The Start of My Inpatient Clinical Rotation

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

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

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

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

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

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

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

Community Rotation: First Week at WIC

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

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

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

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

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

Hope these tips help you on your RD journey!