MPH, RD, LD, FAND
Clinical Dietitian at UH Rainbow Babies and Children’s Hospital, in Cleveland, OH
Allison Thirion-Blasius, MPH, RD, LD, FAND is a firm believer that you can’t live a full life on an empty stomach. She serves as a Clinical Dietitian atUH Rainbow Babies and Children’s Hospital, in Cleveland, OH, specializing in pediatric diabetes and renal nutrition. An educator at heart, she also works as an Adjunct Lecturer at Case Western Reserve University, also in Cleveland, where she teaches future RDs and does research on culinary education for
patients with type one diabetes. Alli has held numerous Academy leadership roles and precepted dozens of future RDs, and she hopes to be involved in the profession for years to come.
Our interview with Allison enlightens readers on how she became a Registered Dietitian Nutritionist and offers advice for those considering the field.
Education and Training
I always knew I wanted to work in healthcare, but I didn’t know what my niche would be in the field. During college, I took a nutrition class as an elective my sophomore year and fell in love. Food has always played a central role in my family, and I was a student-athlete at the time. Having the opportunity to study food in the context of health and performance felt like a great fit. By the end of the semester, I had officially changed my major to nutrition and never looked back.
I took one of the most straightforward paths available to become an RD. I attended a 4-year
university and obtained my bachelor’s degree in nutrition while also completing my DPD
requirements. I went on to complete a master’s degree in public health that was combined with a dietetic internship. In all, the process took six years.
There are many paths to becoming a dietitian, but there are four things all future RDs must complete before sitting for the RD exam: a bachelor’s degree, a master’s degree, an accredited didactic program in dietetics (DPD), and a dietetic internship (also called supervised experiential learning or supervised practice). Currently, future RDs can complete their bachelor’s and master’s degrees in any subject, though many choose nutrition-related degrees. As part of your degrees, a series of courses called the didactic program in dietetics (DPD) must also be completed. The DPD courses include basic science courses, social science courses, and nutrition courses that provide essential baseline knowledge to practice as an RD. DPD curriculum is offered at both the undergraduate and graduate levels, and universities will indicate on their websites if they provide an accredited DPD program (graduate programs that include DPD courses are called Coordinated Programs or CP programs). Lastly, all future RDs must complete a minimum of 1000 hours of hands-on learning, called a dietetic internship. During the dietetic internship, students learn and demonstrate skills that an entry-level RD would need. Students have the opportunity to learn in many different locations including hospitals, schools, government organizations, and more under the guidance of practicing RDs and nutrition professionals.
The DPD curriculum gave me great baseline knowledge that I still apply in my job. Basic science
classes like chemistry and anatomy are notoriously difficult, but they are essential for clinical
practice. My graduate courses on public health nutrition, especially courses about social
determinants of health, taught me how to think holistically about patients’ nutrition status, which I apply every day in my practice.
The internship was essential to help put everything I’d learned in the classroom into practice. You can know things, but it’s a very different experience to apply that knowledge. One of my preceptors early on gave me some good advice: The first time you do something will be the worst time you do something. This helped me embrace trying new skills and not putting pressure on myself to be perfect in doing them. It also helped me be more open to seeking out and accepting feedback to improve, which has served me well in my career.
One thing I did when starting my internship was sit down with my program director to discuss my career goals and interests. I have always been interested in pediatrics. Program directors have some flexibility in the sites that they assign to interns, usually with community, food service, and elective rotations. My program director was able to place me at sites where I was able to fulfill my competencies while also getting more experience working with kids. Having direct experience with the population I wanted to work with was essential in helping me get a job in my desired field right out of internship.
Cost was a major barrier and challenge for me during my training. Obtaining two degrees is
expensive, and most internship programs discourage students from working. I worked part time (24 hrs/wk) during graduate school and internship to offset the cost, though this created another challenge- time management. For me, this meant taking work shifts mostly on evenings and weekends, planning ahead to stay on-top of assignments, and learning how to prioritize when I was being pulled in many directions.
Career Path and Experience
My first jobs as a dietitian was at a children’s hospital. I worked both inpatient and outpatient and saw children with many different nutrition issues- everything from surgical recovery to picky eating. Clinical nutrition is not for everyone, but one benefit of starting in this setting was having the opportunity to work with a large group of experienced RDs. Starting out in the field, I didn’t know what I didn’t know. My clinical judgement and self-confidence developed so much from the mentorship I received and the access to resources that came from working in a hospital system.
I have worked in so many settings! I have worked both inpatient and outpatient at multiple children’s hospitals, at a multi-level eating disorder care facility, at a large urban school district, at a university where I was both a lecturer and a researcher, and at a summer camp for children with type one diabetes.
In clinical practice, my days look pretty similar. I review the medical charts for each patient on my service. This allows me to screen new patients for nutrition risk and to see if my known patients had any overnight issues. Next, I go to multidisciplinary rounds, a time for the whole medical team to meet and talk about the plan for each patient. Then I go see any patients that need assessments and write my notes and update orders. Some days I have clinics to attend in the afternoon, and I regularly work on projects and quality improvement. However, other practice settings can look very different. When I worked in school nutrition, there was no typical day!
My career has changed so much, and I’m still considered an early career practitioner. I’ve worked in many settings, which means that I’ve had to “start over” a little bit each time I change practice area.
My career has been so rewarding thus far. I’ve said “yes” to a lot of opportunities and gotten to do many cool things. I’ve precepted over 50 students. I’ve served as an EAL reviewer and on a national Academy of Nutrition and Dietetics committee. I was recognized as my state’s Young Dietitian of the Year. I was even on Michelle Obama’s Instagram at one point!
The “A-ha!” moment is my favorite part of my job. Whether it’s seeing a patient with newly-diagnosed diabetes understand how to calculate their insulin dose, watching a student make the connection between their school garden and their school cafeteria, or watching a future RD independently do their first assessment, I find so much joy in watching others grow their nutrition knowledge.
Skills and Knowledge
Curiosity and adaptability are key skills for any dietitian. As a dietitian, you need to be curious- about your clients, about new technology and innovations, about policy. As your curiosity exposes you to new information, RDs then need to readily adapt their practice. The field of dietetics is ever-evolving. You may see similar patients with similar conditions, but each one brings unique challenges. Standards of care change. New trends emerge. Being curious and adaptable can help an RD both improve their interactions with clients and their body of knowledge.
I have been practicing for less than a decade and have seen major shifts in dietetics- from the
inclusion of the NFPE and feeding tube placement in dietetics education to clinical advancements like new insulin pumps and the rise of GLP-1 drugs to policy changes around the National School Lunch Program and WIC. No matter what area you practice in, there are always new things to learn. Reading research is key. If you are a member of a professional organization, you typically have free access to their Journal. My hospital holds journal clubs monthly, and when I worked in a school district, we also did journal club or a monthly USDA policy review with our interns. I also stay updated by staying connected in the field. Many of the professional groups I am part of have message boards, email listservs, and continuing education events, and I actively participate in them.
I think the greatest challenge in working with patients with complex dietary needs is considering how their diet fits into the bigger picture of their life. Developing nutrition interventions can pose some challenges, especially if the patient is on complex nutrition support or has limited oral intake, but the greatest obstacles are often not related to their medical conditions. I can come up with a nutrition intervention that meets energy, protein, and fluid needs that’s free of allergens, but is it feasible for the patient? Does it align with their schedule, their food preferences, and their cultural and religious traditions? Will the patient be able to access foods or formula that are part of the intervention? A patient’s social determinants of health are equally as important as their medical diagnoses.
My goal with nutrition education is to meet the client where they are. I try to come from a place of curiosity, not judgement, when education patients, especially if there is some resistance. Food is extremely personal, and each client that I work with comes with a unique set of lived experiences with food. Motivational interviewing is a helpful technique to allow clients to lead the education, which often leads to less resistance.
I had a baby be admitted to my service directly from the NICU who was fully TPN dependent and had many complex conditions- severe lung disease requiring a tracheostomy and ventilator to help them breathe, acute kidney injury, and recent bowel surgery. The case was complex, and the child had poor growth. I was able to advocate to the team to prioritize the child’s nutrition. Good nutrition means good growth, and good growth (usually) means better function of lungs, kidneys, and bowels. By optimizing the child’s nutrition support, they began to grow, and their lungs, kidneys, and GI tract grew stronger. The patient stayed in the hospital for over a year, and during that time I was able to slowly introduce G-tube feeds, wean him off TPN, transition him from an infant formula to a pediatric formula, and eventually, work with our SLP to help introduce solid foods.
Specialization and Professional Interests
I am a pediatric dietitian. However, within the field of pediatrics, I am sub-specialized. I currently work in both pediatric renal nutrition, pediatric diabetes, and pediatric pulmonology, including children with tracheostomy and using ventilators. My next goal is to obtain a specialist certification, but it is hard to choose just one to pursue when I work in multiple, sometimes overlapping, specialties.
Kids are the best! They are malleable and resilient and just more fun. Whether it’s in clinic or a
school garden or in a diabetes cooking class, I really love working with our youngest patients. Kids should always be growing, and what’s a major factor in how kids grow? Their nutrition. As an RD, you can make a major impact on a child’s lifelong health.
I am a member of the Academy of Nutrition and Dietetics. I also have joined groups within the
Academy, including the Pediatric Nutrition Practice Group (PNPG), the Nutrition and Dietetic
Educators and Preceptors group (NDEP), and my local Academy chapter. My Academy membership has been invaluable because of the access to resources and leadership opportunities it has provided me. I use the eNCPT, the Pediatric Nutrition Care Manual, and the Evidence Analysis Library multiple times a week. I use the message boards in to connect with others in the field and discuss current practice. I’ve served in so many different roles, including National Honors committee member, EAL guideline reviewer, and our local continuing education chair. I even participated in the Academy’s mentorship program and got to talk about my career goals with two former Academy presidents. My philosophy has been to make the most of my membership because I pay for them, and to me, the cost is worth it for how much I use the networking and resources. I also participate in organizations outside of the Academy. I volunteer for the Accreditation Council for Education in Nutrition and Dietetics (ACEND). ACEND is a separate organization from the Academy, and its role is to accredit all dietetics education programs and ensure they are meeting program standards. I visit a dietetics education program each semester and do a full review of how the program meets the dietetic education standards. I am also on a few listservs, like the Pediatric Renal listserv, which has helped informally connect me to other RDs in my practice area.
Advice and Reflection
There are many paths to becoming an RD, and there are countless jobs RDs can have. If you’re not sure which path is the best one for you, reach out and talk to someone. Dietetics program directors are great resources if you have education questions. If you want to know more about a practice area, many RDs are open to doing information interviews. There is no one “right” way to pursue a career in dietetics, but seeking guidance can help you find the right road for you.
I wish I would’ve networked more during my education and early in my career. There are so many RD out there doing really cool things. Having a strong network of other professionals can help expose you to new ideas and developments in the field, as well as open doors for jobs and leadership.