What is a dietitian? What is their role? Read on.
Much attention is focused on hospital staff like doctors and nurses right now. Quite rightfully. They fight the critical fight of saving lives and comforting sick and dying patients during the novel coronavirus Covid-19 pandemic. They deserve every bit of this attention and appreciation, and more besides.
As a food website, though — one centered on interviews with women in food — it is important to highlight the role of another category of hospital staff working hard during coronavirus: the dietitian.
What is a dietitian? Is it the same as a nutritionist? What is is like working in a hospital right now? We ask these questions, and more, of a dietitian (and this writer’s sister extraordinaire) Elizabeth Ceccarelli, R.D., L.D.N. Beth works at Paoli Hospital on Philadelphia’s Main Line, an area hit with Covid-19 cases (much like everywhere else).
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The Interview: A Dietitian’s Role During Coronavirus
This interview has been lightly edited and condensed for space.
Lisa Ruland [LR]: To start off, what is a dietitian? How is that different from a nutritionist?
Beth Ceccarelli [BC]: So let’s start out with that a nutritionist is, because that is simpler to respond to. Essentially, anyone can say they are a nutritionist. If you want to see a nutrition expert, look for a credential of R.D. [registered dietitian]. It means that we either got a bachelor’s degree in nutrition or nutrition science, plus clinical work, plus boards. I think in a year or two they’re requiring a Master’s degree, which I have.
Dietitians have to complete 1,200 hours of clinical work. The majority of that is in a hospital. You see a bit of everything. It can start with GI-related diseases like Crohn’s and IBS, then heart disease, heart failure, and then the further along you go, you go into more complicated patients like ICU, who are on tube feedings or TPN, which is getting fed through your veins. You can also have rotations in specialties like pediatrics.
There is no requirement for nutritionists to be licensed. So a lot of people you see at gyms and so on are people who could have just taken classes online and become “certified” as a nutrition coach.
LR: Talk more about dietitian vs. nutritionist.
BC: There may be some nutritionists who do have a degree and do have a lot of very knowledgeable experience, and that does happen a lot. But, if you have gone through the appropriate path as a dietitian, we are experts on how the body works — the biochemistry classes, the organic chemistry classes. We have learned how the body works on a very science-based level.
BC: So we are kind of learning as we’re going, and guidelines are being adjusted clinically for what our needs are. We are not even going onto patient floors anymore, and in fact, we are lucky that we are able to work remotely, except for one day out of the week where we take turns going to the office. We are calling patients on the phone and charting from home. Even our ICU dietitian, who is the one handling most of the Covid-positive patients right now, is able to do everything but physically assess them. We look at their charts and talk to other people on their care team like their doctors and nurses.
LR: What is it like going into the hospital, even though you’re not on patient floors?
Even just walking into the hospital is different. You have to show your badge. There are no outside visitors anymore, so waiting areas are completely empty. There are tables set up in the main entrance — the only entrance to the hospital right now — and there’s someone who checks every single person’s temperature, staff, everyone. And they also check your ID badge. That person is wearing a mask and gloves.
The hospital itself is very quiet because they’ve cut all elective surgeries and there are no visitors. The census [how many people are in the hospital on a given day] is way lower. It’s weird being the only dietitian in the office at any one time. I’m used to having all the chairs in the office filled, but now they’re all empty.
The reality slaps you in the face wherever you go. Even for breakfast at the cafeteria, people are serving you coffee now because you can’t get it yourself. A lot of the lunchtime protocols have been changed to avoid with less direct contact: no salad bar, no self-serve oatmeal or eggs. They have even done away with the hospital’s room service menu. Patients could call anytime for meals, but now they’ve switched to automatic tray delivery. Instead of food service staff bringing food to the patient rooms, nurses will bring it in to cut down more on exposure to other people and staff in the hospital. So it reaches from the direct medical team to how food service operates and custodial staff. Everyone has a mask on. It’s everywhere.
LR: You have been the R.D. for Covid-positive patients. What is that like?
BC: The Covid patients we have now are mostly in the ICU, so we have an R.D. [registered dietitian] who works specifically in that department. But we all have to know how to work with these critically-ill patients and be able to pick up where the last person left off or if we get overwhelmed with critically-ill patients. So just like we would with any patient in the ICU who is on a ventilator — because most of these patients need mechanical ventilation — we have to check their medications and check if they are stable.
If you are on a ventilator, you need your nutrition from a feeding tube. So that is primarily where our skills and expertise come into play. We take into account their past history and comorbidities, which are other health issues going on at the same time, like diabetes.
LR: It must be a hard calculus, because I imagine that nutrition can affect their reactions, their health, and interact with medications.
BC: Yes. Maybe their GI system isn’t even functioning, and then they have to be fed through their veins.
LR: How does someone get fed through their veins?
BC: It’s an emulsion the pharmacy concocts based on what we prescribe their needs to be. We figure out grams of protein, carbs, vitamins, minerals, electrolytes, fluids. What rate do they need it? Sixteen hours? Twenty-four hours? So that’s for someone who either has a bowel obstruction or cannot digest their food through their GI tract. But vein feeding is more serious because it brings in a higher rate of infection; there are lines going into your veins.
LR: You’re an R.D. who is working in a hospital during Covid. You’re also a self-distancing mom of two young kids, who is also not seeing family and friends, trying to balance all aspects of life. How is it going?
BC: I think like anybody else, it’s a day-by-day process. I think I’m learning not to place expectations of any kind on myself. At the beginning, I was waking up and deciding, “This is going to be a great day for me and my family.” And that is just not realistic. I think that my husband and I have started focusing more on “OK, let’s do breakfast. And then let’s get to playing outside.” Don’t anticipate the future. Just be in the moment. Otherwise it’s just too overwhelming.
LR: Do you miss going into the hospital as usual?
BC: I still go in one day a week which is nice. It’s weird not having the direct face-to-face contact with patients. It’s just an odd new reality for right now. We are missing that piece of what we do.
LR: What do you want people to know about a dietitian’s role right now?
BC: I think this is where RDs can and do have an impact on the outcome of patients. And I think a lot of people don’t realize what goes into properly nourishing critically-ill patients and the amount of information that we need to assess on a daily basis to keep them fed, to keep them healthy, to assess how their needs are changing on a daily basis. I think this is a time when our expertise can really be demonstrated.
My other coworkers have all seen so much online — not to diminish what everyone else is doing — celebrating the nurses and doctors, but RDs get overlooked. We are here too, and we’re a really integral part of the care and management of patients.
LR: Well said, Beth. I hope that this can help to celebrate you and your contribution. Thank you so much.
– Lisa Ruland
This is a insightful view into an aspect of Hospital care that we do overlook. Thanks for writing this interview and a huge thank you to the many dietitians that care for all our sick people, not just those with Covid-19.
Thank you for the nice comment, AJ, and great words of thanks to all of our dietitians. Well said.
Dr. Bob Stafford says
Having practiced OB/GYN for 28 years, and Addiction Medicine for the last 20 years (caring for pregnant opiate addicts to achieve a healthy, non addicted baby) has been heavily dependent on a dietician to orchestrate diets for pregnant Mom’s, newborn infants, addicted Mom’s, and baby’s in withdrawal, when not having their Mom’s to withdraw long enough. All of us praise the nurses, and dietitians, and all supportive staff who keep the hospitals running smoothly to care for our patients!! We should thank God for them not daily, but hourly!!!
Amen! Thank you so much for this thoughtful comment, Dr. Stafford. I can’t wait to pass this along to my sister so she can see it (and my mom, a retired nurse). What a career, and what important work you do. Thank you again for writing, and thanks for your dedication to such vulnerable patients.