Why I Chose Community

January 12, 2020

When I say to people that I’m a Community Dietitian, I often get the same type of responses:

“What’s that? So you’re like a chef or something?” – I’m sure every Dietitian or trainee has been up against this reply before.

“God I bet you see some sights in that job” – a fave, you see sights in any job in healthcare, it’s part of the job.

And finally, “oh so you work in a hospital or something then”. Finally, we got there, almost.

Another one I get asked by fellow or future Dietitian’s is “why do you like community so much”, which is something I thought I’d touch on today. From my cohort, I am one of very few who commenced their journey in community rather than acute. In our training and throughout our careers, there is a large focus on acute practice and working in an acute setting. Even myself at the beginning of my postgraduate course had my heart set on working in a hospital – the idea of getting a community placement seemed horrible, like it would be the longest and most boring three months of my life. When I got my placement allocations, just that happened. Placement C was solely community and inside, secretly, I was pretty gutted.

My Community Placement Experience

I honestly couldn’t of asked for a better community placement. I’m quite lucky in that I got to do a community placement, as I know a lot of people didn’t get to do one – but I’m so thankful I did. After having my heart set on acute and having the best A placement ever, I thought that community would just be three months I’d have to grit my teeth with and get on with. But after my B placement experience, it made me realise many factors about acute where I felt totally limited in both myself and helping patients. I then was really looking forward to community and see what it’d be like. On my first day, what really struck me was how much more CHILL community life was to acute. Now don’t get me wrong, this simply could have been down to my placement provider, but even going forward into my jobs I’ve found this the case too! Like on my first day I was literally sobbing inside because I couldn’t get an acrylic nail off and I thought I was gonna be done for on my first day.. but nope, my manager was just like “oh don’t worry that’s cool just get it off when you can”. Sounds stupid but it was something that made me feel at such ease and relaxed about the whole thing.

People fear that on community placement you won’t get the opportunity to do consolidation – don’t worry, you still do! Although there is an increased risk as you’re lone working, the staff are kind and give you established patients to review and care facilities, so you won’t be going anywhere out of your depth. The rest of the time beforehand you do get to shadow fellow community staff, which I really enjoyed compared to shadowing on wards. You really get to know the patient and make time for them, where as on wards it was kinda a 10 minute job of get ya information, go (of course, totally my opinion). Just even making sure an elderly lady had a cup of tea before you left really made me love community work more. I didn’t just get to do visits though, I did audits, presentations, talks, information displays, GP clinics and more across a wide range of locations, so it never got boring and you never got the feeling of being trapped inside the same 4 walls! Also, one of the trivial things I loved? Driving to patient houses in the summer with your windows down, sunglasses on and music playing – didn’t even feel like work!

Working as an RD in community

Working as a Registered Dietitian isn’t much different to what I did as a C placement student, only better, as you’re much more independent and you get your own caseload. It’s not to say that you don’t ask questions and you don’t consult with your team, because EVERYONE does that during their career, not just students – it’s safer practise if anything and keeps your brain ticking!

Like my placement, I got to see patients in their own environment. For me, this is so much nicer than seeing them in hospital because you almost get to see the real them at home and with families. I think such an important part of this is highlighting the importance of social care and social influences which could influence patient’s care, something you definitely touch on in acute but don’t really see with your own eyes until you’re there in the community. You see how patients really live, what they have available, what they don’t have, what they need. You see support networks and how they can get access to community facilities. And some of these will shock you. I’ve seen elderly people who can’t open the fridge because the handles on the side of their arm which has poor mobility and weakness because they’ve had a stroke. I’ve seen people too weak to even hold up a cup of tea. I’ve seen people sleeping and soiling themselves on their sofa because they can’t get up the stairs. They’re sad sights to see, but important ones in ensuring they have the best quality of life. This is where working so very closely with OTs, carers, Macmillan nurses and many others is so important. They help us put provisions in place to make sure these patients have the best quality of life. It’s so important to them and for their care and when you make them really happy and make their life a little bit easier for them, that’s when community work really makes it’s worth.

My first job I wasn’t able to go out into community settings as much as do talks, displays and interventions, but I’m really happy I will be doing more of this in my current role. It’s really important to educate people to prevent or manage their condition in the early stages, which is such a good excuse for talks and education sessions.

Promotions for Dietitians Week – I hosted this stand around several locations during the week, including health centres and GP surgeries.

If you don’t mind driving quite a bit, then the jobs a good one. I spend probably around 1hr of each working day in my car.

However, there is one down side to community I have to admit – bags and bloody scales. Carrying around scales and supplements trials and information leaflets is kinda a manual handling case calling. They can be really heavy and they take up so much room in your cars – but again, this is just part of the job and just one little minor inconvenience to community work, in my opinion.

The Importance of Long Term Care and Prevention

One thing I think REALLY doesn’t get highlighted about community work when studying or on acute placements is the importance of prevention and long term care, especially things such as chronic disease management and palliative care. Think about it, how much of our lives do we spend in hospital? Hopefully, not a great deal, but how much time do we spend at home? Yep, a lot. And ideally, we want to keep people out of hospital and be able to manage conditions at home as best they can. That’s where community teams come in. No we probably don’t deal with as many acute issues such as AKIs and surgery, but we do do a hell of a lot, such as pressure sores (major MAJOR problem in care homes and bed bound patients), UTIs and yep, you guessed it, bowel problems. I’ve had many a patient show me their commode full of poo….! But we also deal with management: heart health, diabetes, COPD, cancer, neuro, alcoholism, drug abuse, IBS… just to name a few. Community teams are so key in helping people with these conditions: we visit, we assess, we do talks, we do clinics, we do information gathering and displaying, we do our very best to keep people out of hospital.

Community is bloody important, so don’t think that it isn’t. Just because you’re not in the “thick of the action” doesn’t mean you won’t see any or provide help because I can guarantee, you will!

And now?

Fast forward six months and I’ve just started my second Band 5 role – again in community! Sometimes, yes, I do miss life on the wards and the hustle and bustle of hospital life and no, I’m not completely dismissing ever going into acute at some point in my career, but I know that right now, community is where I want to be!

I hope this has given you an insight into community work and perhaps stopped you from dismissing it in your career options. We NEED more community Dietitians and their work is just as valuable as anybody else’s!

Muchos love,

Emma x

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