There are some common registered dietitian problems you’ll see all the time when you’re starting out in clinical nutrition. And how to solve them.
Common registered dietitian problems
There’s a lot of information to absorb when you’re starting out in clinical nutrition.
You spend years learning facts and science. You’re constantly quizzed on all the medical nutrition therapy tools needed for working with patients in clinical nutrition settings.
But when you’re finally thrown into the real world. It can be hard to connect everything you’re supposed to know with all the challenges that come up when you’re also managing personalities and people.
And a lot of these issues are not things you were tested on in school.
The three most common registered dietitian problems are:
- Dealing with doctors who don’t agree or don’t follow your recommendations
- Talking with patients who are non-compliant, not ready to change, disinterested
- Working with CNAs and nurses who are not team players
Each of these challenges requires a different type of conversation. Plus clarity on what you need to manage each of these issues successfully.
Let’s talk about how to handle each one.
Dealing with difficult doctors
The only thing harder than stating your case in front of a doctor and telling them they need to do something, is having that doctor challenge your recommendation. In public. In front of other people.
Working up the nerve to request something from your patient’s doctor is hard enough.
But when you’re worried that you’ll be asked questions you can’t answer or get a hard and cold-blooded refusal you can’t argue with. It can be a huge hit to self-confidence when you’re just starting out as a new RD.
Successfully talking to doctors, especially when they don’t agree with your recommendations, requires two essential things.
2 Essentials when talking to doctors
First, you need to have an exact reason you’re making a specific request.
Before you make a call to a doctor with a request for them to make a change in your patient’s care plan. You will have to be able to provide complete justification for that request.
You must be able to say:
- Why it’s important to change
- How you know it’s important to change
- Proof in the form of labs, patient statements, notable intake needs, recent weight changes, etc
Did you pick up that those three things essentially mirror a PES statement? Good, because they do. No matter if you’re using that fancy PES phrasing or lay terms. You need to be able to clearly articulate each of those items.
If you find yourself in a position where the doctor is pushing back and asking you “why” questions. You’re going to want to have all this information ready to go so you can answer their questions like the professional you are.
Second, have the confidence to know you’re their professional equal.
This doesn’t mean you know as much about medicine or medications as they do.
But it also (and equally) means they do not know as much about medical nutrition therapy as you do.
You and the doctor are both professionals tasked to support the same patient in different ways. You have a master’s degree in nutrition. Most doctors do not have more than a semester of nutrition education.
And for that reason (and that reason alone), you’re the registered dietitian who is in charge of specifically supporting their nutritional well-being.
Lean into all of that.
Registered Dietitian Problem #2: Talking with difficult patients
Not every patient you work with will want your help. The faster you learn this lesson, the more headaches you’ll save yourself.
This is especially true if you’re working in an acute care hospital environment. Hospitals are short-term care centers that deal with getting patients discharged as quickly as possible.
Because of this, many of your patients will be feeling exhausted, possibly in some kind of pain, or be a bit scared of what you’re going to tell them they have to do when you introduce yourself as a dietitian.
None of those feelings makes having difficult conversations about lifestyle change with patients who feel like crap, any easier.
So, how do you deal with this registered dietitian problem?
When you find yourself talking to a patient who’s not interested in making any changes, there are two things you can do.
- Gently explore the limits of their interest and give them what they’re interested in learning about.
- Realize they’re not ready to change, then let it go, and move on.
For those patients who are engaged in what you have to share and are ready to make some changes, give them what they’re looking for.
Go above and beyond. Make sure they have everything they need to meet the goals they’ve chosen to set for themselves. Be responsive and generous.
But when you hit a wall with a patient, often the best course of action is to simply let them not be ready yet.
Offer opportunities to revisit the conversation. Ask about what’s holding them back. Explore new ways to support them. And if none of it works, let it go and move on.
Even if the things they’re not ready to do include are significant. Like filling prescription orders or following life-changing dietary recommendations and diet orders provided while they’re admitted.
With the kind of limited time for each patient you have in clinical nutrition acute care settings, it’s often better to share the precious minutes you have with the patients who are most interested in making a change.
Remembering that it is not your job to force someone into either being ready to change or wanting to make the changes you know are valuable to their health is fundamental to being a dietitian who can get their job done.
Working with difficult RNs and CNAs
The health care team doesn’t begin and end with doctors.
Together, nurses and CNAs play an essential role in making sure your patient gets everything they need to be truly well taken care of during their stay.
Nurses are your patient’s primary caregivers. They manage all the daily medical tasks needed to support and sustain every patient’s overall health, while also preparing them to be discharged. RNs manage everything from medications, vital signs, IV lines, family issues, and everything in between.
CNAs (certified nursing assistants) are the primary line of support for the RN staff. They are not responsible for the medical side of cares. But CNAs are the ones who do the everyday dirty work and document all the little things that make everyone else’s jobs easier.
Some of the many things the CNAs are responsible for include: changing the sheets, bathing patients, helping patients to and from wherever they need to go, and supporting patients who need to be fed. And most notably, they’re usually responsible for weighing your patients.
So, what’s the registered dietitian problem you’ll see?
The problem most facilities face is a critical shortage of nurses and CNAs.
This means there’s often a backlog of patient cares that either doesn’t get completed or is not recorded efficiently.
For many, the golden rule of working in a hospital is if you don’t document it, it didn’t happen.
This means a lack of primary caregivers can dramatically change the way the rest of the healthcare team can obtain that information.
The big registered dietitian problem with this is the difficulty getting necessary information that much of your ability to do your job can hinge on.
For example, when you’re stuck without a weight on admission or a new weight status for a follow-up assessment, you’re going to have to track down a nurse or a CNA and request a weight until you get one.
It might take one ask. It might take a week.
But if you cannot do your job without recent weight, keep pushing until you get one. And if you can’t, document your efforts. Every time.
And That’s It!
These three issues are some of the most common registered dietitian problems that you’ll bump into over and over again.
Looking for a little more information on where to start in clinical nutrition?
Begin with the Acute Care Starter Guide. You’ll get your feet wet with a solid roadmap to clinical nutrition — and you can move forward with everything on this list as you need it.
Want even more to help in clinical?
Check out The Nutrition Cheat Sheets Shop for all the nutrition education and clinical resources that will make your life easier.
