Tag Archives: dietetics

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!

Livin La Vida DaVita

We are in the home stretch…I am currently in my final rotation: Riderwood for Food Service!! Before I started Riderwood this past week, I spent time at a couple DaVita clinics, where patients receive hemodialysis treatments (and occasionally some peritoneal dialysis patients come in too). The dietitians are so well respected there because nutrition has such an important impact on dialysis patients’ health.

hello kidney

The thing I love about renal nutrition is the complexity of it. Phosphorous, protein (albumin), calcium, iron, vitamin D, parathyroid hormone (PTH), potassium, and sodium must be carefully monitored, and they often have an effect on each other. Because the kidney’s don’t work correctly, they cannot regulate these levels (such as getting rid of excess electrolytes in urine, or protein being taken out of the body during dialysis) like a healthy person can. This can be very dangerous! And at DaVita, dietitians work directly with correcting lab values through proper diet and even medication.  Another great thing about working in dialysis?  You get a clinical point of view, but develop long-term relationships with your patients.  Getting to know the people I’m helping and seeing them improve over time would be so rewarding!

My partner Ala and I handed out samples of a protein drink and discussed the importance of adequate protein and albumin levels. We also conducted a few individual assessments and went over lab value “report cards” with patients during their treatments. Our preceptor Leah was very helpful in explaining all the ins and outs (pun intended 😉 ) of dialysis and its nutritional concerns.

For more information about all things kidney, see the National Kidney Foundation and DaVita webpages.

CNPP, in Photos

At the “Center” of it all

Interning at the Center for Nutrition Policy and Promotion (CNPP) is going great, I’m really enjoying it (especially because it is so timely!) With my background at the Food and Nutrition Information Center (FNIC), I already knew that I really enjoy consumer education and web-based nutrition communication.

However, I also love the whole nutrition policy part of USDA.  To think that you could influence the way America learns about healthy eating is really great.  I told my preceptor: it will be so cool in the coming years, no matter what I do as a Registered Dietitian, the Dietary Guidelines and Food Guide Pyramid will always be a large part of dietetics.  So a couple years from now, I can look back and see how some of my work has helped- even with my little five week rotation.  Speaking of, the past three and a half weeks has flown by.  I can’t believe next week is our last!  Then, I’m back to community nutrition, interning at Moveable Feast in Baltimore, MD.

Until then, I’m working on my abstract and poster presentation for the Maryland Dietetic Association, and I’ve already started preparing for the RD exam a little bit.  I know…it’s four months away…but I don’t want to forget anything I learned in clinical at the beginning of the internship!

Getting into the Swing of Things

It’s nearing the end of the second week and I’m learning so much!  Yesterday I performed a diet history with a diabetes patient, and today I did two more.  We do this to measure how much they adhere to their prescribed diabetic diet and monitor their blood sugars, use insulin, etc.  Using that information, we are better able to make a recommendation on how to improve their health outcome.  I was a little nervous at first, but I’m gradually getting a little more comfortable with interviewing patients.

Today I was also able to write two patient notes and enter them into the complex computer system that the hospital has.  Unlike where I used to volunteer,  this hospital doesn’t write standard notes; they enter data into a sort of database that generates a note for them!  It’s extremely efficient if you know what you are doing…which is what I’m working on for now!  It takes a while to get used to, but I’m sort of getting the hang of it.  Practice makes perfect, right?

There are many parts to a nutrition note: assessment, diagnosis, intervention, and monitoring/evaluation.  My job is to scour the doctors’ and nurses’ notes for relevant information such as height, weight, general appearance, diagnosis, past medical history, and medications.  Then, I go and speak to the patients about their habits.  Next, I make a nutrition diagnosis using the American Dietetic Association standardized language, which for now I have to look up in a book until I become more familiar with it.  It goes: “(problem) related to (etiology) as evidenced by (signs/symptoms).”  Then I decide what intervention needs to be done, such as their caloric and protein needs, and which kind of hospital diet they should be assigned.  Last, I set goals and describe how to monitor them.

It took my whole day to do two patients; by the end of the rotation I’ll be able to do 5-6 complex patients per day!  Although we’ve been focusing a lot on diabetes, soon we’ll change the focus to oncology, then to cardiology.

First Up: Clinical

I have jumped headfirst into the internship with the seemingly busiest, most demanding rotation first: clinical.  In this internship, we have a partner that we do rotations with.  However, the clinical portion is individual, so it’s a bit intimidating!

I am so grateful that I had a lot of volunteer experience at George Washington University Hospital in DC.  I remember how terrifying it was to just walk into a patient’s room and speak to them at first!  I was fortunate enough  to be able to shadow some of the dietitians there as well, which has made the start of clinical just a tad easier.  At least it’s not all brand new!

So far, I have become oriented to the hospital and shadowed my preceptor doing the normal tasks of a clinical dietitian such as writing tube feedings, visiting with a couple patients, and working with the nurses and other hospital staff.  Next week, I will become more involved in the daily duties of a dietitian.  I also have homework to work on, both for clinical assignments and to begin building my electronic portfolio!

For now, I will enjoy the long weekend 🙂 Happy Labor Day!

Not Your Average Internship

Match for Internship

The Greatest Relief EVER!

For those of you not in the field of nutrition, you may be wondering why I am blogging about a silly little internship.  So I can share stories of getting coffee for the boss? Doing menial tasks to assist the real workers? Silently suffering at the bottom of the ladder in the hope of one day being hired?

While I’m sure that would be a thrilling blog to read, this is NOT that kind of internship.  Instead, I like to think of it as nursing school, but for dietitians.  A college degree is required, and completion of an internship is necessary to obtain the coveted “RD” (Registered Dietitian) credentials behind my name so I can get a job.  It’s sort of a graduate program that you pay for, but you don’t earn graduate credit.  Basically, I am in career limbo.

My dietetic internship has a ton of different rotations and sites that I will be blogging about.  For example, I’ll be working at a local hospital for my clinical rotation, Riderwood Village and UMD Dining Services for my foodservice rotations, Food & Friends and School Lunch for my community rotations, and IFIC (International Food Information Center) and CNPP (Center for Nutrition Policy and Promotion) for my information technology rotations.  My internship director explained this process as “A 10.5 month job interview.” All the rotations will definitely help me pinpoint where I would like to go in my career, and who knows, maybe a job will come out of it as well!

Getting here wasn’t necessarily simple.  For each internship I applied to, I had to write a slightly different essay, fill out lengthy forms, and solicit three letters of recommendation from my work supervisors and professors.  The various internships I applied to had different requirements and different due dates; this caused me many afternoons of stressing out at the post office, triple-checking to make sure I had everything in order for an overnight, traceable delivery (I couldn’t risk my applications getting lost in the mail!)

After that, there was a long period of waiting: first for an invitation for an interview, and eventually for match day.  Match day was the day that we found out 1) If we got an internship 2) which one we got.  No, we weren’t offered admission from different programs and then got to choose; instead, we had to rank the internships, they ranked us, and we were matched by a computer system.  Sound stressful? It was.  Of course, the <50% acceptance rate to dietetic internships didn’t help with the anxiety.

Fortunately, on that fateful day, I was matched to the UMD internship, and here I am!  I loved the variety of rotations within the program and its focus on nutrition communications and information technology.  I could not be more excited to get started!  First up: clinical rotations!