So I’m only about FIVE months behind on my “Notes from the Intern” posts. Whoops. This internship has certainly kept me busy, so bear that in mind if you’re a dietetics student looking to apply to a DI in the near future…
Anyway, let’s pick up where we left off, shall we?
When I first started this internship, I had little to no experience with nutrition support–my graduate program really included just a few lectures on the topic. Fortunately, I took an entire class devoted to nutrition support in the fall, so I was adequately prepared to be set loose in the hospital setting. I used to think calculating tubefeedings and TPN would be so complex and scary, but it’s really quite straight-forward. Easy multiplication, really. So by the time I started the nutrition support rotation, I had the skills and confidence I needed. I completed this rotation at a local VA Hospital, so the setting was a little different than my previous clinical rotations.
What I did: As you might imagine, I calculated a lot of tubefeedings and a few TPN solutions during my two weeks at the VA. The preceptor was very trusting, so she pretty much just assigned me half of her patients every morning and said, “Go at it!” So I did. I love it when my supervisors give me a little autonomy. Really, the two things that were difficult about this rotation were 1) learning a new electronic charting system, and 2) writing PES statements for every patient. (PES=problem, etiology, signs/symptoms, part of the Nutrition Care Process).
My favorite aspect: I really liked working with veterans. The nutrition support dietitian doesn’t get as much patient contact (their patients are much more likely to be on sedatives or a ventilator), but I still got the chance to do several diet educations. I’ve never laughed so much as I did in this rotation–the veterans I worked with were all so good-natured and liked to joke around. I can see myself working with this population again.
I had been looking forward to my pediatrics rotation for quite some time. The children’s hospital in this area is quite well-known for its superior level of care, so I was really excited to get to be a part of the healthcare team in the facility. I spent three weeks with the pediatric renal dietitian.
What I did: The dietitian and I primarily saw patients on dialysis and those who had received a renal transplant. Unlike my other rotations, I didn’t have the ability to chart on patients on my own; I didn’t have a computer log-in for the hospital’s system. So, I didn’t really have as much independence as I did in other facilities. I did assist in the diet educations, primarily focusing on either the renal diet or on the post-transplant diet (which includes SO MUCH FLUID).
I also spent a few days in the cardiovascular intensive care unit, the eating disorder clinic, and the weight management clinic. The CVICU was an interesting experience in that I got to see several patients with rare heart defects and learn about their specific nutritional needs. It was also heart-breaking, as I witnessed parents making decisions about withdrawing life-support. Visiting the eating disorder clinic was also emotional, as it was the same clinic I visited in high school for my anorexia treatment. It was pretty surreal to be sitting in the same exam room but on the “other side;” that is, to be sitting in as part of the healthcare team rather than as a patient. The experience definitely confirmed my desire to work with the eating disorder population at some point in my career. As for the weight management clinic, I definitely got to see the opposite end of the spectrum. Childhood obesity is a very real problem and affects a lot of kids in this part of the country.
My favorite aspect: Unlike older adults, kids and their parents are a lot more interested in what the dietitian has to say–at least in my limited experience. It’s nice to feel like the patients you’re spending time with actually care that you care, if that makes any sense.