job description

I am a registered clinical dietitian.

I work at Metropolitan State Hospital, which is a state-sponsored psychiatric treatment facility. I started there about four years ago.

As a clinical dietician, I am the one on staff in charge of nutritional assessment. I have around one hundred patients, and depending on their nutritional status, I make certain recommendations with the help of the nurses and doctors I work with. I make these decisions based on factors like the patient's possible high risk for diabetes, which are part of the patients' charts. The process of "charting," or making recommendations after reviewing the patient's history, is something I do every day. Sometimes, if the patient has a medical condition that may be diet-related, the doctors will send me on a diet consult, which allows me to check on the patient. The doctor and I can then exchange information about the medical condition of the patient, and from there, the doctor and I can jointly intervene in the patient's lifestyle, including diet. These interventions are things that can solve or alleviate the symptoms of a patient's medical conditions, as well as the complications that arise from them, like diabetes. My goal is to stabilize those patients' blood sugar levels to normal using changes in diet.

Because I work in a psych facility, my workplace isn't exactly normal. I do talk to my patients at the Metropolitan State like I would any other patients, but at any time, my patients may assault me, which has happened before. I was okay, of course, thanks to an alarm our hospital gives us a pen-like device that alerts the staff of any problems. And if a patient assaults any staff member, the staff member will not see that patient again.

Well, we have "treatment mall activities." Now in layman's terms, a "mall" is a place to shop and see stores. But in my hospital, those are activities that we do with the patients. It's like school staff members teach different kinds of things to the patients to make them happy, to engage their minds. In my case, I have a group called nutritional wellness. I hold group meetings twice a week about proper nutrition, the importance of diet, and healthy eating habits. Patients can order from the canteen and can get food from family, so I recommend healthy choices. I also have a section of the class devoted to exercise, which I encourage them to do every day for healthy living. There are patients that are compliant and non-compliant, but I can still provide them with nutritional education.

education & career path

It started in the Philippines, where I received my bachelor's degree in Food and Nutrition after four years of study. My diet therapy teacher in college then encouraged me to choose a specialty, so I choose Dietetics, which is the science of nutrition and its effect on human health. I spent a year interning in a hospital, which is like a residency program for doctors. When you go through an internship program like this, you really need to be on the job nonstop I lived in the hospital where I worked, in Manila. During internships, we were exposed to different areas of dietetics: food service, public health, and research.

The reason I came here to America was my profession. Right after graduation, I found out that dietetics was an open field in America, so I applied right away I started at the a hospital as a Tray Line Supervisor.

I was the one in charge of checking the individual trays that goes to all the patients in the hospital, be it regular or specialized diet trays. I had to know the constituents of regular meals and modified ones, and that was for about seven to eight hundred patients from the babies to the elderly.

I was the one checking all 700-800 trays. I did that for two hours for each meal. And at the same time, I managed the people in the tray line, who were employees with different responsibilities: for example, there were starters who started a conveyer belt system for assembly of each meal. There were different stops for hot food, condiments, silverware, entrees, and vegetables. I had a set of menus to choose from, which included a regular, diabetic, and other different kinds of diets. Usually there were about 10 kinds of diets, depending on condition. As soon as I was done with the tray line, I went to the units to make sure that each patient receives the right diet for their conditions in a timely manner. I followed up each meal. I had to do a lot of paperwork because I managed people as well; I checked also the sanitation of the employees. I saw to it that everyone was healthy as well.

I was exposed to all fields of dietetics and nutrition I even taught at a college in the Philippines for awhile; classes like Food, Science and Technology and Nutrition.

Eight years ago, I entered into state service, where I started in Corrections, which was too far from my family. I then worked in an institution for the developmentally disabled. The commute, again, was too far, and I ended up at Metropolitan.

my day

I start at 8:45 a.m. and continue until 5:00 p.m. I then check my mailbox to see if there are any new admissions, which are new patients, or diet changes for my existing patients. I have to see any new patients personally within five days. Then I go over to the nurse's station to start my day.

Mostly, I stay in the nurse's station, where I can look at charts of different patients. I can then perform different tasks of charting and nutritional assessment in there. However, I also go out into the hospital and meet with patients individually in different rooms of the hospital. Additionally, I do leave to go meet with different doctors in the hospital to discuss patients. Also, I travel between the three units I am assigned to in the hospital.

In order to complete a nutritional assessment, I first record the name, diet, and unit of the patient. I then check his vital signs, that is, his height, weight, and blood pressure. From this, I determine his weight status and compute nutritional requirements and whether or not their diet conforms to what they need. I basically determine whether the patient's diet fits his needs. I do this by checking the patient's diet history, food allergies, cultural/dietary preferences and current medications (to check if certain medicines could be causing or related to their condition). Also, I check for any possible food and drug interactions, as well as medical side effects in relation to nutrition. After that, I meet with the patient to provide him with nutrition education. I talk to him about food intake and I look at his compliance and response to his diet orders, which is the diet I prescribe. I ask him if he understands an individual order, and whether he is practicing that order. Finally, I observe any behavior towards the diet I prescribed.

Well, I have a patient with a liver problem. Her lab results were abnormal, so I met with her medical doctor to discuss the test results. After the meeting, I came up with a certain type of diet restricted in protein, and encouraged her doctor to emphasize a low protein diet to help her liver process foods correctly.

Depending upon my workload for the day, I sometimes choose to work through my break. I do take my breaks from time to time, but for the most part, my day is filled with work. From 1:00 to 5:00 p.m., I have meetings with the patients and doctors. I also teach a class called Nutritional Wellness to the patients twice a week, and I have to complete my nutritional assessments, which is on top of charting, patients' requests, and talks with the nurses and doctors.

Not really. I just do what I described to you.

salary & lifestyle

Well, the state doesn't offer much. The private sector offers more. The state has better retirement benefits, though. The only advantage to working for a private company is the slightly better salary. The private sector, for an entry-level position, would pay around $3700 to $4000 per month. Of course, depending upon your educational credentials, which can include a master's degree, that salary may be higher.

It would be decreased, so it would be around $3500, depending on tenure and the way our union works, of course. It's a union for county and state services: AFSCME, or the American Federation of State, Country, and Municipal Employees.

We went on strike about two or three months ago. I even picketed!

I am assigned to three units in the hospital, so I go between those three places.

Well, let me put it this way: the reasons I am in this profession go beyond my patients. My knowledge can help everyone. I consider my profession a practical profession. The basic necessity of manis food! Although I am a clinical dietitian, and I am supposed to be there for the patients, my friends, family, and even the doctors I work with also come up to me and ask, "Can you put me on a diet?"

It's a constant struggle. I am trying, of course. It's hard! When I am at work, I really try to focus my mind on the task at hand; I especially focus my actions into my high risk or more difficult patients. And when I am at home, I aim to forget my work. My full attention goes to my family. It's all about just trying your best in both realms.

Well, normally, I get two weeks a year. However, the more time you spend in the service of the state, you can get more. I normally save mine, though.

The most satisfying thing I have done with work was back in the Philippines, where I operated a feeding center in Zimbales, a poor mining community. We targeted the depressed area, where we got small children, about one to seven years of age, weighed them, determined their nutritional status, and put the ones suffering from malnutrition in the center along with their mother. We taught the mother proper food safety and sanitation, while the mothers served as the work force of the center. Our main concern was rehabilitating the children suffering from malnutrition to a state of normalcy. I have handled several feeding centers, but in Zimabales, we got about 90% of the targeted population to a state of normalcy.

pros, cons & trends

America is an affluent country. Though there is a lot of money in the country, there is also rampant malnutrition (bad nutrition), which comes from "overnutrition," or the overabundance of food and food choices. In the Philippines, the opposite, "undernutrition", or lack of food and food choices, is true. There will always be working room for dietetics and nutrition. People ask me for nutritional advice all the timefriends, family, and even the medical professionals at work.

Technology really advances our field the science of nutrition and dietetics is a continuing, constantly updating science. The older, more traditional, "accepted" recipes and menus are constantly changing, and have been analyzed again in order to give our patients the best nutritional therapy we can give, given their medical conditions. These kinds of updates will continue into the future as computers and science take closer looks into how what we eat affects our health.

There's a lot! It's a continuous, ongoing science because of the research being constantly conducted, especially nowadays in respect to cancer. In the old days, cancer wasn't such a big emphasis in research. Now, there are so many things about sickness being discovered all around the world. Our field is trying to respond to that continuously, because of that diversifying disease. So much research being done is aimed at alleviating that, or controlling it. Even I am affected in my everyday work: I am required to have continuing development units so I don't lag behind, and so I can better help our patients.

There will definitely be change in the future. There's so much potential for advancement. As I said before, the basic need of man is food. There are so many changes, and everyone has diverse needs. All the existing food production changes, and with that, the medical conditions will change along with that. Also, the advances in technology continue to arise. You never know we might return to old methods of cooking food. Now, we have TV dinners we still don't know the effect of this on our bodies. Even the effect of microwaves, bioengineered food (like imitation crabmeat) and preservatives may have unseen effects. There are just so many possibilities! We make these things and we just don't know what they will do in the long run. The profession itself will change as well just to meet the needs of the medical profession. Right now, the demand is nutrition. It will always mirror the time. Our field just responds.

advice

I wish I had more familiarity with computers. It's entirely different now.

You need to be capable of adapting to different kinds of personalities. All the patients can be so different.

That's right.

Those things are probably only about a quarter of what you need. More important, however, are people skills it's the majority of the job.

Yes. I interview people that apply to be diet technicians, who are basically dietician's assistants.

Of course, I first look at the background of the candidate. And at the same time, I look at the candidate's capability to cope with different kinds of patients. Of course, the candidate's personality is important.They need to understand that they should be a team player.

I don't normally look at the GPA. Of course, if they were able to finish a degree and they have internship training, and have undergone certification, I assume they are able to handle basic information. All I have to do, if they should have any additional experience, is examine three basic characteristics. Academic background is only a third of what I look at; past experience is another third. If I decide to hire the candidate, their progress in on-the-job learning, that is, ability to grow and learn once hired is the last third of what we look for. I see if they are capable of performing their job well.

First, they need to know which specialization interests them. Nutrition and dietetics is a really broad field. You can go into teaching, research, food service, hospital settings and even management. You need to analyze yourself where would you like to go? Through internships, you can expose yourself to different areas. So the moment you finish your internships and pass your certification test, you can know where you want to be.

Interpersonal skills are essential.

I am in one professional organization called UFANDA, or the United Filipino-American Nutritionists and Dietitians Association.

You need a college degree geared towards nutrition and dietetics, and at the same time, you must have your credentials evaluated in order to be placed into internship training at a hospital that offers that kind of program. And then, you will be evaluated again for RD (registered dietician) eligibility.

Diet therapy is really important coming from the standpoint of a clinical dietician. My specific field really depends on diet therapy.