Showing posts with label dietetic internship. Show all posts
Showing posts with label dietetic internship. Show all posts

Sunday, October 22, 2017

Ask The Dietitian (Student Edition)

Welcome back to My RD Journey! I am finally getting into a groove of teaching and running my business. I am looking forward to the holiday break when I can work on planning some more online packages for my clients. My goal is to have a fully functional online business with products and downloadable content to lighten up my face-to-face service. All in good time.

Over the past week, I moderated two career panels with Dietitians for students at college-level. The students had a lot of great questions and it prompted me to expand more on some of the topics in today's blog. I have been thinking about doing an, "Ask the Dietitian," within my blog anyways and I figure that this would be a great topic to start with!

How do you get experience?
For both the dietetic internship (DI) and future jobs, experience is going to be key. For RDs-to-be, you can start with your local hospital. See if you can land a position as a food and nutrition aide in the kitchen. If no-one is hiring, look at volunteer positions. Can you volunteer at a hospital, long-term care facility, food bank, food pantry, soup kitchen, etc? Reach out to local RDs and see if you can shadow them or help on a project (like a class). One really awesome thing that a fellow RD said this past week was that it isn't necessarily the type of position you get, but the experience YOU gain from it and how that can be related back to dietetics. Let's say you are a server at a restaurant. You could be gaining customer service skills and food safety knowledge; all of which are critical in dietetics.

How do you deal with the monetary aspect of the DI?
Start saving now! Put away that Birthday money. Put your tips and checks right into the bank. Think twice about spending on frivolous items.  I didn't realize until my Sophomore year of college that there was a DI AND it was unpaid AND we paid them AND it was after graduation. I worked since I was 14-years-old, and I was used to putting away the money I earned, since my parents were huge on saving (thank you Mom and Dad). Besides saving, look at internships that offer financial aide, scholarships, and/or stipends. Also, do some research into scholarships from the Academy of Nutrition and your state and local groups. From what I hear about these scholarships, they often have minimal students even apply, so your chances are good!

Can you work during the DI?
Going along with the previous question, yes you can work during the DI. A lot of internships will tell you not to do so; however, it really depends on your work ethic and level of time management. I worked weekends during my DI and the occasional weeknight. I know other interns at the time, who could barely keep up with the workload, let alone a side job. If you can handle a job on the side, without sacrificing your learning experience, great. Just remember to be clear with your boss on what the DI entails. Look for positions that are flexible with hours and can accommodate a changing intern schedule. Even if you don't work during your DI, you still want to make sure you plan your time well to accomplish all of your competencies and assignments.

What are some of the top skills for the DI and career that you feel would lead to success? 
I wrote a blog on this topic a few months back; however, I want to hone in on one really key point, "Never burn a bridge in dietetics." Really though, the world of dietetics is so small! The dietitian who took my position at my last job before starting my practice full-time had interned with a Dietitian I knew and went to school with. I learned about my current teaching role from an RD I connected with about a year ago and kept in contact with on social media/listservs. I would have never known about the teaching position or maybe even gotten the job had I not been friendly with her. So, even if you don't think you will need a connection, always keep it open and professional. Save business cards. Follow-up with old preceptors. You never know when you might run into that person again!



Feel free to post a comment with your question for the Dietitian! I will answer and include in my next "Ask the Dietitian" post! 

Sunday, May 21, 2017

Top 10 Tips for a Successful Dietetic Intern

I am going to switch gears for a bit from my usual Dietitian-related tips to a focus on dietetic internships. I have been a preceptor for the last 2.5 years and it has been awesome. I would highly suggest any professional to take on an intern at some point in their career. It is such an eye-opening experience when you are teaching and basically helping to mold someone into their profession.

Over the last month, I have had a lot of interns reach out to me to be their preceptor for 2017-2018 dietetic internships. Only a small handful I ended up meeting with and agreeing to become their preceptor. In the process, I had a few asking what the qualities are of a "good" intern. While I hate using the word "good," I do like thinking in terms of success. The top 10 list I complied below is a blend of tips from my own experience as being a preceptor plus what I observed during my internship (way back when).

Tip #1 - Show up on Time
This is an absolute must. There is nothing more off-putting than a late intern. Get up earlier and never assume traffic will be great (especially if you have a long drive). My practice is super busy and I am usually on a time crunch, especially if running a class that day, so tardiness just won't cut it for me. If you do happen to be running late for some reason, always contact your preceptor. Let them know why you are running behind and your estimated time of arrival.

Tip #2 - Always Dress to Impress
I am sure you have heard this one a lot, but take it seriously. I have had interns show up for meetings with me in jeans (and not nice looking ones)! It is way better to be overdressed for a meeting. For your actual rotations, always contact your preceptor and find out the dress code. For my practice, there are days where we need to get dressy for classes or seeing clients. Other days, I am just working out of my home so there is no sense in getting all dolled up to just sit around and work.

Tip #3 - Come Prepared 
One of my biggest pet peeves is when an intern shows up with absolutely no work to do, no outlines or class assignments printed (or available on their computer), or nothing to do for downtime. Whether you are heading in for an initial interview with a potential preceptor or your first day on-site be PREPARED! Have an idea of what your rotation entails. What assignments do you need to accomplish? What tasks need to be done? Don't assume your preceptor will have that information. Set aside time to speak with them to review everything. Also, make sure you have something to do when there is downtime. This could be reading journals, working on assignments, or studying for your RD exam. Again, this is a good time to ask your preceptor what the expectation is. Do they want you to be working on something for them? Do they want you to work on assignments? Lastly, don't sit on your phone while you wait. Honestly, that makes me think you don't take nutrition or the rotation seriously enough.

Tip #4 - Engage and Ask Questions
I always have interns tell me they don't want to bother me with questions. I love questions and to me, this means you are excited and passionate about nutrition. One thing about questions is to time them correctly. If your preceptor is in the middle of a call or email, that might not be the best time to ask a question. Again, find out what they prefer for this too. I had preceptors who would tell me to interrupt them with anything. I had others that told me if they are busy to let them be. Asking questions about something is not a sign of weakness at all, instead it shows me that you are willing to learn, grow, and challenge yourself. If anyone ever gives you heat for asking questions, apologize maybe for your timing, but never, ever, apologize for your curiosity and desire to learn.

Tip #5 - Be Organized
For anyone that knows me personally, they know I am highly organized. My expectation for organizational skills is probably much higher than most professionals; however, it is for good reasons. My practice involves just me. I do all the scheduling, client-seeing, billing, follow-ups, emails, etc. I need to be organized to make sure everything gets done in a timely (and good quality) manner. While I don't expect my interns to be like me, having some sense of organization will really suit you well.

Tip #6 - Give Good Quality Work
If your preceptor gives you an assignment or task to work on, take it seriously and take your time to produce good quality work. Don't just slap something together to get it done. Do the research, invest the time, and don't be afraid to ask for help.

Tip #7 - Respond to Emails (Professionally)
As I mentioned earlier in the post, I have had a lot of interns reach out to me as a preceptor in the last month, yet I only interviewed a few for my practice. A lot of this was due to that first impression I received via email. Frantic and desperate emails were red flags for me. I questioned if they prepared at all for the internship (i.e. finding preceptors). Again, are you taking this seriously? This makes me think about lack of organizational skills. Also, if students reached out for a clinical rotation with me or with incorrect information about my practice, another red flag went up. Obviously, you did not do your research very thoroughly, so this makes me think that attentiveness to detail is not a strong suit. I have also had potential interns reach out to me, interview with me, not get matched and never let me know (though they said they would). While this doesn't seem like a big deal, I spent the time setting up an interview with you, filling out paperwork and blocking your rotations in my calendar. At least have the decency to let me know if you will actually be coming. I had these same students reach back out again later when they did get an internship and needless to say, I was hesitant to work with them. While some of my perceptions could be totally off from the actual reality of the situation, that first impression is everything for me in choosing an intern that will work well in my practice. After all, this is my business and I rely on it for my income.

Tip #8 - Be Aware of Preceptor's Time (Assignments)
Your preceptors are taking the time to work with you during your internship, so as much as you can make that process easier for them, the better. This means being on-top of your assignments and tasks, which goes along with being organized. Plan out when you will do your assignments and don't wait until the last minute and then expect your preceptor to work it all out for you.

Tip #9 - Be Open to Learning
You might not love every rotation and you might already have an idea of which area of dietetics you want to go into. This doesn't mean you should just do the bare minimum for your other rotations. Even if you know clinical is not for you, engage and ask questions. You never know when you might find a new passion or learning something exciting.

Tip #10 - Be Open to Feedback 
One of the most important pieces of any profession is getting and giving feedback. Feedback is crucial since it can help to shape you into a better professional. Always be open to getting feedback from your preceptor, even if it is negative. After such, do something about it! If your organization is slacking, how can you improve? Get used to giving feedback as well. Don't just say everything is great when it isn't. You can always attempt to improve a situation (or work environment) by giving constructive feedback. Are you frustrated with the lack of time your preceptor is giving you for questions? Are you not learning enough from them? See if you can compromise or come up with a solution that will work for the both of you. I always say that the worst that can happen is someone says, "no" but at least you know that you tried.

I hope this list helps any current or potential interns out there to enhance their experience in the dietetic internship. Good luck to everyone beginning their internships and leave a comment to let me know how yours is going!

For more tips on Preparing for Your Internship, check out the BLOG 
For more information on joining the AND Preceptor Database, click the LINK.

Thursday, September 3, 2015

Grad School, Vacation, and Dietitian Shore Eats

Well we are officially in September and I am finally on vacation! This week has been kind of weird for me. This is my first PAID vacation from my new job (started last year) and the first week of grad school! I am doing online school for my Masters in Dietetics Administration from Utah State University, which is also the University I did my dietetic internship through!

It definitely felt weird to turn my work phone off, and leave it at home! Normally, on my days off from work, I leave it on and check my emails and voicemails. I figured it would be good to disconnect for a while! I do keep having weird dreams where I come back to work with 533 emails or a huge pile of boxes at my desk (this happens when I am gone for just a day or two). It never felt weird being away from my part-time job for a while; however, I figure because I am full-time and more invested in my new position that it feels so odd. This time next year I will probably be thinking I was crazy for saying this! HA-HA.

So, Monday marked the first day of grad school! Yay! I was excited about getting back into school; that is until I started getting overwhelmed with all the assignments and deadlines! Balancing school and work has never been an issue for me. I always worked 1 (or 2) jobs and went to school full-time. I just need to be even more organized with working 2 jobs + getting my new business off of the ground! I'll feel better once I have all my assignments mapped out in my planner and highlighted in their different colors :) I am a highlighter junkie!

Everyone always asks me if I ever eat junk. Well of course I do! Just rarely and mostly saved for vacations HA-HA. Yesterday was a prime example of this. I had a morning smoothie with fruit, unsweetened almond milk, chia seeds, and plant-based protein powder. I like to try out different types of powders to see which I like best. This was the first time I had vanilla cinnamon and it was really good!

I followed that up with some So Delicious cookies and cream "ice cream," which was sooooo delicious. I made tofu, broccoli, stewed tomatoes (from my garden), and sautéed potatoes for lunch. I followed that up with some chips :) I finally cut and ate some of the watermelon we bought Sunday. Again, I followed this with 1/2 of a corn muffin. For dinner, I made refried bean burritos and more broccoli. I followed that with some more chips :) Do you see a pattern yet? :)

Here is my personal stance on vacation eating. Try to still eat healthy (maybe the main meals) and sprinkle some unhealthy in between. I know I don't normally eat these kinds of foods; however, if I want them on vacation, I am going to indulge and not feel bad about it. I also try to keep active on vacation (aka like our 32-mile bike ride on Tuesday or my 2 beach walks today). I figure that also evens out the not-so-healthy-foods :)



Sunday, July 19, 2015

My New Garden and Being a First Time Preceptor

It has been quite a while since my last blog. I have been crazy busy between both my jobs, recently moving, planting a garden, and being a preceptor. Not to mention the impromptu summer mini vacations.  Nonetheless, I am back in action :)

About 2 months ago, I was asked to be a preceptor to a distance intern for their community rotation. I am sympathetic when it comes to distance interning (I was one myself). I remember just how hard it was to find all of my preceptors! I must say, it was definitely weird to be the one doing the teaching. The first couple of days with my intern were odd purely because I was not used to someone following me around all day! It was cool sharing my knowledge and experience with someone who has the same passion as me. It was definitely helpful to have a second pair of hands when I was working with a group of young children too! I would suggest to anyone to become a preceptor if your job allows. I felt it was a learning experience for me as much as them!

Post digging out 
3 weeks after planting
My biggest project since my boyfriend and I moved into our duplex was my garden (or should I say gardens). One, I am no garden expert. Two, I learned plenty of things I should and shouldn't do. Three, things taste wayyyyyy better when you grow them yourselves! Four, don't try and attack your overgrown, new yard with a tank top on or you will become a vesicle for bugs and itching.

I never had my own yard space until now. My dad always had a garden in our yard growing up; however, it was never something I really worked on. Our yard with quite overgrown when we moved in, so it took about a week or so to pull weeds and get the dirt ready for planting. The lady that lived in the house years back had put down some bricks around plots of land. It made for great sectioning of my garden:) I ended up with 3 plots for vegetables and a 4th for a butterfly bush. We also had an overgrowth of mint in the yard, which was super fun pulling out (not). A few things about mint: never ever plant in the ground unless you want it to take over your yard and be prepared to muscle out the roots if you try and pull it out!

Tomatoes, peppers, etc
Tomatoes, peppers, parsley
I ended up planting one plot with cucumbers, carrots, kale, spinach, and lettuce. I trim the kale, spinach, and lettuce every other day. I love fresh garden salads! The cucumbers I am still waiting to grow an actual cucumber and not a thousand more leaves and flowers. My other plot has tomatoes, peppers, and parsley. I got about 4 peppers so far and 50 tomatoes, all of which are still green. The 3rd plot has parsley I started from a seed, basil, peas, and another tomato plant I just moved out of a pot. I also have aloe, hot peppers, and a weird cactus looking plant in pots along the edge of my garden.


Having a garden is hard work between prepping the soil, planting, weeding (almost every day), and watering. Despite all that (plus the poison oak/sumac I got on my arms), I absolutely love it. Someone said to me that gardening was therapeutic and I totally believe that! I can spend hours outside and I wouldn't even care. You wouldn't believe how excited I was when my first leaves poked out of the ground, or my first green tomato sprouted. It is like my little baby!

First pepper

First tomatoes
It definitely makes you appreciate the food you eat when you grow it yourself. And if you were wondering. After I got poison oak/sumac, I went outside with pictures of all the poisons, found the tree/bush with both sumac and oak twisted around each other and hacked it apart. Take that!

Stay tuned for my new "What I ate Wednesday" posts, inspired by fellow dietitian, and "Fresh Fridays" post with my garden updates!


Friday, September 19, 2014

Top 10 Dietitian Misconceptions

"Dietitian...that means you make meal plans, right?" (Said by someone I encountered at my one job). If you are a fellow Dietitian (or Nutrition major), you have probably heard that phrase, or something like it, before.  If you haven't, just wait and see :)

Here are my top 10 things I hear and chuckle at (I've gotten over being annoyed) that are complete misconceptions (at least for me)!

#1 Do you only eat salad?
Nope. I eat meat, veggies, fruit, etc. I do enjoy a salad and I will often eat from the salad bar at work. And by salad I mean a small amount of lettuce with a crazy amount of toppings (mushrooms, broccoli, croutons, chicken, chickpeas, etc). But again, I don't just eat it because I am a RD, I actually like it.

#2 I am not judging what you eat.
People will literally say to me, "Oh, I know what I am eating is bad for me, I was just really hungry." I could care less what you eat! I just came into the room to make phone calls for work. Along with me not judging what you eat, you can refrain from hiding your food from me. One day at work, I was walking down the hall and a lady with a bag of fast food literally put it behind her back when I walked by. After I said hello, she looked genuinely embarrassed and hurried off. TRUE STORY.

#3 Please stop judging what I eat.
I love the occasional ice cream (with my Lactase pills of course) or chips. Who doesn't?! I really don't like when people see me eating something "unhealthy" and say, "Wow, you're eating chips?" Yes, I am human and do enjoy these pleasures once in a while.

#4 Now that you are a RD, can you write me a meal plan?
Much to what people think, I don't just write meal plans. Actually, I rarely write out a meal plan for someone. I generally like to give people the tools to be able to choose foods that fit their dietary needs. Plus, if I told you what to eat for each meal, chances are that would become very boring. I also don't like putting people on "diets" or talking about them for that matter. I am all about healthy lifestyle changes, which do not fall in line with a meal plan.

#5 So, you are not going to tell me to cut out my favorite foods?
This goes along with my whole no-diet-thing. Generally, when you cut foods out, you tend to miss them. This can lead to binge-eating and "going off the diet" wagon. In my experience, with both counseling and my own life, it is better to keep in your favorite foods and just eat them in small portions.

#6 Yes, I did go through 4 years of school, an unpaid internship, and a final exam.
A lot of people I talk to think that I became a RD once I graduated. I wish! After getting my bachelors, I had to apply to internships, get accepted, pay large amounts of money, and then sell my soul for 9 months (not counting the lack of life for the 2 months I spent studying to take my exam). Dramatic enough for you? But seriously, becoming an RD is not easy and props to anyone who is embarking on the journey.

#7 Dietitian and Nutritionist are not the same.
Nutritionist is not a licensed term, at least in PA. Basically, anyone could call themselves a Nutritionist. A Certified Nutritionist has more credentials than a regular Nutritionist; however, Registered Dietitian trumps all :)

#8 I don't know everything and I am not afraid to say it.
It surprised me how people are shocked that I don't know something specific about a food. Example: "What are baby romanesco good for?" First of all, I have never even seen one until now. Second, I don't know all the nutrients in every fruit and vegetable. Yes, green leafy veggies have Vitamin K and red/orange veggies have Vitamin A; however, I mainly just tell people to eat fruits and vegetables. You don't really need to focus on eating specific ones for specific nutrients. That is so complicated! Make it simple and just choose a variety. In the words of many RDs, "Color your plate."

#9 Every counseling session should be standardized to cover the same thing. 
I don't know where people got that idea from; however, none of my counseling sessions are ever the same. You don't talk to a 60-year-old the same way you talk to a 12-year-old. You can standardize the process (aka you have the same introduction of yourself, similar forms, same waiver, etc); however, what is covered in a session is completely client-centered. I not only learned that in school; however, leading counseling sessions has taught me to be super flexible. I might want to cover protein with someone (seeing as they don't eat enough), but they get into their binge eating habits. That last bit of information is more important to cover first. Counseling is all about getting to know your client and helping them to reach the goals they want to set.

#10 "You don't need to see a Dietitian because you are not fat."
Just because you are thin does not mean you are healthy. As a Dietitian, I help people gain weight (if they are underweight or looking to gain muscle), lose weight, and maintain their weight. People come see me for all different reasons. Plus, a skinny person might have horrible eating habits that lead them to become Diabetic or deficient in certain nutrients. Again, I am here to help the client reach their goals. I never judge by body size because it is such a horrible indicator of actual health.

These 10 items are all things I have encountered between my jobs, friends, family, community, etc. You may have more to add to this list or things to change (depending on your situation).

Hope you enjoyed the read. Stay tuned for my next blog "10 Tips for Conducting a Recipe Demo."

PS: This is a Baby Romanesco. Tastes and looks like a cross between broccoli and cauliflower!

Monday, June 2, 2014

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

Tuesday, May 20, 2014

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!




Thursday, April 10, 2014

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

 

Tuesday, March 25, 2014

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 :)

Friday, March 7, 2014

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.

Thursday, February 27, 2014

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!


Monday, February 17, 2014

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!

Saturday, February 8, 2014

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!

Thursday, January 23, 2014

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 :)

Friday, January 10, 2014

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.

Friday, January 3, 2014

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! :)



Friday, November 29, 2013

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!



Sunday, October 20, 2013

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!

Sunday, October 6, 2013

Food Service Management Rotation: Tips and Information

This Monday, I will be heading into week 8 of my Food Service Management rotation of my Dietetic internship. It seems as though the time is flying by! I can't believe I am halfway through my longest rotation of my internship. Things have gotten a little more stressful; however, I found that being able to manage my time efficiently has worked to my benefit.

Throughout the past few weeks, I really had to step up, in terms of leadership and initiative. My old preceptor (an RD) had left to join the Navy. My new preceptor was the General Manager, who had a ton of things to do already. My new preceptor would run errands around the schools in the morning and attend various meetings. This left me alone in the office for the majority of the time. I found myself becoming the RD for the school district. All of the carb counting and menu nutrition questions came to me. I also sat at the RD desk and answered various parent and employee phone calls. Some of the calls were pretty basic (how do I load money on my child's account) while others required a lot more thought and time (child allergies and special diets).

The school district I am working with uses a program called PrimeroEdge, which is similar to NutriKids, just way more in depth and complicated. This program was where you inputted ingredients, recipes, and cycle menus for the district. It was my duty to create the menus in the system, and assign them to the schools in the district so they could complete their production records. The program is a very useful tool; however, the first few weeks were very difficult, as I was teaching myself how to use it. Once I mastered certain aspects of the program, things ran a lot smoother. One thing I had to consider was the slowness of the program. It is internet-based, so it gets very overloaded at certain times of the day (mid morning and late afternoon). Just adding in 1 ingredient to 1 day often took 5 minutes because of the webpage loading time. I had to plan when I would input and assign menus, so that I would not be using the program at its slow times.

The past few weeks were very stressful; however, the experiences I had strengthened my leadership and conflict negotiation skills. I also got much better at handling employee issues and multi-department management. I had to make a lot of decisions, so it was important to trust my knowledge and use good judgement. Management was very impressed with my work ethic and ability to handle what was thrown at me. I just did what I needed to do because at some times, no one else had the training I had to do it (answering carb or specific nutrient questions). It felt really good when upper management talked about me so highly to other administrative employees. I wasn't just an intern working there anymore. I had gained a lot more respect than that. When the new RD came in, I found myself training her. It was a very weird feeling for me, the intern, to be training someone in a higher up position, none-the-less, an RD. Much of what I trained her on was office procedures, PrimeroEdge (she had been using NutriKids), kitchen location, etc.

During her first week, the new RD had brought in a lot of materials for me to look through; including her RD test review binder, teaching resources, and a ServSafe training manual. The ServSafe book was a better resource for me than my college food service textbook. It laid out everything in a short and simple format. I would definitely suggest adding this to your resource library. She also brought in a book called "Strengths based Leadership." I haven't gotten a chance to read the whole book yet; however, after glancing through a few chapters, it is well worth the read.

Another major portion of my time over the past few weeks was spent on various lesson plans, presentations, and building promotional materials. My next blog will be on the lessons I taught and tips for teaching various age groups.

Tips for FSM Rotation
1. Whether you are in a distance or on-site program, it is really important to plan out your assignments at the beginning of your rotation. Try to knock out the easier assignments/tasks in the beginning. Since I needed my preceptor's help with scheduling things for other assignments, I tried to do what I could on my own.
2. Give your preceptor an updated assignment list after you have gone through a few weeks. My preceptor needed to be reminded of my assignments on a daily/weekly basis. He was very busy with other duties of his own, so this was pretty typical. It helped to scale down my assignment sheet to things that just dealt with him. It made it easier to work through assignments and get things planned ahead of time.
3. Be flexible! As much as planning is helpful, always be prepared to change up what you are doing. An employee might call about an issue that needs to be handled ASAP; you might have to switch up dates for meetings or presentations. Expect change to happen and roll with it. It will just make everything run a lot smoother.
4. Be able to multi-task. A lot of times I would be working on something (making a poster, writing a lesson) and I would get phone calls, or questions handed to me. Being able to handle multiple tasks, without stressing out, will really help your rotation run smoothly.
5. Work on negotiation and conflict resolution skills. If you haven't had much training or read a lot on these 2 topics, do so. I found myself researching them a lot as I moved through the leadership portion of my rotation.

Lastly, if you are still working at a job during your internship, kudos to you! If you are thinking about whether or not you should keep your job, know that it is manageable with the internship. I still maintain my position at a YMCA teaching nutrition. I have 7 different classes during the week that I teach. I am lucky, in that I was able to schedule the classes at a certain time that worked best for me. My earliest class starts at 4:45pm. This gives me enough time to get from my internship to the teaching site. While my weeks are very busy, it is manageable with proper scheduling and time management!

Monday, August 26, 2013

First Week of FSM Rotation

This past week, I completed my first 5 days of my food service management rotation. Overall, I think the rotation went pretty well. I attended a lot of meetings and in-service trainings, so I was able to meet most of the staff that I would be seeing throughout my rotation. It was very interesting to see the dynamic among the food service workers in the schools. A lot of the employees had strong bonds and cliches with other employees of their specific school. I could see the vast amount of support both the food service workers and managers had for one another. That is something I will come to appreciate even more throughout my tougher weeks of my internship.

I found myself having a lot of time to work on assignments and plan/prepare upcoming projects and studies. It was definitely helpful for me to bring my laptop, assignment binder, and resources to pull ideas from.

Before leaving for the weekend, I received some unexpected news from my preceptor and the general manager. I was super nervous before the 3 of us sat down for the meeting. My preceptor had said, 15 minutes before, that her and the boss needed to speak with me about something. I don't know about anyone else, but, my immediate thought was, "Uh-oh, what did I do?" After stopping my train of negative, rash thoughts, I reminded myself that it was my first week, and it was probably something un-related to me.

Much to my surprise, I was informed that my preceptor would be leaving that next Friday to join the Navy as an RD! While this was very exciting news for her, I was a little worried about the rest of my rotation. Who would become my preceptor? Did they know all of the work involved? Would I be able to complete everything that was required of me?

Again, once I calmed myself from my racing thoughts, I came to realize that I could do this. It was just another bump in the road. Plus, I not only had the support of the management team and staff; however, I also had the support of my internship director and fellow interns.  Having an RD for food service management wasn't a requirement for my program, so I was lucky enough to have one as my preceptor. It was decided that the general manager would be taking over the position as my preceptor. He is quite knowledgable and understands that I have a lot of different assignments required of me.

My current preceptor and I sat down this week to plan out all of the school nutrition assignments and set up meetings with who I needed to speak with. My preceptor is much more informed on not only general nutrition, but also nutrition education in schools. That being said, her and I worked together so that she could continue to be a resource to me for the last week of her working there.

Next week will definitely be a change with the school year up and going. Not only will management be down a staff member, but I will be working with a new preceptor. This situation reminds me of something that my internship director had said to me. It went something like "You can plan out what you want to do for food service and how you want your assignments to go; however, there will be some days that everything will just go completely off plan. You need to be ready to deal with whatever is there and be flexible." That statement has never been so true!

On a final note, I received an official badge from the school district I am working in. Under my name it says "Support Staff." Boy, do I feel important :):)