My RD Journey

From Undergrad -> Internship -> RD -> Private Practice!


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Dietitian Interview Tips

Welcome back to My RD Journey! Things have been a bit crazy over here the past few weeks. I half expected my client load to decrease with the end of summer and beginning of the school year; yet, it is has been the opposite, which is good! I also got the opportunity to teach an in-person class at a local community college for this semester. It was super last minute as in I found out about it on Thursday, interviewed Friday, went to an in-service the following Monday and started teaching Wednesday. I didn’t have access to anything, just a textbook and role-book on my first day. I am now heading into week 4 of classes and I love it! I love being able to teach young minds about nutrition and I especially love that I have so much flexibility in how I teach the materials. Despite the craziness in my schedule, I love that I have the opportunity to teach and ultimately grow professionally. It is very gratifying!

I have been doing a lot of thinking lately about my business and the direction I want to move in. I have enough clients to bring on another Dietitian, yet, I am hesitant to do so since I would have to change up my business structure, figure payroll out, and whatnot. I know a few other RDs that do this; however, I am not sure if this is my ideal long-term business plan. I am also finishing up the editing for my first book and I definitely want to get it out for September. I have about 6 other book ideas fleshed out (some for RDs and some for public); however, I am just struggling to find time to write. I am at the point where I could just continue with my current load of clients and classes; however, a part of me wants to change it up. I also want to have more time to myself versus running around every day. I am wondering if teaching is something I will end up wanting to do more of long-term. Anyone else reach this turning point in their business? What did you do in moving forward?

Since I had recently interviewed for a college faculty position, I wanted to share some of the tips I gained. Whether you are a new RD looking for a job out of your internship or an RD that is debating switching careers, these tips will hopefully provide you with some insight.

(Dietitian) Interview Tips 

1 – Do Your Research
For almost every interview I had, I was asked the question, “Why did you choose ____(insert facility name here” or something along those lines. So, think to yourself, “Why are you interested in this facility or this position?” If you are just trying to get any job, spend a few minutes on the company’s website or Facebook page. Are there programs that they run that you think are great? What about their philosophy for wellness or patient care? Pinpoint some aspects of the facility that you could touch on in the interview.

2 – Bring the Essentials
For my interview, I brought in my resume, CV (which had more detailed information about my education), cover letter, list of 3-4 references, and some examples of my work. Even if the information was submitted already online or via email, I always bring hard copies with me. I have had interviewers put my copies in with my employee file or review with me during the interview. When thinking about bringing work examples, I tailor the materials towards the type of interview I am in. For example, with teaching I had sample lesson plans I wrote for high school students and adults. I normally wait to bring out my work samples until it comes up in conversation.

3 – Be Prepared
If you haven’t interviewed in a while (or ever), make sure you do some practicing with a friend or family member. Go through some of the most common interview questions like: what are your strengths and weaknesses or what is your teaching philosophy or why would you be a good fit for this position or how would you handle scenarios for conflict or working in teams. Trust in the education and experience that you have!

4 – Dress to Impress
I always say to fellow Dietitians and interns that it is better to dress up and be told to dress down than the opposite. Come to the interview in your best professional attire even if you know the position you are applying for involves wearing scrubs.

5 – Come with Questions
When you go in for an interview, you are also, in a sense, interviewing the facility/interviewer. Will this place be a good fit for you? Do they offer the benefits you need? Always come prepared with questions. The last thing you want to do is get into a job and realize it was not what you expected! Ask what a typical day looks like for the Dietitian. Ask about the interview process or training procedures. Don’t be afraid to come with a list of questions to ask. This also shows your organizational skills, that you prepared for the interview and you care about your role as a Dietitian.

Remember to just be yourself and trust in the experience that you have. Leave a comment and let me know your best interview tips!

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Life After the RD Exam

So what exactly happens after you are a RD/RDN? For one, you feel relieved and not sure what to do with all the free time you have (if you are not already tied to a full-time job). If you don’t have a full-time job, almost everyone you know will be asking you when you will be getting a job, if you already applied, and what your plan is.

After you pass, the CDR will contact you via email in a few days (took them 3 days for me). They will congratulate you and give you a bunch of information on using their online system (good email to bookmark). About 4 days after that, I received an email about the fees I would need to pay. If you don’t feel broke enough already, (after college, your internship and $200 for the test), you will after you see all the money you have to send to the CDR and your state. I had thought the $60 maintenance fee to the CDR for your registration card was a one time deal. I thought wrong! It’s $60 per year ($300 up front for the 5-year certification period) for them to maintain your portal for the CPE credits and what not. I will be posting another blog about how to set-up your learning plan (another complicated task that I was glad my internship had us practice prior!).

PA Licensure
Finding the licensure information for my state was very difficult! I didn’t realize that Dietitian-Nutritionists are listed under the State Board of Nursing (because that makes sense…not). Anyways, if you are in PA, follow the link below and find the link that says “Application for Dietitian-Nutritionist.” You will need to print, fill-out, and mail this form along with $45 to PA Board of Nursing. The form is pretty simple; however, you need to request verification of the registration letter from the CDR. I have a link below for that as well. It will ask for the email address of the person who needs it, in this case “st-nurse@state.pa.us,” which is at the top of the paper application. The CDR will then send an email with your letter. I also got a copy sent to myself, just to have it. Some states do not require their Dietitians to be licensed. If so, you have saved yourself $45.

2014-06-01 16.14.582014-06-02 14.46.30 One thing I definitely suggest you doing after you pass your test is go out, celebrate, and/or go on a vacation! You deserve it and it will give you a refreshed mind for when its time to set-up your learning plans, build your resume, and do some job searching. My vacation landed me right by the bay/beach. I love having this time to myself so I can do all the things I have been putting off (for studying purposes) like reading a good novel, painting, or just spending good quality time with my friends, family, and boyfriend 🙂

As always, good luck to those finishing up your internships or studying for the RD exam!

Links:
PA Licensure Application: http://www.dos.state.pa.us/portal/server.pt/community/state_board_of_nursing/12515/licensure_information/572048
Verification from CDR:
https://secure.eatright.org/cgi-bin/lansaweb?procfun+prweb28+p28fn01+prd+eng
Additional Information about Licensure:
https://www.cdrnet.org/state-licensure


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Tips for Passing the RD Exam

Well, the next chapter of my RD journey is complete! I am now a Registered Dietetic Nutritionist (RDN)! It feels good to know I can finally get rid of the hundreds of index cards I made over the past few months. Now that I have passed, I have been getting the questions of “How was it? How long did you study? Was it what you expected?” These are the same questions I asked everyone else who took it too 🙂 I must say, it doesn’t feel real just yet. In just 1.5 hours I went from an intern (who graduated) to RDN. Anyways, let me get into what you have been looking for to begin with.

How long should I study?
I took my exam about 6.5 weeks after I finished my internship. You want to aim for 1-2 months of study time (or so I heard and went with). The first week, I got things together to study. I made index cards, set up a study schedule, relaxed from my internship, etc. I used Jean Inman and RD in a Flash to study from (For more information on study materials: Studying for the RD Exam). The second/third/fourth week, I dedicated about 2 hours in the morning and 1-2 hours at night to studying. I would focus on a single domain each week (Week 2: food science, Week 3: Disease states and MNT, etc). The fifth week, I bumped up my studying to about 4 hours a day. I wouldn’t sit for that whole block though. I would study for an hour, take a break, get coffee, study, go to work, study, etc. I would usually spend at least an hour at a time (takes time to focus and get started). To be honest, there were days I just didn’t get a chance to study because of family events, work, or other things going on. It is good to give yourself a break every now and then.

The days leading up to my exam, I re-read all of Jean Inman. I also re-wrote my notes (re-writing things helps me to remember better). Four days before my exam, I was in panic mode thinking I should post-pone my test. I kept focusing on all of the things I didn’t know and getting frustrated. I was worried I would fail and have to wait the 45 days to re-test. I was rating my knowledge at about an 75-80% (Not from any specific math equation). After speaking with another intern, and current RD, I stuck with my test day. She reminded me how much I do know, and that I know more than I think (that last part is especially true). My boyfriend also reminded me that if I failed, it’s only a test. Yeah, it is a pretty big test; however, it is just one test! I just had to keep reminding myself that I knew a lot and it was okay if I didn’t pass (the world wasn’t going to end). The last 2 days before my exam, I spent time reviewing the answer keys to tests and focusing on the concepts I needed work on. I spent about 8 hours each day studying like crazy!

This was a schedule that worked best for me. It is important to find the best way for you to study. I heard of other interns only taking 3 weeks to study with 8-hour study days. I heard of other interns taking a 4-5 weeks to study with 3-hour study days. Again, it is all about how you study as to what schedule will work best.

What is the Exam like?
The day of the exam, my stomach was doing flip-flops. Everything is so formal and rigid when you go in to test! Throughout the exam, I kept thinking “I am definitely failing!” I found out that this is a pretty natural response. As I was answering questions, I was surprised at how much I studied and how little was actually on the test (only about 40%). I was happy to realize that all of the information I was worried about not knowing wasn’t even on the exam! There was one point where it took a couple of seconds for the screen to move to the next question. I remember thinking, “that’s it, I failed.” My heart sunk until I saw the next question. It is definitely hard not to panic when you are taking it. Just remember to keep calm and take it one question at a time. I thought it was funny that the night before I felt like there was so much I didn’t know and after leaving the exam I was surprised at how over-prepared I felt!

Best Tips for the Exam
1. Take deep breaths between each question. I found myself holding my breath because I was so nervous!
2. Read each question twice! I tend to go through things too fast and miss important parts of the question. My strategy was to read each question and answers twice, pick out the key points of the question, pick the best answer, and re-read the question to make sure I was picking what they were looking for.
3. A lot of the questions end up with 2 answers that seem to fit. At this point, re-read the question and pin-point what they are looking for.
4. Go with your first gut answer. Try not to over-analyze things too much. Remember, this is an entry-level test!
5. Be confident in what you know. As I said, only about 40% of what I studied was on the exam. Goes to show how much you really know from all the schooling and internship!
6. Bring tissues! Whether you pass or not, you will probably need them. When I left the testing center, I burst into tears of happiness.

Hopefully, this helps you as you begin to study for your exam! Best of luck to all those who are RD eligible!


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Studying for the RD Exam

This past Friday, I completed my dietetic internship! (35-weeks and many long drives later). Definitely a lot of pressure was lifted off of my shoulders, as I now only have 1 thing to focus on at this point—my RD exam. With many of the other interns finishing up at the same time, I have been noticing the same questions getting passed around: What are you using to study? How are you studying? Is product x better than product y? How long do I wait to take the exam? Based on other intern testimony (who have taken and passed the exam their 1st time) and the RDs throughout my internship, I have a good idea of how/what to study.

What are you using to study?
I have a copy of Inman’s Review of Dietetics ($385) with the 2014 CDs (compliments from another RD and intern in my rotations). Inmanis basically the go-to book for studying. It has everything you need in it and it is easy to follow. The CDs are great for listening in your car; however, be prepared for the voice you will soon despise. Inman also has a course for the RD exam (where she teaches for a weekend). I’ve heard mixed reactions on this. One RD said that it was a waste since she read from the book (but she is not a lecture-type learner). Another RD said that the course was great and worth going to (he was a lecture-type learner). I’d say if that is your style of learning and you don’t mind the price ($385), go for it.

I purchased, from another intern, the RD in a Flash Cards (over 630 index cards). If you are a notecard person, I definitely suggest this. They were great to grab a few and take with me during my internship when I had down time. I also got the opportunity to look throughHess and Hunt Review of Dietetics: Manual for the RD Exam ($100). It is very similar to Inman with a few extra charts and notes. I don’t think they have CDs, which could be a deal breaker for some.

How are you studying?
A few months before I finished my internship, I began making note cards from Inman. I find it easier to study by using notecards and rewriting my notes. By doing a little bit each night, I was able to transform the whole book into notecards by the end of my internship. For the disease states, I made charts listing the description and treatment/diet. I found this to be easier to study and reference while in my internship. Besides the notecards I made each night, I would try and read through some of my nutrition notes daily. It is kind of difficult to do while you are in your internship, so don’t stress too much on that. Also, you are learning so much from your rotation that you are “studying” as you go.

Now that I am finished, I made a study schedule for myself. Monday-Friday I study for 2 hours in the morning, hit the gym (to clear my head), and then block off 2 hours in the afternoon. I also set time to study on the weekend (2-4 hours depending on what is going on). I am not someone who can just sit for hours and hours, so I will take a 5-10 minute break during my study time. I’m finding this to be pretty manageable for me. Also, in making my schedule I noted which sections I would be studying each day/week. This kept me on task and prevented me from skipping anything.

How long do I wait to take the exam?
Generally, about 1-2 months is a good range for the RD exam. Based on the interns in my class who passed the exam, they took 1 month to study and passed the first time. You don’t want to go longer than 2 months because you don’t want to forget things you learned in the beginning of your internship.

Final Tips (Based from RDs in my rotations)
1. Don’t just focus on things you don’t know. Still focus on things you do know so you won’t forget those concepts.
2. Don’t spend too much time on one aspect. There is a lot to study from!
3. Don’t study the night before the exam.
4. Ask around and look online for past interns selling their materials.
5. You will feel like you are failing the entire time you take the exam. This is normal!

Hopefully, this helps you as you prepare for your exam!

Additional Links
RD Study outline from CDR
RD Study Exam


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Working with Eating Disorder Patients

I can finally see the light at the end of the tunnel as I finish my last 2 weeks of my dietetic internship! I can’t believe how fast the time went already! In my last leg of the internship, my outpatient rotation, I am in a facility with eating disorder patients (both inpatient and outpatient). The hospital also has a couple other wings with patients suffering from mood disorders (adolescents and adults), which I also get to work with occasionally for consults.

This is my first time working so closely with eating disorders (ED) and it was a bit overwhelming the first couple of days. I never realized how much time the RD spends counseling and how important it is. The patients see the RD 1x/week for a session; however, the RD ends up seeing and talking to some of them almost every day. The RD will walk onto the unit and patients start calling to talk to her about their weight, their meal plan, etc. It takes a lot of reassuring and challenging of eating disorder thoughts. Some of the patients will become so upset if you need to up their meal plan 200 calories due to not gaining weight or weight-loss that it is hard to calm them down. You have to be patient and understanding when giving news that they will not take lightly.

Some of the best lines I learned in counseling were, “How do you feel about what I said,” “Where do you think your weight is,” (They find out their weight 1x/week and that phrase is asked prior to them knowing) and after a patient says something so absurd “Reality check does eating an orange really make you fat.” You can’t be afraid to challenge an ED thought, you just need to know how to phrase it towards each person.

One of my biggest fears with ED is saying the wrong thing. I’m always thinking that I will say something that will trigger one of the them or make them upset. I learned that besides practicing, the key things you need to do are: be empathic, don’t downplay how they feel, always give praise when you can (for finishing a meal, etc), let the session be guided by the patient, ask “why they feel that way” when they have something to say about their body image or weight, and ask as much open-ended questions as you can.

There are also a ton of meetings every day with MDs, RNs, social workers, etc. The care team needs to really collaborate on the treatment plan, not only to aid the patient in recovery, but to provide a united front. Some of the patients are very sneaky and will lie to your face about purging or hiding food. It is really helpful to have team meetings to see if what the patient says, or doesn’t say, is consistent (they tend to slip up when they lie). Seeing the food rituals some of the patients have is crazy. Some of them tend to be very OCD (they have to have even numbers of foods or eat in a certain manner) and you can definitely tell when you observe their meal times.

Some of the comments/situations I heard this week that will show you how distorted some of the thoughts ED patients have are:
1. I am morbidly obese and I am concerned about breaking the chair. (Patient is underweight).
2. RD: “If your BMI is in that range, you will be considered emaciated”. Patient: “That’s okay with me.”
3. Scales don’t apply to me. (Patient stated after saying her family is genetically modified to need less food than everyone else),
4. Since I got my menstrual cycle, I know I gained too much weight. (In case your not familiar, patients with eating disorders tend to lose their cycle. Some patients have not had 1 in over 5 years).
5. I’m concerned with getting diabetes from eating all this food. (1600 calorie diet that is).
6. I don’t need to eat to live.
7. I don’t know why I am here. I am fine. I just purge after each meal and when I drink water.

If you every work with eating disorder patients, be prepared to hear comments like the ones above. Some of the ones I hear every day are centered on feeling fat or bloated and being disgusted with themselves. It seems silly to think about a 100lb person being fat; however, these patients truly believe that the distorted thoughts they have are in fact real. It definitely takes a lot of patience and empathy to work with EDs every day. While I love being in this rotation and learning so much so quickly, I can say that this is not the field of nutrition I would want to work in at all 🙂


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First Week of LTC

Today, I finished the first of my 2 weeks of long-term care! I can’t believe I am 4 weeks away from graduating from my internship. I’m at the point now where I am really starting to focus on studying for the RD exam (key word “starting”). So far, I have been making index cards from Inman’s Review to add to my stack of RD in a Flash cards. Since I have had such long commutes, I have been listening to the InmanCDs in the car on the way to my rotation. I just can’t stand her voice any longer after a whole day at my internship. Anyway, I feel like it’s been working well so far.

This week was an interesting experience. I went from being in my IPC facility where everything was computerized and organized to paper charting (huge binders for each patient) with utter chaos. Also, when you are in a hospital, you focus more on diet education and the occasional people not eating well. In the LTC facility, there are no educations! It is all about getting residents to eat, giving them supplements, checking weights, and doing wound assessments (and giving supplements to them as well). Did I mention it was very supplement based? Some patients are on diets, but it is much more liberalized than in an inpatient hospital. I mean if someone is 95 years old and wants some cake, she’ll get her cake…and eat it too.

One of the toughest things this week was getting used to another facility’s format. I felt like a chart-writing pro at my last facility. Now, I feel like I am starting from scratch with someone else’s preferences and their facility’s rules. I am very glad that I did my inpatient clinical rotation first because I feel like you are flying solo a lot more in LTC. Also, with paper charts, you have to sift through everything and find what is important (knowing medical terminology is helpful!).

I think my favorite story of the week happened when I was doing fluid restriction audits. I had the job of checking to make sure each patient on a fluid restriction had a palm tree picture outside their door and above their bed. As I went into one patient’s room, this was the conversation that occurred:
Me:  Hi, I am just checking to see if you have a palm tree on your wall.
Resident: What? (very hard of hearing)
Me: I am looking for a picture of a plant on your wall.
Resident: Oh, that isn’t on my wall, it’s in my bathroom.
(So, I just think this lady is crazy; but, proceed to check in the bathroom. There in her shower was a huge plant.)
Resident: See, I told you I had a plant.
Me: You sure do.
Resident: Now, will you get someone to hang it up for me already.

Lesson learned: Sometimes the residents aren’t as crazy as you think! Definitely my good laugh for the day.


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Final Days of Staff Relief

Tomorrow marks my final day of staff relief and my final day of my IPC rotation! I will be starting on Monday at my long term care facility.

My past 2 weeks of staff relief have been crazy, but really good. I started off feeling a bit overwhelmed; however, as time progressed, I became very comfortable out on my own. Although this rotation was stressful at times, I wouldn’t have changed a thing. The situations I was put in tested both my knowledge and my patience. Some days went very smoothly; however, other days I was ready to leave at 10am. It was the days that I was ready to leave at 10am that I now appreciate the most. Being able to accomplish what needs to get done on stressful days has made me a stronger dietetic intern than when I first started back in August.

One of the things I will miss the most being at my IPC facility, besides the free breakfast and lunch I got each day, is having another intern with me. I had interns that came during my last couple rotations; however, they would come after I was already there. Sure, we bonded, but I was never with them long enough to really get to know them. This rotation was the opposite. I started my first day with another intern so we got through that first scary day together. I could not have asked for a better person to spend my rotation with. Besides the fact that she had awesome notes and charts I could copy (and cookies to feed me), she was sweet and always there to listen and vent to (as I was able to do for her some days, haha). We shared stories about our internships, patients, boyfriends, and frustrating situations. I used to think it would be crazy to share my internship rotation with another intern; however, I think having that experience (and becoming so close) made it all the better. Now ends the sappy part of my blog 🙂

Although there were people and things I will miss now moving on to my next rotation, there are certainly things I could live without. This refers to my 1.5 hour drive each way to my rotation, the long drive being mixed with snow, the obnoxious amount of potholes on the roads I take, and the 2 sets of train tracks I seem to hit every other day on my drive home.

Some of my favorite, interesting, funny, not-so-funny patients of the week consisted of:
1. A patient who overdosed on 270 pills.
2. A patient with a BMI of 54.4 (also unemployed and adamant that they were fine in their diet <– my favorite part).
3. A patient who had uncontrolled diabetes who told the nurse that he felt short of breath at home, so he took some cocaine. This same patient told me he does not take his blood sugar at home because he gave his machine to a friend…sure.
4. A patient (came in as an overdose) who threatened to pull out his IV if he didn’t receive pain meds (the nurse told him he could sign himself out AMA if he wanted, and he became very quiet).
5. Seeing x-rays with a collapsed lung, fluid in lungs, and blood clots.
6. A patient (next door to the patient I was visiting) who was screaming that the nurses were trying to kill him.

Some things I found to be useful during my rotation were:
1. A sheet with lab values and what it means to be high and low.
2. A sheet with common diseases (cirrhosis, diabetes, cardiac, renal failure, pancreatitis, etc) and the accompanying diets (for the ones I wasn’t familiar with).
3. A sheet with TF formulas used in the facility.
4. A cheat sheet of when to use certain formulas (Nepro-renal, Glucerna-Diabetes, Isosource-low blood pressure).
5. Knowing that I needed to be confident in my recommendations for a diet!
**Don’t stress too much over not knowing things about clinical. I felt the same way going into my rotation; however, by my last few weeks, I felt like I knew so much and how to appropriately apply the information.

I’m excited to start the next part of my RD Journey. T minus 5 weeks until graduation!