What It Takes to Become a Dietitian

  • 4+ years of classes in the science of nutrition and dietetics, including organic chemistry, biochemistry and nutrient metabolism
  • 1280 supervised, unpaid, practice hours
  • hours of homework, reading journal articles, and completing case studies
  • studying for (and passing) a registration examination
  • a passion for all things food and nutrition

These are just a few of the things it takes to become a Registered Dietitian, or a nutrition expert. It’s hard work. Seven years ago, I sat down at an info session at Sage College with interest in starting their nutrition science program. I had just lost 80 pounds and was really interested in food and nutrition. I learned then that in order to be a real expert in nutrition, I would have to become an dietitian. I took three years of required science classes at HVCC, followed by three years of full time coursework (while working!) in nutrition and dietetics on campus at Sage. Finally, last August I began my Dietetic Internship, a program of 1280 supervised practice hours required to become a Registered Dietitian. For 10 months, I was to work full-time, for free, under the supervision of  Registered Dietitians, a Food Service Manager, and a Food Access Team. I gave up my job with great benefits to work for free. I completed five rotations: food service management (10 weeks), long-term care (2 weeks), acute care and outpatient clinical (13 weeks) and community (7 weeks). Last Friday was the last day of my internship–it feels so surreal to be done.

The Dietetic Internship has taught me so much more than I could ever learn in the classroom. I went into it with preconceived notions of what I wanted to do once I was done and I’ve completely changed my mind. I thought I wanted to be a sports and weight management dietitian, but realized that’s not the path I want to take, at least not right away! I really enjoyed my clinical rotations–I loved long-term care, critical care, oncology and renal. I loved writing tube feeds and working with patients one-on-one, helping them improve their health through nutrition and working to combat chronic disease with medical nutrition therapy.

I also chose to become a dietitian because quite frankly, I love food. Not only is food needed to sustain life, proper nutrition can greatly improve a person’s quality of life. Being directly involved in a patient’s care is extremely rewarding. I’ve also experienced first-hand how one’s life can completely change with good nutrition. I’ve been working toward this goal for so long, it feels surreal to almost be done.  I am going to celebrate when I can finally write those two letters after my name.

What is the difference between a Nutritionist and a Registered Dietitian?
There’s a huge difference between a dietitian and nutritionist. Dietitians must complete science-heavy coursework in nutrition science, metabolism, food science, organic and biochemistry, as well as counseling and food service management—either earning a Bachelor’s Degree in Nutrition or a Post-Baccalaureate Certificate in Nutrition (if you have a Bachelor’s in something other than nutrition). To top that off we must compete the 10 month, unpaid dietetic internship. I can call myself a nutritionist now because I’ve completed all of nutrition coursework and internship, but to call myself a dietitian I must pass the Registration Examination. I can’t take the exam until successfully completing the internship along with meeting the set of competencies set by the Commission on Dietetic Registration. Dietitians are nutrition experts! Anyone can take an online class and call themselves a nutritionist—but it takes a lot of hard work,  and dedication to become a Registered Dietitian. Remember, be wary of those handing out nutrition advice without the RD credential.

Dietetic Internship FAQs
What type of internship program were you in?
I got into the distance dietetic internship program at Sage College. They have two tracts-distance and onsite. As a distance intern, I had to find my own rotation placements. The only time this was difficult was when I was looking for a facility for my acute care rotation. Because I was a distance intern, I couldn’t utilize any of the hospitals in the Capital Region. I called about 15 hospitals within a 2 hour radius of Albany because I didn’t want to have to physically move for my clinical rotation. I also tried about 10 hospitals in Florida where my parents are in the winter, as well as hospitals near where my sister lives in New Jersey. Thankfully, my internship director gave me contact information for the Nutrition Director at Berkshire Medical Center in Pittsfield. One of the RDs there decided to take me on as an intern! Pittsfield is only an hour from my apartment and my parents have friends who live in Dalton, MA, about 15 minutes from the hospital. They rented their fully-furnished house to me, while they were in Florida for the winter for three months, while I was interning at the hospital. Even though it sucked to pay rent in two places at once, it was convenient when the weather was bad, which was often as the hospital was in the Berkshires and my rotation was January – March! I came home on the weekends. Other than that rotation, all of my other placements were in the Capital Region and were easy for me to find.

Are you done with school?
The DI program at Sage is also a combined MS program. Since I had taken all but three of the required MS courses previously, I only had to take one online course concurrently with the internship (Advanced Medical Nutrition Therapy, which I took in conjunction with my clinical rotation). I only have two more research courses left until I have my MS in Applied Nutrition and will be graduating in May 2018! Then I can finally say that I’m done with school!

How did you live without an income for 10 months?
It was a struggle. If you are in school and you know you’ll be taking the RD tract then save as much money as you can! I really wish I had saved more to live on during my internship. But thankfully I have a good support system and family that helped me out when I needed it. I also relied on student loans much of the time. I also worked over the winter break, which helped. Working for nothing can be an inconvenience, but it’s worth it to gain the experience you need to become a dietitian.

Other Nutrition FAQs
I want to lose X number of pounds; can you create a meal plan for me?
Achieving your healthy weight requires more than just a meal plan. As soon as I’m an RD, I will consider private consultations—but at this moment I need to focus on studying for my RD exam! But if you have any nutrition-related questions, do not hesitate to send me an email and I will try my best to answer them!

What diet do you follow?
I don’t follow any specific diet. In fact, I don’t believe in diets. I eat a variety of fruits and vegetables, whole grains, dairy products, and healthy fats. I also have a sweet tooth and thoroughly enjoy ice cream and cupcakes! These foods can be part of a healthy meal lifestyle. I don’t eliminate anything. You shouldn’t have to restrict foods to be healthy–unless medically necessary due to allergies, intolerances, or a medical condition. There is no good food vs. bad food or clean food vs. dirty food. In fact, I despise the term clean eating because it gives the connotation that certain foods are “dirty”. I try to eat intuitively—paying attention to hunger cues and eating when I’m hungry and stopping when I’m full—but it will always be a work in progress for me as I do have a history of obesity and overeating. If I’ve learned anything these past few years, no diet is perfect, it is not black and white.

Suggested reading materials – Interested in nutrition? Check out these books.
Body Kindness
: Transform Your Health from the Inside Out–and Never Say Diet Again by Rebecca Scritchfield, RDN – I have yet to read this one, but I know it’s going to be good. According to Amazon, “Body Kindness helps you let go of things you can’t control and embrace the things you can by finding the workable, daily steps that fit you best. Think of it as the anti-diet book that leads to a more joyful and meaningful life!”

Intuitive Eating by Ellen Tribole, MS, RD – Ellen Tribole is the pioneer of Intuitive Eating and her book is great–it focuses on how to let go of dieting and achieving a new and safe relationship with food and, ultimately, your body.

Nancy Clark’s Sports Nutrition Guidebook by Nancy Clark, MS, RD – I’ve seen Nancy speak a few times and I love her Sports Nutrition Guidebook—it’s easy to understand and is a great resource for any athlete looking to improve performance or just maintain weight while training. I frequently turn to her book for information on sports nutrition.

Suggested Nutrition Blogs
Fannetastic Food
The Real Life RD
Nutrition QED
Summer Tomato
Nourish Nutrition Blog
Mind on Nutrition (a fellow Sage Alum!) 
Heather Caplan, RD
The Educated Plate

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Day in the Life of a Clinical Dietetic Intern

Happy Registered Dietitian Day! By this day next year I’m planning on being part of the club. But for now, here’s a post about what it’s like as a clinical dietetic intern. Enjoy!

7:30AM Arrive at the hospital. Today I am scheduled to observe a gastric bypass surgery! Gastric bypass, or Roux-en-y surgery, is a a type of weight loss surgery. In this type of surgery, a small part of the stomach is used to create a new stomach pouch, about the size of an egg. This new, smaller stomach is then connected to the small intestine (or jejunum), “bypassing” the rest of the stomach and the top of the small intestine (or duodenum). Those that undergo this surgery have to follow a strict liquid diet afterward because the stomach is now so small it cannot handle large amounts of solid food. Eventually the diet can progress to regular food and the patient will only be able to consume small amounts at a time, resulting in weight loss. It was my first time ever inside an operating room! The surgery was done laparoscopically and a portion of it was also done with a surgical robot. It was fascinating!

12:15pm: After observing the surgery I headed back to the nutrition office to eat my lunch quickly before heading over to the Cancer Center.

12:30pm: Drive to the Cancer Center. This week I’m working with our oncology dietitian.

12:45pm-3:00pm Visit patients in the infusion center. We talk with patients while they receive treatment. We discuss how they’ve been eating, if they have an appetite, etc. This is a good time to talk to them because they are already here receiving treatment and are usually here for a few hours. They don’t have to worry about scheduling a nutrition appointment, we go right to them. Side effects of cancer treatment include loss of appetite, dry mouth or bad taste in their mouth, mouth sores, and nausea/vomiting all of which can result in weight loss and put the person at risk for malnutrition. Some patients are prescribed medical marijuana to increase their appetite and relieve symptoms. I spent some time going through recipes to give to them. Never in my life did I think I would be doing this as part of my internship!

3:00pm-4:00pm. One-on-one initial nutrition counseling session. Patients can also schedule appointments with the dietitian one-on-one. Like I stated above, the biggest side effect of cancer or cancer treatment is decreased appetite and weight loss. The primary goal for patients with these issues is weight maintenance. We discuss ways to increase calories and protein during the day. Eating more small, frequent meals will give them more energy, while more protein will prevent loss of lean muscle mass. Both are very important during cancer treatment.

Boost is a supplement frequently recommended to patients who don’t have much of an appetite. They also may be fatigued and too tired to prepare meals. It’s a quick and easy way for them to get adequate nutrition. Although consuming real foods is always preferred, sometimes drinking their meals are all that the patient can manage.

4:00-4:30: Write a tube feed! Today the RD showed me the demo that she uses when showing patients how to tube feed.

Some patients require a tube feeding (also called enteral nutrition) because they have trouble swallowing (called dysphagia) or eating food by mouth. The tube can either be placed through the nose to the stomach or intestine, go directly into the stomach to the intestine, or directly into the small intestine to be absorbed. Today I finally got to write a tube feed for an actual patient! This patient needs a new enteral nutrition formula to prevent weight loss. I suggested that we find a more concentrated formula for him so that he gets more calories per carton, providing him more nutrition. The RD checked over my tube feed calculations and approved it! We can now write it on a prescription pad to get signed by the MD. So cool! I have to say writing tube feeds is one of my a favorite parts of being a dietetic intern.

4:30pm Drive home. I have to say I am loving my clinical rotation. This was the rotation I was most nervous about, by far! But I am having a great experience at this hospital. Every week I’m with a different RD who has a particular specialty, so I get to see all aspects of nutrition in a clinical setting. They have been amazing mentors.

Seven years ago I sat down at an information session for a nutrition program. Little did I know it would be seven years of hard work. Back then, the internship seemed like it would be eons away. Now, I have three months left of the internship and then I can take the RD exam. It’s all going to pay off! If you are a dietetic student reading this, just know that it will all be worth it in the end!

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Day in the Life of a Food Service Management Dietetic Intern

If you aren’t familiar with a dietetic internship, it’s supervised practice that every dietetic student has to complete in order to sit for the Registered Dietitian exam. Each dietetic internship consists of five rotations in the following areas: Food Service Management, Clinical (Acute Care, Long Term Care and Outpatient), and Community. There is a list of competencies we must meet in order to complete our internship. In August, I took a leave of absence from my job to complete this internship, since it’s 40 hrs/week and there was no way I could do both. Thankfully, I can focus on my internship and not have to worry about any other responsibilities.

So anyway, I just finished my Food Service Management (FSM) rotation (there are 10 weeks, or 400 hours required total for this rotation). Each rotation has a few major projects that need to be completed. For example, during my FSM rotation I have to complete a menu project where I design a one-week menu for my facility and actually implement one meal from it! My meal  happened a few weeks ago, on National Pumpkin Day!  My other project was a Process Improvement Project, where I selected a management process to assess and evaluate for improvement. For this project, I chose to assess plate waste at my facility and actually implemented a “food sharing table” in an elementary school in hopes of decreasing plate waste.

8:00AM Arrive at my facility’s kitchen (my facility happens to be a school!) This morning I’m meeting the Sanitation person who comes in monthly for a sanitation inspection. We go over the basics of her inspection. She checks the temperature logs to make sure food is being cooked and held at the appropriate temperatures. She also checks the ware washer and the cleanliness of the facility. She demos how to properly clean stainless steel appliances.

8:45 AM After the inspector leaves, I get out my standardized recipes for the dishes I’m making for my theme meal on Wednesday. Today I’m prepping for my harvest salad by dicing and roasting butternut squash, assembling the salad and portioning out pumpkin chocolate chip bars, which I made on Friday from scratch.

9:00 AM Start dicing squash. Toss in olive oil and then roast in the oven.

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9:30 AM Assemble ingredients for salad: spinach, craisins, and apples. The apples need to be removed from baggies and diced. I’m extremely thankful they are already cored and sliced! Take squash out of oven and let cool in racks. Once it’s cool, I add it to the salad. Toss salad and wrap in plastic wrap, store in cooler for tomorrow.

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10:30AM -12:30PM Lunch start and usually I’m helping with prepping and cooking lunch, but today I’m cutting and portioning out my pumpkin bars for my lunch tomorrow! It takes about 2 hours to cut them into individual bars, plate them and wrap them in plastic wrap. I made a total of 330 bars!

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12:30 PM Last lunch line goes through, start cleaning up. Wash dishes, bring them to ware washer. Clean and sanitize work stations.

12:45-4:00 Head back to central office to finish up working on the papers required for my projects. Check in with my preceptor, the Food and Nutrition Services Director.

4:20 Arrive home for a quick stop. This evening I’m heading up to Clifton Park to take part in Let’s Go, a childhood obesity prevention program, with five other Interns from my internship program. It’s held at a local pediatrician’s office. Let’s Go is a wellness program for 10-12 year olds and their parents, which teaches them to adopt healthier habits, focusing on the 5-2-1-0 message (5 fruits and vegetables a day, 2 hours of screen time or less per day, one hour of physical activity per day and zero sugar sweetened beverages per day).

5:30-7:00PM I’m at the pediatrician’s office with the other interns, RD and the pediatrician. Tonight we’re meeting with the kids and their parents to answer any nutrition questions they may have and give them tips/advice on how to make healthier choices!

7:30PM Finally home! Make some dinner, relax and watch some TV, the newest episode of The Walking Dead!

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Journey to RD

A few weeks ago I officially began my last full-time semester of graduate school to become an RD. It’s pretty crazy. I’m in the process of applying to Dietetic Internships (DI) and my application is due in two weeks. I can’t believe I’ve finally gotten to this point!

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Around the time when I started this blog, in 2010, I decided to go back to school for nutrition. I attended an info session at my current school, applied, and got in! But, from 2010-2013 I took prerequisite courses that I needed for the Didactic Program in Dietetics (DPD) at my college. Thankfully I already had a Bachelor’s, but since it wasn’t in science, I had to pretty much start from scratch. The DPD program is required to apply to a DI and eventually take the RD exam. The pre-req courses included Psychology, General Chemistry, Microbiology, Statistics, Accounting, Intro to Nutrition (I had to re-take at my current school, even though I got an A!), and Anatomy & Physiology 1 and 2. I took these courses in the evenings at Hudson Valley Community College, after work. I was working full time (at the same place I still work part time) and taking classes and doing homework, and training for marathons. Busy! Little did I know, it would get way more intense.

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In spring 2013, I completed my last course at HVCC, A&P 2. Next fall it was time to start graduate school! I was enrolled in the Applied Nutrition graduate program for a Master’s degree, but I also knew I wanted to become a Registered Dietitian, so I had to complete two different programs. I started taking graduate classes and courses for the DPD program, which are mixture of undergrad and grad students. I was a full time student again! My classes were in the evening, and I was still working full time. I was taking three courses a semester! Every night after work I was at school. That year was really hard, but I got through it.

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By fall of 2014, it came time to take more DPD courses, all of which were held during the day. I knew something had to give and I decided to work part time. Thankfully, my Agency let me cut my hours and work half the amount. I got to organize my work schedule around my classes, and for that I am forever grateful! It also gave me more time to work on homework and get projects done. Now it is 2016 and I’m in the process of applying for my DI. We rank the DIs we want to apply to and submit our application electronically through a program called DICAS. On April 3, we get matched with one of the programs we’ve selected. The DI is 10 months long with rotations in clinical nutrition, food service, community nutrition, and out patient care. To say I’m looking forward to April 3 in an understatement!

This process has been pretty crazy. It has been almost six years since I started. Since then I’ve moved five times, ended one relationship and began a new one, ran four marathons, and started hiking the 46, all while chugging along to another goal: becoming an RD! And now, there is a light at the end of the tunnel. If I get matched to an internship this year, I will be completing it from August 2016 through June 2017, finishing seven years after starting this process. All that remains after that will be taking and passing the RD exam (and finding a job)! I’ll also be graduating in May 2017 with a Master’s in Applied Nutrition. Thank you to everyone who has supported me through this crazy long process. The end is near!

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