Dietitian Interview Tips

Welcome back to My RD Journey! Things have been a bit crazy over here the past few weeks. I half expected my client load to decrease with the end of summer and beginning of the school year; yet, it is has been the opposite, which is good! I also got the opportunity to teach an in-person class at a local community college for this semester. It was super last minute as in I found out about it on Thursday, interviewed Friday, went to an in-service the following Monday and started teaching Wednesday. I didn't have access to anything, just a textbook and role-book on my first day. I am now heading into week 4 of classes and I love it! I love being able to teach young minds about nutrition and I especially love that I have so much flexibility in how I teach the materials. Despite the craziness in my schedule, I love that I have the opportunity to teach and ultimately grow professionally. It is very gratifying!

I have been doing a lot of thinking lately about my business and the direction I want to move in. I have enough clients to bring on another Dietitian, yet, I am hesitant to do so since I would have to change up my business structure, figure payroll out, and whatnot. I know a few other RDs that do this; however, I am not sure if this is my ideal long-term business plan. I am also finishing up the editing for my first book and I definitely want to get it out for September. I have about 6 other book ideas fleshed out (some for RDs and some for public); however, I am just struggling to find time to write. I am at the point where I could just continue with my current load of clients and classes; however, a part of me wants to change it up. I also want to have more time to myself versus running around every day. I am wondering if teaching is something I will end up wanting to do more of long-term. Anyone else reach this turning point in their business? What did you do in moving forward?

Since I had recently interviewed for a college faculty position, I wanted to share some of the tips I gained. Whether you are a new RD looking for a job out of your internship or an RD that is debating switching careers, these tips will hopefully provide you with some insight.

(Dietitian) Interview Tips 

1 - Do Your Research
For almost every interview I had, I was asked the question, "Why did you choose ____(insert facility name here" or something along those lines. So, think to yourself, "Why are you interested in this facility or this position?" If you are just trying to get any job, spend a few minutes on the company's website or Facebook page. Are there programs that they run that you think are great? What about their philosophy for wellness or patient care? Pinpoint some aspects of the facility that you could touch on in the interview.

2 - Bring the Essentials
For my interview, I brought in my resume, CV (which had more detailed information about my education), cover letter, list of 3-4 references, and some examples of my work. Even if the information was submitted already online or via email, I always bring hard copies with me. I have had interviewers put my copies in with my employee file or review with me during the interview. When thinking about bringing work examples, I tailor the materials towards the type of interview I am in. For example, with teaching I had sample lesson plans I wrote for high school students and adults. I normally wait to bring out my work samples until it comes up in conversation.

3 - Be Prepared
If you haven't interviewed in a while (or ever), make sure you do some practicing with a friend or family member. Go through some of the most common interview questions like: what are your strengths and weaknesses or what is your teaching philosophy or why would you be a good fit for this position or how would you handle scenarios for conflict or working in teams. Trust in the education and experience that you have!

4 - Dress to Impress
I always say to fellow Dietitians and interns that it is better to dress up and be told to dress down than the opposite. Come to the interview in your best professional attire even if you know the position you are applying for involves wearing scrubs.

5 - Come with Questions
When you go in for an interview, you are also, in a sense, interviewing the facility/interviewer. Will this place be a good fit for you? Do they offer the benefits you need? Always come prepared with questions. The last thing you want to do is get into a job and realize it was not what you expected! Ask what a typical day looks like for the Dietitian. Ask about the interview process or training procedures. Don't be afraid to come with a list of questions to ask. This also shows your organizational skills, that you prepared for the interview and you care about your role as a Dietitian.

Remember to just be yourself and trust in the experience that you have. Leave a comment and let me know your best interview tips!

Life After the RD Exam

So what exactly happens after you are a RD/RDN? For one, you feel relieved and not sure what to do with all the free time you have (if you are not already tied to a full-time job). If you don't have a full-time job, almost everyone you know will be asking you when you will be getting a job, if you already applied, and what your plan is.

After you pass, the CDR will contact you via email in a few days (took them 3 days for me). They will congratulate you and give you a bunch of information on using their online system (good email to bookmark). About 4 days after that, I received an email about the fees I would need to pay. If you don't feel broke enough already, (after college, your internship and $200 for the test), you will after you see all the money you have to send to the CDR and your state.  I had thought the $60 maintenance fee to the CDR for your registration card was a one time deal. I thought wrong! It's $60 per year ($300 up front for the 5-year certification period) for them to maintain your portal for the CPE credits and what not. I will be posting another blog about how to set-up your learning plan (another complicated task that I was glad my internship had us practice prior!).

PA Licensure
Finding the licensure information for my state was very difficult! I didn't realize that Dietitian-Nutritionists are listed under the State Board of Nursing (because that makes sense...not). Anyways, if you are in PA, follow the link below and find the link that says "Application for Dietitian-Nutritionist." You will need to print, fill-out, and mail this form along with $45 to PA Board of Nursing. The form is pretty simple; however, you need to request verification of the registration letter from the CDR. I have a link below for that as well. It will ask for the email address of the person who needs it, in this case "st-nurse@state.pa.us," which is at the top of the paper application. The CDR will then send an email with your letter. I also got a copy sent to myself, just to have it. Some states do not require their Dietitians to be licensed. If so, you have saved yourself $45.



One thing I definitely suggest you doing after you pass your test is go out, celebrate, and/or go on a vacation! You deserve it and it will give you a refreshed mind for when its time to set-up your learning plans, build your resume, and do some job searching. My vacation landed me right by the bay/beach :)

I love taking this time to myself so I can do all the things I have been putting off (for studying purposes) like reading a good novel, painting, or just spending good quality time with my friends, family, and boyfriend :)

As always, good luck to those finishing up your internships or studying for the RD exam!


Links:
PA Licensure Application: http://www.dos.state.pa.us/portal/server.pt/community/state_board_of_nursing/12515/licensure_information/572048
Verification from CDR:
https://secure.eatright.org/cgi-bin/lansaweb?procfun+prweb28+p28fn01+prd+eng
Additional Information about Licensure:
https://www.cdrnet.org/state-licensure

Tips for Passing the RD Exam

Well, the next chapter of my RD journey is complete! I am now a Registered Dietetic Nutritionist (RDN)! It feels good to know I can finally get rid of the hundreds of index cards I made over the past few months. Now that I have passed, I have been getting the questions of "How was it? How long did you study? Was it what you expected?" These are the same questions I asked everyone else who took it too :) I must say, it doesn't feel real just yet. In just 1.5 hours I went from an intern (who graduated) to RDN. Anyways, let me get into what you have been looking for to begin with.

How long should I study?
I took my exam about 6.5 weeks after I finished my internship. You want to aim for 1-2 months of study time (or so I heard and went with). The first week, I got things together to study. I made index cards, set up a study schedule, relaxed from my internship, etc. I used Jean Inman and RD in a Flash to study from (For more information on study materials: Studying for the RD Exam). The second/third/fourth week, I dedicated about 2 hours in the morning and 1-2 hours at night to studying. I would focus on a single domain each week (Week 2: food science, Week 3: Disease states and MNT, etc). The fifth week, I bumped up my studying to about 4 hours a day. I wouldn't sit for that whole block though. I would study for an hour, take a break, get coffee, study, go to work, study, etc. I would usually spend at least an hour at a time (takes time to focus and get started). To be honest, there were days I just didn't get a chance to study because of family events, work, or other things going on. It is good to give yourself a break every now and then.

The days leading up to my exam, I re-read all of Jean Inman. I also re-wrote my notes (re-writing things helps me to remember better).  Four days before my exam, I was in panic mode thinking I should post-pone my test. I kept focusing on all of the things I didn't know and getting frustrated. I was worried I would fail and have to wait the 45 days to re-test. I was rating my knowledge at about an 75-80% (Not from any specific math equation). After speaking with another intern, and current RD, I stuck with my test day. She reminded me how much I do know, and that I know more than I think (that last part is especially true).  My boyfriend also reminded me that if I failed, it's only a test. Yeah, it is a pretty big test; however, it is just one test! I just had to keep reminding myself that I knew a lot and it was okay if I didn't pass (the world wasn't going to end). The last 2 days before my exam, I spent time reviewing the answer keys to tests and focusing on the concepts I needed work on. I spent about 8 hours each day studying like crazy!

This was a schedule that worked best for me. It is important to find the best way for you to study. I heard of other interns only taking 3 weeks to study with 8-hour study days. I heard of other interns taking a 4-5 weeks to study with 3-hour study days. Again, it is all about how you study as to what schedule will work best.

What is the Exam like?
The day of the exam, my stomach was doing flip-flops. Everything is so formal and rigid when you go in to test! Throughout the exam, I kept thinking "I am definitely failing!" I found out that this is a pretty natural response. As I was answering questions, I was surprised at how much I studied and how little was actually on the test (only about 40%). I was happy to realize that all of the information I was worried about not knowing wasn't even on the exam! There was one point where it took a couple of seconds for the screen to move to the next question. I remember thinking, "that's it, I failed." My heart sunk until I saw the next question. It is definitely hard not to panic when you are taking it. Just remember to keep calm and take it one question at a time. I thought it was funny that the night before I felt like there was so much I didn't know and after leaving the exam I was surprised at how over-prepared I felt!

Best Tips for the Exam
1. Take deep breaths between each question. I found myself holding my breath because I was so nervous!
2. Read each question twice! I tend to go through things too fast and miss important parts of the question. My strategy was to read each question and answers twice, pick out the key points of the question, pick the best answer, and re-read the question to make sure I was picking what they were looking for.
3. A lot of the questions end up with 2 answers that seem to fit. At this point, re-read the question and pin-point what they are looking for.
4. Go with your first gut answer. Try not to over-analyze things too much. Remember, this is an entry-level test!
5. Be confident in what you know. As I said, only about 40% of what I studied was on the exam. Goes to show how much you really know from all the schooling and internship!
6. Bring tissues! Whether you pass or not, you will probably need them. When I left the testing center, I burst into tears of happiness.

Hopefully, this helps you as you begin to study for your exam! Best of luck to all those who are RD eligible!

Studying for the RD Exam

This past Friday, I completed my dietetic internship! (35-weeks and many long drives later). Definitely a lot of pressure was lifted off of my shoulders, as I now only have 1 thing to focus on at this point---my RD exam. With many of the other interns finishing up at the same time, I have been noticing the same questions getting passed around: What are you using to study? How are you studying? Is product x better than product y? How long do I wait to take the exam? Based on other intern testimony (who have taken and passed the exam their 1st time) and the RDs throughout my internship, I have a good idea of how/what to study.

What are you using to study?
I have a copy of Inman's Review of Dietetics ($385) with the 2014 CDs (compliments from another RD and intern in my rotations). Inman is basically the go-to book for studying. It has everything you need in it and it is easy to follow. The CDs are great for listening in your car; however, be prepared for the voice you will soon despise. Inman also has a course for the RD exam (where she teaches for a weekend). I've heard mixed reactions on this. One RD said that it was a waste since she read from the book (but she is not a lecture-type learner). Another RD said that the course was great and worth going to (he was a lecture-type learner). I'd say if that is your style of learning and you don't mind the price ($385), go for it.

I purchased, from another intern, the RD in a Flash Cards (over 630 index cards). If you are a notecard person, I definitely suggest this. They were great to grab a few and take with me during my internship when I had down time. I also got the opportunity to look through Hess and Hunt Review of Dietetics: Manual for the RD Exam ($100). It is very similar to Inman with a few extra charts and notes. I don't think they have CDs, which could be a deal breaker for some.

How are you studying?
A few months before I finished my internship, I began making note cards from Inman. I find it easier to study by using notecards and rewriting my notes. By doing a little bit each night, I was able to transform the whole book into notecards by the end of my internship. For the disease states, I made charts listing the description and treatment/diet. I found this to be easier to study and reference while in my internship. Besides the notecards I made each night, I would try and read through some of my nutrition notes daily. It is kind of difficult to do while you are in your internship, so don't stress too much on that. Also, you are learning so much from your rotation that you are "studying" as you go.

Now that I am finished, I made a study schedule for myself. Monday-Friday I study for 2 hours in the morning, hit the gym (to clear my head), and then block off 2 hours in the afternoon. I also set time to study on the weekend (2-4 hours depending on what is going on). I am not someone who can just sit for hours and hours, so I will take a 5-10 minute break during my study time. I'm finding this to be pretty manageable for me. Also, in making my schedule I noted which sections I would be studying each day/week. This kept me on task and prevented me from skipping anything.

How long do I wait to take the exam?
Generally, about 1-2 months is a good range for the RD exam. Based on the interns in my class who passed the exam, they took 1 month to study and passed the first time. You don't want to go longer than 2 months because you don't want to forget things you learned in the beginning of your internship.

Final Tips (Based from RDs in my rotations)
1. Don't just focus on things you don't know. Still focus on things you do know so you won't forget those concepts.
2. Don't spend too much time on one aspect. There is a lot to study from!
3. Don't study the night before the exam.
4. Ask around and look online for past interns selling their materials.
5. You will feel like you are failing the entire time you take the exam. This is normal!

Hopefully, this helps you as you prepare for your exam!


Additional Links
RD Study outline from CDR
RD Study Exam

 

Working with Eating Disorder Patients

I can finally see the light at the end of the tunnel as I finish my last 2 weeks of my dietetic internship! I can't believe how fast the time went already! In my last leg of the internship, my outpatient rotation, I am in a facility with eating disorder patients (both inpatient and outpatient). The hospital also has a couple other wings with patients suffering from mood disorders (adolescents and adults), which I also get to work with occasionally for consults.

This is my first time working so closely with eating disorders (ED) and it was a bit overwhelming the first couple of days. I never realized how much time the RD spends counseling and how important it is. The patients see the RD 1x/week for a session; however, the RD ends up seeing and talking to some of them almost every day. The RD will walk onto the unit and patients start calling to talk to her about their weight, their meal plan, etc. It takes a lot of reassuring and challenging of eating disorder thoughts. Some of the patients will become so upset if you need to up their meal plan 200 calories due to not gaining weight or weight-loss that it is hard to calm them down. You have to be patient and understanding when giving news that they will not take lightly.

Some of the best lines I learned in counseling were, "How do you feel about what I said," "Where do you think your weight is," (They find out their weight 1x/week and that phrase is asked prior to them knowing) and after a patient says something so absurd "Reality check does eating an orange really make you fat." You can't be afraid to challenge an ED thought, you just need to know how to phrase it towards each person.

One of my biggest fears with ED is saying the wrong thing. I'm always thinking that I will say something that will trigger one of the them or make them upset. I learned that besides practicing, the key things you need to do are: be empathic, don't downplay how they feel, always give praise when you can (for finishing a meal, etc), let the session be guided by the patient, ask "why they feel that way" when they have something to say about their body image or weight, and ask as much open-ended questions as you can.

There are also a ton of meetings every day with MDs, RNs, social workers, etc. The care team needs to really collaborate on the treatment plan, not only to aid the patient in recovery, but to provide a united front. Some of the patients are very sneaky and will lie to your face about purging or hiding food. It is really helpful to have team meetings to see if what the patient says, or doesn't say, is consistent (they tend to slip up when they lie). Seeing the food rituals some of the patients have is crazy. Some of them tend to be very OCD (they have to have even numbers of foods or eat in a certain manner) and you can definitely tell when you observe their meal times.

Some of the comments/situations I heard this week that will show you how distorted some of the thoughts ED patients have are:
1. I am morbidly obese and I am concerned about breaking the chair. (Patient is underweight).
2. RD: "If your BMI is in that range, you will be considered emaciated". Patient: "That's okay with me."
3. Scales don't apply to me. (Patient stated after saying her family is genetically modified to need less food than everyone else),
4. Since I got my menstrual cycle, I know I gained too much weight. (In case your not familiar, patients with eating disorders tend to lose their cycle. Some patients have not had 1 in over 5 years).
5. I'm concerned with getting diabetes from eating all this food.  (1600 calorie diet that is).
6. I don't need to eat to live.
7. I don't know why I am here. I am fine. I just purge after each meal and when I drink water.

If you every work with eating disorder patients, be prepared to hear comments like the ones above. Some of the ones I hear every day are centered on feeling fat or bloated and being disgusted with themselves. It seems silly to think about a 100lb person being fat; however, these patients truly believe that the distorted thoughts they have are in fact real. It definitely takes a lot of patience and empathy to work with EDs every day. While I love being in this rotation and learning so much so quickly, I can say that this is not the field of nutrition I would want to work in at all :)

First Week of LTC

Today, I finished the first of my 2 weeks of long-term care! I can't believe I am 4 weeks away from graduating from my internship. I'm at the point now where I am really starting to focus on studying for the RD exam (key word "starting"). So far, I have been making index cards from Inman's Review to add to my stack of RD in a Flash cards. Since I have had such long commutes, I have been listening to the Inman CDs in the car on the way to my rotation. I just can't stand her voice any longer after a whole day at my internship. Anyway, I feel like it's been working well so far.

This week was an interesting experience. I went from being in my IPC facility where everything was computerized and organized to paper charting (huge binders for each patient) with utter chaos. Also, when you are in a hospital, you focus more on diet education and the occasional people not eating well. In the LTC facility, there are no educations! It is all about getting residents to eat, giving them supplements, checking weights, and doing wound assessments (and giving supplements to them as well). Did I mention it was very supplement based? Some patients are on diets, but it is much more liberalized than in an inpatient hospital. I mean if someone is 95 years old and wants some cake, she'll get her cake...and eat it too.

One of the toughest things this week was getting used to another facility's format. I felt like a chart-writing pro at my last facility. Now, I feel like I am starting from scratch with someone else's preferences and their facility's rules. I am very glad that I did my inpatient clinical rotation first because I feel like you are flying solo a lot more in LTC. Also, with paper charts, you have to sift through everything and find what is important (knowing medical terminology is helpful!).

I think my favorite story of the week happened when I was doing fluid restriction audits. I had the job of checking to make sure each patient on a fluid restriction had a palm tree picture outside their door and above their bed. As I went into one patient's room, this was the conversation that occurred:
Me:  Hi, I am just checking to see if you have a palm tree on your wall.
Resident: What? (very hard of hearing)
Me: I am looking for a picture of a plant on your wall.
Resident: Oh, that isn't on my wall, it's in my bathroom.
(So, I just think this lady is crazy; but, proceed to check in the bathroom. There in her shower was a huge plant.)
Resident: See, I told you I had a plant.
Me: You sure do.
Resident: Now, will you get someone to hang it up for me already.

Lesson learned: Sometimes the residents aren't as crazy as you think! Definitely my good laugh for the day.

Final Days of Staff Relief

Tomorrow marks my final day of staff relief and my final day of my IPC rotation! I will be starting on Monday at my long term care facility.

My past 2 weeks of staff relief have been crazy, but really good. I started off feeling a bit overwhelmed; however, as time progressed, I became very comfortable out on my own. Although this rotation was stressful at times, I wouldn't have changed a thing. The situations I was put in tested both my knowledge and my patience. Some days went very smoothly; however, other days I was ready to leave at 10am. It was the days that I was ready to leave at 10am that I now appreciate the most. Being able to accomplish what needs to get done on stressful days has made me a stronger dietetic intern than when I first started back in August.

One of the things I will miss the most being at my IPC facility, besides the free breakfast and lunch I got each day, is having another intern with me. I had interns that came during my last couple rotations; however, they would come after I was already there. Sure, we bonded, but I was never with them long enough to really get to know them. This rotation was the opposite. I started my first day with another intern so we got through that first scary day together. I could not have asked for a better person to spend my rotation with. Besides the fact that she had awesome notes and charts I could copy (and cookies to feed me), she was sweet and always there to listen and vent to (as I was able to do for her some days, haha). We shared stories about our internships, patients, boyfriends, and frustrating situations. I used to think it would be crazy to share my internship rotation with another intern; however, I think having that experience (and becoming so close) made it all the better. Now ends the sappy part of my blog :)

Although there were people and things I will miss now moving on to my next rotation, there are certainly things I could live without. This refers to my 1.5 hour drive each way to my rotation, the long drive being mixed with snow, the obnoxious amount of potholes on the roads I take, and the 2 sets of train tracks I seem to hit every other day on my drive home.

Some of my favorite, interesting, funny, not-so-funny patients of the week consisted of:
1. A patient who overdosed on 270 pills.
2. A patient with a BMI of 54.4 (also unemployed and adamant that they were fine in their diet <-- my favorite part).
3. A patient who had uncontrolled diabetes who told the nurse that he felt short of breath at home, so he took some cocaine. This same patient told me he does not take his blood sugar at home because he gave his machine to a friend...sure.
4. A patient (came in as an overdose) who threatened to pull out his IV if he didn't receive pain meds (the nurse told him he could sign himself out AMA if he wanted, and he became very quiet).
5. Seeing x-rays with a collapsed lung, fluid in lungs, and blood clots.
6. A patient (next door to the patient I was visiting) who was screaming that the nurses were trying to kill him.

Some things I found to be useful during my rotation were:
1. A sheet with lab values and what it means to be high and low.
2. A sheet with common diseases (cirrhosis, diabetes, cardiac, renal failure, pancreatitis, etc) and the accompanying diets (for the ones I wasn't familiar with).
3. A sheet with TF formulas used in the facility.
4. A cheat sheet of when to use certain formulas (Nepro-renal, Glucerna-Diabetes, Isosource-low blood pressure).
5. Knowing that I needed to be confident in my recommendations for a diet!
**Don't stress too much over not knowing things about clinical. I felt the same way going into my rotation; however, by my last few weeks, I felt like I knew so much and how to appropriately apply the information.

I'm excited to start the next part of my RD Journey. T minus 5 weeks until graduation!

Beginning of Staff Relief

T minus 6 weeks and 4 days until I am done my internship! 1 week and 4 days until I move to a new rotation!

This week, I started my staff relief at my inpatient rotation. It was kind of crazy the way everything panned out. Last week, I was still with the RDs, only seeing about 4-5 patients on my own. While it was great to be with the RD in the beginning, it was tough bouncing between 2 RDs and their styles of teaching. I really wanted to find what worked best for me (while including all the necessary components of a good assessment/education). I brought my concerns up to my preceptor and discussed with her what my staff relief entailed. I was really glad that I spoke up and talked to her.

Today, I came in and was handed 17 patients to see on my own. I really felt like I went from 0 to 100!  I felt a little overwhelmed as I started to look through the patient sheets. I had 2 initial visits, 15 follow-ups, a low-fiber/weight-loss education, a TPN, and 17 charts to do on my own. As I started to work through the patients, I began to "chill-out" and go with the flow. I knew I would have the time to see everyone and I just needed to have confidence in myself that I was ready to do this.

My first day of staff relief went really awesome. I got everyone done and had 1.5 hours to work on my own assignments. There were 2 patients I saw today that really touched me. The first patient was  consult for low fiber education/weight-loss. She was very interested and asked me a ton of questions! I was nervous at first, because I kept thinking she would ask me something I didn't know and I would look really dumb. Once I started to talk to her, however, the answers just came pouring out. I ended up spending about 45 minutes with this patient and I didn't even realize it. One of the best things about the visit, was what she said at the end: "You are really good at what you do. I really appreciate all the time you spent explaining everything to me. I wish you so much luck in finishing your internship." The second patient I saw had colon cancer. She was the most lively, elderly lady I have seen in a while. She was very informed about nutrition and was telling me about her journey as an RN in her past years. At the end of the visit, she had asked me for my number so she could call with questions about her nutrition. I explained to her that I was only an intern, didn't have my own card, and would give her a card for the RDs at the hospital. Her response to that really made me smile: "You are not just an intern, so don't say that."

One of the things I liked best about staff relief, was being able to really connect with the patient. I loved spending time with them and not having to rush through a visit because I was working with someone else. I also loved being more of an authority figure. Sometimes, when I was with the RD, I would do the talking and educating, yet some patients would ignore me and talk to the RD. It was a way different ball field being alone!

Some of my favorite/interesting/funny patients of last week and today were:
1. An autistic, elderly patient who aspirated a tooth into his lung (and I got to see it on the x-ray!).
2. A patient who overdosed on a gallon of antifreeze. I don't know about you, but I wondered how anyone could get it down! Well, I googled it and found that antifreeze has a sweet taste (some companies are making "less sweet" versions to deter kids from drinking it)...go figure.
3. A type 1 diabetic who ran out of insulin, so ended up in diabetic ketoacidosis. She then tried to sign herself out of the hospital, with no more insulin at home.
4. A patient, in his 40s, who fell asleep mid-conversation with me.
5. An 88-year old woman who decided to jump out her bedroom window, thus breaking her femur.
6. A patient who stops breathing (they had to call code blue 2-3x on this guy) every time he falls asleep.

No matter what the day is, there is always someone/something interesting going on at the hospital!

Accomplishing a Week Full of Stressfulness

At this point in my inpatient clinical rotation, I am 5.5 weeks in with about 14 days left to go! Despite my 3 hour total commute every day, this rotation has been my favorite so far (something I thought I would never say!).

IPC is both challenging and rewarding at the same time. Seeing a really complicated patient and trying to figure out the best nutrition advice is like being a detective. You need all of the pieces (patient's medical history, hospital care, food intake, etc) before you give tips on how to eat healthier. Missing something like Chronic Kidney Disease (need lower protein) or not knowing if a patient is on dialysis (higher protein is needed), can really alter what you say.

This week, I had some really dumb moments, like thinking LOS >7 meant a loss of 7 pounds (it really means length of stay > 7 days), really crazy moments (Seeing an anorexic patient who is receiving chocolate ensure via her tube feeding, since that is all she says she can tolerate; oh and she is receiving only 200-300kcal a day from her TF because she won't let us increase her rate), really interesting moments (finding a patient who had a Whipple procedure done, which is now my new case study), really great moments (working with a quadriplegic patient to figure out calorie needs with high protein for wound healing), really sad moments (seeing a young patient go on hospice care from cancer), and really gross moments (taste testing boost pudding with prosource for a patient on a fluid restriction needing a supplement). Just as a side note, never ever try prosource unless you are dared to do so.

You never know what you will see when you are in a hospital. You will always see patients with CHF or diabetes (dia-be-tus as some call it in the hospital) or who are obese (some with a BMI of 51). What is frustrating is going to see a patient, who is diabetic and morbidly obese, and speaking to them about their diet. I can't even count how many times a diabetic patient will say they are following a diet and don't need any education, yet they gained weight from their last visit and/or are in for an amputation due to uncontrolled diabetes. It's times like that where you need to be able to walk away and know that someone will not be able to change unless they really want to do it.

One of the best things for me, is following a patient from being in critical care in the ICU to the floors. It is especially awesome to see a patient come off a ventilator and be able to eat and function normally. I had a few patients over the past few weeks where I thought they would not be turning out okay. To my surprise, I am now following a lot of the patients out of the ICU and to their way home.

This week was really stressful in that I finished my research paper (10 pages on the effects of probiotics on antibiotic associated diarrhea, IBD, and IBS), presented my case study to my internship directors (my last one!), and worked on 2 additional case studies. It is often tough trying to manage my time properly between my internship (8.5 hours/day), 3 hour commute, part-time job where I teach nutrition, social life, and homework. One of the biggest tips I can give to anyone juggling a lot is to schedule in when you will do things. And by schedule, I mean put your assignments and plans on a calendar with a due date. One of my goals for this past weekend was to finish my research paper and find a new case study. I did both, even though I really wanted to just curl up and relax. Now, I have one less thing to stress about as I am finishing my rotation.

As I wrote my research paper, I came across some really great ways that helped me to figure out how to get 26 research studies into my paper in the right place. Here is what I found to be the best strategy for me:
1. Once you find a topic, gather all the information you will think you will need (plus more). I was trying to figure out what else to add to my paper after I got to 8.5 pages and couldn't think of what else to write.
2. Either print the studies you find, or download as PDFs.
3. Go through each study and highlight important information you would use in your paper.
4. Create an outline of your paper: Paragraph 1: introduction, 2: probiotics, 3: C diff. 4: C diff and probiotics, etc
5. Type or cut and paste the information from each research paper into the word document with your outline under the appropriate sections.
6. When you start your paper, look back at all of the research pasted under each topic point in your outline.

I found this way easier to organize my thoughts. It may have been a little time consuming, but it definitely made the research paper much easier for me to tackle.

Finally, this is my last week before I start my staff relief portion!

Week 3-4 of my Inpatient Clinical Rotation

I'm almost through my 4th week of my IPC rotation! Last week, I rotated with the RD in the ICU. This week, I rotated with the RD on the general patient floors. I'm not sure which one I like better at this point.

The ICU rounds are really intense! We (myself and the RD) rotate patient rooms with nurses, pharmacists, the intensivist, and a speech therapist. It is really interesting to talk so in depth about a patient. The intense part is when they start talking about medications, interactions, and using big medical jargon. I definitely take a lot of notes! The one thing about ICU, is you don't get to interact with patients much. You look at a ton of labs and do ventilation calculations (calculating energy requirements for a patient on a ventilator, taking into account the medications they are on). You also write a lot of TF or TPN recommendations, but that's about it.

When I rotate on the patient floors, I get to do a lot more educations (Coumadin, CHO-controlled diet, Renal diet, etc). You really get to chat with the patient about their home eating and the diet they are on. You might recommend/initiate a supplement and you track what the patient eats as well. Some patients are way more talkative and inviting than others. Also, don't judge anyone by their age. I met a patient today, who was in her 90s, still living on her own and cooking all her meals. She was lively and in relatively good health. Later today, I went on a home care visit and met a lady in her early 60s. She was using a walker, had uncontrolled diabetes (BG levels in the 500-600s), and was achy and in pain. She was an "interesting" visit, to say the least. Some of my favorite quotes from her were, "I only buy pork chops to chew on the bone," "Why do I even have to eat protein?" and my favorite, "I may eat some spar-a-grass tonight (aka asparagus)."

Some of my other favorite moments/quotes of the week were:
1. "My weight has been stable at home, but high. But that is because I eat a lot. I eat cake cookies, candy. I know I shouldn't but I do anyway." (Patient had: T2DM, CHF, Obesity, Renal failure etc)
2.  "Your name sounds like a nice soft kitty." (From an 80 year old patient to me. What she meant, I don't know).
3.  Patient: "You won't believe me when I say why I am here. The KKK are after me and my neighborhood and I can't believe it is not covered on the news yet." (enough said).
4. Meeting a 3 year old patient in PEDs with a PEG tube in. He was so cute and sweet! He was born premature, but looked as normal as could be now.  He was my first PEDS patient thus far :)

So far,  I really like the rotation. It is very busy! I come in and do research on patients (medical/food and nutrition history, diet orders, etc). I calculate TF and calorie/protein/fluid requirements on a daily basis. I do all of the nutrition assessments when I rotate with the RD and I have been doing most of the patient educations. I feel like I am getting to know some things like the back of my hand. I really like the fast paced nature of the hospital. It is always different and there are always, always interesting patients to see :)

First Week of my Inpatient Clinical Rotation

This week, I completed my first full week of my inpatient clinical rotation. I've found myself really liking being in the hospital. Each day is so different. One of the best things about being in clinical is there is always a variety of diseases, diets, and interesting medical histories.

Every day when I came in, I would research the new patients (needing initial assessments) and follow-ups for the day. I sifted through EMRs on the computer to find the patient's height, weight, BMI, medications, allergies, I&Os, diet orders, and lab values. Using the information I researched, I would calculate the patient's energy, protein, and fluid needs. When the RD came in, we would go out on the floor and do patient rounds. After the first few days, I was charting on all of the patients we saw (with supervision).

There were some really interesting patients this week. One lady had her stomach removed a few years ago and her intestine stretched to create a pouch. I ended up calculating her tube feeding recommendation. She was one of the many tube feeding recommendations I calculated this week (and 1 TPN). Another patient I saw, had a PEJ tube and a G-tube for drainage due to cancer. The patient ended up excreting almost 3 liters of fluid and was severely hypovolemic and had hyponatremia.

I also saw 2 swallowing evaluations this week. I was in the radiology room with the patient and technicians. They would give the patient a small amount of food (applesauce, cottage cheese, etc) with barium in it. They would then have a screen where you saw the food enter the patient's mouth and esophagus. Both patients I saw had food get stuck in the esophagus, due to poor swallowing abilities. One patient ended up back on NPO and the other was advanced to pureed. Just as a side note, I had to taste test a pureed diet for an assignment. One item I tasted was pureed chicken. It tasted like gross chicken mashed potatoes. I would definitely not suggest trying that if you don't have to.

One of the hardest things in clinical was seeing patients with a laundry list of diseases and medications. A lot of the issues were diet related. I saw a few patients with amputations due to uncontrolled diabetes and bedridden patients due to their morbid obesity. The craziest part was that they were still adamant on not changing their diet to a healthier one. It was rewarding to talk to a patient that was interested in what you had to say. One of the patients I got to educate had a cardiac diet. We talked about how he could lower his sodium intake at home and the importance of small changes to make a habit stick.

I really found it to be helpful to have a clipboard and small binder with equations (calculating protein, calories, ideal body weight, and fluid needs), lab values (and what they mean for disease states), and tube feeding information. You could also use an IPad if your facility allows you to. I also brought a small notebook on rounds with me so I could jot down information about the patient and tips for performing a nutrition assessment. It definitely gets easier the more you do it.

Next week, I will be with another RD that does the ICU rounds. I'm really excited to participate in interdisciplinary meetings on patients.

The Start of My Inpatient Clinical Rotation

As of today, I am 18 weeks into my dietetic internship! Just to recap, I completed food service management with school nutrition education and community (at WIC). I am currently in my inpatient rotation in a 200-bed hospital.

I have only been at my clinical facility for 2 days now, but, I really like it. I'm pretty surprised too. I used to work as a Food and Nutrition Aide at a hospital and I hated it! Most of the patients didn't care what you had to say. They just wanted to "go home and eat their bacon" (a quote I heard fairly often of cardiac diet patients). It is different being with the RD and seen as more of a professional.

My first day, I mostly had orientation to the facility. I was introduced to all the hospitals procedures and protocols. I spent a lot of time learning their EMR system with all the patient information. My preceptor gave me a booklet with equations (for calculating calories and protein for certain BMIs) and tube feeding protocols. This is literally my go-to book for the rotation. If you don't receive something like this, ask your facility what procedures they use to calculate calorie and protein needs. You can make your own sort of "cheat sheet."

My second day was where most of the action occurred. I learned how to complete a nutrition profile for new patients that needed nutrition consults. This involved researching the patient past medical history, current medications, diagnoses, lab values, BMI, anthropometrics, and calculating requirements for calories, protein, and fluid. I was able to shadow the RD for the second half of the day. I got to see a range of medical diagnoses in such a short time; congestive heart failure, acute renal failure, hypertension, dementia, hyperlipidemia, hypothyroidism, and more! I even got to chart on 2 of the patients :)

When I first started, I was afraid that I wouldn't know what to say to patients. The more I learned about diets in clinical, the less I felt I knew! After the first few days, I began to feel more comfortable. You find out everything you need to know about the patient prior to going in to do an assessment. The assessments are usually short (<30minutes). Also, my facility (and probably many others), have access to the nutrition care manual, which lists every disease, lab values, educational handouts, and more. So, if you don't know something, you definitely have the tools to find out.

Just some tips I have for the first few days of inpatient clinical:
-Ask as many questions as you can about nutrition assessments and patient procedure. I think it really helps to hear it explained different ways by different RDs.
-Practice finding nutrition information on patients. The one RD had me on a nutrition profile hunt my first day. I would get a patient and find out their BMI, calorie needs, medications, etc. It helped me to navigate through their system and to research different medications.
-Follow the RDs on their rounds; even if they don't outright ask you, ask them!
-If the facility has access to the nutrition care manual, peruse through it. It is such a great resource (it is expensive to buy).
-This website was useful too: http://www.uptodate.com/home

Hopefully, I will be seeing patients on my own in the next few weeks! :)

Community Rotation: First Week at WIC

I survived my first 7 days at WIC! Only 13 more to go and trust me, I am counting down to the end. For my internship, I spend 120 hours at WIC and 8 of those hours at a non-profit or government agency. This is only my second rotation (finished 13 weeks of FSM and School Nutrition Education). I can't wait to finished up this rotation; not only because it is stressful, but because I will have 2 weeks off before I start my in-patient clinical rotation :)

So, here are some of my tips for your Community/WIC rotations:

Things to Do Before Your Rotation:
1. Brush up on WIC packages, how participants get certified, and issues in both pregnancy and infants (mainly iron-deficiency).
2. Know your assignment sheet! My rotation is only 4 weeks long; so it is important to know how to schedule assignments efficiently.

Things to Do Your First Day:
1. Sit in with as many Nutritionists as you can. Get a feel for the different styles of counseling.
2. Grab as many brochures as you can in the office. These are really useful in counseling and for quick reference.

Things I learned:
1. No matter how nice you are, some participants will not give you the time of day. Just continue to be nice and try to counteract their rudeness.
2. You will learn everything you need to know about WIC within your first week. Someone told me this before I started and it was definitely true! I sat in on multiple counseling sessions my first day and I quickly began to get the hang of the WIC packages and most common problems (iron-deficiency anemia, high juice intake, low vegetable intake, etc).
3. Bring a laptop/assignments to work on! If it rained at my location, very very few people came into the office. That being said, you will have a lot of downtime.
4. Don't be afraid to ask questions about the charting system. Some nutritionists I sat in with, would just start typing their normal note, and I would have no clue what they were doing. They might not even think about showing you what they are doing, so just jump in and ask, or scoot in closer to see.
5. WIC used a really interesting format of chart note: A (Assessment), B (Biochemical), C (Clinical), D (Dietary), E (Environmental: mostly if anyone smoked in the house), O (Other), G (Goal: These are mostly added after the participant leaves). It was a lot simpler than I was imagining; however, with the short amount of time between participants, it is perfect for them.

Hope these tips help you on your RD journey!

End of FSM Rotation

Last week, I finished my first rotation of my dietetic internship (Foodservice management and school nutrition education)! It felt like the 13 weeks flew by!

Some of the things I did during my rotation included:
-Menu planning: created a 6-week cycle menu for the school district; input menu items into PrimeroEdge system (similar to that of NutriKids); assigned menus for the district; created new recipes (and taste tested them); ran nutrient analysis of the menu items to ensure that they met the guidelines for SLP.
-Kitchen work: observed/participated in ordering, inventory, serving, food prep, temperature/sanitation check, etc.
-Lesson planning: taught a 3-day lesson for 6th grade students; taught a fitness/nutrition lesson for 1st and 2nd graders; in-service for staff members.
-Research project: I created a new chickpea salad, had it taste-tested, and put it on the menu. I was trying to determine if increasing student involvement in the planning of new items and implementing the changes they made, would increase consumption.
-Miscellaneous work: answered phone calls in the office; organized nutrition materials, made posters for events, etc.

Things I learned throughout my rotation:
1. Always, always, always ask questions! Sometimes, I felt like I was bothering people asking them; however, everyone was really friendly and there to help. The internship is to help you learn more about nutrition, so asking questions about things you are not sure of is needed.
2. Be confident in what you know and how you speak about it. If you sound unsure, people won't trust what you say. I've said it before and I'll say it again, you know more than you think!
3. Before a food service rotation (in a school district), brush up on food safety, the school lunch program, and food science (I definitely didn't study much on food science until I realized I needed to know some for my rotation).
4. Nurses would call a lot about carbohydrate counts for menu items in order to give insulin to the kids with diabetes. If you find yourself answering these types of questions be sure to have menu nutritionals on hand (I found nurses to be calling last minute and frantic).
5. Get as many resources as you can from the RD or FS manager. My RD had a SafeServ book, Inman's Review, and miscellaneous lesson/training binders, which will all be helpful in studying for the RD exam. She also mentioned she only used Inman's Review for the RD exam and passed the first time.
6. Take the initiative on projects and tasks whenever you can. Not only will this give you great experience, but, it will also show the staff you are committed and a team player. Even doing small tasks without complaint are noticed.
7. If you find downtime in your rotation, read food service related materials (I found this to be helpful when taking my comprehensive exam) and/or ask what else you could be doing to help.
8. Be flexible! Things will not always go to plan. Just roll with the punches and do what you can to make the situation run smoothly.
9. Accept the changes that happen. This kind of goes along with number 8. One day you may have planned to do x, y, and z; however, you may get something new thrown your way. An employee (or 5) might call out, and you need to help in the kitchen. A truck may have broken down and you need to drive the manager around. Anything can change in foodservice! (By the way, these things have all happened in my rotation).
10. Be ahead/aware of all your assignments/tasks. You never know when something will come up that relates to an assignment. It really helps to have your assignment sheet on hand.

Overall, I had an amazing rotation. It was stressful at some points; however, in the end, I wouldn't have changed anything. I really feel like I developed/fine tuned my leadership and interpersonal skills.

Hopefully, my experiences will help you in preparing/finishing your food service rotations!

FSM Week 9: My Nutrition Promotional Event

Starting on Monday, I will be in my 10th week of my FSM rotation of my dietetic internship. This past week has been so fun and exciting; definitely one of my favorite parts of the internship (besides teaching).

October 14-18th was National School Lunch Week. I decided to run my nutrition promotion event (part of one of my rotation assignments) during that week. My event theme was NSLW: Fun with Fruits and Vegetables! I highlighted the featured vegetables and fruits on the menu.  Since my facility was in between RDs and my new preceptor was super busy, I planned most of the event on my own. I spent a lot of time coordinating with the elementary school I would running my event in, talking to staff members, getting the PR coordinator involved, holding meetings, and creating materials/prizes for the kids. I started planning my event about 1 month in advance. I created bookmarks for the students (laminated them as well), brochures to send home to the parents, flyers for my table, and recipe cards for teachers and support staff. I also made posters highlighting the different fruits and vegetables with fun facts and nutrition information. Monday, Wednesday, and Friday I just hung posters at the elementary school. Tuesday and Thursday I was at the school running different contests (guess the bean content of the jar and trivia questions) and giving out stickers/bookmarks for students who had a fruit or a vegetable on their tray.

One of the posters I created for the lunchroom.
One student told me that I should be an artist :)

About a week prior to the event, I discovered that the office I was working in had costumes in their closet; a pea pod and a banana. I was way too excited about wearing them! I also found out that the press would be coming on Thursday to interview me and take pictures!

My first day, Tuesday, of my event went so well! It was a bit crazy because the 1st, 2nd, and 3rd grade lunches overlapped. I felt like I was running around crazy (in a pea pod costume) trying to get student guesses for my bean costume. I also ran a lucky tray, in which 1-2 students from each lunch had a sticker on the bottom of their trays indicating they won a prize. Even with all of the craziness, the event went better than I could have hoped. The kids got so involved! One of my favorite parts was reading what the kids wrote on their guessing slips for the bean jar. One first grader wrote for a guess, "200, or 198." Other students wrote the #1 followed by as many zeros as would fill the line. (Total bean count for the jar was 16,438).

Day 1 Table Set-Up

Pea Pod Costume!

Thursday ran a lot smoother than Tuesday did. Since all of the kids had guessed the beans on Tuesday, I spent time taking pictures, handing out prizes, and asking trivia questions. The kids were so excited about the costumes, contests, and prizes. One student said, "You should wear that banana costume all the time, so I always know where you are." Another student said, "We should do stuff like this each week. Put it on the agenda." A lot of the students asked when I was coming back and what costume I would be wearing. It was so exciting to see the kids smiling and having a good time, all in the name of healthy eating!

Day 2 Table Set-Up

Picture Time!

Banana Costume!

While I was running around the cafeteria in my various costumes, teachers were saying things like, "Wow you must have drawn the short end of the stick," "Oh, the joys of being an intern." That was exactly the opposite of what I was thinking! I was more than excited to be prancing around in different costumes. I chose to wear the costumes (in place of a colored shirt). Seeing the kids' faces get excited was priceless to me. I wished they had more costumes for me to wear :)

After all my hard work, the story was put into 2 different newspapers! It was really exciting to have such good publicity for not only the school district, but also my internship program!