Clinical Nutrition Experience
Western North Carolina
May 2022 – July 2022
This past summer I completed the remainder of my dietetic supervised practice hours. Traditionally in the program I completed students complete the clinical hours the first summer. Due to the COVID pandemic many students in my cohort had to switch it up and complete their clinical hours during the second summer. I was one of these students and I completed my clinical hours as my last requirement before becoming eligible for the national registration exam. I completed my clinical hours at a hospital in Western North Carolina and I liked it so much that I ended up getting a clinical job.
Going into clinical I expected to enjoy it and I did. I completed 10 weeks of clinical rotation. In the hospital I worked at I had 6 weeks with the clinical team rotating floors and preceptors, 2 weeks with the metabolic support team that covers the ICUs, 1 week in pediatrics and 1 week with associated outside facilities. Over the course of the ten weeks I learned so much about how to practice clinical dietetics. I enjoyed working with each of my preceptors learning about the floors they cover and why they enjoy covering those floors.
Although many in my cohort had already completed their clinical rotation and informed me that it wasn’t as intimidating as you’d expect, I still went in a bit intimidated. I mean people in the hospital are most of the time very sick and what you do or don’t do can really impact their health. I am here to be one of those voices that tells you that it really isn’t as intimidating as you believe it is. As an intern and as a dietitian there are many checks put into place so that no major mistakes are made. As an intern this includes having all your notes and orders reviewed and signed by a licensed professional. This is a great way to learn as they can give you regular feedback on your work. Internships are a time to learn and the best way to learn is to do the work and ask questions along the way.
One of the biggest things I think I had to learn and practice was finding the most pertinent problem at one moment in time and how nutrition could be used to impact that problem. Many patients come in with multiple comorbidities and figuring out the right thing to do in the moment can be challenging. It’s funny too to think back to our medical nutrition therapy class final exam where the standardized patient had like 2-3 comorbidities and everyone in class freaked out trying to figure out what to do. This is understandable as in our lectures we went over one body system and possible disease states that affect that system as if they don’t ever occur with other diseases. In the real world patients often have more than one thing going on with them and you just have to figure out what is the most important problem at this time.
During my rotation I completed educations, calculated estimated needs, learned to use an electronic medical record, calculated tube feedings and total parenteral nutrition (TPN) and more. All of which are very important clinical nutrition skills. And if I’m being honest again, with a little practice not as intimidating as you may believe them to be before starting your clinical rotation.
For each of our rotations we had a few deliverables, or projects we had to work on in conjunction with our preceptors at our rotation site. During the clinical rotation this included a case study, quality improvement project, an education, EMR review, and a food environment assessment. Thankfully for me I was able to do much of the work for my deliverables during short chunks of time I had before leaving for the day so I didn’t have to do much after work which was nice. The case study was the project I was most worried about as I hadn’t given an in person presentation by myself in years. Thankfully, my topic, galactosemia, was interesting and the team was truly interested in learning about the topic and asked great questions. Standing in front of the team I’d been working with all summer to present to them felt funny, and trying to figure out the technology was a bit stressful, but I believe I did a great job in presenting my case study.
My quality improvement project was also pretty interesting and gave me a better look into some of the tasks that a clinical nutrition manager may be required to do. The one unfortunate thing was that although I did a good amount of work and research on the project and it was thought that it could be a good project to move forward with I don’t believe much will be done with it at this time. There was potential that it could get picked up as a project and more data collection would be completed, but the last I heard no one was moving forward with it at this time. It sounded like it would’ve been a big uphill battle to make changes even if the data supported the need for change. So that was a bit disappointing, but also just how things go sometimes.
The other deliverables for our cohort were mainly just check offs of things I did every day. We had a chart review or chart audit that was completed for competencies and had to be graded on how well we gave a patient education. Both of which were pretty chill and were completed closer to the end of my rotation when I was feeling much more confident in my abilities.
All in all I enjoyed my clinical experience and it was truly one of my favorites. I like the interdisciplinary nature that comes with working in a clinical setting, although sometimes it can be challenging to get everyone on board with a plan…. But in my opinion it feels like a great place to continue learning as a first job for myself. I also felt very supported by the team I was working with which I’d imagine could make or break a situation and experience. If you’re reading this and about to go into your clinical dietetic internship know that you know so much already, AND you will still learn so much and that is what this experience is all about. Be open and listen wholeheartedly to feedback and learn as much as you can from this feedback. Ask questions and don’t be afraid that they’re stupid, or that you should already know the answer. And know that no matter what you are going to be a great dietitian one day I just know it.
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