What I like…and don’t like about being a Renal Dietitian

I have worked as a renal dietitian for the past 2 years. If you’re thinking, “Wait, didn’t you just change jobs in January?”, the answer is yes, but I simply switched companies. Not much about my job duties changed, just location, patient load, and salary.

To start, the word “renal” refers to the kidneys. The kidneys are an organ in the excretory system and perform many vital roles in the body, including: blood pressure regulation, activation of vitamin D, red blood cell production, urine production and fluid removal, the excretion of waste, and so much more! These bean-shaped organs are on the back side of the body and lie just above the waistline.

My work was performed in dialysis units. Dialysis refers to the artificial process of cleaning the blood when the kidneys have failed (most often due to uncontrolled hypertension and complications of diabetes, though there are other causes for kidney failure). Dialysis can be done in-center by exchanging one’s blood through an artificial kidney and large machine, or by way of inserting a sugary fluid into the peritoneum (the space in between all of your organs in your belly) and draining it out. There are benefits and drawbacks to the different types of dialysis and it is up to the interdisciplinary team to help a patient receive the treatment regimen that best fits their needs.

I covered 2 dialysis units (and always have), and in my 24-26 hour work week, I generally cared for about 70-75 patients. The renal dietitian is responsible for completing nutrition assessments on each patient (initial, after 90 days, semi-annually, and annually), assessing each patient’s labs every month and making changes to their diet and recommendations to their prescriptions, dosing their vitamin D, performing nutrition education on the renal diet, monitoring weight status, conferring with hospitals and extended care facilities to meet patient’s needs, referring patients for IV nutrition, charting, and collaborating with the interdisciplinary team by way of physician rounds and attending quality control monthly meetings. My typical work hours were 7-8am to 3:30-4:30pm, though this can vary significantly and is extremely flexible.

Would I recommend renal nutrition to other dietitians? Absolutely…for a period of time. Working as a renal dietitian is such a specialized area of nutrition and it’s not for everyone!

The Good

  1. I got to see the same patients over-and-over. I knew my patients REALLY well. While this can come with plenty of disadvantages, I feel that having that rapport and relationship with patients was invaluable. I knew about their health history, social history, habits, preferences, personalities…I knew them! This made my job more fun and more successful in helping them meet their nutrition goals.
  2. Historically, renal dietitians are part-time employees because most dialysis units can only offer treatment to so many patients (patients run dialysis 3-5 hours, 3 times a week). Again, this comes with positives and drawbacks, but I was able to be very flexible in my schedule. I didn’t have a specific “start time” or “end time”. Some weeks are much busier than others and I could easily adjust my schedule to maximize my time and efforts. I absolutely loved having this flexibility.
  3. I thoroughly enjoyed being a part of a small interdisciplinary team and at the same time, being the only dietitian. If my job didn’t get done or didn’t get done right – I was to blame. Conversely, I didn’t rely on others to get my job done. I enjoyed being able to interact with my coworkers without “sharing” the workload, if that makes sense. I was a one-woman show and I liked it that way. Similarly, the physicians and I built rapport and my suggestions were generally well-accepted.
  4. Nutrition is valued in renal care. Fortunately and unfortunately, lab work that is monitored in dialysis patients is STRONGLY linked to their diet — everything from potassium to calcium to protein to phosphorus to fluid. The role of the dietitian is INTEGRAL to the outcomes of the patients and that is rewarding.

The Bad

  1. Health care is changing and the way physicians approach health care is changing. Because I would see the same patients 2-3 times a week, I would hear about each and every one of their health concerns. While I understand the need to draw lines in the sand as to which health care professional should be “treating” which issue, so many issues affect dialysis outcomes. Due to the changes in reimbursement and thus health care, it is becoming difficult to treat patients as a “whole”. It’s concerning and a disservice to the patient.
  2. It’s hard to see patients so ill and have patients pass away. By the time patients are to the point of requiring dialysis, many of them only live a few short years. It is a blessing that you can live on dialysis a very long time and the kidneys are an organ that can fail and there is treatment other than transplant, but most patients live 5 years or less once starting dialysis. That said, patients who take care of themselves after beginning dialysis can live very fulfilling lives. In the older dialysis population, it is usually a situation of MULTIPLE health complications and conditions that result in death, not the dialysis itself. Sorry so morbid, but it’s a reality.
  3. My job could be very repetitive at times. Draw labs, do assessments, discuss labs and diet changes, chart, calculate dose changes, chart, educate, chart…again, and again. My months all mapped out the same which was nice for planning my schedule, but the work was very predictable and cyclical. I like a bit more variety!

The Ugly

  1. I won’t beat around the bush with this one – 9 out of ever 10 dialysis patients (if not more!) are non-compliant. They are non-compliant with their diet, fluid restriction, coming to treatment, taking medications…you name it. The population can be very trying. Seeing as dietitians are in the business of “change”, non-compliance is a major barrier and hardship to face. As much as you want something for your patients, it always came down to their motivation and follow-through. I think this was the #1 challenge of working in dialysis.

I can honestly say I learned a ton (if you ever want to chat about secondary hyperparathyroidism, I’m your gal!), but my passion is in disease prevention. I want to help diabetics never, ever end up on dialysis. I can speak to the reality of dialysis and outcomes if people don’t change their lifestyle.

I met some AMAZING people – patients and coworkers, and I did enjoy my job. I can’t say I loved it by the end, but I love working with people. I am very excited to open up my next career chapter and bring with me so much of what I learned working in dialysis.

Be well,

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27 Comments

  1. Ma & Pa Prevention
    June 16, 2012 / 8:13 am

    Well written babe. This post certainly helps us wrap up all of what you’ve shared with us over the years in one tight bundle; the good, bad and ugly. It was good experience for you and now it’s on to something new and exciting. We are anxious to hear about your next chapter in life and the fact you’ll be moving so much closer to us is a bonus we are looking forward to. XOXO

    • Nicole, RD
      Author
      June 16, 2012 / 10:57 am

      I love you, Maaa. πŸ™‚ Very excited to be closer to you guys!

      • K Lynn
        June 17, 2012 / 5:52 pm

        and…..ME!!!! πŸ™‚

        • Nicole, RD
          Author
          June 17, 2012 / 6:38 pm

          Kristen Lynn. What does this even mean?! πŸ˜‰

          • Nicole, RD
            Author
            June 17, 2012 / 6:41 pm

            OH haha. I haven’t seen that this was a thread. I’m very excited to be closer to you BOTH! πŸ™‚

      • Tiffany
        April 18, 2018 / 4:57 pm

        Hi Nicole ,
        Find out your blog by accident and I think it s lucky! I cried when I read it because make me remember about my husband. He is on dialysis 1 year now and actually it s very sad and painful when think what will happen And I m scared think about that day. I try my best to help him with diet because I know it will affect on his kidney health a lot, but once again I have to go to work for living, go home late and can not do good diet for his kidney and most important that’ I m not nutrition so things with me not easy. I m looking for the kidney dietitian for planning the meal for my husband every month bases on Husband blood test. So I really hope you can help me this please! It’s said you save one person it is same to you build up big pagoda. So hope you can help me this! Thank you so much!
        Tiffany

  2. June 16, 2012 / 9:03 am

    Very interesting – thanks for sharing!

  3. June 16, 2012 / 11:36 am

    Great post Nicole! I agree about the non-compliant part of illness – I know so many diabetic people who just don’t want to do the work to maintain their blood sugars saying its too hard, too complicated – a woman my sister works with convinces herself that its okay to eat a giant piece of apple pie because it takes her all day to eat it, instead of eating it at one sitting.

    All I know is that I will still have my feet when I am 80! Good luck packing up this weekend – looking forward to reading about your next life chapter!

  4. June 16, 2012 / 1:36 pm

    Wow, I loved reading this. I’ll be completely honest, I really wish I had found my love for food and nutrition and all that before I had kids. I would absolutely love to go to school to become an RD but now I don’t see that ever happening(we live about 8 hours away from the closest university that offers the program here in BC). I also loved reading this because my brother in law has kidney problems so it’s really nice to see the other side of things. And what even bothers me is the “non-compliance” that you talked about. I’m not qualified in any way to even say anything but I can still see that how he eats isn’t helping him and it bugs me that he wont change it! I know the power of a persons diet and he could be doing so much better if he was eating better and he could be helping himself stay off dialysis for a little longer. It drives me a little crazy. I also had no idea that some thyroid problems were related to the kidneys which also run in my hubby’s family. Very interesting! Thanks for writing this!

  5. Heather
    June 16, 2012 / 6:23 pm

    Thanks for the post! Very informative for us other RDs:) I really respect you for having that position for so long! I don’t think I could do it.

  6. June 16, 2012 / 8:42 pm

    This is a really balanced review.

  7. June 18, 2012 / 1:26 pm

    Even though I’m not a dietitian and have no interest in being one, this was an interesting read for me as a hospital chaplain! Definitely the changes in healthcare and the emotional toll of having patients die is something I share with you. I really appreciate your work with this patient population and the importance of nutrition in treating illnesses.

  8. STH
    June 22, 2012 / 6:30 pm

    Hi there! I just found your blog through a link on Pinch of Yum. I’m looking forward to reading through the archives here.

    The issue of noncompliance struck me, as it did others. My boyfriend just got diagnosed with diabetes and we’re working on changing our diet to keep him healthy, but I’m seeing a bit of resistance to all the changes he needs to make. He’s doing pretty well on his diet–because I do all the cooking and he’s been bringing his lunch to work since he got the diagnosis–but he has yet to start testing his blood or keeping his food diary. Sigh. I feel like I just fought this battle with my (late) father and here I am again! Kudos to you for taking on this issue every day at work; I don’t think I could.

    • Nicole, RD
      Author
      June 25, 2012 / 9:14 pm

      Hi there! Thanks for stopping by! I send all of my love your way. It’s a tough road for everyone, but helping educate the ones you love is so important πŸ™‚ All my best to you annd yours!

      • Howard Horwitz
        February 13, 2013 / 11:12 pm

        Just came across your site. I’m just now finding out I have serious kidney disease and am seeing a nephrologist. I’ll ask him for a dietician referral because that seems to be the key to avoiding dialysis. You sound very dedicated to preventing further disease. Do you have any recommendation for what I should look for in a dietician and how to find one? Thanks for your caring attitude.

  9. Paula
    June 29, 2012 / 8:28 am

    Just had to write as I am a dialysis nurse from North Dakota AND also married to a diabetic who has been not so compliant! FRUSTRATING! I have dealt with all the issues you discussed both at work and at home! Though I can control what my husband eats for meals I can’t control what he eats behind my back or getting him to check his blood sugars like he needs too. I can say he is doing better but it has taken 13 YEARS! It seems no matter how much education some people just won’t listen until they are ready. Anyway I enjoy your blog & just wanted to check in as a fellow colleague who knows where you came from! Good luck in your new position!

  10. Jen
    August 7, 2012 / 7:03 pm

    Hi, thank you so much for your post!! I am actually faced with the difficult decision to maintain my current status as a general clinical dietitian in a hospital or choose a career with Davita. I am so torn because I really enjoy renal but also very scared to make this career move- I have only been an RD for 1 year and I am already sick of the hospital and seeing inpatient. I like building relationships with patients, however I think it must be hard with the non-compliance and seeing patients you are close to pass away. What have you heard about Davita? Do you think a career as a renal dietitian could last much longer than how long you stayed? I am so lost on what to do!! I want a career that is challenging and academically stimulating.

  11. Melissa
    February 3, 2014 / 9:47 am

    Hi Nicole! Thank you for sharing what you do. I am currently going to school to become an RD and I am applying for the Deitetic Internship within the next two weeks in the New York/Long Island area. I had decided to go into nutrition because I wanted to help people lose weight and learn healthy habits for a more fulfilling life. However, I am having such a hard time deciding which field I would like to go into, since there are so many areas to choose from. I am finding that most jobs are in clinical nutrition and weight-loss is more for independent practice. I am debating different areas including renal nutrition, working with diabetic patients, and patients with eating disorders. I also thought of working for a company in wellness but I hear they are usually short-term contracted jobs. As you can see I am all over the place! In the end I just want to work with people to help them accomplish their goals and learn about nutrition and making positive life-style changes. Do you have any advise for me? Thank you so much! – Melissa

  12. Melissa
    February 3, 2014 / 9:48 am

    Hi Nicole! Thank you for sharing what you do. I am currently going to school to become an RD and I am applying for the Dietetic Internship within the next two weeks in the New York/Long Island area. I had decided to go into nutrition because I wanted to help people lose weight and learn healthy habits for a more fulfilling life. However, I am having such a hard time deciding which field I would like to go into, since there are so many areas to choose from. I am finding that most jobs are in clinical nutrition and weight-loss is more for independent practice. I am debating different areas including renal nutrition, working with diabetic patients, and patients with eating disorders. I also thought of working for a company in wellness but I hear they are usually short-term contracted jobs. As you can see I am all over the place! In the end I just want to work with people to help them accomplish their goals and learn about nutrition and making positive life-style changes. Do you have any advise for me? Thank you so much! – Melissa

    • Nicole, RD
      Author
      February 3, 2014 / 10:49 am

      Hi Melissa! You’re not alone, trust me! It’s overwhelming!! You’ve made it this far, so I’d say just look to try something. You may not get it right your first attempt, but there’s always time to try something new. Due to moving around with my husband’s job, the longest I’ve been at a job is 2 years πŸ™‚ What I love most about my job is the variety – I get to do in-patient, out-patient, MNT, cooking classes, management…you name it. Maybe looking for something with variety will enable you to figure out what you like most and least? Apply to any job that fits your criteria (i.e. full-time, part-time, proximity to home, etc.) and see how the interviews go. Chances are you’ll know what’s right πŸ™‚ Good luck! Please feel free to email me with any more questions. And, congrats!

  13. Selina
    April 21, 2014 / 8:27 am

    Hi Nicole!

    I am currently a Master’s student in Dietetics & Nutrition and am looking forward to my journey on becoming a clinical dietitian. I love what I’m learning as well as the thought of helping people. Besides the knowledge and great flexibility the job offers, the thought of dealing with non-compliant patients can be a bit frustrating. You wish you could control your patients diet and help them get better, but none of it is done if they’re being stubborn.

    Among all of your patients, including the non-compliant ones, do you feel as if you have made a difference in helping them control their eating habits? How do you deal with their stubbornness? I think I’m just afraid of the profession being unfulfilling in the long run if I don’t feel like I’m making a difference in my patient’s lives.

  14. Cat
    January 30, 2015 / 5:32 am

    thanks for writing this!! I was just looking up info on what’s it like to be a renal dietitian (i am an RD but never worked in dialysis other than in my internship). Thanks so much for the good, bad and the ugly breakdown.

  15. Tammy
    January 29, 2016 / 9:56 pm

    That was a very good summary of working as a Renal Dietitian. I have been working in this field for 16 years, and for the most part have loved much of my time. I must say that it is starting to get harder and harder to get motivated to go to work. All the cons that you have listed do start to weigh in. It is very hard working with patients that do not want to do what they need to in order to have the best health possible. It is hard to be responsible for their outcomes, when it seems like you care about them more than they care about themselves.
    I too love the concept of prevention so much more than working at this side of the disease process. But unfortunately those jobs are few and far to find.

  16. Megann Harris
    July 7, 2017 / 6:02 pm

    Thank you for sharing these invaluable insights!! I was recently laid off as a diabetes educator and I’m considering dialysis, not sure which direction to go yet. I’ve even been wondering if I qualify for anything with somewhat comparable pay outside of the field altogether. I am right with you on our healthcare systems’ issues and the great difficulty we have in practicing holistically. Its a big problem and it has to change! It seems like its only gotten worse unfortunately.

  17. Jess
    May 1, 2019 / 10:50 am

    Thank you for this thoughtful post. I am a Dietetic student right now, I have been exploring career options and renal care is one of my areas of interest. I appreciate your insight! Best of luck on your journey ahead.

    • Nicole Morrissey
      Author
      May 1, 2019 / 9:41 pm

      Thanks so much, Jess! Best wishes to you! <3

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