"A lot of them are on a ventilator and need to be fed through an IV or a tube that goes through their nose down to their stomach," Cimperman told ValuePenguin. "And that’s the way I explain it to people, particularly without a health care background."
Cimperman, officially a clinical dietitian at University Hospitals Case Medical Center in Cleveland, also broke down for us the basics of her career while including the necessary context.
Why did you become a dietitian in the first place?
I was drawn by the fact that nutrition is something that we can control, and it has a significant impact on not only our risk for disease, but also our ability to lead the healthiest life possible. Not just to avoid disease, but to optimize our health. And I liked that idea that, in this world of so many uncontrollable factors, that we really can take very significant steps towards controlling our own health.
Was there ever a point where you weren't sure what you wanted to do?
In college, I actually started off being an English major. I wasn’t quite sure what I was going to do with that, like most college freshmen. I happened to take an intro to nutrition course, and that’s what got me hooked. I saw a more clear career path in nutrition and dietetics, and I found I actually enjoyed the science classes we had to take to complete that major.
What sticks out about your dietetics education at Case Western University?
First of all, it’s been, what, 15 years, 14 years, since I graduated, so I’m pulling things back from my memory. But basically, it was a four-year degree, and after you complete your four-year degree you need to complete an internship. I happened to intern at University Hospital’s Case Medical Center because it and Case Western Reserve University have a master’s degree and dietetics internship program that is coordinated.
So I went to class for my master’s degree on Mondays, and then Tuesday through Friday was the internship part of the week. The criteria for exactly what classes you need to take, and how long the internship needs to be, and exactly how many hours you need are set by CDR, the Commission on Dietetic Registration.
Do you remember those four to six years as being especially rigorous?
Certainly, college and your education should never really be easy, but I felt appropriately challenged and confident I was on the right career path. As far as my undergraduate education, I think it’s important for people to realize that nutrition is a science. So you take your basic science courses, like organic chemistry, biology, microbiology, and then you get into more specific nutrition courses as well. But I think that sometimes there’s this misconception that maybe nutrition isn’t a hard science, and it certainly is.
And then obviously in your internship, you begin to process these things that you learned in school, and that’s more of the practical, hands-on part of your education.
You already have your master's, but all new RDs will have to have one starting in 2024, as mandated by the CDR. Is this good news for the profession?
There’s actually a lot of disagreement. Myself, and I think a lot of dietitians are in the same boat; where we want to know exactly what the intentions are, and how this is going to affect the profession. I’ll be honest; there are still some things that I need some more information on and other things that I disagree with at this point. But I’m certainly not an expert on it.
The bottom line is this: If people are going to be required to get their master’s degree, we need to make sure that that master’s degree is appropriately valued and compensated for. Mine was expensive, but I don't know how much it has changed my salary or my earning potential.
And now you've been working at the same hospital that you interned with for the last dozen years.
While I’ve been here for 12 years, going on 13, I’ve actually had a number of different roles here at the hospital. So, when I first started, I worked in outpatient dietetics. Doing something like that, I have patients coming to see me in an office. Typically we were working on weight loss, diets for better heart health, diabetes, kidney failure, etc. In outpatient, the major component is educating clients and patients on improving their diet, and potentially improving their diets with an effort to control certain diseases' states, like diabetes or renal failure. So I started out doing that.
I actually have done some research as well here at the hospital. We did a study on probiotics, and then I transitioned to doing inpatient care, and I’ve covered a number of different medical, surgical floors at this hospital. Now I’ve ended up in this critical care realm, where I’ve been for the past eight years.
And are those transitions natural for a dietitian in your space, or did you want to vary your day-to-day from year to year?
A little bit of both. The career of dietetics is nice in that there are so many different options available. It’s hard to get bored doing this job because there are so many different areas you can use your skills in. For myself, I have personally always been open to new experiences. I’m the type of person who needs to have a challenge, and I’m always interested in trying new things. I never want my career to be stagnant. So to your point, some of these changes were simply just opportunities that came up and I took advantage of, and others were things that I actively pursued in an effort to advance my own career.
Now that you're a part of the critical care team, what is your average workday like?
Typically, I’ll round up with the ICU team, and this allows me to interact with the physicians and others on the health care team who are also taking care of the patients. It allows me to have direct input into the patient’s care and handle any problems or issues that may arise on the spot. Communication is really essential in the ICU. We’ve gone to, obviously, computer documentation, but it’s important to note that that face-to-face relationship with both physicians and patients is still the main way that health care should be practiced.
Then the rest of my day is focused on seeing patients in the ICU, completing nutrition assessments and providing recommendations for nutrition support. I’m also involved, as I said, in caring for patients who are not in the ICU; they’re just on a regular floor. That may involve educating those patients on their homegoing diets.
Generally, are patients and their families amenable to your nutrition instruction?
I certainly get different reactions to the recommendations that I provide. Overall, most patients are ready to accept the information I have to provide to them, but not everyone is ready to actually act on changing their diet. I am in kind of a unique position because my patients may have just had open-heart surgery, and sometimes an event like that is really what it takes to motivate individuals to make big changes in their life. It’s that slap in the face that some people might need to actually make changes.
With all that said, most people think that dietitians are the food police, and we’re really not. As I’m sure anyone who’s even considering a career in dietetics knows, we’re just really interested in helping individuals have the healthiest diet to live their lives to their fullest potential. And that includes dessert sometimes.
How has technology affected your daily routine with patients in recent years?
I wouldn’t say that the care that I provide to patients has not changed, but certainly, the way that I document things has changed significantly. So we went from paper documentation to computer documentation. I would say that in some cases, computer documentation can suck time away from that face-to-face contact. But I think that as we have become more adept at electronic documentation, and as we have adapted to it, I think that it hasn’t had a negative effect on our ability to provide that face-to-face care.
With many patients to tend to, how many hours are you working on a weekly basis?
The hours I’m actually here at the hospital do vary. It’s never less than an eight-and-a-half-hour day, and potentially longer, depending on what responsibilities I have for that day. I also work at least one Saturday a month, and then we have an evening on-call rotation schedule. So there are 10 other dietitians in the adult part of the hospital, and we rotate through one week on call in the evenings.
I’m also involved in a number of other activities, like educating the residents; this is a big teaching hospital, and I do monthly lectures for our ICU residents on nutrition support. I lecture at Case Western Reserve University for both the nutrition students as well as the nursing students. My day often includes at least one meeting on some topic or another. For example, right now we’re looking at putting together education materials for patients who receive feedings through a jejunostomy.
I’m also on a task force that’s focused on standardizing our parenteral nutrition orders. And media activities are also part of my day often, where either I may be doing an on-camera interview for the hospital, or potentially a phone interview on behalf of the Academy of Nutrition and Dietetics. You name it, and I’ve probably given an interview on it.
Here are a few standard interview questions then: What is the most challenging part of your job?
The thing that I need to be most conscious of is always staying on top of new research. Being at this point in my career, you run the risk of things becoming routine and becoming very comfortable in your position. I think that as a clinician, and having that strong science background, I always need to be focused on reevaluating my practice, to make sure that I am providing the most up-to-date care for my patients.
Which part do you enjoy the most?
I enjoy making a difference in peoples’ lives. I think dietitians really do that. Sometimes it’s not the actual nutrition care that I provide to patients, but simply that human interaction that I provide to them. Quite honestly, the brightest part of my day might be just making a patient smile or reassuring them when they’re scared about a procedure or something. It’s that human interaction that keeps me here at the hospital and really makes me value what I do every day.
I also really value the support I receive from my peers. And that is something that, the longer I‘m in this career, I’m finding out even more. My coworkers here at the hospital are some of my best friends. And what I notice as I go to national conventions and meetings — the Food and Nutrition Conference and Expo every October, and the American Society for Parenteral and Enteral Nutrition every February — is there’s this same vibe of support and solidarity among dietitians that is really encouraging. It makes one happy to be part of such a great group of individuals.
Based on those interactions and your own experiences, what in your mind separates a very good dietitian from an average one?
Individuals who excel in this career are very self-motivated. They have an interest in improving the lives of others. And they also have a significant drive to, as I said before, constantly reevaluate their practice and improve upon their practice. I think that, as with any career, you have those who truly excel and those who don’t. I think for those who don’t, there’s probably a variety of reasons. But I think that any time where you become stagnant and just kind of accept the status quo, your performance taps out.
For someone who is considering beginning a career as a dietitian, what's your advice?
My biggest advice would be to be open to opportunities as they present themselves to you. There are so many different avenues of dietetics that you can become involved in. To pigeonhole yourself may actually limit those opportunities. And that’s one of the best things about a career in dietetics: that there are so many different ways you can use your education and use your credentials. So my advice would be really just to explore things and try out different things, even if you think it’s something that you never thought you might be interested in.