The Various Roles of an RD: Clincial Dietitian

As many of you know, I am currently in the middle of my Dietetic Internship (DI) which is the last step before I'll be certified to take the exam to become a Registered Dietitian (RD). Every DI across the country, whether based out of a college like the one that I got matched to or based out of hospital, has three elements to the rotations: clinical, community, and food service. Some DIs focus more on one particular element, but each program must incorporate each of those elements at some point. It's a great way not only to learn from many different preceptors and prepare us for the big exam that comes at the end, but also to see the varied roles that are out there for an RD once we pass the big exam! So I've decided that as I go through my internship and work with RDs in different settings I'll highlight that career path here. Hopefully this will give you a better picture of what an RD does and the various options available to someone in this field. Keep in mind that these descriptions are based on my experiences with people in these roles but the responsibilities are certainly different in different places.

Clinical Dietitian
A Clinical Dietitian works in a hospital with patients who are admitted as "in-patient" - this is different from someone who might work in a hospital with patients who schedule appointments to see him or her (that would be "out-patient").

At my clinical rotation a typical day for a clinical dietitian would look something like this:

First thing in the morning, print the sheets that tell us everyone who is currently admitted to the hospital including what date they were admitted and what their admitting diagnosis is. Based on their diagnosis, we then figure out when we need to see them. Basically if they are admitted for something nutrition related, we see them sooner. This prioritization is necessary because there isn't enough time to see everyone while they're in the hospital and it would not make sense for us to go see someone who has had hip surgery but has a normal appetite when someone who has stopped eating gets discharged before we have a chance to see them!

Based on their diagnosis, or if a nurse or doctor has requested that we see a patient, we now know who we need to see that day (each day's notes get carried over to the next day so that we can keep track of how many days a person has been here and when we need to see them based on the prioritization). Once you know who you'll be seeing that day you can start to do some research into their past: what is their medical history, have they had weight change recently, have the nurses been recording their appetite, etc. After the background has been researched we head to the floors where the patients' rooms are. We hope that the ones that we need to see are in their rooms and available though often they're off the floor for a test or busy with another medical professional. Once we do get in to see the patient we do our interview to gather information from the patient. Depending on their admitting diagnosis we ask questions such as: What is your normal weight? How is your appetite currently? Have you noticed your pants are feeling looser? Do you typically follow a diabetic/low salt/fat free diet at home? Would you be open to trying a supplement such as Ensure?

Once the interview is over we go off to type our note into their medical file. The note includes information from the interview as well as our nutrition diagnosis. The nutrition diagnosis is written as a PES statement: Problem, Etiology, Signs and Symptoms. Here is an example of a PES statement: Inadequate oral intake related to nausea and vomiting as evidenced by patient report of not eating for 5 days prior to admission. We then address what we're going to do about the nutrition diagnosis such as suggest supplements, educate them on the diabetic diet, etc and how we will monitor their progress (track lab values, weights, how much they're eating).

In addition to repeating that process for all of the patients on the list for that day there are also meetings such as interdisciplinary rounds to attend and patients on nutrition support to follow-up with (tube feeds or total parenteral nutrition).

There is even more that a clinical dietitian does in their day-to-day role in a hospital but hopefully this sheds some light on one very important role that an RD can play!