School taught you how to understand scientific papers. Your dietetic internship teaches you how to complete assessments and check all the right boxes. But who teaches you how to think like a registered dietician? Keep reading for some first steps.
How to Think Like a Registered Dietician
Picture this:
You’re suddenly dropped into the ICU for a high-risk consult. You learn that your patient, admitted for a heart condition, is suddenly dealing with renal dysfunction. You stop by the ICU and the doctor tells you your patient is about to be intubated.
Your first thought is they look way too thin.
You do the math and realize they’ve lost a significant amount of weight since the last time they were in the hospital.
After digging through their chart a bit more, you learn they’ve also been recently diagnosed with diabetes. And when you compare the labs taken at their last admission, you notice their A1C is starting to creep up.
This is a lot.
A severe heart condition and acute kidney failure in a patient at high risk for malnutrition, and progressing diabetes. All of that sounds important.
But most “high-risk” patients who need nutrition support while in the hospital are not admitted for just one thing.
And with 6 out of 10 adults having at least one chronic disease, we deal with complex patient cases in clinical nutrition every day.
Untangling this complexity can be one of the hardest things to figure out when we’re just getting comfortable in the clinical setting.
It’s easy to start worrying about:
- Where are you supposed to start?
- Did you miss something you should be worrying about?
- How do you even know what you don’t know?
These are big questions.
As the clinical dietitian, it’s your job to figure out which of your patient’s chronic diseases are nutritionally relevant. And then decide which of those must be dealt with immediately.
Most of us don’t learn this in school.
At least not like this.
How to (actually) start to think like a registered dietitian
Being a dietitian is about one thing only: how to provide the nutritional support your patient needs so they can get better, heal faster, and (in acute care) get discharged as quickly as possible.
And to do that, you’ve got to be able to three things really well:
- Look at each patient as an individual
- Be able to articulate your interventions in a way that makes sense
- Adjust those interventions as the needs arise.
Some of these (or all of them) might sound obvious.
But it’s easy to start feeling overwhelmed with what you need to figure out, what you think you’re supposed to do, and how exactly to prioritize getting those things done.
Let’s take a look at each of these and talk about how you can start using them in your every day.
#1: Look at each patient as an individual
When we’re in school, we usually learn nutrition as a single condition.
Someone has diabetes, you give them a Carbohydrate Controlled Diet.
Someone else had a heart attack, you give them a Cardiac Diet.
But most of the time, our patients are not this simple. Which is why we need to start to think like a registered dietitian.
In order to be able to figure out if the pressure ulcer is more important than the CKD, you’ve got to determine which is the most acute nutritional issue.
And the answer to this question requires you to recognize that every patient you see will require something a little different in their nutritional intervention.
What separates your patients and makes them individuals? Things like:
- Weight status
- Labs
- Ability for adequate PO intake
If you take three patients who each have CKD and pressure ulcers, these three things can dramatically change the way you decide to manage their care.
Of course, this isn’t a complete list of what you should be looking at. But they are the highlights of every nutrition assessment you’ll write.
It’s also why it’s so important to remember that nutrition operates on a continuum.
We have recommended ranges for things like protein intake and energy needs because the flexibility for thinking through your patient care – and then making decisions based on their personal needs – is crucial to providing the best possible care.
#2: Be able to articulate your interventions
This one is huge.
It’s essential to being able to write effective nutrition notes, talk to MDs and explain yourself to patients.
If you aren’t able to say what you’re doing and WHY you’re doing it, you’re going to have a very hard time writing your notes.
This means both your PES statements and your nutrition assessments with interventions attached.
Get comfortable articulating and then writing out your thought process in a clear and precise way.
This doesn’t mean you need to be writing dissertations, lengthy paragraphs, or even grammatically correct sentences. It does mean you need to be able to quickly think through and clearly explain, why you’re doing what you’re doing.
You’re going to do this every single time you make an MNT decision.
Part of being able to think like a registered dietitian is being able to explain yourself like one.
And speaking like an RD means talking to doctors and patients about your recommendations to improve their health.
This is an essential skill to have — no matter the kind of clinical work you end up doing as an RD.
When you have the confidence to clearly state your recommendations to the care team, your patients will get faster and more accurate care.
#3: Adjust when needed
The way you think about what your patients need and the types of nutritional support you want to provide them will likely change a lot over the course you’re caring for them.
Why?
Because you’re going to get new information, see changes in medical cares, and have new conversations with your patients.
And when things with your patients change, their nutritional support needs will often also shift.
What this means is although you’ve settled on one set of interventions based on what you thought was more important yesterday, you might still need to change everything tomorrow.
And being able to think through these changes and make the kinds of adjustments that will best serve your patients, is crucial.
Don’t fall into the trap of thinking once you make one decision, you’re stuck with it.
If you see your patient change, improve, or even decline you ARE allowed (and are even expected) to make adjustments to your interventions.
There’s no limit to how many you make or when you’re allow to make them.
The only requirement is you ALWAYS say why you’re doing what you’re doing. You should be justifying your recommendations, every single time you make one.
When should you feel confident as you think like a registered dietitian?
Today. Right now.
School for dietetics is tough. Getting into a dietetic internship is really hard. The RD exam is a total nightmare.
Every dietitian knows the level of training that goes into getting those two little letters after their name.
Remember that you are the health care professionals with the training to provide accurate MNT.
Don’t let doctors intimidate you out of making or changing the recommendations you know are most needed for your patients.
Most MDs are not nutrition experts. Especially residents who are just starting their medical careers in internal medicine rotations.
No matter how confident they might sound. You know more about nutrition.
And the more patients you see, the easier it will be to implement these three parts to thinking like a dietitian.
You’ll start making personalized recommendations, quickly writing nutrition assessments, and then seeing where to adjust your patient care before anyone else does before you know it.
Just take your time. Take a few deep breaths. Then dive in.
You got this.
And That’s It!
Start with these basic concepts, and you’ll be thinking like an RD sooner than you think.
If you feel like you’ve got to start one place, make it 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.
