I asked and you guys answered! Many of you were interested in hearing what a day in the life of a RD looks like. And let me tell you- every day is different. So obviously, I can only speak on clinical dietetics, since this is what I do. However, there are MANY other routes you can take in dietetics and each one provides vastly different experiences. Throughout my internship, I was able to experience several different areas of dietetics including community, private practice, sports nutrition, renal and Foodservice. Each one of these providing different job descriptions and the dietitians all had different personalities to fit! So if you are looking at going into dietetics, you do not have to be the typical stereotype type A individual.
I truly love this topic and am SO happy that you all are so interested in hearing about it, because I feel as if there is a lot of misunderstanding when it comes to dietetics. People often think that dietetics is solely providing meal plans and nutrition counseling and although in some instances this can be true, there is so much more that dietitians do.
So to give you an idea of my workplace- I work in a rehabilitation/long-term care center with ~160 beds. It also has an assisted living center, however we rarely provide nutrition counseling for them and we do not follow them clinically. Another dietitian and I split the building – she has the long-term care and I have the rehab side. So a lot of my patients may be ortho, however I also have a lot of patients with heart issues, diabetes and cancer, just to name a few.
The first thing I do when I go in, is look up all of my new patients. With my side being more rehab, I usually have between 2-8 new patients a day to see. I review their records from the hospital, including all of their diagnoses, recent labs, previous weights, speech therapy notes, PT/OT notes, medications (and if they have received IV fluids or IV dextrose as this is a HUGE reimbursement for centers) and get an overall picture of the patient and what they need from me. Then, I go and see them and either complete a MNA- mini nutritional assessment (65 and older) or a MST – malnutrition screening tool (<65 years old). We are required to write an admission note within 24 hours of admission, so I head back to the office and type those and add any interventions needed. I always try to take the food first approach- meaning that if a patient if over 75 and screens at risk for malnutrition or malnourished and they say that they have a decreased appetite or have lost weight over the last 3 months, I am going to liberalize their diet.
For example, if I had a 84 year old diabetic patient, who scored a 5 (malnourished) on the MNA and says they have had a moderate decrease in food intake and have lost ~15 pounds over the last 3 months- I would liberalize them to a Regular diet to promote adequate intakes. This is because the symptoms of hypoglycemia (low blood sugar) compared to hyperglycemia (high blood sugar) is much more severe. Such as, dizziness, lack of coordination (which can be very dangerous in the population we have) and even seizure or loss of consciousness.
*Note: Other food first approach interventions may include increasing portions, adding food preferences and fortifying foods.
After that, I begin to start my full assessments on the patients scheduled for that day. Usually this ranges between 3 to 6 full assessments a day (depending on how many admissions we had and what else pops up that day). Full assessments almost end up being a follow-up for all of the patients I saw on admission, however it is usually between 5-8 days after they admitted to the center, so I now have almost a week’s worth of weight trends, labs, food intakes and an overall idea of how they have been doing in the center. So I do an overview of their profiles and then go check in on them. This is when I would do any education such as, diabetes if they have elevated blood sugars, weight loss or gain, need for protein supplements if they have a wound, renal diets if they are on dialysis, etc. Then, I head back to the office and complete their full assessments, make any interventions needed and update their care plan. Interventions may include – the education I have provided, changing a diet, adding supplements or even just honoring a patient’s food preferences- to name a few.
We also have many meetings throughout the day – including meet and greets with new patient’s families, care plan meetings to go over what we have been doing for the patient and make any adjustments and then center meetings to ensure we are taking a whole interdisciplinary team approach in providing the best care for our patients.
We have monthly documentation requirements that include checking in on our patients who have tube feeding, are receiving dialysis, have wounds and any weight loss patients. This ensures that we continue following these patients throughout their stay and have interventions in to either aid in wound healing, promote adequate intakes or prevent continued weight loss and make sure that our patients are tolerating their tube feeding.
Our center’s physicians, nurse practitioners, therapy staff and nursing staff may also consult us any day if they have concerns about a patient losing weight, having poor intakes, worsening of wounds, high blood sugars, etc.
This is just a brief overview of what I do as a clinical dietitian on a daily basis. Obviously every day looks a bit different. Some days, I may be able to stick to the usual routine of seeing new admissions and then completing my assessments, but some I may give a bunch of educations- some I feel like I am forcing my patients to eat – and others I am adjusting every tube feeding in the building. (ha, not really- but it feels like it). Overall, being a clinical dietitian is a very rewarding job; I’ve seen the joy on a stroke patients’ face when they have been on tube feeding for months and are able take their first bite of food. I’ve seen patients beat cancer, gain their weight and strength back and go home with their families. And I’ve watched patients who have became bed bound and lost significant amounts of weight turn around from nutrition and therapy and watched them walk out of the front doors. It is an amazing feeling to be a part of someone’s journey and regardless of many others opinions on what a dietitian does, we can truly make a huge difference in someone’s life.
Like I said earlier, this is just a general “normal” day for me at work. If you guys are more interested in seeing my typical habits outside of work (i.e. agenda for getting up, working out, eating, etc) as well, let me know!
I hope this is what you all were looking for and if you guys have any other questions after reading this – please email me at firstname.lastname@example.org, comment your question or direct message me on insta @thedieteticdiaries. I would love to answer any or hear your feedback.