Monday, October 8, 2012

A Day in the Life of a Clinical RD

Hi there!  I've seen other bloggers post "a day in the life" posts.  I thought creating a post of my own could give a little light into what it's like to be a clinical RD.  I've had grad school friends who are studying to be RD's and students who are interested in becoming RD's ask, so I figured why not give a little insight.  Dietetics is unique in that there are so many different areas to practice in - inpatient, outpatient, food service, long term care, community, corporate wellness... all of these containing numerous specialties within themselves, so if this isn't the area for you, it's not a big deal!

My particular position is unique in that I see both inpatients and outpatients - almost like the best of both worlds.  Obviously, every day is a little different and of course every hospital is a little bit different.  I work full-time and am lucky to have another part-time dietitian that works with me.  A lot of our days are crazy busy and I'm grateful to have someone else to bounce ideas off of and ask for advice. On any given day, we might see anywhere between 12-30 inpatients, along with outpatients, test trays and meetings.

One of the most challenging and rewarding aspects of my job is that I work with people who are often ill.  This is challenging in the fact that it can be heartbreaking - imagine talking to a patient and working with them and then finding out that they've passed away overnight.  Imagine reading in a patient's chart that they have cancer and then talking to them about their lack of appetite and realizing in your head that they haven't been told yet.  However, the rewards of my job are worth the brief moments of sadness.  Imagine having an outpatient come back to tell you that they've lost 40 lbs because of your help.  Imagine having an eating disorder patient tell you they never could have successfully gotten further down the path to recovery without you.  Imagine having a patient tell you that you brought sunshine into their room with your smile.

It takes a special kind of person to work in healthcare - you have to be kind, but resilient.  You have to be patient and understanding while simultaneously telling it how it is.  You have to set goals that work for the individual person and have to assess their readiness for change.  Then, if your an RD, there's the basis of anatomy, physiology and biochemistry.  I'm lucky that I found a career that I love so much.  And so now, here's a little bit more about my day.... 

7:30 - 9:00 am - Arrive at work.  On most days, I create a to-do list to organize my thoughts before the day gets started and log into my computer to check my work emails.  I print out the census which tells me all of the patients in the hospital, their room numbers and their primary diagnosis.  Next, I head to the cafeteria to grab a cup of hot tea and heat up my breakfast - usually oatmeal or an egg & cheese sandwich plus fruit.  When I get back to my desk, the next part of my day starts - screening.  In other words, I go through the list of patients to determine who we need to see for the day based upon their diagnosis.  Every hospital is a little different in their screening protocol, but a simple way to think of it is that we see the most complex patients the fastest.  We also receive consults from physicians/nurses and those patients move to the top of our list as well. 

9:00-11:30 am - Leave my office and head up to the floors - the Intensive Care Unit (ICU) is always first, although on days that there are two of us we split up ICU and the Rehab floor.  ICU patients often need nutrition support - either through IV nutrition (Total Parenteral Nutrition, TPN) or tube feeding (Enteral Nutrition, EN) - any dietitians out there know that we always prefer EN to TPN... but I won't make this post too technical.  If I was recommending a tube feeding for the patient, I would look at their past medical history, labs, diagnosis, whether or not they were mechanically ventilated etc. and then I would pick the formula that was most appropriate for the patient.  In basic terms, a formula is a liquid nutrition supplement - different formulas meet the needs of different patients based upon their ratio's of amino acids, carbohydrates, fat, vitamins and minerals.  On Rehab days, I'll see the patients on the floor and then I'll attend an interdisciplinary meeting - other disciplines will discuss the patients progress and I'll contribute where I think the patient is from a nutritional standpoint and how we can improve their nutritional plan of care. 

11:30-12:00 pm - Time to head back to my office for lunch time!  I always pack and then we eat our lunches in the cafeteria :)

12:00-1:30 pm - Back up to the office to pick up my binder.  Now, the medical floors are a little different.  Essentially, I do the same type of thing as I visit patients all afternoon.  However, on these floors the patients are often at a lower acuity level, meaning that providing dietary education here is often more appropriate than it would be in the ICU setting.  Other things I'm concerned about aside from education include weight loss, poor dietary intake, taste changes and problems chewing/swallowing.  Dietary education doesn't always mean "how to lose weight" as one might think - typically, it's more along the lines of "how to manage your chemotherapy symptoms," "how to follow a low sodium diet," "how to count carbs and manage your diabetes" and "how to eat higher calorie/higher protein snacks".  Honestly, the education that I give to inpatients is almost never about weight loss.

1:30 - 2:15 pm - Pack up my binder and head to interdisciplinary rounds.  The patients are discussed one at a time; I love rounds because they give me the opportunity to learn about patients that I need to see that may not have triggered in my earlier screening.  Things I might learn include extremely low or high BMI's, the presence of pressure ulcers or uncontrolled blood sugar. 

2:15-3:30 pm - Continue to see patients until I've finished everyone that I need to see for the day.

3:30-4:00 pm - Return to my office track how many patients have been seen for the day, schedule any outpatients, return any phone calls I've received throughout the day.  Clean up my desk and head home!

There you have it :)  Often, my days are also filled with things like meetings and outpatients, but if I had to describe a basic day then it would be this one :)

Any questions?