Final Days of Staff Relief

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

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

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

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

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

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

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

Beginning of Staff Relief

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

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

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

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

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

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

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

Accomplishing a Week Full of Stressfulness

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

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

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

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

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

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

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

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

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

Food Service Management Rotation: Tips and Information

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

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

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

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

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

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

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

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

First Week of FSM Rotation

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

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

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

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

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

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

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

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