A Day in the Life of a Registered Dietician

A Day in the Life of a Registered Dietician

Jacqueline Daughtry grew up in Montego Bay, Jamaica, but she moved to the United States to pursue a career as a cosmetologist. After 17 years in cosmetology, however, Daughtry decided to pursue a second career. Considering her family commitments and her interest in medicine, she chose to complete a university degree in dietetics. After graduating, Daughtry was readily accepted into an accredited dietetic internship program. Now, as a clinical dietitian, she allowed me to spend the day with her at the Regional Medical Center in Memphis, Tenn., in order to present to the readers of Diversity: Allied Health Careers just what it takes to be a clinical dietitian.

Daughtry is one of six clinical dietitians in food and nutrition services at the Regional Medical Center. Located in downtown Memphis, adjacent to The University of Tennessee Medical School, the 350-bed, state-funded hospital is home to multiple Centers of Excellence including the Burn Center, High-Risk Obstetrics, Newborn Center, Elvis Presley Memorial Trauma Center and Wound Care Center.

According to Daughtry, her favorite aspect of her job is working with a diverse patient population that has a high acuity level. She also likes being part of a medical care team but appreciates the autonomy she has in managing her patients’ nutritional needs. Daughtry enjoys working in a teaching hospital and interacting with allied health and medical students.

Characteristics that help Daughtry excel as a dietitian include her organizational skills, ability to multitask, positive attitude, flexibility and interpersonal skills. She’ll quickly tell you that the rewards of her job outweigh any negative aspects. Daughtry loves teaching patients why it is important to make specific dietary choices. She promotes the teaching philosophy of “meeting the patient where they are.”

Many opportunities are possible for Daughtry as a registered dietitian. In the future, she foresees completing a master’s degree to become a clinical nutrition manager or education coordinator.

8:00 a.m.
In any given workday, Daughtry is responsible for the nutritional care of patients in the medical-surgical, rehabilitation, obstetric-antepartum, postpartum and progressive care units. Each morning, in her office, she plans and organizes her day by first reviewing her computer printouts. She checks the printouts to screen for albumin levels, MID ordered consults, surgery patients, modified diet orders and nutrient/drug interactions.

At her desk with printouts in hand, Daughtry eats a bowl of instant oatmeal and makes notes about three patients with albumin levels suggestive of moderate to high nutritional risk, a new admit over 65 years of age who is scheduled for surgery, an anteparturn patient under 17 years of age, a postpartum patient with a two gram sodium diet order and three medical dietician consults. Over the course of the day, Daughtry will interact with patients from 13 to 92 years of age.

9:00 a.m.
Daughtry’s first stop is at the newly redone 20-bed Rehabilitation Hospital of Memphis that is located within the Regional Medical Center. She is involved in the discharge planning of rehab residents each week. She evaluates tube feedings and monitors weight, nutritional lab data and dietary intake of the residents. Daughtry has MD approval to write nutrition orders as needed. Today, she reviews lab data on the unit computer and checks the medical charts of three residents. She visits a 92-year-old new admit with cardiovascular disease who also has aphasia. Daughtry notes her breakfast tray, asks about her food preferences and checks her weight. After visiting a patient who has been in the hospital nine days and a 17year-old patient, Daughtry enters nutritional progress notes in their charts. Daughtry also interacts with the nursing staff and the nurse manager.

10:30 a.m.
At the Obstetrics-Postpartum, Unit, a consultation has been ordered for a postpartum mom who is considering breastfeeding. Daughtry reviews her chart and checks her current lab data. She was admiitted with preeclampsia and has high blood pressure and,an elevated albumin. A review of her medications, unfortunately, indicates that she should not breastfeed. Daughtry discusses infant feeding options with the mother. The new mom seems relieved, confident and appreciative of having the facts to guide her in feeding her new baby.

11:05 a.m.
Daughtry’s pager rings. She wears a pager at all times while at work. An RN is requesting diabetic nutrition education materials for her nursing students. Daughtry encourages her to send the students to the patient diabetic education classes offered today to learn about the diabetic diet. They agree this will be more effective than just providing the diabetic nutrition handouts.

11:15 a.m.
At the general ICU, the dietician is on vacation; so Daughtry checks on a consult to evaluate a tube-feeding regimen. She is pleased that another registered dietician has already: responded to the consult. Having the ability to multitask is an important part of the job. On the
unit, Daughtry takes the opportunity to interact with the speech therapist about a mutual patient. Daughtry is a member of the hospital dysphagia team and works closely with the speech therapist.

11:45 p.m.
Back in the nutrition office, Daughtry checks to see if any other consults have been ordered. She typically eats lunch at her desk while completing paperwork. Tomorrow afternoon she is invited to present a nutrition education program for a third grade class of about 80 children. Community outreach is valued by the hospital
administration, so Daughtry, spends some time preparing for this presentation during her lunchtime. Daughtry also volunteered and was selected to serve as a professional mentor for minority students majoring in dietetics at The University of Memphis.

1:00 p.m.
The Progressive Care Unit is a 16 bed step-down unit from ICU. Daughtry is responsible for eight of the beds there. She checks the recent labs on her patients and the Admission Health Assessment Form for a new patient. Although the new admit is at low nutritional risk, he is on a two gram sodium diet. He is coherent and complaining that he did not get any meat for breakfast. Daughtry talks with him about his dietary restrictions. They determine that he wants more food. Daughtry decides it would not be appropriate to send him low sodium bacon since it would not be available at the residential facility where he resides. Instead she decided to provide larger servings of his favorite breakfast cereals and will monitor whether or not these larger servings satisfy him in the future. Daughtry uses the hospital meals as educational tools whenever possible. She fills out the appropriate charts on this patient.

2:30 p.m.
Back at the Medical-Surgical Unit, the nurse manager talks with Daughtry about dietary problems she is having following removal of her gallbladder. After a few questions Daughrty provides her with several suggestions that are well received and appreciated. Unit tabs are checked. A patient’s low albumin is determined not
to be nutrition-related. A follow-up visit with a diabetic patient allows Daughtry to clarify some information and respond to dietary questions. She completes charts on several patients.

3:45 p.m.
Daughtry provides dietary instruction for a patient with cirrhosis who is being discharged. She also visits a patient scheduled for testing who has to restrict red food coloring.

4:15 p.m.
In Daughtry’s office, she interacts with other registered dieticians about the Performance Improvement Project for Clinical Nutrition that is ongoing. She completes her log of activities for the day and will be able to leave work by 4:30 p.m. today. She works Monday through Friday and every sixth weekend. A perk of her job is that she has “flex time.” She may need to come in early or leave early one day, This enables her to balance personal and professional commitments. She is usually able to arrange her schedule so she can attend her children’s school programs, make dentist appointments, teach an aerobics class for employees and more.

Exploring Alternatives to Healthy Eating and Lifestyle with a Plant-Based Diet

Exploring Alternatives to Healthy Eating and Lifestyle with a Plant-Based Diet

Nurses are integral in the care of patients and their health. Exploring a plant-based diet may be beneficial to patients so they can take back their health. It is time for health care disciplines to be aware of a plant-based diet and to dispel any myths that exist. In fact, a plant-based diet is not a diet—it can be viewed as a way of life. A plant-based diet are foods consumed that is devoid of animal ingredients, such as dairy and meats. A plant-based diet relies on foods that are grown from the ground such as fruits, vegetables, whole grains and nuts, and seeds.

People are living longer, but we are also living with more chronic diseases, with heart disease being at the top of the list. Heart disease, diabetes, and hypercholesterolemia are contributors to sickness where medicine is the answer. Health care providers tell patients to lose weight by restricting food intake. While patients may see results initially, they usually do not adhere to this long term as it is not sustainable for them for a variety of reasons. In addition to that, the medications with their side effects usually do not highlight many benefits. One-third of animal products in the American diet are very concentrated in calories and are deficient in antioxidants and vitamins. Needless to say, the vast majority of chronic illness is highly correlated to what we eat. There is a different biological effect of meat versus plant-based protein such as beans. The body can store these amino acids and complete them without overshooting the hormone, Insulin Growth Factor 1 (IGF 1). On the contrary, processed foods and meats produce a lot of IGF1 where insulin ends up storing a lot of fat. It is also attributable to cancer and inflammation.

People have long touted the benefits of a plant-based diet. Brooklyn Borough President Eric Adams reversed his diabetes Type 2 due to a plant-based diet. He was already suffering from nerve damage as a result of his disease with a hemoglobin A1C of 17 (anything over 6.5% is considered diabetic), so his was very high and the doctor was surprised that he was not in a coma. Adams was placed on medications, but he also sought the help of Caldwell B. Esselstyn, Jr., the same doctor who treated Bill Clinton and author of the book, Prevent and Reverse Heart Disease. He was informed by doctors that he would be on insulin for the rest of his life. He was placed on medicine for his acid reflux, medicine for his high cholesterol, and medicine for his burning and tingling of his hands and feet. His family is diabetic and was told that it runs in his family.

This past August, there was a launch of a plant-based lifestyle program at Bellevue Hospital in New York City. Doctors, nurses, dieticians, and life coaches will help at least 100 patients across all five boroughs adopt healthy eating patterns focused on legumes, whole grains, fruits, vegetables, nuts, and seeds while reducing animal products, fried foods, refined grains, and added sugars. Michelle McMacken, director of NYC Health + Hospitals/Bellevue Adult Weight Management Program, is director of the program.

At Montefiore Hospital, Dr. Robert Ostfeld spearheaded the Cardiac Wellness Program where plant-based nutrition is the prescription for management of cardiac disease. The population most affected by these diseases are non-white populations. Dr. Kim Williams, past President of the American College of Cardiology, advocates for a plant-based diet for heart disease prevention. Affronted with a high cholesterol, he decided to take measures into his own hands, and adopt a plant-based diet.

While medical doctors are beginning to advocate this lifestyle, nurses should also set an example of this lifestyle approach. Nurses are part of the health care discipline and minority nurses, especially, need to set an example. We want patients to take control of their lives. We can teach patients eating a plant-based diet instead of a standard American diet, as a form of primary prevention. Like any diet, it may take time to adjust, but this is not just a diet, it is a lifestyle. Patients would need to make an informed decision as to whether they would want to incorporate it into their lifestyle or not. There is enough supportive evidence out there that a patient can access such as documentaries, “Fork Over Knives” and “Fat, Sick, and Nearly Dead.” There are a variety of resources, including the 21-Day Vegan Kickstart program, to include in dietary prescriptions to help patients treat and prevent obesity, type 2 diabetes, and heart disease. This will require support from the patient’s primary provider, and, whether the provider is an advocate of this lifestyle or not, it should be considered. Benefits such as less medication, weight loss, and improvements in mood as well as cholesterol have been shown. Dispel the myths about a plant-based diet and protein.

This is a plea as something to consider to take better care of ourselves and take control of our lives. There have been many initiatives and programs to lose weight. Drastic measures have also occurred due to the outcomes of being overweight, such as drastic surgery and restrictions from carbohydrates. Patients are sometimes misinformed and have to get rid of the idea that medications will solve the problem—it only delays the problem. There is a possibility of reversing diabetes and cardiac disease. This is a decision that the person has to make: continue with their lifestyle with animal protein and processed carbohydrates or see a reduction in their overall weight and health by incorporating a plant-based diet.

A plant-based diet may be considered “extreme” by some people in altering their lifestyle. But given the choice between a plant-based diet or open=heart surgery, it can be posed to the patient which one they consider as extreme. Again, it is a personal choice, an evaluation of familial and cultural values would be assessed to fit the needs of the patient. Surgery can be viewed as a band-aid in that it will manage the symptoms temporarily unless the patient alters their lifestyle. Of course, it helps if the patient has a supportive network to embrace the lifestyle. It can start off as small, simple steps, as little as incorporating a plant-based meal in their day and slowly add these meals to their lifestyle. There are vegan starter kits to kick a healthier you.

A Day in the Life of a Respiratory Therapist

Name: Tonie Perez

education: Kettering College of Medical Arts
title: Respiratory therapist
workplace: Cincinnati Children’s Hospital’s Regional Center Neonatal Intensive Care Unit (RCNIC)
location: Cincinnati, Oh.


Every eight seconds in the United States a new baby is born. Each newborn begins their lives as independent humans with their very first breath. Throughout our lives, how often we breathe and how much we breathe is often taken for granted. For some children, however, this simple function is not so effortless.

The science of respiration or breathing leads us to the profession of respiratory therapy. Respiratory therapy is utilized in all hospital settings, nursing homes and even home health care. Some respiratory therapists choose to become instructors in the world of education, while others work within the hospital environment where there are various levels of care.

Meet Tonie Perez, a respiratory therapist at Cincinnati Children’s Hospital Medical Center. Perez has been a respiratory therapist for 17 years. She graduated from Kettering College of Medical Arts in Kettering Ohio in 1987. “I chose Kettering because they are state-of-the-art, and I knew I would get a good education,” she says.

At the Cincinnati Children’s Hospital Perez works in the newborn intensive care unitÑthe Regional Center Neonatal Intensive Care Unit (RCNIC)Ñwhere she is involved with the intensive care aspects of respiratory therapy.

The population of the RCNIC varies from pre-term (24-weeks gestation) to post term (greater than 40 weeks). The role of the respiratory therapist in this critical care environment is to work with pre-term infants prior to 40-weeks gestation or a term pregnancy, which requires constant monitoring of respiratory status. The infant’s lungs are not fully mature until 34-weeks gestation, so birth prior to 40 weeks brings potential problems. For example, during the lung development a substance called Surfactant, which is critical for normal lung function, isn’t readily available.

Being born early not only requires more ventilator support, it also necessitates the need to give Surfactant artificially. Oxygen given to the infants must be monitored continuously because of potential detrimental side effects to their eyes and lungs. It’s like that old adage, too much of a good thing is bad.

Some of the patients require medication like bronchodilators to increase the diameter of their airways in order to decrease the work it takes to breathe. Airway management is also needed when patients stop breathing. Immediate intervention is required until the problem is resolved. Respiratory therapists will place a mask over an infant’s face and squeeze a bag that inflates the lungs and breathes for the infant. Depending on the severity of the situation, infants may also be placed on a ventilator. Doctors, nurses and respiratory therapists all work collaboratively for the best care of the child.

Obviously this is challenging and demanding work, but Perez thrives in the environment. She recently received the Zenith Award as an acknowledgement that she has gone above and beyond the call of duty in her position.

Perez originally chose this field of expertise because she felt she could make a profound difference in her parent’s lives. She also enjoys being part of a team that is working together to improve patients’ outcomes.

Perez encourages all students interested in respiratory therapy to learn more about this exciting field. “I can’t stress enough the fact that respiratory therapy is an ever changing and growing field,” she says, “and if you are one who loves new and exciting things and loves people, respiratory [therapy] is for you.”

Read on to discover what a typical day is like for respiratory therapist, Tonie Perez.

7:00 a.m.
Perez’s day starts early; she will work a 12-hour shift, three days a week. Upon arrival to the unit, the night shift gives her a progress report on the patients she is assigned to for the next 12 hours. Once Perez has gotten the report, she checks her orders for the patients.

8:00 a.m.
Perez is in her area making ventilator rounds. She
assesses the patients and their ventilators and makes sure they are working correctly.

9:30 a.m.
The physicians, residents, nurses, dieticians, pharmacists and respiratory therapists go to each bedside and discuss the course of care for that particular patient. Patients on ventilators are assessed and ventilator settings are documented every two hours.

10:00 a.m.
Ventilator rounds are again made, settings are documented, and patients’ lungs are listened to and assessed for secretions or other negative sounds. If needed, corrective intervention is made.

Perez says that this is the predictable element of her job, which makes up about 40%. The other 60%, she says, is not scheduled or predictable because this is a very unstable environment. “Our doors are open 24-hours a day, seven days a week to accommodate the various needs of the infant population,” she says.
11:00 a.m.
A 30-week-old infant is coming in with the transport team from an outside birthing center that was not able to accommodate his breathing needs and possible surgical issues. He is placed in a radiant warmer and connected to a ventilator. The monitors are functional so they are continuously monitoring him. An x-ray is ordered to determine if the ventilator is adequate, and blood is drawn, which will be sent to the lab so that they can access his ventilation.

11:30 a.m.
A half hour has passed while they admit the infant boy. Surgery is called in to assess the need for surgery on a questionable lung mass that was seen on his x-ray. Meanwhile, the staff is doing total supportive care.

With all the activity, the infant in the next bed is becomes sensitive to the increased noise. She starts to show signs of distress; her heart rate drops and she begins to have an apnea episode where she holds her breath and begins to turns blue. Perez attempts to stimulate the infant’s breath by repositioning her and making sure her airway is open. The girl begins to breathe again and her color returns to normal.

1:30 p.m.
Perez begins assessing various ventilator patients. With the new baby boy, she now has four patients to attend to. On any given day Perez can have from two to 12 patients, but she says that she usually has six.

“You’re responsible for those patients’ ventilator assessment every two hours, respiratory medication administration, laboratory blood draws, and constant monitoring of their vitals,” she says.

3:00 p.m.
Surgery returns to the new admit to inform Perez and the nursing staff that surgery is not needed at this time. They continue supportive methods.

4:00 p.m.
Perez is informed that another new admit will be coming in. The mother of the baby girl had no prenatal care and has no idea what the gestation is of the infant.

5:15 p.m.
The infant girl arrives. It was determined by the outside birthing hospital that the infant was approximately 29 weeks old. The birthing hospital was not equipped to take care of her, so she came to RCNIC for supportive care. She’s placed on a nasal cannula so that oxygen can be delivered to her. She’s also placed on monitors and observed. Perez obtains lab values to assess her ventilatory status. Everything appears normal, but the staff will continue to watch her.

6:30 p.m.
Perez makes her last ventilator rounds and takes notes. When 7:00 p.m. arrives she’s prepared to give her progress report on all the patients for that day.

“The average day is very lively but that is what I love the most about my job,” Perez says. She also values her great co-workers and the continuous learning environment.

“There is nowhere else you can get paid to learn,” Perez asserts. “Medicine is always changing and you have to be the kind of individual that accepts change and takes it with open arms.”

Nursing with Diabetes: Tips for Coping on the Unit

Nursing with Diabetes: Tips for Coping on the Unit

“Diabetes is so prevalent in our society, and I feel as though I have a better understanding of my own patients with diabetes,” says Heather Weber, an RN who works in a busy outpatient GI department. She has type 1 diabetes, and she has experienced what it is like working as a nurse with diabetes. “I recently had a GI sickness at work, and as a result, my blood sugar dropped rather quickly after lunch,” she relates. “My coworkers noticed that I was diaphoretic and quickly sat me down, giving me some apple juice to drink. I ended up going home since I was sick with a GI bug, but only once my blood sugar was stable enough to drive. I was grateful for my coworkers’ assistance.”

Since diabetes is such a major problem amongst the population, it only stands to reason that nurses can have diabetes, as well. According to the American Diabetes Association, 30.3 million people in America have diabetes. In addition, 1.25 million adults and children have type 1 diabetes. How can nurses manage their condition? Nurses have a difficult time eating a balanced diet due to skipping meals. They are also on their feet most of the time, putting them at risk for complications of the foot, such as ulcers.

Fortunately, many nurses want to share their experiences to help others navigate the challenge of balancing diabetes and providing excellent patient care. Diabetes educators strive to help all people who have diabetes, and they are an excellent resource for nurses who want to manage their diabetes.

Nurses generally know how to handle their condition. They know diabetes front and back through the job, and they are intelligent professionals who know how to adapt those ideas for themselves.

“I can usually slip away for a few minutes or have a coworker cover for me so that I can test and/or eat a snack,” explains Weber. “When I worked as an ICU nurse doing twelve-hour shifts, I would typically eat snacks to prevent low blood sugars as I did my charting at the nurses’ station.”

Tips like this are invaluable because they are grounded in the actual experience of being a nurse with diabetes.

Fran Damian, MS, RN, NEA-BC, works at Boston Children’s Hospital and is a staff member at Diabetes Training Camp. She has tricks that she uses, as well. “Managing well with diabetes requires good planning and being well prepared with extra supplies all the time,” she says. “I live a healthy lifestyle as much as possible. That includes regular exercise and a well-balanced diet. I feel best when I eat a lot of fruits, vegetables, and lean protein, and I drink a lot of water …. [I] always have glucose tablets on me in case I start feeling low.”

“Our unit was pretty good if we were slammed and did not get lunch,” says Danielle Kreais, MSN, RN, CPNP-PC. She got her diagnosis and learned to cope, all while working a busy OB unit on nights. “The manager ordered lunch meat sandwiches and chips for us. There was another diabetic I worked with and the advice she gave me was to make sure I always had one of those Nature Valley bars in my work bag, in the glove box of my car, and my locker. The peanut butter ones have protein and they are a carb, so it was a great combo if lunch was missed.”

She continues: “She told me for lows to keep those peppermint striped candies [in your pocket] that are soft, and you can chew them. They are enough to bring your sugars up, plus they don’t melt.”

Nurses newly diagnosed with diabetes would do well to carry glucose tablets at all times to prevent low blood sugar. Be sure to tell your manager and your coworkers what’s going on so that they can help you when needed. Snacks and water are essential to good blood sugar control. Don’t forget to use your resources, such as endocrinologists, dieticians, and diabetes educators to plan the right meals and strategies for you to use on the job.

Although tips from nurses can be invaluable, they are nothing like the kind of focused information that can come from a certified diabetes educator (CDE). These are medical professionals who are responsible for teaching all people with diabetes in all situations how to manage their lives and prevent complications.

One such expert is Lucille Hughes, DNP, MSN/Ed, CDE, BC-ADM, FAADE, director of diabetes education at South Nassau Communities Hospital in Oceanside, New York, and treasurer of the American Association of Diabetes Educators. Considering some of the challenges nurses can face when dealing with diabetes on the job, she had tips for some of the most common ones.

Nurses often don’t get the chance to eat during a shift, and this can severely impact blood sugar levels. “When nurses with diabetes find themselves in this situation, planning and being prepared is the best medicine,” says Hughes. “Keeping snacks on hand that are a blend of carbohydrates, protein, and fats can be a tremendous help in these situations.”

“Meal planning is the secret to living with diabetes and being a healthy person,” Hughes continues. “Investing in a good lunch bag (or two) will allow you to plan and pack all the essentials to eating and snacking healthy. Being unprepared and finding yourself at the mercy of a vending machine is not a good situation to be in. It is very unlikely you are going to find a ‘healthy’ lunch or snack option.”

In addition to poor nutrition, nurses also face significant impact to their feet, and this can cause foot related complications for nurses who have diabetes. “First and foremost, investing in a good pair of comfortable shoes is essential for anyone who spends most of their day on their feet,” says Hughes. “Calluses and skin evulsions due to rubbing of a shoe on a toe, heel, or ankle area can be dangerous and yet avoidable.”

Here are six tips that Hughes has on how to find shoes that fit and how to determine if they are a healthy choice:

  1. When trying on a shoe in the store, make sure it feels comfortable. If it isn’t comfortable, don’t buy it.
  2. Many think that new shoes require a bit of breaking in and you must endure the associated pain. This is not true. If new shoes start to hurt, immediately remove them and don’t use them again.
  3. Don’t think that the only shoes you can wear as a nurse with diabetes are unfashionable ones. There are many options for shoes that fit, so do your due diligence and find shoes that will protect your feet.
  4. In addition to finding the right shoes, foot inspection is vital in protecting your feet. Check them every day. Use a mirror to see the bottoms and sides of your feet. If you notice any redness, cuts, or blisters, see your podiatrist immediately. Take care of small changes immediately before they expand into something unmanageable.
  5. Podiatrist. Yearly, no exceptions. More often if necessary.
  6. Finally, any time you see a medical professional, ask them if they will take a look at your feet at your office visit. This could be your primary care doctor, your endocrinologist, or any other specialist you may see—within reason, of course. Many dentists would have trouble with this request. Seriously, though, any professional who looks at your feet could possibly see a problem early enough to stop it. Use these resources.

Nurses spend so much time taking care of others that the self is often forgotten and ignored. Unfortunately, this is unhealthy for any nurse, but particularly troublesome for a nurse with diabetes. Yet, these challenges are not insurmountable, although they may take a little work. Planning your diets and meals are key to ensuring that you will have food on hand for sudden lows. Meal planning can also help you keep your high blood sugar under control. For your feet, planning is again essential. You must find shoes that are comfortable—no questions asked.

Following these steps, nurses with diabetes should be able to function well as nurses—and many are! If you find yourself troubled by mixing diabetes and nursing, let your doctor know. They may be able to refer you to any number of professionals who can help. The most important item, though, is to catch things early and always plan how to confront any challenges.

Midlevel (Physician Assistant/Nurse Practitioner) – Spirit Lake, IA

Midlevel (Physician Assistant/Nurse Practitioner) – Spirit Lake, IA


Vacancy Identification Number (VIN): 1753600

Our mission: To fulfill President Lincoln’s promise – “To care for him who shall have borne the battle, and for his widow, and his orphan” – by serving and honoring the men and women who are America’s Veterans. How would you like to become a part of a team providing compassionate care to Veterans?

At the Sioux Falls VA Health Care System (SFVAHCS), we strive to hire only the best! Working with and for America’s Veterans is a privilege, and we pride ourselves on the quality of care we provide. In return for your commitment to quality health care for our nation’s Veterans, VA offers an incomparable benefits package. The SFVAHCS is a teaching hospital providing a full range of patient care service, with state-of-the-art technology as well as education and research. Care is provided to eligible veterans in eastern South Dakota, northwestern Iowa, and southwestern Minnesota. Comprehensive health care is provided through primary care, tertiary care, and long-term care in the areas of medicine, surgery, psychiatry, physical medicine and rehabilitation, neurology, oncology, dentistry, geriatrics, and transitional care. The SFVAHCS is part of VA Midwest Healthcare System (VISN 23), which includes facilities in Minnesota, North Dakota, Iowa, Nebraska, and South Dakota. Every job at the VA impacts the Veterans that we serve. You can be part of that team, helping to make sure that our Veterans receive the top-quality care they deserve.

As a VA professional nurse, your opportunities are endless. With many openings in the multiple functions of VA, you will have a wide range of opportunities at your fingertips. Not only is it the largest, most technologically advanced integrated health care system in the nation, but we also provide many other services to Veterans through the Benefits Administration and National Cemeteries. VA professionals feel good about their careers and their ability to balance work and home life. VA offers generous paid time off and a variety of predictable and flexible scheduling opportunities. For more information on the Department of Veterans Affairs, go to http://www.vacareers.va.gov/

The procedures outlined in AFGE Master Agreement, Article 23, Section 8 will be followed. First consideration will be given to current Sioux Falls VAHCS employees.

VA encourages persons with disabilities to apply. The health related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority.


The Sioux Falls VA Health Care System is currently recruiting for a Full-time, Permanent, Midlevel Provider. This position will be located in the Primary and Specialty Medicine Service Line at the Spirit Lake, Iowa Community Based Outpatient Clinic (CBOC).  As a Midlevel Provider, under the direction of a Physician, you are responsible for the following duties to include, but not limited to: 

  • Review consults, complete patient history, examination, diagnosis, treatment and education for new and follow up visits.
  • Respond to Clinical Reminders, and order appropriate lab tests and studies by Provider Order Entry.
  • Responsible for interpreting as appropriate and the implementation of results & recommendations from studies ordered.
  • Initiate and adjust medications as medically necessary, practices & maintains skills in EKG, and recommends appropriate follow up. 
  • Complete electronic encounter for each visit and conducts telephone clinics and responds to patient phone calls as appropriate.
  • Respect time commitments, provide customer service appropriate to VA standards, and provide patient care through face to face visits and other modalities (group clinics, telephone clinics, secure messaging, etc).
  • Under the direction of a medical doctor, the candidate performs oversight of primary care clinical studies to include appropriate scheduling of patients, patient flow, safety, quality management, capacity, backlogs, results reporting, wait times, and consults.
  • Assist in meeting Performance Measures for Primary Care outpatient clinics, and coordinate care for patients as appropriate between specialty medicine, mental health, surgical/surgical sub-specialty, extended care and rehabilitation, community, and other ancillary services. 
  • Participate in Peer Review and work as a team with medical doctor, nursing, technicians, administration, lab, pharmacy, dieticians, and ancillary staff. 
  • Serve on committees, teams, workgroups, and chart reviews as requested/approved by administration.
  • Meet standards of licensing and certification.
  • Function as an advocate for Veterans and direct them to indicated points of contact for clinical and follow-up care when needed.

NOTE: Assignment to other areas of the service line, medical center, or other CBOC’s may be required. The  Midlevel Provider reports to the Spirit Lake, IA CBOC  Medical Director and works in collaboration with his/her assigned CORE team, however, assignments may be made to other areas for purposes of cross coverage.

Work Schedule: The tour of duty for this position typically is Monday – Friday, Days.  Additional information regarding the tour of duty for this position will be covered during the interview process.

Functional Statement: Physician Assistant / Registered Nurse – Advanced Practice

Throughout the duration of this vacancy announcement, applications that are received will be referred to the selecting official on a bi-weekly basis.

Travel Required

  • Occasional Travel
  • Occasional travel to Sioux Falls VA Medical Center and other Community Based Outpatient Clinics.

Relocation Authorized

  • No

Job Requirements

Key Requirements

  • Must pass pre-employment examination.
  • Must be proficient in written and spoken English.
  • Designated and-or random drug testing required.
  • Background and-or Security Investigation required.
  • Selective Service Registration is required for males born after 12/31/1959.
  • Subject to a two year probationary period.


BASIC REQUIREMENTS (Physician Assistant):

  • U.S. citizenship.
  • Proficient in written and spoken English.
  • Current and Continuous Certification by the National Commission on Certification of Physician Assistants (NCCPA) is a requirement for employment.
  • Education:
             – Graduation from a PA training program, or of a surgical assistant program which is accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) or one of its predecessor organizations;  AND
  •          –   A Bachelor’s degree from an accredited PA training program or in another health sciences related field from an accredited college or university recognized by the U.S. Department of Education.

BASIC REQUIREMENTS (Nurse Practitioner):

  • U.S. citizenship.
  • Proficient in written and spoken English.
  • Possess and maintain a full, active, current, and unrestricted license as a Nurse Practitioner in a State, Territory, or Commonwealth of the U.S. or in the District of Columbia.
  • A Master’s degree (or higher) from a program accredited by the National League for Nursing Accrediting Commission (NLNAC) or the Commission of Collegiate Nursing education (CCNE).
  • Possess and maintain a full and current certification as a nurse practitioner from the American Nurses Association or another nationally recognized certifying body. Note: The certification must be in the specialty to which the individual is being appointed or selected.  For this occupation the applicant would need to be certified in Family Practice or Adult Medicine.  Other certifications will be reviewed, and may be appropriate if in compliance with the certification requirement.

Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.
Grade Determination:
The full-time annual salary range for a Physician Assistant is: $59,246 – $109,781.
The full-time annual salary range for a Nurse Practitioner is: $59,243 – $99,283.
Applicant’s education, experience, and license/certification will be considered by a Professional Standards Board in determining the grade and salary of the applicant selected.
VA Handbook 5005/27, Part II, Appendix G6, Nurse Qualification Standard.  This can be found in the local Human Resources Office.
VA Handbook 5005/78, Part II, Appendix G8, Physician Assistant Qualification Standard. This can be found in the local Human Resources Office.

APPLICANTS PLEASE NOTE: Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications (particularly positions with a positive education requirement.) Therefore, applicants must report only attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education. Applicants can verify accreditation at the following website: http://www.ed.gov/admins/finaid/accred/index.html All education claimed by applicants will be verified by the appointing agency accordingly. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education.

Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. All education claimed by applicants will be verified by the appointing agency accordingly.

PHYSICAL REQUIREMENTS: The work requires some standing, walking, bending, lifting, and carrying of light items.  The work requires agility and dexterity and may require heavy lifting of equipment or patients.  In many situations, the duration of the activity (such as most of a workday) contributes to the arduous nature of the job.  Duties require extensive periods of standing and walking.  Working with patients requires regular and recurring bending, lifting, stooping, stretching, and similar activities.

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