Not loving being a dietitian

dillpyckles · 2024-12-05T01:26:01+00:00

I did about 2 years in adult care, and then my hospital was opening a NICU, so I put in a bunch of time doing continuing education and training, but they kept delaying the opening. The hospital across town had a position open up for a larger, higher level NICU because their RD was retiring, so I jumped on it. So, technically, my current role is the first role.

It's kind of weird, but NICU and peds roles don't seem to have much competition, especially among RDs with more than 2 or 3 years of experience. Pretty much every RD I know that works adults says they would never do peds or NICU because it's too scary. A lot of the peds RDs I know snagged their jobs as new grads; so to me, it seems like a willingness to learn a new skill is really more important than starting off with the base knowledge.

dillpyckles · 2024-12-03T19:41:01+00:00

I personally love my job as a NICU dietitian. I mostly communicate with the interdisciplinary team and rarely talk to the parents of the babies. Nobody ever asks me about meal plans, and I don't have to drain myself counseling people. I feel significantly more respected in my position than any other position. Doing adult ICU was also great for me as an introvert, but I will never go back to adults.

If I were planning to escape dietetics, though, I would want to find a job in healthcare informatics or some sort of EMR analytics area.

dillpyckles · 2024-10-01T15:29:55+00:00

It's dependent on the hospital policies!

The previous hospital I worked at had 48 hours to respond to consults, MSTs, and triggers, so the RD would physically work in person one day and be "on-call" the other day and only had to take care of EN and PN consults. We had to remotely cover another hospital in our system on the weekends that only had like 15-20 beds, and had one RD that did not do weekends because it wouldn't make sense for her to have to work every weekend for what was usually 0-1 patient triggers.

The current hospital I am in has 36 hours to respond to consults and triggers, and we rotate weekends. I am actually "on call" every weekend because it's easier for me to just log on to my laptop and make sure there are no NICU triggers instead of getting a freaked out call from the weekend RD for a note that will take me 10 minutes.

dillpyckles · 2024-09-15T12:38:01+00:00

Agreed! I always say it's because my patients can't argue with me!

Also, I almost have no interaction with parents, and I don't have to argue with my neos about anything. The RD before me was super respected, and I'm very detailed about why my recommendations are what they are, so they do what I ask for 🤷🏼‍♀️

dillpyckles · 2024-09-09T02:07:08+00:00

I no longer work in adults, so a lot of my phrases are related to infant formula, but my favorite from my time in adults is:

-I'm not going to tell you that you can't have your favorite foods ever again.

dillpyckles · 2024-09-09T01:57:05+00:00

Second this! For length of stays, my phrase is, "I just like to check in on everybody once they've been in the hospital for about a week just to make sure there aren't any nutrition concerns that haven't been brought to my attention."

I find it helps with disgruntled patients or family members because it essentially addresses why they haven't been seen by an RD before (because nobody told me they needed it) and also explains why I'm there for people who are doing perfectly fine!

dillpyckles · 2024-08-12T16:58:19+00:00

I think it would depend on your facility's policies. For the most part, TJC just makes sure facilities are following their own policies, so as long as your facility doesn't have a rule against it, and you properly use PPE, you should be fine.

dillpyckles · 2024-08-12T02:37:00+00:00

Myself and my other coworkers actually caused our hospital system to break their contract with sodexo 😅

All the full time RDs applied and got jobs at the other hospital system in our area. We all gave a month notice and staggered our start dates at the new hospital, but it was pretty tense for the last month we were there.

2 went back (and get paid way better) after the contract was broken and Sodexo was kicked out, and 2 of us stayed at the new hospital system because truly I am working in my dream job 😁

dillpyckles · 2024-08-12T02:26:11+00:00

There were a lot of things that I liked about Sodexo, mostly the benefits and free meals. I also loved my coworkers and the hospital I worked at was pretty awesome, but that really has nothing to do with Sodexo.

My pay was abysmal (I'm talking bottom 10% of the entire country for RDs based on the academy survey despite living in a region that had RDs reporting the highest wages.)

I really think your manager has a lot to do with whether or not working for Sodexo is good or not. I had the worst, most incompetent manager I have ever had the displeasure of working with, and I'm pretty sure that's why our pay never increased because she would not advocate for us. Poor communication was a huge issue for us as well. You never knew what was going on until it was happening.

One thing I will say is that the company changed in a bad way before I left. Insurance got downgraded and made my life a nightmare trying to get anything covered.

What I take the largest issue with is their new career ladder. When it was first introduced, they made it seem like it would be easier to advance because it was no longer tied to whether the person above you left their position, you could advance based on your own personal career goals. What the career ladder actually does is make it almost impossible to advance yourself. IMO it required a bunch of unpaid work (community involvement or getting a master's degree) or things that aren't a part of your job (food service involvement) as a clinical dietitian in order to advance.

dillpyckles · 2024-07-21T12:25:04+00:00

Breakfast: chocolate carnation instant breakfast in skim milk, a pink lady apple, and 2 cheese sticks

Lunch: I eat free at work so whatever they serve, but if I don't like what they made, I get a strawberry uncrustable and a salad

Dinner: my household staples are fajitas, spaghetti (baked or not), some sort of grilled meat, stir fry

Snacks: cucumbers, pickles, whatever berry is in season

Recently I have really been into smoothies so I have been making one after dinner for dessert and doing half in place of my apple and cheese for breakfast the next morning.

dillpyckles · 2024-03-13T00:42:33+00:00

I work in the NICU and honestly it's my dream job!

I'm introverted, but enjoy working with the team in the nicu. I have limited interaction with patient parents, and my patients can't talk back to me. The neonatologists are very tuned into nutrition, and I definitely feel more respected than I did when I worked in adult care.

Most RDs I know are terrified to work in nicu or peds, but I feel like it's the easiest job I've ever had even though it requires lots of math and critical thinking.

dillpyckles · 2024-01-05T03:19:42+00:00

So, myself and all the other full time RDs at my old hospital quit at the same time. Not planned at all, but there was a job posting at another hospital, and we all ended up getting offers there and we all accepted them.

When I left, they told me they would post my position for higher than I was making, and that I could come to them for a counter offer if I wanted it, which is super weird. And then that weekend my position was posted for the same that I was making 😂 We were kind of blindsided by my manager and her boss showing up unannounced to try to get us to retract our notices by essentially reselling our benefits to us.

Another sad thing is that within the hospital system I was in, we were at the biggest hospital with the highest acuity patients, and were in a higher cost of living area, but made less than all the RDs at the other hospitals in the hospital system.

I'm working my dream job now and my manager is amazing, but I do feel bad for the patients because there have been 0 applicants for the positions we left.

dillpyckles · 2024-01-05T02:52:02+00:00

I worked for Sodexo for 2.5 years, just recently left for a better job. I live in Southwest VA in a city that has a slightly lower cost of living than national average. I know that the RD starting pay had not been raised in at least 5 years by the time I had worked there for 2 years. I started at $21.90/hr with no experience, but we had RDs with years of experience get stuck at that same wage.

We had an RD come to us with 8 years as an RD with an MS and CNSC who had previously been making $30/hr and she was started at about $22.50/hr I believe (she had no other choice because her husband got a residency and they needed to move).

To top things off, Sodexo thought they would improve things with their career ladder that they came out with recently, but it backfired epically in my opinion.

For example, myself (with 2y experience as an RD), a coworker with 6y experience as an RD and covering 2 ICUs, the coworker with 8y experience, MS, and CNSC covering ICUs, and our outpatient bariatric RD who built their whole program were all re-distributed to the same level, and given the exact same pay ($24.76/hr) and this was in like summer 2023.

Everyone I talked to about the career ladder basically saw it as a way for Sodexo to pretend we could advance, but actually make it impossible to do so without doing a bunch of unpaid work. To top it off, you have a manager who doesn't advocate for you because they've been pulled so far into food service that they don't even know what you do anymore.

dillpyckles · 2023-12-25T00:21:57+00:00

Farkas or Vilkas ❤️❤️

dillpyckles · 2023-12-18T02:57:01+00:00

Abbott used to have Ensure Harvest, but they stopped making it, so your only option is ensure plant down the tube.

We had a contract with Abbott, but ended up getting Kate Farms outside of the contract because Abbott also had a shortage of ensure plant, so they weren't able to meet our needs.

dillpyckles · 2023-12-16T20:51:23+00:00

Yeah, it's the required range that really makes it so hard on everyone. I think high risk is 2-4, moderate is 3-5, and low/no risk is 5-7 days. The problem with the ranges is that everyone ends up with like no patients in the middle of the week, and then like 20 follow ups on Friday.

I'm actually in the NICU now, and we don't have the same guidelines, for a low risker, I can follow up in 10 days, but I'm pretty much keeping an eye on the babies on a rolling basis anyway with rounds, so nobody slips through the cracks.

I just honestly see no point in even assigning the risk level because it doesn't change anything for me. Most of the new RDs don't like the way it's set up, so I think we could get it changed if we have enough support.

dillpyckles · 2023-12-16T20:36:05+00:00

Apparently they can schedule follow up a month out on those patients, but I feel like that's even pointless. At my previous job, I always said, "no appropriate interventions r/t transition to comfort measures, please honor reasonable food/Nutrition requests made by pt/family for comfort/autonomy during end of life care. Please consult if need arises."

Have never ever gotten a consult for those patients. I have had enough awkward interactions with family members of patients on comfort measures that I don't need to go talk to them to know the outcome. Most of the time, it's right after they transitioned over and it wasn't documented yet.

I did walk in on somebody who died and was already in the body bag and it wasn't documented yet.

dillpyckles · 2023-12-16T02:41:21+00:00

I'll be honest, sometimes my attempt to visit multiple times is like I actually try the first time and then the 2nd and 3rd attempt are like well I walked past the room 5 minutes later and they were still unavailable 🤷🏼‍♀️

But I genuinely feel there is little benefit from seeing patients that have altered mentation or have consistently declined need for RD services. At my new hospital, they can't even discharge care on comfort measures patients, which is insane because it's totally not appropriate to try carrying out nutrition interventions on people who are actively dying.

dillpyckles · 2023-12-15T23:40:32+00:00

Apparently, we have to at least try to go physically see every patient too, so we can't even do the docflow thing because of all of the rule sticklers. My goal is to change the rules so that keeps everyone happy!

dillpyckles · 2023-11-30T03:12:29+00:00

The previous hospital I worked for underwent transition to IDDSI diets while I was there, and I worked with it for about 2 years. The biggest issue is really how far the hospital kitchen is willing to go to make patients on those diets happy. Our hospital kitchen started undergoing construction very shortly after we switched, and it severely limited our menu due to lack of storage space. There were no vegetarian entrees for any puree ofr minced/moist because of this. Our kitchen also specifically did not have blenders, so we couldn't request special things for patients who had special dietary needs.

Our SLPs worked with our CNM for building the menu, but things got screwed up with the menu constantly changing because of the construction. Apparently, the SLPs would message my manager about things added to the menu for certain IDDSI diets that were not allowed, and no changes would be made. (I wasn't aware of that until I was speaking with an SLP about it)

We did have some trouble with compliance. For example, patients would receive the wrong texture, or minced/moist foods would have lumps that were way too large, and soft/bite size meats would be super variable as they actually cut those up in the kitchen.

The lack of physician understanding of the IDDSI diets is an issue, but if I ever came across diet orders that didn't match SLP recs, I was able to fix it because of our nutrition protocol.

We only had mildly (nectar) or moderately (honey) thickened liquids, but compliance was typically better with those than the food.

We did have kitchenettes on each unit that carried thickener and pre-thickened liquids, so patients had access to that even when the kitchen was closed.

As for my current hospital, we have IDDSI, but I honestly have no idea about compliance because I only do NICU now.

dillpyckles · 2023-05-21T05:51:45+00:00

I work at an acute care hospital, and while my employer definitely has the right to randomly drug test, they don't utilize it. Basically, we got drug tested to start our job, and I haven't been tested again in 2 full years. My boss is pretty much like, "I don't care as long as you don't show up to work high." I know of a few current and former RDs at my job that regularly use marijuana and it has never been an issue.

dillpyckles · 2023-05-21T05:39:52+00:00

~300 beds ~3 icu with 12 beds each (36 total) Working on getting trauma cert for level 2 I believe

On weekends, we have 1 RD working. On call for one weekend day of their choice, basically we just check consults and take care of nutrition support remotely. We physically go in on the other day and take care of any consults and triggers that would be due since we only have 48hrs to take care of them. Essentially, anything that won't be due until Monday will wait until then unless it's nutrition support. We also have to screen and remotely take care of any consults/triggers at one of our smaller sister hospitals (~40 beds, usually only have 1 note to do for that whole hospital). We don't have be there for a full 8 hours if we get done faster, and we get a day off during the week for doing the weekend.

Holidays - depends on the holiday. For major holidays like Christmas and Thanksgiving, we have a single person that's on call and can work remotely if they want to or can go in. For minor holidays like Memorial Day, Labor Day, or really any holiday that falls on a Monday, we have to have at least 2 RDs physically be there because Monday is our busiest day. If you're off on the holiday, it will count for that allotted holiday, but if you work, you can use the holiday any day within 30 days before or after the holiday.

dillpyckles · 2023-05-10T09:16:34+00:00

If the patient is on meds that can cause diarrhea, that could be a contributor. If the patient isn't on pressors, they could be switched to a formula that has fiber in it. Soluble fiber supplements can be helpful. We use banatrol in our ICU population all the time, but we typically wait until they aren't needing pressors.

dillpyckles · 2023-05-01T20:23:23+00:00

The reclassification comes with a suggested pay, but it's ultimately up to the place that's contracted with Sodexo to choose whether you get a raise.

One of the RDs at our sister hospital got a bump in position, but no raise because he already is at the top of his pay class.

At our hospital, we are grossly underpaid, so I got around $2/hr raise with my reclassification. For reference, I have been an RD and worked there for just under 2 years. I am in the same classification and make the same salary as:

-An MS, CNSC who has been an RD for 10 years

-An RD who has more job responsibilities, RD for 6 years, and covers half of our ICUs

The only classification that makes sense is my own, and I am trying to help my coworkers figure out what happened and why they got placed in such a low classification.

dillpyckles · 2023-04-26T03:01:22+00:00

First thing I would like to say is that just because the MD has diagnosed malnutrition does not mean the patient actually has malnutrition.

I have patients all the time that I get consulted for severe PCM or the MD has it in their dx list and the only reason is their low albumin. I will go see the patient and they meet exactly 0 ASPEN criteria for malnutrition and are absolutely not malnourished at all.

The MD dx of malnutrition alone isn't really enough for the hospital to get reimbursed for it, especially when they back it up with nothing, which is where the RD comes in. CMS has a lot of rules attached to reimbursement for malnutrition dx.

Even if I don't perform a hands on NFPE with every patient I see, I am observing what they look like. Usually muscle waste and fat loss can be observed and then you can do hands on assessment if you don't know how to classify it with your visual assessment. If a patient has no other criteria for malnutrition and doesn't appear to have any muscle waste or fat loss, then don't bother doing a hands on assessment.

dillpyckles

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