What Nutrition Counseling Is REALLY Like

In my field of work, I do nutrition counseling with a lot of people (about 10 per week on top of my other duties). More and more, I notice people have this skewed idea of what counseling is like. Some examples: "So, you'll tell me what to eat right?" or "You make diet plans, right?' or when non-clients state, "Your job must be so easy" or when co-workers say "Don't people know this stuff already?" The truth is, I won't tell you what to eat (exactly), I don't typically make a "diet plan," my job isn't always the easiest, and people certainly do not know this stuff (to put it simply).

So, if nutrition counseling isn't any of those things, then what is it? Counseling is not only an assessment of the person's diet and health history, but also their emotions towards food. Counseling is establishing a rapport with the client so they will trust your suggestions. Counseling is working with clients to figure out how they can be motivated to make changes (and see them through). Counseling is not only being the credible knowledge source, but translating that knowledge into practical strategies that will work for various clients. Counseling is..... well you get the idea :)

Besides being all of those things I mentioned, doing one-on-one nutrition counseling can be a little intimidating when you first start out (whether it is inpatient or outpatient). When I first started doing outpatient counseling, I would stumble over what I was explaining. I was nervous about clients asking crazy questions and me not knowing the answer. I brought every handout I owned JUST in case. I was constantly saying to myself, "I wish I had said this instead of _____." I had a lot of bumps in my early stages of counseling; however, I began to find my own rhythm (trust me, you will too!) and things ran much more smoothly. It seemed like the information just came out so easily when I needed it to! Just a side note here, if you ever do any courses or credits for counseling, it seems like so much to learn (being empathetic, saying key words, phrasing properly, etc); however, once you get practice, these strategies become so natural!

One of my greatest pieces of advice is that it is perfectly okay to say, "I don't know much about the research for ______, but I can find out and get back to you." People look to you for credible information and yes they can Google it themselves, but lets face it, they don't/probably won't. Plus, most of the people I see in counseling say they get overwhelmed and just don't know where to look. Again, where the Dietitian comes in :) Just an example, I had a client come to me looking for the Vitamin K content of edamame. This person had to watch their intake because of the medication they were on. I certainly do not know how many micrograms of Vitamin K are in edamame (41mcg for frown unprepared in case you were dying to know). So, I said to this client that I wasn't sure off the top of my head, but I could get back to them about it. They were very happy with that and came back later for a print-out. Again, MOST people just want the information handed to them and know that you are the credible source to give it. Just a side note, the USDA has an awesome database for this!

Another thing I learned in nutrition counseling is that you can PLAN for what you want to cover; HOWEVER, always be prepared for a curve ball.  Like a client who brings you a list of 15 supplements they are taking or a client who doesn't have time for snacks because they exercise for 2 hours between meals (aka 10000 crunches, push-ups, etc) or a client who has an underlying pre-occupation with food or a client who said they would be bringing their family and that meant 6 other people. And if you are wondering, these people exist because I have counseled them! Don't let situations like these rattle you! Go with the flow and just make do with what you have. Again, situations like these will get way easier with more practice.

The way I handled the first person in counseling consisted of me mostly asking about the supplements and the reasons for use. I didn't tell the client to stop taking them, we just discussed ways of spacing them out or how combining a few into one pill would be better. You are not going to change people's mind by telling them they should or should not do something. It is best to give them all the information and allow them to have tools to make a more science-based decision. With the second client, we talked about bulking up the meals for more calories instead of having snacks. The third client, started off talking about sports nutrition and turned into obsession over calories. This client was a lot more rational than the typical eating disorder patient; however, they did have a history. That being said, I didn't refer out since the client was focused on being healthy and eating enough for both exercise and the potential carrying of a baby. The last client(s) was a bit chaotic, since I have a small counseling space; however, it worked well to have most of the family sit while I stood in front of the "U-shaped circle" to talk about nutrition.

With all that being said, hopefully you have a better idea of what nutrition counseling is like as a client or Dietitian. Feel free to leave a comment or send a message of your experience with nutrition counseling :)

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)!

The Start of My Inpatient Clinical Rotation

As of today, I am 18 weeks into my dietetic internship! Just to recap, I completed food service management with school nutrition education and community (at WIC). I am currently in my inpatient rotation in a 200-bed hospital.

I have only been at my clinical facility for 2 days now, but, I really like it. I'm pretty surprised too. I used to work as a Food and Nutrition Aide at a hospital and I hated it! Most of the patients didn't care what you had to say. They just wanted to "go home and eat their bacon" (a quote I heard fairly often of cardiac diet patients). It is different being with the RD and seen as more of a professional.

My first day, I mostly had orientation to the facility. I was introduced to all the hospitals procedures and protocols. I spent a lot of time learning their EMR system with all the patient information. My preceptor gave me a booklet with equations (for calculating calories and protein for certain BMIs) and tube feeding protocols. This is literally my go-to book for the rotation. If you don't receive something like this, ask your facility what procedures they use to calculate calorie and protein needs. You can make your own sort of "cheat sheet."

My second day was where most of the action occurred. I learned how to complete a nutrition profile for new patients that needed nutrition consults. This involved researching the patient past medical history, current medications, diagnoses, lab values, BMI, anthropometrics, and calculating requirements for calories, protein, and fluid. I was able to shadow the RD for the second half of the day. I got to see a range of medical diagnoses in such a short time; congestive heart failure, acute renal failure, hypertension, dementia, hyperlipidemia, hypothyroidism, and more! I even got to chart on 2 of the patients :)

When I first started, I was afraid that I wouldn't know what to say to patients. The more I learned about diets in clinical, the less I felt I knew! After the first few days, I began to feel more comfortable. You find out everything you need to know about the patient prior to going in to do an assessment. The assessments are usually short (<30minutes). Also, my facility (and probably many others), have access to the nutrition care manual, which lists every disease, lab values, educational handouts, and more. So, if you don't know something, you definitely have the tools to find out.

Just some tips I have for the first few days of inpatient clinical:
-Ask as many questions as you can about nutrition assessments and patient procedure. I think it really helps to hear it explained different ways by different RDs.
-Practice finding nutrition information on patients. The one RD had me on a nutrition profile hunt my first day. I would get a patient and find out their BMI, calorie needs, medications, etc. It helped me to navigate through their system and to research different medications.
-Follow the RDs on their rounds; even if they don't outright ask you, ask them!
-If the facility has access to the nutrition care manual, peruse through it. It is such a great resource (it is expensive to buy).
-This website was useful too: http://www.uptodate.com/home

Hopefully, I will be seeing patients on my own in the next few weeks! :)