RD Career Spotlight Interview: Nancy Bloom, RD, Cardiovascular Associates of Marin & San Francisco

NutritionJobs: You are currently working as an RD alongside a team of cardiologists at the Cardiovascular Associates of Marin & San Francisco, where you practice Medical Nutrition Therapy (MNT) with patients and their families. Can you tell us how you got there?

Nancy Bloom: I’ve always liked cardiac nutrition having been a volunteer with the American Heart Association since 1979. When I moved back to California from New York I heard about an individual counseling job here through a friend. I interviewed, got the job and I’ve been here over 12 years. At first my practice ebbed and flowed. Then about 4 years ago, I took a Motivational Interviewing (MI) course from Molly Kellogg, RD, from Philadelphia, and was able to take my counseling program to another level and grow my practice to where it is today.

Can you tell us more about Motivational Interviewing (MI)? 
MI has been successful as a learning technique because with MI the answer is inside of the patient, with the patient making their own decisions and finding their own motivation. It’s a tricky thing because it involves assessing stages of change. The person that is ready will make the change but if they are not ready you have to work to bring them up to a stage of readiness. Part of the counseling technique is to get the patient to maintain the process, because the process is different for everybody.

How has MI helped grow your practice? 
Motivational Interviewing has been very helpful in creating an active client base. Patients come back, which is how I measure success. I have a client that has been coming back for 7 years and is still making progress!

What is your relationship with the physicians in your office? 
The staff trusts me with their patients because they understand what techniques I am using and what type of patient encounters I have. I SOAP note in the medical record so that the physicians and all other health professionals can see what’s going on with nutrition counseling. It also allows them to encourage the patient to continue the plan as well as talk intelligently about it. The physicians here are very busy and they all have different personalities. Sometimes part of my job is to cheerlead for the physician and encourage the patient to do what the physician prescribes. There is a fine line of encouraging the patient to do what the physician says and also empower the patient to ask the physician questions.

What is the most challenging aspect of your job? 
Getting a client to show up, because you can’t counsel unless the person is ready and willing to make the decision to listen.

What is the most rewarding part of your job? 
When people come in and say, “I told 5 people about you” or “thank you for answering my questions” or “thank you for making nutrition not chaotic”. A big part of my job is teaching people how to filter through all the information that is out in the media and to determine what is important to their health.

With all of this in mind, what are your predictions about dietitians and nutrition professionals working with MD’s in an outpatient capacity in the future? I think that if MNT were a reimbursable therapy for most diagnosis and prevention, it would explode. As a dietitian, to be confident in the counseling process is key. I have been teaching nutrition for a long time. Some of my wisdom comes from having done it for so long but if I were taught certain techniques earlier, I think I could have been more successful with individual outcomes sooner. The profession always needs evidence-based studies that show the positive effects of working with registered dietitians.

Are there other job search tips can you offer for dietitians and nutritional professionals looking to work outside the hospital or food service arena? 
Sell yourself and what you are able to do. It is a great skill to inform someone about what you can do and then be willing to take a chance and prove it. Dietitians sometimes have been talking about not getting respect but part of getting respect is being confidant and showing outcomes. Lastly, being in local and statewide dietetic associations has helped me throughout my career. Not only is this helpful with gaining continuing education credits but interacting with other dietitians is paramount. You get to know faces, find mentors and access a stream of knowledge. It takes time and you will want to participate more at certain times in your career than others, but it is always nice to have these connections.