My First Week as a Supermarket Dietitian (And Free Materials)

So, this was my first official week as being a Supermarket Dietitian and I loved it! I'm still training and shadowing people; however, the more I learn about the job, the more I am loving it. If you are the type of person who is an independent worker, loves doing different things each day, and is comfortable in the public, then this is a job for you! I am pretty excited that I will have a huge brown desk out on the floor of the store. I'll also have a large storage area for all my nutrition materials. It is nice to finally have my own space at a job.

The in-store events include produce picks (feature a fruit or vegetable, preferably on sale/in season with a recipe for taste testing), product sampling, easy dinner meal ideas (with a recipe sample), kid's days, cooking classes, diabetes classes, weight-loss classes, etc. They also have counseling and individual store tours. They are always open to new ideas for newsletters, recipes, and programs. It is perfect for me since I have experience in running programs and I like trying new ideas out. I'm excited to be able to post "RD selection" stickers around the aisles. These will be products that fit a certain nutritional criteria and are a healthy option for consumers. Since my supermarket has a hot/cold food section to take items to go (or dine in), I will also have stickers there. It is an awesome feeling to know that I will be able to reach out and help people on such a large scale.

Another awesome thing about being in a supermarket is that you have connections with all the other supermarket RDs in your area. It is great to have such a huge network of RDs to be able to bounce ideas off of, swap materials, and support one another in our efforts.

For anyone that knows me personally, you know I love getting free nutrition materials. There are tons of websites that will send you coupons, handouts, and/or lessons for FREE! In my free material search this week, I got Yoplait Greek Yogurt coupons, Diabetes handouts, Weight Control handouts, and Blood Pressure cards. There are also a ton of materials for free download; however, I don't have the ability to print large quantities of handouts. I have the links at the bottom of this blog!

My last exciting nutrition find of the week was my Garden Heroes! I ordered these cute little guys from Learning Zone Express. No, they were not free; however, they were pretty cheap. I teach kids nutrition a lot, so these will come in handy for lessons.

Eddie Eggplant, Buddy Broccoli, Andi Apple, Alonzo Avocado

Stay tuned for my blog on "Top 10 Dietitian Misconceptions"

Resources:
http://www.bellinstitute.com/Coupons.aspx
https://catalog.niddk.nih.gov/index.cfm
http://win.niddk.nih.gov/order/orderpub.htm
http://catalog.nhlbi.nih.gov/catalog/home

Job Searching, New Career, and New Stage of Life!

It's been quite a while since I made my last blog post. I could say life got in the way; however, it was really that nothing too crazy happened to want to write about. Just being honest :) So, quick recap is: I passed my RD exam, got my PA state license ($65), renewed my PA state license (another $65), applied for a bunch of jobs (most of which said they wanted people with their RD title for more than a year aka NO), paid for an Adult Weight Management Online Self-Study Module (through the Academy of Nutrition and Dietetics for 16 credits), looked at the first section of the module because it is super long, brainstormed some blog ideas, looked into private counseling, worked my current job, did some webinars for free CPE credits, went on a few vacations, and lastly....got a job!

I'm pretty excited about that last part, not only for the nice pay increase from my current position at the YMCA, but also, it was exactly what I was looking for! I will be a part-time retail dietitian at my local supermarket. The position will also be heading towards full-time in the Fall/Winter when the programs get up and running. The RD will do everything from counseling to store nutrition tours to kid's day events.  I really love working in the community and doing so many different things each day. I hate the whole 9 to 5 boring job routine. I like that I will be doing tons of different programs with all ages and stages of life. The job is also super flexible (I will eventually be creating my own schedule), I will be doing a lot independently (good thing I am a go-getter/self-motivated type of person), I get the opportunity to network with other RDs in the surrounding supermarkets, and I will be doing what I love :) Today's Dietitian sums up the role of a supermarket dietitian pretty well (for those of you who aren't sure what they do). The supermarket I will be at had 26 events last month, so I will definitely be a busy bee until I find my own routine.

So, how am I feeling about my new job and starting tomorrow? I am obviously very excited and anxious to just get in and get started. I am also a wee bit overwhelmed. There is a lot that goes on each week and besides all the events, I also schedule counseling, store tours, additional classes, and answer customer nutrition questions. It is also a new atmosphere with tons of new faces (been at my current job for 9 years so I pretty much know everyone and everything there is) and I don't really have an idea of what I will be doing every day. Like, how will I structure my day? I will be the only RD in the store, so it is not like I will be trained by the person in the position last. I am so grateful that I will get the opportunity to head to 2 other stores this week and meet the RDs there. I have a huge list of questions I want to ask them! I am very glad I have had experience running programs, creating materials, and working with the public at my current job. I feel like that is giving me a great basis for my new position.

I don't know if this is job where I will be forever (still keeping my YMCA position), but who knows! I am definitely leaning towards becoming a private practice RD. And by leaning towards, I mean I want to do it and get started, I am just slacking a bit :) It is a bit overwhelming to learn about everything you need to do to get started in private practice! I just need to break it down into smaller, more manageable steps (instead of avoiding getting started..haha). This will be something I will be getting back to in future blog posts.

I feel like I am at the stage in my life where all my friends and acquaintances are either having babies, getting married, or getting their career job. I mentioned this to my boyfriend this past weekend and his response was that I am now in this crowd with my new position.  It feels a bit weird to me. I mean you go through college, finish an internship, take a test, but I don't think it really hits you until you land that first job or just do something with your new title (like start a private practice). I feel like I am finally spreading my wings at a place that will give me the tools and knowledge to make even more of an impact on people (and way more people that is). But anyways, moving on from my emotional part of this blog :) Stay tuned for my upcoming blog posts on: "My First Week as a Supermarket Dietitian" and "Dietitian You Say? That Means You Make Meal Plans." (I am especially excited about writing that last one)!

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.



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 taking 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

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!

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). Inman is 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 through Hess 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

 

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 :)

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 Inman CDs 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.