Tag Archives: dietetic internship

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!

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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?

My Very First FNCE: Overview

At FNCE 2011

With another former UMD Intern and the Laughing Cow in the FNCE Expo Hall

Earlier this week, I returned from a whirlwind weekend in San Diego.  Thousands of dietitians, including many of the movers-and-shakers in the nutrition field, gathered in one place for the American Dietetic Association’s annual Food and Nutrition Conference and Expo (ADA FNCE).  Luckily for us, it was in beautiful Southern California!  I was born in Long Beach, and my parents met and married in the area, so we used to go back and visit there often.  I hadn’t been in years so it was great to be back, especially for my first FNCE.

I was so excited to be reunited with three of my fellow dietetic interns, my internship director, and several of my preceptors.  I quickly found out this is half the appeal for those going to FNCE- reuniting with old friends and colleagues!

Back in my internship, I had submitted an abstract to FNCE about a project I did at CNPP, which was accepted, meaning I was to prepare a poster presentation.  Then, last month, I was informed that my abstract scored high enough to also qualify for an E-poster, or a powerpoint presentation that was available at kiosks in the conference center.  Furthermore, I was standing by my poster during the session on Sunday and some women came by and said they were judges for an award, and my poster was being considered!  I was so surprised and delighted that a little project I worked on as an intern gathered so much interest.

See for yourself: (unfortunately I had to submit them RIGHT before I took the RD exam so my credentials are not listed!)

FNCE was such a great experience: I attended educational sessions, met a ton of other RDs at networking events, had a lot of fun exploring the Expo, and enjoyed learning more about new developments in the nutrition world.  I must admit, my bags were significantly heavier going home after getting a ton of freebies in the Expo hall.

I was not employed at the time I signed up for FNCE, so I paid my own way.  However, I have no regrets- it was definitely worth the money.  I came away so inspired from it all.  The sessions were really educational as well!

Did you/would you go to FNCE?  Why or why not?

Studying for the RD Exam? Here’s Some Tips

RD Exam Studying

My study dungeon!

I was determined to take the RD exam ONE time in my life and then move on with my career.  When I googled “RD Exam Study Tips” I got horror stories on forums where certain people had taken the exam multiple times and couldn’t pass.  It was a little unsettling, yet motivating- this is a test you have to take seriously.
Disclaimer: this is just what worked for me! I offer no guarantees! 🙂

I used Jean Inman’s review – not the seminar, just the CDs and written course – as well as RD-in-a-Flash Flashcards.  I studied passively for a few weeks (just every now and then, scanning over things) then set up a schedule to get through the Inman CDs and the corresponding notes, domain by domain.  The Inman materials were definitely most helpful in reviewing everything that could be on the test.  Having the audio helped keep me focused, although I had to pause and take notes quite frequently.  Plus, there are a TON of practice questions for each domain to go through.  I made up my own outlines, charts, etc, then brought the flashcards with me when I wanted to study on the go.

If you are prepping to take the RD exam I highly suggest you sign up for weekly video tutorialsdaily practice questions, and weekly questions.  You can even sign up for the daily and weekly questions way ahead of time and just save them in your email box and look at them when you’re ready to study. (The videos do expire after the week they are released).

Another good resource is a study guide from the American Dietetic Association (ADA).  It costs $35 but is less money than other sources.  It also has a CD-Rom test that mimics the actual format of the exam.

RDStudy.com seems like a helpful resource as well.  I didn’t end up using it, as I already had the Inman review and this service costs additional money, but their free video tutorials were so helpful I can imagine the rest of their tools are too.  It appears that they have practice exams, in-depth tutorials, and even an RD on staff to answer questions.

The following are more resources I found helpful:

I hope any aspiring dietitians out there find this helpful!  For those of you who recently took the test, what materials worked for you? 

Mission: Dietitian SUCCESS

Registered DietitianI am happy to report that after years of developing my career goals, 5 years of intense education, and months of studying, I have taken the Commission on Dietetic Registration (CDR) RD-exam and passed, making me a Registered Dietitian at last!!

The test itself was a challenge, I thought.  It didn’t help that the testing center had a few problems, delaying my start about 30 minutes while they had to make some phone calls to get it running.  I was sitting there, feeling my blood pressure skyrocket- I was so scared that they’d come out and tell me to come back another day.  I just wanted to get it over with finally!  At that point I was just excited to take the test and move on with my life!

There was a quick video tutorial that kind of brought me back down to reality before the actual questions started.  It was nice to get a quick overview of the system and definitely helped me refocus before the test.  Then I began!

There is a minimum of 125 multiple choice questions, and a maximum of 145.  If you’re definitely going to pass or fail at 125 I believe they cut you off, however if there’s a chance you could pass with more questions, they will extend it.  As I pressed submit at question 125, I held my breath.

Then the screen went blank, and I was taken to a survey.  I hardly read the survey however because I wanted to get to my results!  Thankfully I passed- my score was over the required “25” with some room to spare (still not sure how they really calculate that). I got a good mix of foodservice/management as well as nutritional sciences/clinical.  I felt like I was guessing on quite a bit of questions, but I suppose my clinical and managerial judgement was good!  The review materials and practice questions I had definitely came in handy.  My next post will be about what I used to study and prepare for the RD exam.

Please let me know if you have any questions about what the exam was like, or if you have anything to add about the testing experience!

Dietetic Internship Graduation

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It’s official: I have graduated from my internship!  I apologize that it’s taken some time to update my blog, but I have good reason for the delay!  Right after graduation I had to tie up a bunch of loose ends, pack up all my possessions, and drive across the country from Annapolis, MD to El Paso, TX.

Now that I am getting all settled in my new home, I am prepping for potential interviews and beginning to study for the RD exam.  Any advice from RDs who recently took the exam is much appreciated!

All in all this internship was a great experience to enhance me personally and professionally.  It exposed me to all different areas in dietetics.  Although my short term goals might be more traditional (most likely a clinical inpatient or outpatient position), I plan to use my IT skills gained in my internship to maintain a website and social media platforms.  Some of my long term goals include going back to school, community work, writing, and ideally some involvement in policy and legislation.  Without the exposure from this particular internship, I am not sure I would be aware of all of my options!

Thank you for following my blog- although the internship is over, I will continue to provide updates until I am finally a Registered Dietitian!