Registered Dietitian vs. Public Health Nurse?

[indrani987]

It has been so long since I have posted here that I had forgotten I had an account! It just brings to mind what long strange trip I have had over the past decade. I have read posts on this forum occasionally via google search over that timespan though, and I am always impressed by how thoughtful and diverse the responses are, so I thought I would try writing about my situation and see what people here think...

Basically, I have an MPH, but I found it quite hard to find work when I graduated. I very unwisely entered the program immediately after college with no work experience or direction, and I didn't focus on developing a marketable skill set while in the program. I did find work but basically I ended up in an area that I didn't enjoy at all, and I felt painted into a corner by it. I tried to leave the field, unsuccessfully - meaning, I did leave it, but didn't get into anything better suited to me. Instead, I am now stuck with random low level jobs, unable to re-enter the public health professional arena as my degree is very old now and I have been out of the field for so long. I have been treading water career wise while handling a lot of personal and family issues, so I don't feel I've wasted time in life, but career-wise, I've reached the end of my rope! I need to make a change, a big one. But I am now 36, recently married, and we don't have much money between us. My husband is younger than me and starting out fresh, and I just haven't had good enough jobs to save a huge amount. So we are fine as is, but schooling requires a lot of investment, which is where things get tricky.

I have been very interested in nutrition and have wanted to become a registered dietitian (RD) when I first sought to leave the job I didn't like in public health. To make a very long story short, my attempts have been thwarted twice - first by an administrative fluke, and the next time, by a family emergency.

I recently decided I truly love that field! I want to work in wellness, health prevention, and nutrition (if only I had realized that while in public health school! But I lacked the experience to know it). But my options seem very, very risky. I hate to make this post so long, but for those who don't know the RD route for career changers, I'm explaining below.

There are 2 coordinated MS level programs I could apply to after re-doing my prereqs. Both programs would cost roughly 80K As you can imagine, I don't feel good about digging myself into such a hole financially, especially as RDs don't make as much as their counterparts in other health care professions. It seems very risky to be doing period, but especially at the start of a marriage and at my age already...

There is a more affordable option I could slowly do on my own, while working - then I'd need to apply for internships on my own that have a 50% acceptance rate, which for me would be even harder because I am limiting myself to my home state, as I am married. I can apply for a new distance internship option that would require me to set up my own experiences. These internships cost a lot of money - 10 to 12 thousand dollars, while not making any income for 9 months or so. Again, very difficult financially to even do that to begin with, let alone thinking of how to dig myself out of that financial hole once I'm practicing. As for the years that I might not even land an internship...

Well, I began trying to brainstorm other routes to a career that would deal with nutrition and wellness, even if not to the depth and degree that an RD can. I have, unfortunately, sealed myself out of the public health profession by my huge gap in work experience. I could get an MS in nutrition, but landing a job as a "nutritionist" would be harder without an RD, and I believe there are laws coming into place, state by state, that seek to limit the role of nutritionist to an RD since they have far more schooling and expertise. So that is a risky path, and though state school would be cheaper than the coordinated programs, it still wouldn't be a cheap decision, so I want to be SURE of my outcomes.

Next, there is a credential called "Certified Health Education Specialist", but I would need to go back and take a lot of classes in health education to be eligible to sit for the exam. The cheapest educational options I have found are about 20-25K, I could at least do them online while working! But it would take a few years, and I am reading online that most of these jobs are going to clinicians with the CHES credential rather than people with an MPH. So that could potentially be a waste without having an RD or an RN,

Now...that led me to the option of becoming a nurse. The educational opportunities and pathways seem far more practical and numerous! However, I never wanted to work in a hospital long term - as an RD, I could manage that for a while, yes - but as a nurse? I would really, really hate that. I have huge respect for nurses who do that, but I know that it's not for me.

My interest is in wellness and prevention, rather than disease processes. I like nutrition enough that I am interested in management of nutrition related morbidity, like obesity, diabetes, etc. I can now see nursing education as making one an expert in the human body and understanding a great deal about disease (I hope) so that one can really become a well-rounded wellness expert. I really, really like it when I think about it like that. They also can become certified diabetes educators, work as public health nurses. It seems like a possible route to dealing with wellness and nutrition. But....is it smart, or even right....or even realistic, to go for a nursing degree purely as a step to a solid career in health/wellness rather than as a clinical nurse? And is my idea of what a public health nurse could do even realistic? Could I basically work as a health/wellness/prevention professional? Or is that a pipe dream, or something I'd only aspire to after years of working in the hospital?

My next question is about the programs. I am not naming universities because I don't want to slander....but basically, there are 2 accelerated BSN programs near me. One is WAY too expensive. The other is dirt cheap - and closer to my home! But it is ranked highly on the most dangerous college campuses of the nation list, with rape as being the second highest campus crime. I have read 4 pages of complaints about how terrible the administration, teachers, and even fellow students are. Even those who are neutral say you only get out of it what you put into it, and they don't really teach you effectively. The pass rate for the exam to become an RN from that program is the lowest in our state. Meanwhile, there is an even more affordable associates degree I could get (and sooner, as there are less prereqs!) at my local community college that has good reviews and has a very high rate of passing the RN exam. But I have read you need a BSN to get into public health nursing. So I could do an online bridge program I suppose - or one that is onsite. But basically....there is a risk that I could be stuck without the BSN, in which case....could I only find jobs in hospitals? I am hearing it's hard to even find that without the BSN now.

Lastly, knowing that I don't feel naturally geared towards working in hospitals or stressful clinical environments (I decided not to pursue nursing because I was terrified of sticking a needle in anyone, anywhere! Now I am thinking maybe I could learn to do it, just for the program?), do you think I am rationalizing myself into a very unwise decision here - should I really be steering clear of nursing? I have heard of other public health professionals getting the nursing degree simply to help them advance in the public health degree, but I don't know how well that has gone, or it's just a foolish idea really. Should I just risk financial death and go for the RD? I know that sounds melodramatic, but I know this is a serious concern for both would-be dietitians and newly minted RDs as well.

I apologize for the length of this. I do appreciate your feedback. Thank you!

[HouTx, BSN, MSN, EdD]

You've obviously done a very thorough job of investigating options. However, I want to correct one apparent misperception Without a BSN, you may be limited to non-acute nursing jobs, as hospital jobs in many areas are BSN only. I would also urge caution re: the CHES route. Job opportunities are extremely limited, as most educator-type jobs require a clinical qualification.

IMO, the most significant obstacle to your stated goal is that the US healthcare industry is not 'wellness' oriented because of the lack of profit in that sector. Perhaps this will change in the future, but it won't happen very rapidly. I attended doctoral classes with many RDs who were changing careers due to career dissatisfaction. They indicated that most RD jobs ended up as glorified fast-food managers, dealing with food production operations rather than clinical therapeutics, which was their initial goal.

At the same time, I think it would be a serious mistake to pursue a nursing education as 'plan b', particularly if this is not an area in which you want to actually work. It's too expensive - in terms of time, energy, emotions, and finances - to go this route. Have you investigated any other health professions that may be a better fit?

[twinsmom788]

With an MPH, working with the state Department of Health is a given in most states. I would not recommend spending $$$ on becoming an RD. Your cost/ benefit ratio would be painful. You also probably would not enjoy being a nurse.

[SENSUALBLISSINFL, BSN, RN]

I would also like to add to this post, that as recently married I am sure you have discussed having a family, and this will add to your financial stress. Having to care for family is stressful enough, not having the job opportunities after investing all that time and money in a field; such as nursing, that you do not plan to pursue may not be wise.

Reconsider your options, starting a post here is a good way to see what is out there. Good luck.

You've obviously done a very thorough job of investigating options. However, I want to correct one apparent misperception Without a BSN, you may be limited to non-acute nursing jobs, as hospital jobs in many areas are BSN only. I would also urge caution re: the CHES route. Job opportunities are extremely limited, as most educator-type jobs require a clinical qualification.

IMO, the most significant obstacle to your stated goal is that the US healthcare industry is not 'wellness' oriented because of the lack of profit in that sector. Perhaps this will change in the future, but it won't happen very rapidly. I attended doctoral classes with many RDs who were changing careers due to career dissatisfaction. They indicated that most RD jobs ended up as glorified fast-food managers, dealing with food production operations rather than clinical therapeutics, which was their initial goal.

At the same time, I think it would be a serious mistake to pursue a nursing education as 'plan b', particularly if this is not an area in which you want to actually work. It's too expensive - in terms of time, energy, emotions, and finances - to go this route. Have you investigated any other health professions that may be a better fit?

[turningred15]

I don't know if you should become a nurse and force yourself through nursing school. There are a lot of nonclinical nursing jobs but they do usually require experience. I have had several nonclinical nursing jobs. I was a former public health nurse. A BSN is required. I got the job after one year of clinical nursing experience. Depending on where you work as a PHN your job might not involve much preventative care. We focused on communicable disease investigations. I enjoyed the job but working for the public sector you will be one of the lowest paid BSNs around. Shadow a PHN once to see what you think.

What about other ways of using your MPH? Our health department had a public health specialist (filled by a MPH) role with a focus on education as well as statistics and numbers. What about research jobs, or working as a health coach for an insurance company or company that manages employee wellness. I would encourage you to apply to those jobs and cite "family reasons which have been resolved" as an explanation for the work gap.

I don't have too much opinion on the RD option. I do know two RNs who also have their RD and went on to nursing.

Good luck to you!

[kford84]

Hello!

I would just like to give you a word of caution about becoming an RD. I myself am a Registered Dietitian and am applying to a few accelerated BSN programs this year as being an RD is so frustrating. I work in a hospital and, unfortunately I've found we are pretty disrespected as a profession. Dealing with that, as well as low pay and little room for advancement, is making me change my career. I would NOT shell out that much money to become an RD. I have a couple of friends who are RDs who are so in debt from undergrad/their internship that they are applying to medical school/PA school to make more money to pay off their loans.

Interestingly, I considered going for an MPH but found that the RD, MPH combo would likely not advance my career very much beyond just being an RD.

I can't tell you to go for nursing since it sounds like you aren't interested in a clinical setting, but I can say that the RD path is long, hard, expensive and not worth it in the end. I was SO passionate about nutrition when I was in school but the jobs I've had have sadly worn me down so much I am now just cynical regarding nutrition. I would think that with an RN, MPH combo you could find a job in an area you enjoy as nursing has SO many job options available. Hope this helps and I'm sorry if I sounded whiny. I just wanted to let you know about my experience as an RD.

[sourapril]

We have nurses who work in our WIC. They are certified breast feeding educator. If you are into nutrition, try to apply to WIC jobs. Personally I think nursing gives me more options down the road.