What do dietitians do?

Hi everyone, I’ve got a new job! I recently started my new role as an Acute Dietitian in a large hospital near me.

For those that are new here, I was previously working as a health coach/weight management dietitian at a health-tech start up. And like all start-ups, things can be quite unpredictable. Me and a number of my colleagues were unexpectedly let go due to financial constraints within the company.

I really enjoyed my time in weight management, and it remains one of my interests. But I thought getting more clinical experience would be a good idea.

New role: 

My new role is a big change, in lots of ways. My health coach role was fully remote with flexible working hours, while my hospital role can’t really be worked from home, so I’m in everyday for set working hours. 

It’s also a change in terms of the patients I’m dealing with. The weight management role was a lot of people that were overweight or obese and might have had disordered eating habits. While my new role is mainly people that are malnourished and need some support with their nutrition.

The dietetic team is split into 3 mini teams and I’m on the team that covers the general medicine, oncology, and gastroenterology wards. This means I could be seeing patients with cancer, liver disease, pancreatic disorders, diabetes, or gut conditions. So, it’s a wide and varied role which means there's lots to learn! I’m looking forward to getting stuck in.

Day in the life of a new band 5: 

I thought I’d do a day in the life of a new band 5 dietitian to give you a better idea of what dietitians do. Days are really varied, and things are really busy, so every day is different.

8am: I get into the hospital and get changed. Then it’s straight to the computer to see the new referrals. These are the patients that have been referred to us, usually by nurses, for a nutritional problem. We have a big spreadsheet where we add all the patients that we need to see. I then have to prioritise to decide who needs to be seen on this day and who could wait a bit longer.

In an ideal world we’d be able to see all the patients as soon as they’re referred, but there’s so many patients and not enough staff. Which is, unfortunately, a common trait in the NHS. So being able to decide who’s more urgent is a key skill that’s developed quickly. I also check emails and Teams to see if there’s any updates or anything urgent to do.

8.45am: I then start gathering information on the patients I’m going to see. There's an ABCDE dietetic assessment that we do for each patient. It stands for Anthropometry (weight, BMI, height, etc), Biochemistry (blood results), Clinical (medical conditions of the patient), Dietary (nutritional requirements vs nutritional intake), and Environment (social and psychological history of the patient).

At my hospital, all the patient information and documentation is online so I can get a lot of the information needed to form my assessment while still in the office.

9.30am: After I’ve got the information for the patients I plan to see, it’s time to head to the wards! On the wards, there’s paper food record charts. This is where what the food the patient has eaten is noted down so we can use this to help inform our assessment. I take some time to look through these too.

9.45am: I go and speak to some patients. There’s one patient who is refusing all food as they don’t have an appetite. Due to this, the patient is also losing weight. I explain the importance of minimising any further weight loss and we agree that the patient will try some nutritional supplements. These are milkshake style drinks that contain lots of calories and nutrients.

Another patient is placed nil by mouth due to choking when eating. This means they need to be fed through a tube. A nasogastric tube is the most suitable for this patient. This is a tube that goes through your nose, down your throat, and into your stomach. I have to calculate the patient’s requirements and work out a feed regime of how much feed they’ll need to meet them. I chose a high calorie feed for this patient and start at a rate of 40ml per hour. This means they’ll receive 40ml of feed into their stomach every hour through the tube.

I have a patient that isn’t eating very well as they don’t like the hospital food. Unfortunately, there’s nothing we can do about this. The patient says their daughter will bring in food when they next visit. And I offer to get the patient extra snacks for between meals.

There’s a patient that has alcoholic liver disease. These patients have high nutritional requirements – meaning they need lots of calories and protein to maintain their weight. With this patient I start them on nutritional supplements, encourage them to eat as much as they can, snack often, and ask the doctors to prescribe vitamin supplements. These patients need lots of extra B vitamins to help with their metabolism.

12.15pm: I hop on a computer on the ward and write up all of the plans I made with the patients in their notes. I then prescribe any nutritional supplements if needed, which is also online.

1pm: lunch time! I tend to meal prep my lunches for work on the weekend, and today I’m having a chicken stir fry.

1.30pm: after lunch it’s back to the wards to see some more patients. I see some more patients with poor appetite, and another patient that needs a feeding tube.

3.15pm: I get back on the computer to write up the patient notes. I also check my emails and Teams again.

4pm: I head back to the office for the end of the day. I then get changed and head home.

I hope this has given you a good insight into the life of a dietitian! I’ll be doing more job updates as I progress in my role.

If you’re more interested in what dietitians do, I’ve got some other blog posts here:

• Day in the life of a health coach/weight management dietitian
• Day in the life of a C placement dietetics student 
• What to expect when applying for a job in dietetics 
• What to expect on a dietetics B placement 
• How to become a dietitian

I hope you enjoyed this blog post! Have a Merry Christmas and I’ll be back with a new blog post on the 1st of January.

Bye for now! 👋