it haha).

Chico's Tacos

El Paso fare - Chico's Tacos

It’s a whole different world than the one I came from, but it turns out I have adjusted pretty well and now I am really enjoying my time here.  Working as an RD in a foreign place is a challenge, but I know it’s making me a better dietitian in the long run!

If you have any tips on adjusting to different cultures in the nutrition or healthcare industry, please share them!

RD Web Presence – A Valuable Thing

I have always had a passion for social media and information technology, which is no surprise if you have followed my blog or know my background!  Communicating with the public online is something I really enjoy.

Having a website, blog, Twitter, LinkedIn, etc can be a lot of work to maintain (especially when you have a full-time job, too!)  however it can really pay off.  For example, I was contacted by a company called AD Medical, or America’s Dietitians, which is in Chicago.  One of their employees in the communications department stumbled upon my website and blog, and took the time to contact me directly.  He asked if I would be interested in writing a guest blog for his company’s brand new website.

Just some background – AD Medical works primarily with those on Medicare and with diabetes.  Their new website provides information for both clients and health care providers.  Their new blog, BlogAbetic, offers a more interactive feature for clients to learn tips on healthy living.

I was really excited to be featured as the first blogger featured on BlogAbetic after they debuted their brand-new website.  I definitely hope to work with them more in the future!

Check out my entry – Color Your Plate, Improve Your Health!

Having a website, blog, and various social media platforms have given me many other opportunities as well, such as career advice, notification of available jobs/volunteer work, and even an offer for free RD exam study materials!  Plus, when you apply to a job, all you have to do is refer them to your portfolio to find all the information they’d ever want.

It may seem like a lot of work to maintain a web presence, but don’t give up.  For example, my blog had very few views when I first started, but now I get more than I ever initially expected!

How has social media and web presence helped you in your career/education?

Revival Blog Post – Life as a New RD

Since my last post, I admit I’ve been a little confused on how to progress with this blog.  “Mission: Dietitian” was intended to outline my progress through the dietetic internship and becoming a Registered Dietitian.  Well…it’s over, I’m an RD, now what?

Over the past couple months I’ve been getting quite a bit of feedback from readers, mostly emails from future RDs/interns asking about my experiences and applications (I try to get back to people as best I can, apologies if my responses are delayed!)  Plus my blog views have risen exponentially since I wrote posts about studying for the RD exam and finding a job.  I’m so happy I can help fill the internet void that I encountered when I googled “tips for studying for RD exam”.

Bear with me while I make a few changes to the blog, such as changing my header (I haven’t been a dietetic intern for quite a while now!) and shifting the focus from becoming an RD to actually being a new RD.  Starting my full-time career has definitely kept me busy but I feel confident I can start blogging regularly once again.  I hope that my posts continue to inspire and help potential dietetic students, interns, and other new dietitians!

As always, I welcome your feedback, suggestions, and questions via comments on the blog.  Is there anything about becoming/being a dietitian you’d like me to write about in particular?

Mission: EMPLOYED Dietitian

I’m happy to report that I have officially started my career earlier this month as a clinical dietitian at Del Sol Medical Center in El Paso, TX, part of HCA Healthcare!Del Sol Medical Center

I moved down here early August and my main priority was preparing for the RD exam- but I still devoted quite a bit of time to job searching too.  There did not seem to be many RD jobs in the area; while El Paso is a large city, it is pretty isolated.  There’s not really any nearby towns or counties to look for a job, unlike where I used to live outside of Washington, DC.

Luckily, after about two months of active searching, I was offered a position at Del Sol, which has been fantastic.  I’m on a team with four other dietitians for the 350-bed hospital.  For now, I am overseeing telemetry (cardiac, mostly) and part of the surgical unit.  I’m thankful to have great coworkers who have been so helpful in training me!

Finding a job took time and energy, but it is possible!  Here are some tips I found helpful:

  • Utilize job search enginesIndeed is my favorite, and it’s how I found my current job! Consider nutritionjobs.com, CareerBuilder, DietianCentral, and foodandnutritionjobs.com.  I’m sure there are a ton more out there, but these helped me.  On some, you can even sign up for job alerts in your area.
  • Network!! I joined my local dietetic association, El Paso Dietetic Association, and brought my contact info.  When I made a connection I followed up with them shortly after.  Making a good impression to someone, who can pass on your name, could really come in handy.  Plus I met a ton of nice RDs in the area!
  • Do your research. Look up hospitals, community nutrition centers, and other places that employ RDs and search their websites for any job vacancies, or just contact them directly.  You never know!  Make sure to check government job listings for positions such as WIC dietitians or nutrition educators.
  • Consider telecommuting. Because I am pretty isolated, I opened myself up to an online position, such as a social networking manager, web content contributor, blogger, etc.  Craig’s List is surprisingly useful for this kind of job, as well as the LinkedIn job search; however I didn’t always see these types of jobs on the traditional job search engines.
  • Put yourself out there.  True story: a communications professional from a healthcare company on the other side of the country found THIS blog.  He then contacted me to potentially blog for their company!  I’ve also networked with RDs and healthcare professionals via Twitter, including an El Paso RD who invited me to join the El Paso Dietetic Association.
  • Use your resources. Ask your contacts if they know anyone in the city you plan to work, and if they can pass on your name and contact information.  Because I did my internship in the DC and Baltimore areas, I made a TON of contacts that may have been helpful in finding a job.  Moving across the country? Not so helpful…
  • Use ADA (Academy of Nutrition & Dietetics). Dietetic Practice Groups (found on eatright.org) and their listserves can seriously come in handy.  One of the other dietetic interns in my group knew I was moving to El Paso, and she received an email over the listserve advertising for a job out here.  She forwarded it to me, and although it didn’t turn out to be a job I was qualified for, I still made a contact with that person and kept in touch.
  • Don’t give up! I applied to jobs I wasn’t necessarily qualified for or didn’t think I stood a chance of getting.  I know I was turned down for one job because I didn’t speak Spanish, but it was still good practice, and I established more contacts.

**Also: if you are a new RD, don’t be discouraged by older RDs with masters degrees, etc.  Market yourself as enthusiastic, easily trained, and equipped with the latest nutritional knowledge.  Plus, you’re probably a lot cheaper to hire than a more decorated RD, so chin up!

It may not be a fun process, but when you land a job, it feels so great! Does anyone else have any job-finding tips they’d like to share?

Updated Website

Just a quick note: I transferred my website portfolio from the University of Maryland account (I was told it would expire soon).  Now you can find it at my own domain, at http://csvimini.com. Check it out, let me know what you think! 🙂