In my field of work, I do nutrition counseling with a lot of people (about 10 per week on top of my other duties). More and more, I notice people have this skewed idea of what counseling is like. Some examples: "So, you'll tell me what to eat right?" or "You make diet plans, right?' or when non-clients state, "Your job must be so easy" or when co-workers say "Don't people know this stuff already?" The truth is, I won't tell you what to eat (exactly), I don't typically make a "diet plan," my job isn't always the easiest, and people certainly do not know this stuff (to put it simply).
So, if nutrition counseling isn't any of those things, then what is it? Counseling is not only an assessment of the person's diet and health history, but also their emotions towards food. Counseling is establishing a rapport with the client so they will trust your suggestions. Counseling is working with clients to figure out how they can be motivated to make changes (and see them through). Counseling is not only being the credible knowledge source, but translating that knowledge into practical strategies that will work for various clients. Counseling is..... well you get the idea :)
Besides being all of those things I mentioned, doing one-on-one nutrition counseling can be a little intimidating when you first start out (whether it is inpatient or outpatient). When I first started doing outpatient counseling, I would stumble over what I was explaining. I was nervous about clients asking crazy questions and me not knowing the answer. I brought every handout I owned JUST in case. I was constantly saying to myself, "I wish I had said this instead of _____." I had a lot of bumps in my early stages of counseling; however, I began to find my own rhythm (trust me, you will too!) and things ran much more smoothly. It seemed like the information just came out so easily when I needed it to! Just a side note here, if you ever do any courses or credits for counseling, it seems like so much to learn (being empathetic, saying key words, phrasing properly, etc); however, once you get practice, these strategies become so natural!
One of my greatest pieces of advice is that it is perfectly okay to say, "I don't know much about the research for ______, but I can find out and get back to you." People look to you for credible information and yes they can Google it themselves, but lets face it, they don't/probably won't. Plus, most of the people I see in counseling say they get overwhelmed and just don't know where to look. Again, where the Dietitian comes in :) Just an example, I had a client come to me looking for the Vitamin K content of edamame. This person had to watch their intake because of the medication they were on. I certainly do not know how many micrograms of Vitamin K are in edamame (41mcg for frown unprepared in case you were dying to know). So, I said to this client that I wasn't sure off the top of my head, but I could get back to them about it. They were very happy with that and came back later for a print-out. Again, MOST people just want the information handed to them and know that you are the credible source to give it. Just a side note, the USDA has an awesome database for this!
Another thing I learned in nutrition counseling is that you can PLAN for what you want to cover; HOWEVER, always be prepared for a curve ball. Like a client who brings you a list of 15 supplements they are taking or a client who doesn't have time for snacks because they exercise for 2 hours between meals (aka 10000 crunches, push-ups, etc) or a client who has an underlying pre-occupation with food or a client who said they would be bringing their family and that meant 6 other people. And if you are wondering, these people exist because I have counseled them! Don't let situations like these rattle you! Go with the flow and just make do with what you have. Again, situations like these will get way easier with more practice.
The way I handled the first person in counseling consisted of me mostly asking about the supplements and the reasons for use. I didn't tell the client to stop taking them, we just discussed ways of spacing them out or how combining a few into one pill would be better. You are not going to change people's mind by telling them they should or should not do something. It is best to give them all the information and allow them to have tools to make a more science-based decision. With the second client, we talked about bulking up the meals for more calories instead of having snacks. The third client, started off talking about sports nutrition and turned into obsession over calories. This client was a lot more rational than the typical eating disorder patient; however, they did have a history. That being said, I didn't refer out since the client was focused on being healthy and eating enough for both exercise and the potential carrying of a baby. The last client(s) was a bit chaotic, since I have a small counseling space; however, it worked well to have most of the family sit while I stood in front of the "U-shaped circle" to talk about nutrition.
With all that being said, hopefully you have a better idea of what nutrition counseling is like as a client or Dietitian. Feel free to leave a comment or send a message of your experience with nutrition counseling :)
Thursday, November 20, 2014
Sunday, November 2, 2014
Top 5 Tips for Running a Food Demo
Part of my job as a Retail Dietitian is running food demonstrations. This is one of the parts of my job that I love/dislike. I love demoing recipes and having customers enjoy new foods that they never thought they would eat. I also love when I hear my recipe has become a family favorite! I am, however, not a fan of the recipe planning. I tend to overthink things, like most Dietitians I know. I worry about not choosing a recipe that goes over well with customers. After doing a few demos, I learned that you are not going to please everyone and not to take that personally. With that in mind, below you will find my tips for running a food demo!
Tip #1: Choose Your Recipe Based on Your Population
If you are serving a population of young kids, you wouldn't necessarily choose a spicy or tough-textured recipe. You might, however, choose a healthy and simple snack or a common favorite dish with a healthy spin (like mac n' cheese made with broccoli and chicken). Or if you are serving a group of seniors, you might go for softer foods versus nuts and crunchy items (since a lot of them have a hard time chewing). The population I work with is mostly families and health seekers. These health seekers want quick and easy recipes. I am not going to choose a recipe with 15 ingredients because even if customers like the recipe, they are not likely to make it at home. It is always best to assess your population first, then choose a recipe you think will go over well.
Tip #2: Add Options to Your Recipe
A lot of times, I will create or alter a recipe to make it healthier. I might cut back on the fat, sodium, carbohydrates, etc. I usually add to the bottom of my recipe ways to add flavor or ways to pair the recipe with something else. For example, I made a crockpot chicken fajitas recipe. I gave the option for people to add a wrap or rice for a carbohydrate source. I also gave the option to add extra veggies for more bulk. Another example is a cauliflower mashed potatoes recipe I tried. I used herbs and spices for the recipe, but gave the option to add parmesan cheese for extra flavor. Those who didn't want to add the fat/sodium/calories were free to choose otherwise.
Tip #3: Taste and Prep Test Your Recipe Prior to Demoing
My first demo, I made an awesome sweet potato and acorn squash bake. The recipe went over so well; however, the prep was a disaster! I didn't realize how long it would take to peel and chop 4 acorn squash (almost an hour). I was rushing and trying to recruit help for the prep with only having 1.5 hours before the demo start. It was definitely a stressful start, but you live and you learn :) I've also had a few ideas for recipes and taste tested at home only to realize I needed to add or change things to make it more palatable. You won't always have the time to alter recipes the day of, so it is best to perfect it prior to demoing.
Tip#4: Make a List of Everything You Need
Usually, my demo days are hectic. I come in 1-2 hours prior to the event. I make the recipe, set-up the demo table, and merchandise the items I am using. Unless I make a list, I forget even the simplest things (like my tablecloth for 1 demo). Make your demo run that much more smoothly and have a list of everything you need, down to the napkins!
Tip#5: Have a Copy of The Recipe With Nutritional Facts
Almost every person who comes to my demos will ask me something along the lines of, "Is this good for me?" Or, "I have Diabetes, how many carbohydrates are in this?" Or, "I have to watch my sodium, is there a lot in this recipe?" I find it so much easier to just have the recipe with the nutrition facts on the bottom. Even if I know the recipe is healthy, customers still want numbers. Plus, if you have a entree heavy on the carbohydrates, then those people with Diabetes might need to plan some non-starchy sides to balance it out.
I hope these tips help you in your food demos as much as they did me! Stay tuned for more tips from the life of a RD :)
Tip #1: Choose Your Recipe Based on Your Population
If you are serving a population of young kids, you wouldn't necessarily choose a spicy or tough-textured recipe. You might, however, choose a healthy and simple snack or a common favorite dish with a healthy spin (like mac n' cheese made with broccoli and chicken). Or if you are serving a group of seniors, you might go for softer foods versus nuts and crunchy items (since a lot of them have a hard time chewing). The population I work with is mostly families and health seekers. These health seekers want quick and easy recipes. I am not going to choose a recipe with 15 ingredients because even if customers like the recipe, they are not likely to make it at home. It is always best to assess your population first, then choose a recipe you think will go over well.
Tip #2: Add Options to Your Recipe
A lot of times, I will create or alter a recipe to make it healthier. I might cut back on the fat, sodium, carbohydrates, etc. I usually add to the bottom of my recipe ways to add flavor or ways to pair the recipe with something else. For example, I made a crockpot chicken fajitas recipe. I gave the option for people to add a wrap or rice for a carbohydrate source. I also gave the option to add extra veggies for more bulk. Another example is a cauliflower mashed potatoes recipe I tried. I used herbs and spices for the recipe, but gave the option to add parmesan cheese for extra flavor. Those who didn't want to add the fat/sodium/calories were free to choose otherwise.
Tip #3: Taste and Prep Test Your Recipe Prior to Demoing
My first demo, I made an awesome sweet potato and acorn squash bake. The recipe went over so well; however, the prep was a disaster! I didn't realize how long it would take to peel and chop 4 acorn squash (almost an hour). I was rushing and trying to recruit help for the prep with only having 1.5 hours before the demo start. It was definitely a stressful start, but you live and you learn :) I've also had a few ideas for recipes and taste tested at home only to realize I needed to add or change things to make it more palatable. You won't always have the time to alter recipes the day of, so it is best to perfect it prior to demoing.
Tip#4: Make a List of Everything You Need
Usually, my demo days are hectic. I come in 1-2 hours prior to the event. I make the recipe, set-up the demo table, and merchandise the items I am using. Unless I make a list, I forget even the simplest things (like my tablecloth for 1 demo). Make your demo run that much more smoothly and have a list of everything you need, down to the napkins!
Tip#5: Have a Copy of The Recipe With Nutritional Facts
Almost every person who comes to my demos will ask me something along the lines of, "Is this good for me?" Or, "I have Diabetes, how many carbohydrates are in this?" Or, "I have to watch my sodium, is there a lot in this recipe?" I find it so much easier to just have the recipe with the nutrition facts on the bottom. Even if I know the recipe is healthy, customers still want numbers. Plus, if you have a entree heavy on the carbohydrates, then those people with Diabetes might need to plan some non-starchy sides to balance it out.
I hope these tips help you in your food demos as much as they did me! Stay tuned for more tips from the life of a RD :)
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| Pomegranates I used in a Produce Pick taste testing! |
Wednesday, October 1, 2014
My First (Horrible) Experience with a CPE Seminar
As part of keeping your Dietitian title/license, you need to complete continuing education credits (75 over 5 years). It's pretty standard for many other medical/health professionals as well (Pharmacists, RNs, OTs, PTs, etc). I have been leaning towards a mix of webinars, self-study courses, and lectures to gain credits. It works the best for me with having 2 jobs and an overall busy schedule.
Recently, I went to a seminar called, "Food Addiction, Obesity, and Diabetes," provided by INR. I was super excited! It was going to cover overeating, binge eating disorders, managing food addiction, managing Diabetes, sleep, stress, and so much more. It would also be my first seminar and it was $81 for 6 credits, which isn't too bad at all! Anyways, I made the 45 minute drive and attended with another Dietitian friend of mine. Let me just say, thank goodness for the free coffee and company or I would not have made it through the lecture. What a disappointment!
First of all, the lecturer (we will call her Dr. X) started late. Big pet peeve of mine! So, Dr. X does the introductions and starts off with the food addiction. She used a ton of medical terminology and definitely seemed liked she was very knowledgable. May I just say that "seemed" is the key word here. We get into food addiction, all very interesting; however, we are not following along in the 41 page (front and back) booklet I have, which apparently was due to someone different writing the slides. Anyways, Dr. X quotes a ton of research articles, which is great, except it takes an extra couple minutes for her to locate each one. This might sound great to you because she is using evidenced based research; however, for each claim she had 1 article and only read a few lines in the summary (not mentioning those involved in the study and other information you would want to know). Still not a big deal until we get to the first break and we are already very behind, aka we were supposed to had moved on to obesity and were still on the first section of the first topic!
As we get back from the first break, me with more coffee, I start to notice that when anyone asks a question, she gives a politician answer. By that I mean, she does not actually answer the question. Dr. X gave this round about answer quoting another 1-2 studies (spending the time to again find them) and leaving many people frustrated. We again continue to trudge along and make it to the lunch break. At this point, I notice that we are still not through part 1 (supposed to be on part 2 of 4) and that we spent so much time on the super science part (aka names of specific hormones and transporters) that I didn't feel like I learned anything useful/practical yet.
So, my RD friend and I head to the in-hotel dining area, where lunch is not provided (my mistake for thinking my $81 also extended to lunch). Here we have another depressing scene: $7.95 for cold salad bar and soup or $12-something for the hot bar. Now, I am starving and want to check out the menu for the hot bar. We have vegetables (nothing fancy), bratwurst and cabbage (oh yum), chicken schnitzel, and potatoes with bacon. Glad I looked because chicken schnitzel means breaded chicken patties that you would expect to find in a school lunch program. I went with the soup and salad bar, which actually had a lot of options, and a lovely dessert of fresh fruit and a cookie (very good). It seems lunch was looking like the highlight; however, I go in open-minded to our second half of the day.
In talking about diets, Dr. X mentions the diet fads; one of which is the Paleo diet. Her take on this is that we shouldn't tell people to cut out food groups because it does not work long-term. I generally don't tell people to start cutting things out in counseling either. Dr. X goes on to say that Paleo dieters cut out grains/carbohydrates, using those terms interchangeably. I have a few issues with this. One of which is that not all carbohydrates are grains (aka fruits). Also, many Paleo diet followers (many RDs I follow online) are more-so cutting back on the breads and pastas and aiming for majority of carbohydrates from fruits and veggies. Nothing wrong with that!
Right after saying not to cut foods out, Dr. X answers a question regarding red meat. Here Dr. X states to not eat the red meat because of it having saturated fat. My issue is meat quality. Grass-fed beef is way better than conventional fed meat (fed grains). To quote Mayo Clinic: Grass-fed beef has," less total fat, more heart healthy omega-3 fatty acids, more conjugated linoleic acid (thought to reduce heart disease and cancer risks), and more antioxidant vitamins, such as vitamin E."
My last remaining hope died with Dr. X's statement towards Diabetic meal plans. She quotes this (apparently from the American Diabetes Association) in terms of macronutrient distribution, "50-60% carbohydrates, 30% protein, and 10% fat." What?! The AMDR for fat is 20-35% so 10% is way too low. What Dr. X might have meant to say was the American Diabetes Association recommends less than 10% from saturated fats. What frustrated me the most is that people in the lecture were taking notes and writing down things she said. This misinformation turns into what health professionals are then spreading!
Quick note: I am 6 cups of coffee in for the day (one of the best parts of the lecture was the unlimited coffee). We are getting to the last hour of the seminar and we have 3 parts still to go over! Dr. X decides it is a good idea to have no more questions from the group and to blow through about 25 pages (front and back) of information in an hour. Well, that didn't turn out well. The seminar contained a lot of good information; however, I have to read through and learn it on my own. Part of attending a seminar is so you don't have to spend extra time teaching yourself!
Besides my unlimited coffee for the day, one other benefit was that they had discounted self-study courses. I was able to buy 2 at $10 each (3 credits each) and one at $25 (5 credits). Great deals on interesting CPEs that I can use. Just as a disclaimer, I spoke to another Dietitian who attended the same seminar in another location and she had a much better experience than I did. I apparently just got the bad apple of the lecturers. Looks like I will be sticking to my self-study courses and webinars from now on :)
To end on a positive note, I went to my Dietitian meeting today and got a King Trumpet mushroom!
My Top Webinars/Self-Study Courses
http://www.todaysdietitian.com
http://www.dietitiancentral.com/ceu/continuing_ed.cfm
http://www.pbhfoundation.org
http://www.nutrition411.com
Recently, I went to a seminar called, "Food Addiction, Obesity, and Diabetes," provided by INR. I was super excited! It was going to cover overeating, binge eating disorders, managing food addiction, managing Diabetes, sleep, stress, and so much more. It would also be my first seminar and it was $81 for 6 credits, which isn't too bad at all! Anyways, I made the 45 minute drive and attended with another Dietitian friend of mine. Let me just say, thank goodness for the free coffee and company or I would not have made it through the lecture. What a disappointment!
First of all, the lecturer (we will call her Dr. X) started late. Big pet peeve of mine! So, Dr. X does the introductions and starts off with the food addiction. She used a ton of medical terminology and definitely seemed liked she was very knowledgable. May I just say that "seemed" is the key word here. We get into food addiction, all very interesting; however, we are not following along in the 41 page (front and back) booklet I have, which apparently was due to someone different writing the slides. Anyways, Dr. X quotes a ton of research articles, which is great, except it takes an extra couple minutes for her to locate each one. This might sound great to you because she is using evidenced based research; however, for each claim she had 1 article and only read a few lines in the summary (not mentioning those involved in the study and other information you would want to know). Still not a big deal until we get to the first break and we are already very behind, aka we were supposed to had moved on to obesity and were still on the first section of the first topic!
As we get back from the first break, me with more coffee, I start to notice that when anyone asks a question, she gives a politician answer. By that I mean, she does not actually answer the question. Dr. X gave this round about answer quoting another 1-2 studies (spending the time to again find them) and leaving many people frustrated. We again continue to trudge along and make it to the lunch break. At this point, I notice that we are still not through part 1 (supposed to be on part 2 of 4) and that we spent so much time on the super science part (aka names of specific hormones and transporters) that I didn't feel like I learned anything useful/practical yet.
So, my RD friend and I head to the in-hotel dining area, where lunch is not provided (my mistake for thinking my $81 also extended to lunch). Here we have another depressing scene: $7.95 for cold salad bar and soup or $12-something for the hot bar. Now, I am starving and want to check out the menu for the hot bar. We have vegetables (nothing fancy), bratwurst and cabbage (oh yum), chicken schnitzel, and potatoes with bacon. Glad I looked because chicken schnitzel means breaded chicken patties that you would expect to find in a school lunch program. I went with the soup and salad bar, which actually had a lot of options, and a lovely dessert of fresh fruit and a cookie (very good). It seems lunch was looking like the highlight; however, I go in open-minded to our second half of the day.
In talking about diets, Dr. X mentions the diet fads; one of which is the Paleo diet. Her take on this is that we shouldn't tell people to cut out food groups because it does not work long-term. I generally don't tell people to start cutting things out in counseling either. Dr. X goes on to say that Paleo dieters cut out grains/carbohydrates, using those terms interchangeably. I have a few issues with this. One of which is that not all carbohydrates are grains (aka fruits). Also, many Paleo diet followers (many RDs I follow online) are more-so cutting back on the breads and pastas and aiming for majority of carbohydrates from fruits and veggies. Nothing wrong with that!
Right after saying not to cut foods out, Dr. X answers a question regarding red meat. Here Dr. X states to not eat the red meat because of it having saturated fat. My issue is meat quality. Grass-fed beef is way better than conventional fed meat (fed grains). To quote Mayo Clinic: Grass-fed beef has," less total fat, more heart healthy omega-3 fatty acids, more conjugated linoleic acid (thought to reduce heart disease and cancer risks), and more antioxidant vitamins, such as vitamin E."
My last remaining hope died with Dr. X's statement towards Diabetic meal plans. She quotes this (apparently from the American Diabetes Association) in terms of macronutrient distribution, "50-60% carbohydrates, 30% protein, and 10% fat." What?! The AMDR for fat is 20-35% so 10% is way too low. What Dr. X might have meant to say was the American Diabetes Association recommends less than 10% from saturated fats. What frustrated me the most is that people in the lecture were taking notes and writing down things she said. This misinformation turns into what health professionals are then spreading!
Quick note: I am 6 cups of coffee in for the day (one of the best parts of the lecture was the unlimited coffee). We are getting to the last hour of the seminar and we have 3 parts still to go over! Dr. X decides it is a good idea to have no more questions from the group and to blow through about 25 pages (front and back) of information in an hour. Well, that didn't turn out well. The seminar contained a lot of good information; however, I have to read through and learn it on my own. Part of attending a seminar is so you don't have to spend extra time teaching yourself!
Besides my unlimited coffee for the day, one other benefit was that they had discounted self-study courses. I was able to buy 2 at $10 each (3 credits each) and one at $25 (5 credits). Great deals on interesting CPEs that I can use. Just as a disclaimer, I spoke to another Dietitian who attended the same seminar in another location and she had a much better experience than I did. I apparently just got the bad apple of the lecturers. Looks like I will be sticking to my self-study courses and webinars from now on :)
To end on a positive note, I went to my Dietitian meeting today and got a King Trumpet mushroom!
My Top Webinars/Self-Study Courses
http://www.todaysdietitian.com
http://www.dietitiancentral.com/ceu/continuing_ed.cfm
http://www.pbhfoundation.org
http://www.nutrition411.com
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!
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, August 25, 2014
My First Week as a Supermarket Dietitian (And Free Materials)
So, this was my first official week as being a Supermarket Dietitian and I loved it! I'm still training and shadowing people; however, the more I learn about the job, the more I am loving it. If you are the type of person who is an independent worker, loves doing different things each day, and is comfortable in the public, then this is a job for you! I am pretty excited that I will have a huge brown desk out on the floor of the store. I'll also have a large storage area for all my nutrition materials. It is nice to finally have my own space at a job.
The in-store events include produce picks (feature a fruit or vegetable, preferably on sale/in season with a recipe for taste testing), product sampling, easy dinner meal ideas (with a recipe sample), kid's days, cooking classes, diabetes classes, weight-loss classes, etc. They also have counseling and individual store tours. They are always open to new ideas for newsletters, recipes, and programs. It is perfect for me since I have experience in running programs and I like trying new ideas out. I'm excited to be able to post "RD selection" stickers around the aisles. These will be products that fit a certain nutritional criteria and are a healthy option for consumers. Since my supermarket has a hot/cold food section to take items to go (or dine in), I will also have stickers there. It is an awesome feeling to know that I will be able to reach out and help people on such a large scale.
Another awesome thing about being in a supermarket is that you have connections with all the other supermarket RDs in your area. It is great to have such a huge network of RDs to be able to bounce ideas off of, swap materials, and support one another in our efforts.
For anyone that knows me personally, you know I love getting free nutrition materials. There are tons of websites that will send you coupons, handouts, and/or lessons for FREE! In my free material search this week, I got Yoplait Greek Yogurt coupons, Diabetes handouts, Weight Control handouts, and Blood Pressure cards. There are also a ton of materials for free download; however, I don't have the ability to print large quantities of handouts. I have the links at the bottom of this blog!
My last exciting nutrition find of the week was my Garden Heroes! I ordered these cute little guys from Learning Zone Express. No, they were not free; however, they were pretty cheap. I teach kids nutrition a lot, so these will come in handy for lessons.
Stay tuned for my blog on "Top 10 Dietitian Misconceptions"
Resources:
http://www.bellinstitute.com/Coupons.aspx
https://catalog.niddk.nih.gov/index.cfm
http://win.niddk.nih.gov/order/orderpub.htm
http://catalog.nhlbi.nih.gov/catalog/home
The in-store events include produce picks (feature a fruit or vegetable, preferably on sale/in season with a recipe for taste testing), product sampling, easy dinner meal ideas (with a recipe sample), kid's days, cooking classes, diabetes classes, weight-loss classes, etc. They also have counseling and individual store tours. They are always open to new ideas for newsletters, recipes, and programs. It is perfect for me since I have experience in running programs and I like trying new ideas out. I'm excited to be able to post "RD selection" stickers around the aisles. These will be products that fit a certain nutritional criteria and are a healthy option for consumers. Since my supermarket has a hot/cold food section to take items to go (or dine in), I will also have stickers there. It is an awesome feeling to know that I will be able to reach out and help people on such a large scale.
Another awesome thing about being in a supermarket is that you have connections with all the other supermarket RDs in your area. It is great to have such a huge network of RDs to be able to bounce ideas off of, swap materials, and support one another in our efforts.
For anyone that knows me personally, you know I love getting free nutrition materials. There are tons of websites that will send you coupons, handouts, and/or lessons for FREE! In my free material search this week, I got Yoplait Greek Yogurt coupons, Diabetes handouts, Weight Control handouts, and Blood Pressure cards. There are also a ton of materials for free download; however, I don't have the ability to print large quantities of handouts. I have the links at the bottom of this blog!
My last exciting nutrition find of the week was my Garden Heroes! I ordered these cute little guys from Learning Zone Express. No, they were not free; however, they were pretty cheap. I teach kids nutrition a lot, so these will come in handy for lessons.
 |
| Eddie Eggplant, Buddy Broccoli, Andi Apple, Alonzo Avocado |
Resources:
http://www.bellinstitute.com/Coupons.aspx
https://catalog.niddk.nih.gov/index.cfm
http://win.niddk.nih.gov/order/orderpub.htm
http://catalog.nhlbi.nih.gov/catalog/home
Monday, August 18, 2014
Job Searching, New Career, and New Stage of Life!
It's been quite a while since I made my last blog post. I could say life got in the way; however, it was really that nothing too crazy happened to want to write about. Just being honest :) So, quick recap is: I passed my RD exam, got my PA state license ($65), renewed my PA state license (another $65), applied for a bunch of jobs (most of which said they wanted people with their RD title for more than a year aka NO), paid for an Adult Weight Management Online Self-Study Module (through the Academy of Nutrition and Dietetics for 16 credits), looked at the first section of the module because it is super long, brainstormed some blog ideas, looked into private counseling, worked my current job, did some webinars for free CPE credits, went on a few vacations, and lastly....got a job!
I'm pretty excited about that last part, not only for the nice pay increase from my current position at the YMCA, but also, it was exactly what I was looking for! I will be a part-time retail dietitian at my local supermarket. The position will also be heading towards full-time in the Fall/Winter when the programs get up and running. The RD will do everything from counseling to store nutrition tours to kid's day events. I really love working in the community and doing so many different things each day. I hate the whole 9 to 5 boring job routine. I like that I will be doing tons of different programs with all ages and stages of life. The job is also super flexible (I will eventually be creating my own schedule), I will be doing a lot independently (good thing I am a go-getter/self-motivated type of person), I get the opportunity to network with other RDs in the surrounding supermarkets, and I will be doing what I love :) Today's Dietitian sums up the role of a supermarket dietitian pretty well (for those of you who aren't sure what they do). The supermarket I will be at had 26 events last month, so I will definitely be a busy bee until I find my own routine.
So, how am I feeling about my new job and starting tomorrow? I am obviously very excited and anxious to just get in and get started. I am also a wee bit overwhelmed. There is a lot that goes on each week and besides all the events, I also schedule counseling, store tours, additional classes, and answer customer nutrition questions. It is also a new atmosphere with tons of new faces (been at my current job for 9 years so I pretty much know everyone and everything there is) and I don't really have an idea of what I will be doing every day. Like, how will I structure my day? I will be the only RD in the store, so it is not like I will be trained by the person in the position last. I am so grateful that I will get the opportunity to head to 2 other stores this week and meet the RDs there. I have a huge list of questions I want to ask them! I am very glad I have had experience running programs, creating materials, and working with the public at my current job. I feel like that is giving me a great basis for my new position.
I don't know if this is job where I will be forever (still keeping my YMCA position), but who knows! I am definitely leaning towards becoming a private practice RD. And by leaning towards, I mean I want to do it and get started, I am just slacking a bit :) It is a bit overwhelming to learn about everything you need to do to get started in private practice! I just need to break it down into smaller, more manageable steps (instead of avoiding getting started..haha). This will be something I will be getting back to in future blog posts.
I feel like I am at the stage in my life where all my friends and acquaintances are either having babies, getting married, or getting their career job. I mentioned this to my boyfriend this past weekend and his response was that I am now in this crowd with my new position. It feels a bit weird to me. I mean you go through college, finish an internship, take a test, but I don't think it really hits you until you land that first job or just do something with your new title (like start a private practice). I feel like I am finally spreading my wings at a place that will give me the tools and knowledge to make even more of an impact on people (and way more people that is). But anyways, moving on from my emotional part of this blog :) Stay tuned for my upcoming blog posts on: "My First Week as a Supermarket Dietitian" and "Dietitian You Say? That Means You Make Meal Plans." (I am especially excited about writing that last one)!
I'm pretty excited about that last part, not only for the nice pay increase from my current position at the YMCA, but also, it was exactly what I was looking for! I will be a part-time retail dietitian at my local supermarket. The position will also be heading towards full-time in the Fall/Winter when the programs get up and running. The RD will do everything from counseling to store nutrition tours to kid's day events. I really love working in the community and doing so many different things each day. I hate the whole 9 to 5 boring job routine. I like that I will be doing tons of different programs with all ages and stages of life. The job is also super flexible (I will eventually be creating my own schedule), I will be doing a lot independently (good thing I am a go-getter/self-motivated type of person), I get the opportunity to network with other RDs in the surrounding supermarkets, and I will be doing what I love :) Today's Dietitian sums up the role of a supermarket dietitian pretty well (for those of you who aren't sure what they do). The supermarket I will be at had 26 events last month, so I will definitely be a busy bee until I find my own routine.
So, how am I feeling about my new job and starting tomorrow? I am obviously very excited and anxious to just get in and get started. I am also a wee bit overwhelmed. There is a lot that goes on each week and besides all the events, I also schedule counseling, store tours, additional classes, and answer customer nutrition questions. It is also a new atmosphere with tons of new faces (been at my current job for 9 years so I pretty much know everyone and everything there is) and I don't really have an idea of what I will be doing every day. Like, how will I structure my day? I will be the only RD in the store, so it is not like I will be trained by the person in the position last. I am so grateful that I will get the opportunity to head to 2 other stores this week and meet the RDs there. I have a huge list of questions I want to ask them! I am very glad I have had experience running programs, creating materials, and working with the public at my current job. I feel like that is giving me a great basis for my new position.
I don't know if this is job where I will be forever (still keeping my YMCA position), but who knows! I am definitely leaning towards becoming a private practice RD. And by leaning towards, I mean I want to do it and get started, I am just slacking a bit :) It is a bit overwhelming to learn about everything you need to do to get started in private practice! I just need to break it down into smaller, more manageable steps (instead of avoiding getting started..haha). This will be something I will be getting back to in future blog posts.
I feel like I am at the stage in my life where all my friends and acquaintances are either having babies, getting married, or getting their career job. I mentioned this to my boyfriend this past weekend and his response was that I am now in this crowd with my new position. It feels a bit weird to me. I mean you go through college, finish an internship, take a test, but I don't think it really hits you until you land that first job or just do something with your new title (like start a private practice). I feel like I am finally spreading my wings at a place that will give me the tools and knowledge to make even more of an impact on people (and way more people that is). But anyways, moving on from my emotional part of this blog :) Stay tuned for my upcoming blog posts on: "My First Week as a Supermarket Dietitian" and "Dietitian You Say? That Means You Make Meal Plans." (I am especially excited about writing that last one)!
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
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!
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
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 :)
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.
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!
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!
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!
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 :)
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.
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! :)
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! :)
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