Building and then maintaining confidence in clinical nutrition is one of the hardest parts of being a dietitian. Let’s take a look at three of the most common issues that can destroy your confidence in clinical.
When to Do When Your Confidence in Clinical Nutrition is Destroyed
Building and then keeping your confidence high in clinical nutrition is a big part of feeling like you are the dietitian you want to be.
You’ve spent years learning the nuances of clinical nutrition. You can read a chart and immediately get a good idea of what someone needs to tackle in order to never come back and see you again.
You’re the nutrition professional. You’ve been trained to tell your patients what they need to be doing. And how that thing should be done.
But the fact is this: you’re going to make a mistake one day. You’re going to be unable to support your patient the way you think you should be able to. At some point, you’re going to feel like you failed your patient.
And when this happens, it can destroy your confidence.
The thing to remember, that you probably know but don’t feel is that mistakes don’t mean you’re a bad dietitian. Mistakes happen because you’re human.
This post is all about what to do when you’re stuck in this kind of self-sabotaging rut.
Three common questions that can rock your clinical nutrition confidence
Here are three common issues that can destroy your confidence in clinical nutrition:
- What to do when the most acute issue doesn’t match what your patient wants to do?
- What happens when we say the wrong thing to a patient?
- What happens when our patients don’t meet their goal?
So what does work?
In this post, we’ll be talking about what you can do to either avoid them or course correct when they happen.
Let’s get started.
#1: What happens when the most acute issue doesn’t match what your patient wants to do?
Picture this: your new admit has just been diagnosed with CHF. They’re excited to talk to you. But only about a keto diet.
They don’t want to talk about anything that sounds like the words salt or sodium. They are hyper focused on a keto diet plan so much that you would think they’re the nutrition professional in the room.
You know what MNT for the most acute nutritional issue tells you to do. And you know what your patient is (and is not) willing to do.
So, what do you do?
You give that grown adult what they’re asking for.
When you’re faced with an adult patient who’s adamant about the kind of support they want or do no want to receive you do three things:
First: you document, document, document.
You write down everything your patient is saying to you.
Take note of the recommendations you’ve provided, and the end result of that conversation in your nutrition assessment summary.
This is the justification you need to support why you’re going to do next.
Second: Check your righting reflex.
The righting reflex is that little voice inside your head that says you know better and because you know better, you need to make sure they know how wrong they are.
Your patient is the boss of themselves (unless they have a healthcare proxy), which means there’s nothing you CAN force them to do.
In addition, your job isn’t to implement your idea of healthy on those you treat — even when you know your ideas are scientifically and medically sound.
Your job as a dietitian is to support your patients in meeting their own health goals.
And grownups are allowed to make all the bad decisions they want to make.
Third: Liberalize, liberalize, liberalize.
Whatever that patient is pushing for, you give them.
But not until you’ve made sure you do everything you can to illustrate the urgency or medically necessity to do things differently.
Once you’ve offered options, provided perspective, shared relevant information and you’ve still reached a point of clear disinterest to do things differently with your patient, it’s time to move forward with adjusting your nutritional recommendations to support their personal goals.
This is patient-centered care in action.
It’s not easy to do. But it is essential to being a health-care professional.
#2: What happens if you say the wrong thing to a patient?
Picture this: you’re having a great conversation with a new patient. And as you finish making a really important point, you look up and realize that whatever you just said, your patient is NOT having any of it.
They’re mad. Or at least, they’re clearly not pleased with your valuable, professional insight.
Brace yourself for some truth: this is going to happen at some point. And it’s probably going to happen to you.
You’re going to put your foot in your mouth and say something that embarrasses either you or your patient. And if you’re really good at this, you’ll say the wrong thing that successfully embarrasses both of you at the same time.
Take a deep breath and know that some version of this will happen to everyone.
It’s impossible to know the impact of what we say on everyone we speak to. And the reality that we all might do unintentional harm at some point is hard to face.
There’s only one really good way of handling the situation.
You’ve got to put your ego aside.
This is not the time to get defensive or angry. It’s time to simply acknowledge what happened and ask your patient what a better approach would be next time.
They might be mad, but they also very likely want this situation to never happen again, just as much as you don’t want it to do it.
Your patients might even thank you for taking a moment and facing how they’re feeling head on, giving you one more in to win them over and help them trust you to be supportive in meeting their goals.
And if they don’t, that’s ok too.
But what you can always do is honestly document the interaction you have with them, and then limit your time interacting with that patient moving forward.
No matter how much you try your implicit biases, personal history, individual morals will always impact the way you provide care.
It’s really easy to get lost in our own “this is how it is” or “this is how it should be” mindset without ever realizing we’re doing it.
And that can happen at either end of the dietitian spectrum: RDs who tend towards conservative and restrictive and those who practice a much more liberal and flexible approach to nutrition.
This spectrum can swing between a narrative that there’s only one way to be healthy to a strong believe that there’s no one right answer to the question of what healthy can look like.
And just like dietitians have personal opinions about how to practice nutrition, our patients will have certain expectations about what kind of treatment they believe is appropriate to receive.
So, what do you do?
The only way to get better at limiting the chance at saying the wrong thing is to spend more time listening and asking questions than talking.
This might be:
- If you have information you think is useful, ask permission before giving it.
- Or if you have an opinion about something that’s mentioned, ask about their thoughts on the matter first.
- If you think your patient can do things better, ask what they think about their current actions instead of diving in and making that known.
This way of asking, listening, then asking a follow up question is a major part of motivational interviewing.
It’s not foolproof in making sure you never say the wrong thing. But it will help you reduce the chances of it happening and give you patient a lot more say over the kind of care you provide them.
#3: What happens when your patient doesn't meet a goal?
It’s so easy to let our confidence become tied to how successful our patients are.
But the truth is it’s not your job to make their goals a reality.
It’s your job to set your patients up for success and support them in achieving that success, in whatever way that looks to your patient.
You are here to make sure they have all the resources and information they need to use when they’re ready to start moving towards the goals they choose to set for themselves.
You’re a guide. You’re not a magician.
You don’t live with them. You aren’t grocery shopping or cooking for them. And you certainly aren’t standing over them, ready to slap away every rogue snack item that might find their way into their day.
And all that means is there’s nothing you can directly do to ensure they impact their health in a way that’s most beneficial to them. Or in the way they are most interested in changing their health.
So what do you do?
Ask yourself: who set this goal? Was it them or was it me?
If you realize you’ve been setting your patient’s goals on their behalf, this is a great place to start.
Just like it’s not your job to ensure your patient achieves their goals, it’s also not your job to decide what those goals are.
Your patient is in charge of their life, their health, and their choices. It’s up to them to decide on what things they’d like to change.
And a big problem that comes along with setting goals on behalf of your patients and then watching them fail at those same goals, is your confidence.
Not only does RD-led goal-setting ultimately let our patients down.
It can DESTROY your confidence as a dietitian when you see your patient is not meeting the well planned goals you’ve set for them.
Yes, you can make suggestions about what their change options are and the impact of doing (or not doing) those things.
And yes, you can brainstorm with your patient about how they can make those changes a reality, and come up with some ideas of goals that could be really useful in supporting that change.
Yes, you should be providing encouragement and cheerleading them to the finish line with support, resources, and useful ways to pivot their goals for continued success.
But it’s not your job to finalize any of those things.
Your patient does the choosing when it comes to all the changes they should make to their diet choices, their activity levels, their medical condition management.
And That’s It!
Even before finishing your dietetic internship, the idea of making a mistake can be really intimidating.
Wherever you are in your dietetics career, there will come a point when you’ll feel like you said the completely wrong thing. Or when you suddenly realize your patients are not doing any of the work discussed in your sessions. Or you make a mistake that changes the dynamic between you and your client.
But remember, you’re only human. And as you’re growing as a dietitian you’ll find new ways to move past the mistakes you’re bound to make.
Want even more to help in clinical?
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