My RD Journey

From Undergrad -> Internship -> RD -> Private Practice!


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Business Lessons Learned – Go With The Flow

Happy Memorial Day weekend! I thought about nixing this blog until next week; however, I was up early with my lovely feline friend (aka my cat) so I figured why not! If you have been reading my blogs lately, you will notice that this is the second blog in my “Monthly Recap” series. Back in April’s post, I set three goals for myself. I am super happy to say that I accomplished all three! These have been goals on my list for a while now; however, there is just something about having that accountability factor that pushes you to follow through. While it might seem weird to think I am being accountable to my viewers, it really helped me to focus towards having something positive to share for this post.

Lessons Learned
Be Accountable to Someone
I am always telling my clients to have someone to be accountable to (whether it is me or a spouse/friend). Again, in taking my own advice, I realized that having the accountability really helps to just give that extra push. I would challenge any business owner to identify their go-to person that they will check in with each month (or week). They can help you to review your goals, ideas, issues, etc.

Flow With Your Business
Your business will change every year or month even. Now, while this might not be a huge change, always be open to assessing and adapting with the needs of your clients. I have been changing some of my services and offerings to suit my client needs better. I now have a monthly fee for a coaching option between appointments. I use to think I would always just do the counseling and classes; however, now I want to have more time to myself so I am working towards more products versus services. My point here is not to pigeon-hole yourself into one way of thinking about your business. Always be open to opportunity and change for that matter.

Act First
One of my biggest downfalls is over planning and not acting. It took me so long to get an outline written for my book because I was worried about how I would sell it. Why does selling it matter if I don’t even have a product to sell?? I can often waste hours researching and planning to start something and then not even starting it because I am so wrapped up in the preparation. While I think planning is a great step, don’t get hung-up on it for an extended time. Yes, do some short research and then ACT.

Key Defining Moment
Health Fair Competition
This month, I attended a health fair for one of the companies I work with for weight management classes and also provide on and off-site counseling for. This company has a few dietitians they work with since they have a huge incentive program around wellness. At this recent health fair, about 7 different dietitians were there promoting their business and counseling services. Being the 5th dietitian in the row of tables, I was wondering to myself what sets me apart from them? We all do counseling and accept insurance, so what makes me special? One little edge I have to some is that I offer in-home counseling services and still come on-site for the company. Although, this really got me thinking about my brand and how I want to promote myself.

After the health fair, I had one client tell me that they specifically chose me out of the other dietitians because they were impressed with my professionalism, table set-up, and business cards. Now, I am not one to ever put down another dietitian and I thought some of the other tables looked awesome, so I simply thanked him and moved on in conversation. I was one of the only tables without a food sample (since I had planned a game instead), so I originally thought no one would be interested in what I had. Although I did have quite a few sign-ups for counseling and my newsletter, I still didn’t think I would be standing out as much from the other tables.

0524171435c-02For any health fair, I always bring my PorrazzaNutrition banner, handout holders, 1-2 handouts (tip sheets), info sheet about myself that I put in a plastic stand-up, 2-3 recipe cards, 1-3 coupons, newsletter sign-up + counseling interest list, business cards in my shopping cart holder, pens, and 1-2 visuals (I had an avocado this day + poster on salt). All in all I realized a few things, I always cater to different individuals with my variety of handouts/recipes, I have visuals to grab attention, I have an awesome business card holder that spurs conversation, I keep the table clean and tidy (especially since I didn’t have food to worry about), and I dress to impress. I set-up my table based on my experiences with previous health fairs and what looks visually appealing to me. I learned, in this moment, that comparing myself to others is so silly since we all target different clients and have our own ways of doing things. There may be many clients who preferred other tables based on their specific needs and what appealed to them. This situation was a huge moment for me because I made a commitment to always keep that professionalism and par level high, no matter where I am or who is watching, and to only compare myself to my past self.

Business Goal #1 – Revise and Upload 3 Meal Plans to my Website
I have been trying to brainstorm more products to add to my business and I realized that I have about 50 meal plans that I created for past clients. Why not update those to sell on my website?! So many clients ask me for meal plans and I usually don’t create them, but instead work with the client to brainstorm meal ideas. What I realized is what I want is not always what everyone else does, so why not just give them that? I will still have a personalized plan option and work with clients during their appointments; however, this can just be another passive income stream for me that still supports my clients’ (and potential clients’) current needs.

Business Goal #2 – Finish First Rough Draft of Book
This month, I worked on an outline for my book and I brainstormed chapter ideas. For next month, I want to put that all into a first draft. This book is the first to many ideas that I have, so I am excited to finally be in the writing process! I typically just write ideas down whenever they come and then dedicate a couple hours one-day per week (for now) to fleshing out those ideas and making them into chapters. I find for myself that I have a hard time writing at home and not getting distracted so I have been writing while between classes (since I take the train and am usually pretty early).

Business Goal #3 – Continue Building My Brand (Including Online Presence)
For this goal, I am going to continue with my blog, video, and social media schedules. I am also brainstorming what my “brand” will look like. I want to have everything integrated to match my passion and niche. I want to move away from 100% service and I feel that building more of an online presence is key to this.

What lessons have you learned this month? Did you have any defining moments or obstacles you overcame? Stay tuned for my upcoming blog’s on building YOUR brand!


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5 Tips for Speaking at Conferences

Welcome back to “My RD Journey!” If you read my last blog post, you will already know that this post is all about my first time speaking at a large conference (The Inaugural Women in Business Conference hosted by the Greater Northeast Philadelphia Chamber of Commerce). I was able to lead an individual breakout session and also serve as a panelist for a discussion on balance. In the past, I have lead seminars, given talks to students, conducted cooking classes and more; however, this was the first conference I was apart of. Today’s post, I will recap for you my (awesome) experience, plus give you tips that I learned along the way.

Tip #1 – Keep it Simple & Organized
I decided that for my individual session, I would touch on general nutrition (building a healthy plate) needs and motivation. I find with my clients that a lot know what to do; however, putting it into action is the hardest part. I wasn’t totally sure of my audience beforehand, so I tried to keep it basic and relate-able. I, for one, hate dry presentations, so I mixed up some of the general education with a few myth-busters throughout. I did use a PowerPoint; however, I didn’t put a ton of words on the slides because I didn’t want the audience to just be reading versus listening. I am definitely one that will completely stray from my outline, which isn’t a bad thing, so I didn’t want the audience trying to find where I was on the slides. One key thing here is that while having a lot of information is great, remember to keep it organized. Don’t jump around too much since you might lose the interest of your group.

Tip #2 – Allow Time for Questions
You can decide whether or not to have participants ask questions throughout your presentation or just at the end. I usually say that they can ask questions throughout if they need clarification; however, I do ask them to otherwise wait until the end. I do this mainly because I had a few instances where people just constantly asked questions and I couldn’t get through all the material. Sometimes the questions were relevant to the topic and other times they were too specific for others in the class to benefit from them. I let the participants know I allotted time for questions at the end and I stuck to my timeline to keep to that.

Tip #3 – Have Evaluations
Getting feedback on your presentation is key! Sometimes, participants in my seminars don’t ask any questions and their facial expressions lead me to think they are bored out of their minds. After doing a lot of different presentations over the years, I found that a lot of people don’t want to ask questions for a few reasons. Some think their questions are “stupid” – I have never had a “stupid” serious question. Some would rather ask questions individually after the session. Some are just taking in all the information and don’t have questions just yet. There are so many reasons for lack of questions. With all that being said, the evaluations are a great way for you to get feedback (positive or negative) and work out the kinks for next time.

Tip #4 – Come Prepared
Being prepared is a huge part of your presentation success. Know what your talking about so you are not just reading from your notes. Have your business cards available so the participants can follow-up with you later (possibly become clients of yours). Make a simple handout and pass it out at the end so you don’t end up with distracted participants. Know what setting is available for your presentation too. Do you have the ability to run a PowerPoint and if so, do you bring the hook-ups and laptop? Will there be tables for the audience or just chairs (important if doing writing activities)? Get as much information as you can beforehand so you are ready to go the day of. Being prepared will help you to eliminate unnecessary stress and be able to deliver an effective presentation that will engage your audience.

Tip #5 – Have Fun & Just Be You
This conference was such an awesome experience for me. I am so passionate about what I do and teach that after a presentation, I usually feel energized and invigorated. With practicing a lot over the years in different settings, I am now really comfortable public speaking and answering on-the-spot questions. I typically get at least a few attendees come up to me after with positive comments; however, I was totally blown away by the positive response at this conference. I had so many women come up to me throughout the rest of the day to introduce me to their friends, comment on the information, and speak to my enthusiasm and positive energy for the topic. It really is a crazy feeling to have people tell you that you are an inspiration to them. As a dietitian, I try to help others find a passion for nutrition and healthy eating; however, some days are just really difficult inspiring change. To know that I inspired a group of women in just 45-minutes was just so awesome (for lack of a better word).

So, if you are presenting in any type of setting, just remember that your enthusiasm and your passion can inspire others to make a change. Put your own spin on things and just relate to your crowd in any way that you can. The more you can connect the better the experience is for everyone.


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April Recap – Lessons Learned

April has probably been my busiest month so far in full-time private practice. I had two conferences, both of which I was apart of the planning process, 3 speaking engagements, plus my normal business load (clients and classes). I definitely thought a lot about balance and what that means for myself and my future practice. As I mentioned in my previous blog post, I have been trying to change how I do business to allow for more free time.

So, this month (and those in the future), I want to share with you my “Lessons Learned,” “Key Defining Moments,” and “Business Goals.” I decided on these topics for a few reasons; one of which is that other RDs always ask me what I would have done differently (hence lessons learned) when starting my practice. I also always get asked how I keep myself motivated, which involves pivotal moments and setting goals for myself. My hope is that my monthly recap can help someone else in their practice or career in general.

Lessons Learned 
“Always assume there is something to learn.” “Don’t just show-up, but engage.” 
Sometimes when I think about going somewhere I question whether I will get anything out of it. I mean, after all, my time is critical for me to keep a hold on. I realized that you get what you put into ANY situation. If you want to learn, ask questions and be involved. Engage in conversations and do more than just show-up. If you approach situations with a mindset of knowing you will learn, you will.

“Take advice from the experts.” 
What is funny about this lesson is that I always tell people to see a Dietitian for nutrition help because they are the experts. Somewhere along the way I stopped applying this to my personal/business life. Instead of hiring an accountant for tax season, I figured I would do it myself. About 6 hours later, I filed my federal and state taxes, plus learned how to pay quarterly ones. I then realized I had two city taxes to file only days before the deadline. I tried doing the forms myself online and could not get the numbers to populate correctly. It basically kept saying I owed $0, which I knew was incorrect. After a brief panic attack, I realized that I had the business card of an accountant I knew from school AND I had just reconnected with him while on the train. Despite it being late notice, he helped me to figure out what I was doing wrong fairly quickly and all was well. What I learned from this was breaking down wasn’t going to solve a thing; taking action and figuring out a plan would. I also realized it would have been so much easier (and tax deductible) to have worked with him from the beginning instead of wasting all that time stressing and struggling through it on my own. While I am a huge proponent of learning for yourself, it is really important to know what your limits are.

Key Defining Moments 
PAND AME 
This year I was apart of the planning process for the Pennsylvania Academy of Nutrition & Dietetics’ Annual Meeting and Exhibition. To be honest, I had not gone in the past since I thought I wouldn’t get much out of it. It was such an awesome experience for me. Not only did I get to know some other great Dietitians, but I learned a ton! The best thing about it was that a few RDs came up to me saying they had read my RD Journey blog and had followed me to learn more about private practice. These were people I either never met before or those I knew from years ago but didn’t keep in touch. I also saw a few of my previous preceptors and one had said she still used materials I created for her programming. I was super proud of myself but also realized that I needed to continue on the path I was on to build my brand and products even further.

Running for the Train
Since I really hate driving downtown for my cooking classes, I have been taking the train instead. This means I walk about 1.2 miles to the train station lugging all of my stuff for class. I had a lot of materials for my class last week, so I had a backpack full of stuff plus a rolling suitcase. I had a difficult class attendee who was arguing with me about olive oil being bad for you since it is controlled by the MAFIA, yes the MAFIA. This attendee also said doctors have nutrition certs and you should trust them for diet advice. Needless to say, I was a bit flustered, which then led to me being a careless and cutting my thumb with a knife. Not sure anyone noticed; however, fast forward to me rushing to clean-up to catch the train on time. I ran 3 blocks with a huge backpack and a rolling suitcase all while holding a paper towel on my bleeding thumb since I couldn’t find band-aids. Two ladies also yelled to me, “Run! You will make it. We believe in you,” which just added to the level of crazy. I made it with 3 minutes to spare (only because the train schedule changed and I didn’t realize). So, I am standing there sweating with a bleeding thumb and said to myself, “Never again.” This day was a huge defining moment for me because not only was the afternoon stressful, but I was doing all of it to not even represent my own brand. I definitely had a lot to think about while walking the 1.2 miles home.

Business Goal #1 – Do more as PorrazzaNutrition and less as a contract worker to build someone else’s company.
I made the decision this month, to cut back on the number of cooking classes I do for contract work (see train story above). Not only was the pay not adding up in terms of the time spent, but I also realized these classes are just providing income in the short-term and not allowing me to grow as PorrazzaNutrition. I made a commitment to myself to really focus on doing things that will build my brand and provide income, even if it is in the long-term. This is a huge mental shift for me since I am walking away from quick income; however, long-term, I know this is the best route.

Business Goal #2 – Create and upload at least 3 YouTube videos in May. 
As some of you may know, my drive for video creation was halted when I was in a car accident about a year and a half ago. This is another piece of my business that will not only expand the individuals that I reach, but also, create passive income in the future.

Business Goal #3 – Create a solid outline for my first e-book.
I keep saying that I want to write an e-book and telling people my plan; however, all I have done is write down topics. So, my goal for this month is to actually get more of an outline together and brainstorm chapter specifics. I got so caught up in formatting and how to write the book that I lost sight of the fact that the content is the most important thing. Who cares about formatting and selling when you don’t have a product yet? Priorities!

What lessons have you learned this month? Did you have any defining moments or obstacles you overcame this month?

Stay tuned for next week’s post for my thoughts on my first conference speaking engagement!


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A Day in the Life of a Private Practice RD

I have been getting asked a lot lately how I structure my day and what does a day looks like for me now that I am full-time. Pretty much no day is ever the same for me since I never know who is going to call for an appointment, what important email comes through, or what last minute change in my schedule needs to happen. I broke down my day into two options: seeing clients/having classes and a “work” day so you can see what it looks like to be me all day long 🙂

A Day With Appointments (My Wednesday)

6:45am – Get ready for the day, eat, make coffee, pack my bag, check emails
8:00am – Head over for a committee meeting that I am Vice-Chair for, send out committee emails
9:30am – Chat with a fellow entrepreneur post meeting
10:00am – Leave to head downtown for my cooking class
10:45am – 1:45pm – Prep, have class, clean-up, chat with staff in the building, etc
2:15pm – Home. Eat lunch, check emails, log class information/expenses.
2:30pm -4:00pm – Make any insurance-related calls before offices close. Call back voicemails (if any). Work on posts for FB & IG. Follow-up with clients for paperwork needed for appointments.
4:00pm – Gym
5:30pm – Make and eat dinner. Usually, I take this time to also clean the kitchen.
7:00pm – Follow-up on emails. Work on committee related minutes/events. Prep for the next day. Sometimes I will have a late-night appointment at 6pm. If so, I will bill and write the reports right after.
8:30pm – Continue working on business-related items (could be accounting, billing, lesson plans, blogs, handouts, etc) or watch Netflix or read a non-business book.
10:00pm – Bed

If there is one thing I have learned while being in private practice it is to not overbook yourself. Even the days where I don’t see clients I try not to overbook. Something always comes up to rock the boat! Going along with this, I have learning to go with the flow a lot more. Appointments change. Classes get rescheduled. Things in life just happen. If I get all stressed out and worked up about something, it just makes my day chaotic and negative. I take things as they happen and simply move on.

A Day Without Appointments (My Monday or Friday)

8:30am – Get ready for the day, make coffee, check emails, make pancakes (because why not), make my to-do list (prioritize)
9:30am – 1:30pm – Followed-up on calls. Booked a new class so I had to submit an invoice + signed contract. Write lessons for the new class. Follow-up on unpaid insurance claims. Follow-up on missing paperwork for upcoming appointments. Chat with another RD about insurance issues. Plan blog and social media posts. Brainstorm ideas for business. Input any paid claims into my accounting software. Usually Fridays I do laundry and vacuum in the midst of all of this.
1:30pm – 2:00pm – Make and eat lunch. Some days, this ends up just being a smoothie for convenience.
2:00pm – 5:30pm – Follow-up on more insurance-related issues. Chat with other RDs about insurance. Send appointment reminders to clients. Prep for appointments/classes for next week. Answer emails. Follow-up on patient calls. Schedule appointments as they come + send initial emails with paperwork. Mondays are my food shopping day normally so I also hit the food store mid-day too.
5:30pm – May go to the gym or if not eat dinner a bit earlier. Usually, prepping dinner involves emptying the dishwasher, putting dishes/groceries away, cleaning, etc, all while cooking.
7:00pm – Follow-up on emails. Work on committee related minutes/events. Prep for the next day.
8:30pm – Continue working on business-related items or watch Netflix or read a non-business book.
10:00pm – Bed

My days where I don’t see clients usually end up being the “busiest” since I push everything office-related off until then. Sometimes, checking my emails takes 2-minutes and other times I end up back and forth about something for 10-minutes. As I mentioned earlier, I never really know how a day is going to go. Some days, I get through everything I needed to and can relax by 3 or 4pm. Other days, I work until 7 or 8pm, eat a late dinner, and pretty much go to bed right after. There are some days that I need a mental break so I will go out for a mid-day walk or watch a show. Again, just going with the flow really helps my sanity and productivity.

If you are in private practice, what does your day look like? Anyone reading this surprised at what I do all day?


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My First Week in Full-Time Private Practice

Well, I have officially made it through my first week in full-time private practice! It felt so odd to say to people that I was my own boss. It felt even weirder to not have to go to one facility (my full-time job) for 40 hours/week. It felt totally different for me to JUST do my practice and not juggle it with my full-time gig. I would see clients here or there and chunk everything I needed to follow-up on (insurance claims, billing, etc) on my days off. It felt good to just focus my time and energy on my practice for once.

I was lucky to have an intern with me for my first week. She was with me during my full-time job and still has 2 weeks left to go during her dietetic internship. I love having interns; however, I especially loved having this one since she was able to be apart of my transition to full-time private practice (also, she’s pretty awesome). Since I work out of my home, there was always the want to stop what I was doing to do the dishes or various house chores. I felt like having an intern with me really pushed me to be productive in the hours of the day that she was there. Once she moves on to her clinical rotation, I am planning to translate this type of work schedule into my own. I want to set up “hours” I am working and really stick to it. Everything else can wait!

After my first week, I started to think more on what kind of schedule I wanted to build for myself. While I don’t have an exact plan just yet, I do know that I want to keep 3-4 days of clients/classes and at least one full day dedicated to insurance calls and office type work. I already know the days that I see clients back-to-back that I don’t get much else done on the back end of things.

One huge thing I realized this week is just how much my email/notifications are distractions! Every time my phone went off, I checked the email in case I needed to respond. This was a huge concentration breaker. I took some advice from friends/family/books and set aside windows of time where I would answer emails. Usually, I check email in the AM, mid-day, and at night (7pm or so). I want to cut this back to twice per day instead. I find I am way more productive if I focus on one task at a time instead of just switching back and forth. This has been harder to stick with than I thought, but turning my sound off on my phone really helped!

One last thing I learned from my first week was that I needed to prioritize and not overbook myself. I would stick 15-20 items on my list to do for the day and only end up getting to maybe 10-15 of them. I would never know how long I would be on hold with an insurance company for a claim status, or what questions my intern would ask, or what phone calls came in. Though I would get a lot accomplished, I still was bummed I couldn’t do EVERYTHING. Honestly, that is so unrealistic! Not only am I putting undue pressure on myself, but I am also making my daily goals ones that I know I won’t reach. For this week, I decided to make a priority list and a to-do list. My goal was to complete the priority list and if possible do 1-2 items on the to-do list. This was way more manageable and I felt more accomplished at the end of the day.

I have been keeping a journal of everything I have learned thus far, so each week I will share with you my tips, tricks, slip-ups, and more!


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Dietitian Eats: Dinner Edition

So, today was a bit crazy at work. Let me tell you how absolutely grateful I am to have an intern (and a pretty awesome one at that)! Not only do I have an extra set of hands for events; but, I can also bounce ideas off of her. I also really like teaching someone things I learned. It is pretty cool to be on the opposite side after being an intern myself 🙂

Instead of giving you a rundown of my eats for the day, I decided to focus on dinner. Mainly because I made something pretty awesome from leftovers and also because I forgot to take pictures of all my other meals…Whoops 🙂

I didn’t get in until late tonight, so I was debating on a quick shake or actually making something. I decided I wanted something hot. Let me preface this with earlier in the week, I had cooked off a bunch of brown rice and leftover faro. Made it easy to throw in my lunches. So, I started off with 2 veggie burgers. I get these ones from Aldi’s. I like these for the limited number of ingredients and the fact that I know what all of them are. Each patty has 3g of fiber and 5g of protein. Made with carrots, peas, oats, zucchini, edamame, corn, and string beans mainly.

So, I sautéed my veggie burgers in some olive oil, garlic, minced onion, and oregano. I threw in some hemp seeds for a little more fiber and protein. One the veggie burgers were pretty much cooked, I broke them apart and added my rice. I also splashed on some Bragg’s Liquid Aminos (soy sauce alternative). Bragg’s is a vegetable protein made from certified non-GMO soybeans. No preservatives, no alcohol, and gluten-free. I’ve been in a mood for artichokes lately, so I added a few canned artichokes (marinated in just olive oil and spices). Lastly, I threw in some fresh leftover spinach I had. I left that all cook together for about 5 minutes…and presto dinner!

I’m a huge fan of one dish meals; less clean-up plus I like mixing everything together for the best flavors anyways. I tend to do similar types of cooking for dinner. This only took maybe 10-15 minutes? It could have been shorter, but I was doing homework and forgot to put a lid on to trap the steam. If you do something similar, you can always throw in your favorite veggie (instead of the spinach) or use some shredded potatoes instead of the rice.

What did you make for dinner tonight?


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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.