When most people think about meeting with a dietitian, they imagine a one-on-one consultation that yields advice on heart-healthy eating, guidance on protein and fat ratios or directives for limiting sugar. In a hospital setting, however, the patient-dietitian relationship can look very different, says Shelly Messersmith, RDN, CNSC, who’s been a clinical dietitian at HCA HealthONE Swedish in Englewood, Colorado for nearly 20 years.

Recently recognized as Registered Dietitian of the Month for the compassion she extends to patients, Messersmith understands how to reach people where they are. “I really put my brain into thinking through and calculating how to support patients as they’re going through the worst thing they’ve ever experienced.”

Working closely with physicians, nurses, pharmacists, patients and their families, HCA Healthcare’s dietitians play a critical role in recovery and in preventing complications. Messersmith shares how she ensures patients are nutritionally stable during their hospital stay and their transition to the next level of care.

In the hospital, how a patient eats depends on their condition. While some patients can chew and swallow normally, many require alternative forms of nutrition support.

“Maybe they can’t swallow because they have a brain bleed, for example, or their GI tract doesn’t work and they can’t utilize that route,” Messersmith says. “In the latter case, they have to get their nutrition through their blood.”

When the digestive system is still functioning but patients can’t safely chew or swallow, dietitians recommend enteral nutrition, or tube feeding. This allows patients to receive calories, protein, vitamins, minerals, electrolytes and fluids through a flexible tube. “Let’s say they’ve had a stroke and are sedated. We will put a short-term feeding tube through the nostril and down into the stomach,” she explains.

In other cases, when patients won’t be able to eat normally for an extended period, doctors surgically place a gastric (G) or percutaneous endoscopic gastrostomy (PEG) tube directly into the stomach.

Whether nutrition is delivered by mouth, feeding tube or intravenously, the goal remains the same: to ensure patients receive the nutrients they need to support healing. Dietitians determine the most appropriate formula based on each patient’s needs. “Options range from pharmaceutical formulas to options that are more like whole-food nutrition, if patients want that,” Messersmith says.

For a hospital dietitian, a typical day is a mix of assessment, planning and real-time problem-solving. “There’s always something exciting and new,” says Messersmith, who works primarily with surgery patients.

Messersmith starts each morning by reviewing patient lists and prioritizing care. From there, she gathers and analyzes a wide range of information, including lab results, medications, recent procedures, weight and nutrition history and current nutritional status. “We have a lot of wonderful resources that guide us and help us conduct research,” she says. “People aren’t cookie-cutter; there are so many factors you have to take into account, from how their kidneys are functioning to a massive wound. It’s like a puzzle, piecing things together.”

As Messersmith develops interventions, she sets SMART goals and works to correct any deficiencies. “I may need to adjust electrolytes based on lab results, and then I’ll send those updates to the pharmacy,” she says.

Throughout the day, Messersmith monitors all patients individually, checking on those receiving tube feedings, adjusting formulas or rates as needed and coordinating with nurses, physicians and families. “Some people may need nutrition focused on higher protein to help that kind of healing,” she says. “I’ll talk to them about their preferences and then make sure it gets delivered.” Every intervention is tailored, tracked and adjusted to ensure patients are receiving exactly what they need to recover.

More than the science of her job, Messersmith values being a part of a patient’s recovery. She recalls a young ICU patient who, after complications, required nutrition delivered through the bloodstream.

“Eventually, we knew that would not be a long-term solution because his gut became more available for use. So we placed a feeding tube and transitioned from bloodstream nutrition to tube feeds,” she says.

In time, the patient was cleared to try swallowing again. “That doesn’t just happen overnight, and it’s often a big struggle for patients,” explains Messersmith. “When someone has been in the hospital for months and is tired, and their family is tired, you’re really just trying to support them so they can eat more and get back to where they were before the injury.”

As her patient healed, he and Messersmith became friends. “I got to know him really well, and it was such a pleasure to see his mood improve. He got stronger, gained weight and eventually was eating and able to go to a rehab facility. It’s exciting when you can see that progress — seeing them smile and feeling like you helped in your own small way. As dietitians, we know we’re contributing by giving patients’ bodies what they need to heal from the inside out.”

Messersmith says people are often surprised to learn her days aren’t spent in the hospital kitchen preparing meals. “Most people don’t know we are really on the floor with the surgeons and the nursing staff, and our approach is not preparing the meals but building what the patients need to put in their bodies,” she says.

If she could change one thing about how people view food and health, it would be the perception that there are “right” and “wrong” foods. “Really and truly, all food fits,” she says. “It’s about moderation and exercise.”

For all the data, calculations and clinical protocols that guide their work, hospital dietitians don’t follow a single road map. Each patient presents a different set of challenges, and no two care plans look exactly alike.

That’s why nutrition support is as much an art as it is a science — requiring constant communication with patients, families and care teams to understand what’s working, what isn’t and how to adjust. It means meeting patients where they are, whether that’s managing complex lab values, troubleshooting a feeding plan or simply finding a flavor they’re willing to try.

At its core, the work is about more than delivering nutrients. For Messersmith and her colleagues, it’s about connection, trust and compassion during some of the most difficult moments in a patient’s life. And while dietitians may not always be the most visible members of the care team, their impact is felt in steady progress, small victories and every step of healing along the way.