My RD Journey

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


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Top 10 Tips for a Successful Dietetic Intern

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

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

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

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

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

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

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

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

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

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

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

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

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

For more tips on Preparing for Your Internship, check out the BLOG 

For more information on joining the AND Preceptor Database, click the LINK.

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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 🙂


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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 InmanCDs 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.


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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!


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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!


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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 🙂


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End of FSM Rotation

 

Last week, I finished my first rotation of my dietetic internship (Foodservice management and school nutrition education)! It felt like the 13 weeks flew by!

 

Some of the things I did during my rotation included:

-Menu planning: created a 6-week cycle menu for the school district; input menu items into PrimeroEdge system (similar to that of NutriKids); assigned menus for the district; created new recipes (and taste tested them); ran nutrient analysis of the menu items to ensure that they met the guidelines for SLP.

-Kitchen work: observed/participated in ordering, inventory, serving, food prep, temperature/sanitation check, etc.

-Lesson planning: taught a 3-day lesson for 6th grade students; taught a fitness/nutrition lesson for 1st and 2nd graders; in-service for staff members.

-Research project: I created a new chickpea salad, had it taste-tested, and put it on the menu. I was trying to determine if increasing student involvement in the planning of new items and implementing the changes they made, would increase consumption.

-Miscellaneous work: answered phone calls in the office; organized nutrition materials, made posters for events, etc.

 

Things I learned throughout my rotation:

1. Always, always, always ask questions! Sometimes, I felt like I was bothering people asking them; however, everyone was really friendly and there to help. The internship is to help you learn more about nutrition, so asking questions about things you are not sure of is needed.

2. Be confident in what you know and how you speak about it. If you sound unsure, people won’t trust what you say. I’ve said it before and I’ll say it again, you know more than you think!

3. Before a food service rotation (in a school district), brush up on food safety, the school lunch program, and food science (I definitely didn’t study much on food science until I realized I needed to know some for my rotation).

4. Nurses would call a lot about carbohydrate counts for menu items in order to give insulin to the kids with diabetes. If you find yourself answering these types of questions be sure to have menu nutritionals on hand (I found nurses to be calling last minute and frantic).

5. Get as many resources as you can from the RD or FS manager. My RD had a SafeServ book, Inman’s Review, and miscellaneous lesson/training binders, which will all be helpful in studying for the RD exam. She also mentioned she only used Inman’s Review for the RD exam and passed the first time.

6. Take the initiative on projects and tasks whenever you can. Not only will this give you great experience, but, it will also show the staff you are committed and a team player. Even doing small tasks without complaint are noticed.

7. If you find downtime in your rotation, read food service related materials (I found this to be helpful when taking my comprehensive exam) and/or ask what else you could be doing to help.

8. Be flexible! Things will not always go to plan. Just roll with the punches and do what you can to make the situation run smoothly.

9. Accept the changes that happen. This kind of goes along with number 8. One day you may have planned to do x, y, and z; however, you may get something new thrown your way. An employee (or 5) might call out, and you need to help in the kitchen. A truck may have broken down and you need to drive the manager around. Anything can change in foodservice! (By the way, these things have all happened in my rotation).

10. Be ahead/aware of all your assignments/tasks. You never know when something will come up that relates to an assignment. It really helps to have your assignment sheet on hand.

 

Overall, I had an amazing rotation. It was stressful at some points; however, in the end, I wouldn’t have changed anything. I really feel like I developed/fine tuned my leadership and interpersonal skills.

 

Hopefully, my experiences will help you in preparing/finishing your food service rotations!