By the second week I had found all of the information I needed in reference for my charting. After doing a few follow-ups it became easier. It’s important to ask what the protocols are for each follow-up: monthly, quarterly, annually, and initial. They all require the same analysis of data, but the longer you go without seeing them or the more critical the case is the deeper you go into assessment.
- We had the opportunity to sit in on a few interviews for a new cook. The RD had us sit in and then ask the applicants questions. I made sure to look at their resumes – look for any strengths/weaknesses – and ask a question. Fortunately, I had hired some employees when I worked administration so I knew what to look for. After finishing up the interviews we discussed who would be the best candidate for the position. I selected the candidate with the best availability, experience, and background in my opinion. My preceptor agreed and called HR to schedule him for the next week. I was shocked to know that I had been given such a decision during my first few weeks of being an intern.
- Sitting in on IDT Meetings (Interdisciplinary Meetings). This is where the whole medical team comes together to discuss the status of the patient such as their success in meeting goals and their prognosis. It’s very inspiring hearing every discipline talk about their work with the patient. I would say my most favorite to hear is the physical therapist since I used to be in the PT program before going into nutrition. Coming together and hearing everyone’s efforts to helping each child is a beautiful thing. You can really sense the heart of these teams.
WEEK 4 – 5
I’ve finished my first rotation today!!!
208/1240 HOURS COMPLETED
These last 2 weeks have gone by so fast. I didn’t realize I would struggle so much with energy. Most days I felt like taking a nap after my shift.
Now that I’m finished with this rotation I feel more confident working in a clinical setting. This rotation was outpatient/long term care so it focused more on maintenance of patient diets rather than starting tube-feeding calculations from scratch. I feel it was a good start for me. I’ll be honest it’s very intimidating walking into a hospital that specializes in these types of cases because in school they can only teach you so much. You realize how much you still need to learn and it will take time in the hospital (at least a year or two) to get everything down. In undergrad I learned only adult assessment procedures and general MNT (medical nutrition therapy) care for cardiac, kidney, diabetes, obesity, etc. So this was much different – a little stressful but I had a great preceptor to teach me how to calculate energy requirements for children and what to account for in congenital birth defects, neurologic injuries, cardiac and respiratory illness, seizure disorders, and premature birth complications. With some hard work in the beginning I was able to read up on working with peds and how to adjust my assessment to their diagnoses. I will say this rotation was a great stepping stone into acute care. I was still really nervous going in because I felt that there was so much to know, but fortunately dietitians are given time to sit in an office and work on their cases. Our preceptor had affirmed that it is impossible to know everything and that we are only as good as our references. It’s important to stay up-to-date and know where to look for accurate and evidence-based information. I felt relief after hearing her say even after working in the field for 40 years that she is still constantly learning and still has to look up equations, intake ranges, DRIs, etc…
WHAT I DID AT THIS ROTATION:
- Performed assessments to calculate patient energy (macro), fluid, vitamin/mineral (micro) requirements and growth trends.
- Determined if current diets were adequate for the patient (monthly, quarterly, semi-annual, annual – all of them were different).
- Monitored patient weights/heights and plotted their z-scores to see their current status.
- Made recommendations to the doctor to either change or continue diet orders.
- Sitting in meetings: interdisciplinary team (IDT) for all levels of care, admits/discharges, reports to administration.
- The IDT consists of all the health care team: Doctors, Nurse Managers, Dietitian, Physical Therapist, Speech Therapist, Occupational Therapists, Recreational Activity Therapist, Respiratory Therapist Manager, Administration, Social Workers, etc. Something I didn’t know since I didn’t have any hospital experience prior to this internship.
- Updated the IDT and patient’s family about the current status of a patient I was assessing. I was able to answer questions a mother had about her child’s diet and growth status.
- Sat in a few feeding groups. One with the occupational therapists and another with the speech therapists. It was a great opportunity to see how speech therapists assess these patients.
- Discussed with doctor and team about suggestions in ways to increase food intake for one of our picky eaters. Gummy vitamins for the win!
- Created weekly menus for children on a PO (by mouth) diet based on their diet order.
- Created a food preference questionnaire that included foods that were in stock.
- Created audit and inventory forms to push for more efficient tracking.
- Performed audits for FIFO, labeling, expiration dates, dishwashing/sanitation temperatures, equipment upkeep, proper food handling and food storage temperatures.
- Hiring and evaluating kitchen staff.
- Performed a weekly inventory of food in the kitchen, satellite kitchen, and disaster room. Moving around items to make sure our satellite and disaster pantries were fully stocked and then order foods to replenish kitchen.
- Created a hydration handout to educate parents on the importance of drinking water and risks of sugary beverage intake.
- Assisted in preparation for a staff BBQ and learned the process in how the director prepares for events like this.
- Routine schedule. You’re able to do things at your own pace. It was also nice to break away to attend meetings. It’s comforting to know that even though there is so much to know and do you know what it takes to become a dietitian in this facility very quickly.
- Wearing blazers and slacks. Looking the part made me feel the part. It helped build my confidence and feel like all my hard work was paying off.
- Working in a professional environment. You feel like you’re learning a lot from other fields.
- Knowing that what you do is making a difference. You feel like you are a valuable part of the team. Without a dietitian assessing, monitoring, and making suggestions a patient’s health would decline.
- Working with another intern helped so much. We were able to bounce off each others ideas and help each other in working our way through problems. I’m so glad we clicked – it helped pass by the time. We had soooo many laughs! So much so we thought we’d get in trouble for it. Luckily we didn’t. I’m happy to say now she is a good friend of mine – we’ve been through it.
- My best friend got engaged and passed her boards to become a nurse practitioner! In the same week I might add. Another friend of mine passed her RD exam just a month after finishing her internship. I love seeing my friends do well.
HEADS UP/TRUTH BOOTH/NOT SO POSITIVES:
- Being responsible for someone’s life: this isn’t necessarily a bad thing, but it can be stressful. You don’t want to make the wrong decision.
- There are times I felt like there were more opportunities that could be given to learn more. You might feel that you’ve plateaued in learning, but I’ve heard that this is common at rotations.
- RDs are not being compensated for their time in teaching you. They have to teach you as well as do their job so they might not be able to give you their undivided attention or have the time to walk you through things. Don’t be discouraged, you are getting your hours…if you feel like you are unable to suggest a project just keep busy doing what you are told to do and stay positive.
- One of my preceptors didn’t read my compentencies checklist that my internship director sent to him until my last day, which meant there were some things that I didn’t learn. He wasn’t able to check these off so now I’m having to make sure this is covered in another rotation. Luckily this isn’t my only food service rotation. I still wasn’t very happy about that. Now I know to make sure to review all of my competencies with each preceptor so I know I’m meeting them all to receive my verification statement.
- Having the energy to do things after working rotations. After the rotation your work is not done. You have to research for references that can help you in assessing and treating patients. You might also have assignments to do outside of your hours. Luckily these hours counted towards my time there. Not all rotations allow this though.
My goal to work towards increasing my energy levels is by eating a bigger breakfast and getting to the gym at least 3x/week, which I’ve done for three weeks. It’s helped a bit. Cooking mostly at home has helped me save money too. In my free time I’ve also been studying Medical Nutrition Therapy (MNT). I started the first module this week (1st out of 3). Luckily, it’s the same textbook I used during undergrad so most of it is review. I like the fact that it’s one module at a time so we are able to focus on one subject.
Next week I start at a eating disorder clinic in Newport Beach. I think I’m most excited about this one.