This article has been updated by Michelle Saari, MS RD, on August 18. 2026 with the most up to date information available.
Starting a new job as a long term care dietitian can feel overwhelming.
You walk into a building full of new people, new residents, new systems and a lot of information. Someone gives you a login. Someone else asks if you reviewed the weight report. You may be handed a list of residents and suddenly realize you are responsible for nutrition care for dozens or even hundreds of people.
And you are probably thinking, where do I even start?
The good news is that you do not need to know everything during your first day. Or your first week.
Long term care takes time to learn. There are clinical responsibilities, documentation requirements, regulations, care planning, MDS, weight monitoring, food service concerns and a whole lot of communication.
Trying to learn all of it at once will only make you feel more overwhelmed.
Instead, focus on building a strong foundation first.
This checklist will help you figure out what to focus on when you are new to long term care and give you a clearer idea of where to start.
1. Get to Know Your Facility
Before you dive into resident charts, take some time to understand the building where you work.
Every long term care facility is different.
You may have worked in long term care before and still find that your new facility does things completely differently. The systems, people, policies and expectations can vary significantly from one building to another.
Start by learning the basics.
Ask yourself:
What type of residents live here?
How many residents are there?
How many units or neighborhoods does the facility have?
Which units am I responsible for?
Are there short stay rehabilitation residents?
Are there residents receiving hospice or end of life care?
Are there specialized units, such as dementia care?
How many residents are you responsible for?
Are you the only dietitian?
Is there another dietitian or nutrition professional on the team?
What are your regular responsibilities?
What are the expectations for your role?
It can also be helpful to ask someone you trust a simple question:
What are the biggest nutrition challenges in this building right now?
The answer can tell you a lot.
Maybe the facility has struggled with weight loss. Maybe documentation is inconsistent. Maybe there are concerns about meal intake. Maybe the dietitian before you left behind a long list of residents needing follow up.
You do not need to fix everything immediately. But understanding the bigger picture can help you figure out where to focus your energy.
2. Meet the People You Will Work With
Long term care is not a job where you work alone.
You may complete nutrition assessments and write recommendations, but good nutrition care depends on the entire team.
Take time to introduce yourself and learn who does what.
Some of the key people you may work with include:
The Administrator
The administrator oversees the overall operation of the facility.
They may not be involved in every nutrition decision, but it is helpful to understand their expectations and know how they view the dietitian’s role.
The Director of Nursing
The Director of Nursing is an important person to know.
Nursing is involved in many areas that directly affect nutrition care, including weights, meal intake, nutrition interventions and communication about changes in a resident’s condition.
You will likely work with nursing regularly.
Nurse Managers and Charge Nurses
These are often the people who know what is happening with residents on a daily basis.
If you are trying to understand why someone is not eating, why a weight changed or whether an intervention is actually working, nursing can provide valuable information.
Get to know them.
The MDS Coordinator
The MDS process can be confusing when you are new to long term care.
Your MDS Coordinator can help you understand how the process works in your facility, what information they need from you and how nutrition fits into the bigger picture.
The Speech Language Pathologist
You may work closely with the Speech Language Pathologist when residents have swallowing concerns. They are likely on a consult only basis, so you may not see them often.
You will need to communicate about food textures, fluid consistencies, intake concerns and changes that may affect nutrition. It’s important to have their contact information on hand.
The Food Service Manager
The Food Service Manager is another important person to know. They will likely be the person you will work closest with.
You may work together on food preferences, special diets, supplements, meal concerns and ways to help residents get the nutrition they need. You may also perform audits on the food service department and work with them to resolve issues.
The Social Worker
The social worker can provide important information about a resident’s preferences, goals, family concerns and psychosocial factors that may affect eating and nutrition. You won’t work together too closely, but they’re good to go to for family issues.
The Pharmacist
Medications can affect appetite, weight, nutrient absorption and overall nutrition status.
The pharmacist can be an important resource when you have questions about possible medication related nutrition concerns. But you will likely have very little interaction with them unless necessary.
Occupational Therapist & Physiotherapists
Occupational therapists and physical therapists may also provide useful information.
Changes in mobility, function and independence can affect a resident’s ability to eat and drink.
You do not need to become best friends with everyone during your first week.
But learn who they are. Learn what they do. Know who to contact when you need help.
That alone can make your job much easier.
3. Get Organized Before You Try to Fix Everything
One of the biggest mistakes a new dietitian can make is trying to review every resident chart immediately.
You may have 80, 120 or more residents. You cannot learn every detail about every resident in one day.
And honestly, you do not need to.
Start by creating a system that helps you identify who needs your attention.
Depending on your facility, you may need to review information such as:
Residents with significant weight changes
Residents with unintentional weight loss
Residents with poor meal intake
Residents receiving oral nutrition supplements
Residents with wounds
Residents receiving enteral nutrition
Residents with swallowing concerns
Residents who are underweight or malnourished
Residents with recent hospitalizations
Residents who need nutrition assessments
Residents who need routine follow up
You need a way to keep track of this information.
This might be a spreadsheet, a report from your electronic medical record or another system that works for you.
The exact system is less important than having a system.
You should be able to answer a few basic questions quickly.
Who needs to be seen?
Why do they need to be seen?
When were they last assessed?
What interventions are currently in place?
When do they need follow up?
Without an organized system, it becomes very easy for important things to get lost.
You may remember a resident who needs follow up today and completely forget about them by next week when ten other things happen.
Trust me, this job gives you plenty of things to remember.
Do not rely on your brain to hold all of them. If you’re starting to feel overwhelmed, don’t worry. I’ve built a spreadsheet that can house ALL of this information for you.
It’s available inside our membership website at Clinical Nutrition Central!
4. Learn How Nutrition Care Works in Your Building
You probably know how nutrition care should work.
But you need to learn how it actually works in your facility.
This is important.
For example, you may assume that you receive a nutrition referral when a resident has poor intake. But what if nursing does not know they are supposed to notify you?
You may assume weights are reviewed regularly. But who is actually responsible for reviewing them?
You may assume nutrition interventions are communicated to the care team. But where is that documented?
Do not make assumptions.
Ask questions.
Find out:
How are nutrition referrals made?
Who contacts the dietitian when there is a nutrition concern?
How often are residents weighed?
Who reviews the weight reports?
What happens when there is a significant weight change?
How do you learn about poor meal intake?
How are nutrition supplements ordered?
How are supplements monitored?
How are diet orders changed?
How are food preferences communicated?
Where do you document nutrition assessments?
Where do you document follow up?
How are nutrition care plans completed?
How are physician recommendations communicated?
How does nutrition fit into the MDS process?
These are the practical details that can make or break your day.
You can be an excellent clinical dietitian and still struggle if you do not understand the systems around you.
Spend time learning them early.
It will save you a lot of frustration later.
5. Understand What Needs Your Attention First
When you are new, everything can feel urgent.
You have emails to answer.
Charts to review.
Weights to look at.
Meetings to attend.
Questions from staff.
Documentation to complete.
A pile of things that the previous dietitian may or may not have finished.
It is easy to look at all of it and think, I need to do everything right now.
You do not.
Part of becoming comfortable in long term care is learning how to prioritize.
Ask yourself:
Is there an immediate nutrition concern?
Is the resident experiencing significant unintentional weight loss?
Is there a major change in meal intake?
Does the resident have a new or worsening wound?
Is there a concern about swallowing?
Is the resident receiving nutrition support that needs monitoring?
Does the resident need an assessment or intervention now?
If the answer is yes, that may need your attention first.
On the other hand, some things can wait.
You do not need to completely reorganize every spreadsheet during your first week.
You do not need to memorize every regulation immediately.
You do not need to understand every feature of the electronic medical record before seeing your first resident.
Focus on what matters most right now.
Then work your way through the rest.
6. Get Familiar With Survey Expectations
Survey readiness is not something you should only think about when you hear that surveyors are coming.
It is part of everyday practice.
You do not need to become an expert in every survey requirement during your first month.
But you should start understanding what surveyors may look for and how your nutrition care supports resident care.
Some important areas include:
Nutrition assessments
Weight monitoring
Significant weight changes
Unplanned weight loss
Nutrition interventions
Care planning
Food preferences
Therapeutic diets
Nutrition support
Documentation
Interdisciplinary communication
You want your documentation and care to tell a clear story.
If you want a full explanation of what your responsibility is in the survey process, read ‘Dietitians Role in State Surveys: How to Stay Ready Everyday.’
Good survey readiness is not about creating a massive binder and hoping for the best.
It starts with having systems that help you provide and document good nutrition care every day.
As you become more comfortable in your role, continue learning about survey expectations and how they apply to the work you do.
7. Your First 30 Days in Long Term Care
You do not need to have everything figured out after your first week.
Or even your first month.
But having a general plan can help you feel less overwhelmed.
Your First Few Days
Focus on getting oriented.
Meet the people you will work with.
Learn your basic responsibilities.
Get access to the systems you need.
Find out how to access resident information.
Learn where nutrition documentation is completed.
Review the most urgent nutrition concerns.
Start building your resident follow up system.
Your First Two Weeks
Start learning how things work.
Review high risk residents.
Understand the weight monitoring process.
Learn how nutrition referrals are made.
Get familiar with nutrition assessments and care plans.
Learn how diet orders and supplements are managed.
Understand your role in the MDS process.
Ask questions when something does not make sense.
This is important.
You are not expected to know everything.
Ask.
Your First Month
Start building your routine.
You should begin to have a better understanding of:
Your regular responsibilities
Your resident population
Your follow up system
The people you work with
Your documentation process
Weight monitoring
Care planning
The biggest nutrition challenges in your facility
You may also start noticing areas that could be improved.
Maybe the weight process is confusing.
Maybe there is no consistent system for following up on residents with poor intake.
Maybe documentation could be easier.
Maybe staff need more education.
Do not feel like you need to fix all of these things immediately.
Make note of them.
Then tackle one thing at a time.
You Do Not Have to Know Everything Yet
Starting in long term care can feel like being dropped into the middle of a very complicated puzzle.
There is a lot to learn.
You will have questions.
You will come across situations you have never dealt with before.
You may occasionally stare at your computer and wonder how everyone else seems to know what they are doing.
That is normal.
You do not need to become an expert during your first week.
Start with the basics.
Learn your facility.
Get to know your team.
Understand your residents.
Create a system to stay organized.
Focus on the nutrition concerns that need your attention first.
Learn how nutrition care works in your building.
Ask questions.
Then keep learning.
Long term care is complicated, but you do not have to figure it all out at once.
Take it one resident, one process and one day at a time.
And before long, you will be the person someone else comes to when they are new and wondering where to start.
Need More Help as a Long Term Care Dietitian?
If you are feeling overwhelmed, you are not alone.
Long term care dietitians are expected to understand clinical nutrition, aging, regulations, documentation, MDS, care planning, survey readiness and the many day to day challenges that come with caring for older adults.
That is exactly why I created Long Term Care RD.
You will find practical resources designed specifically for dietitians caring for older adults, including education, tools and resources to help you save time, feel more confident and provide better nutrition care.
You do not have to figure out everything on your own. Some more helpful information for you is:
Follow our Facebook and Instagram page @ LongTermCareRD, I share daily helpful tips for you.
Listen to our weekly podcast @ LongTermCareRD as well!
Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.
Very helpful information here! These spreadsheets are great, especially the weight one that automatically calculates weight change percentages. How do I use these spreadsheets? They are in “view only” mode when I open them up on my google drive. Thanks!
Hi Vanessa,
Thanks for the comment! You can copy and paste any of the spreadsheets to a new google sheet and you’ll be able to use them and edit as needed:)
That worked! Thank you so much:)
Thank you for the great information! I’m new to the LTC population but have been an ICU RD for 13 years. I love spreadsheets to stay organized. One question about keeping them in a binder. Do you then print out changes daily? Would it be easier to just keep information in a laptop you carry with you? Thanks!
Welcome to the LTC club Stefania!
I definitely kept mine up to date on my laptop, but once a week I would print them out and provide vital information to my units. It completely depends though on the type of work you’re doing. If you carry your laptop around all day and work off of that, then there likely isn’t a reason to print it off. I printed mine off because I liked to have all my patient information at my finger tips when I was on units. Throughout the week I would mark up my paper copy and ensure at the end of the week that all the changes I made to nutrition care plans was updated in the computer. When it comes to Surveys/Audits, it’s critical that you know what is going on with all your patients and make sure records are kept up to date. Whatever method you find works best is great, there’s no set method.
Pingback: Resource: Resident Nutrition Information – All the Info For Audits!
Pingback: Resource: Resident Nutrition Information – All the Info For Audits! – Long Term Care Nutrition