Monday, June 19, 2017

3 Life Skills I’ve Learned Throughout my Dietetic Internship

As the internship comes to a close (I graduate on Friday – yay!), I’ve found myself reflecting on all the things I have learned throughout this past year. Of course, I have learned more about nutrition than I could ever put down on paper: the ability to assess nutrition risk, educate and counsel patients, calculate EN/PPN/TPN formulas, and to write educational materials geared towards numerous different populations, to name a few. When I began the internship, I expected to strengthen my knowledge in the field of dietetics, but I did not anticipate gaining so many life skills throughout the process.


If I had to choose one skill where I have seen the most personal growth throughout the year, I would say teamwork. Although I have always considered myself a “team player,” I previously felt most comfortable working on projects individually. I quickly learned that I would have to step outside of my comfort zone to be successful throughout the internship. At the beginning of the internship, each intern was assigned a partner. My partner, Ben, is extremely creative and clever, and I am organized and systematic. We quickly learned each other’s strengths and used them to our advantage. Together, we were stronger as a team than we would have been as individuals.

Me and my partner, Ben. 

As a dietitian, this skill is essential in all workplaces, especially a clinical environment. I witnessed this firsthand during my pediatric oncology rotation. My preceptor and I attended rounds each day with the entire oncology team. Each team member was valued as an integral part of the team. My preceptor was in constant communication with the doctors, nurses, and social workers to determine the best nutritional care for the patient. For example, the nurse reported the intake and output and weight of their patients, which my preceptor used to determine the appropriate tube feeding for the individual.


This one is huge. I have rotated through 14 different facilities this year. You know that awkward, nervous feeling you have when you start a new job? I had that feeling 14 times over the past 10 months! Each rotation and workplace is very different. Flexibility is key to making a good impression with the preceptors. During my rotation at the International Food and Information Council (IFIC), I was asked to switch between tasks often. On one occasion, my preceptor asked me to compile a list of universities that offer graduate degrees in nutrition. At the time I was in the middle of creating a blog post, but, after assessing the priorities of my projects, I was able to switch tasks quickly to assist with the more pressing project.

Flexibility is a skill I know I will use in my career as a dietitian. I found this skill particularly useful at my long-term care rotation. My preceptor had various tasks to do each day. She had to attend numerous care plan meetings, screen and visit patients, and chart on them, including filling out the Long Term Care Minimum Data Set. The meetings were intermittent throughout the day, so my preceptor had to be able to make the best of her time between meetings to fulfill her other duties. Seeing this skill in practice opened my eyes to the importance of flexibility as a Registered Dietitian in all types of workplaces.  


You know what they say: “communication is key.” I have definitely found this to be true over the past year. Email has become my best friend. I now know how useful it is to have things in writing that I can refer back to. This helps ensure everyone is on the same page.  Plus, email seems to be the communication method that most people prefer. I use email to clarify expectations for projects with my mentors, prepare for new rotations, and network with dietitians I’ve met at conferences and during rotations.

Communication is extremely important when speaking to patients. I’ll be honest, I was pretty nervous when I initially started speaking to patients on my own. My interviewing skills were a little bit rocky at first. With time and practice, I learned the importance of tailoring my discussions with each patient to their specific needs. For example, some older patients were hard of hearing. I would make an effort to speak especially loudly and clearly to these patients. At my pediatric rotation, I used fun metaphors to explain nutrition so it was easy for the children to understand. Communicating with patients in a way they can understand enables them to comprehend their condition and dietary goals, a necessary first step to positive dietary changes.   

Me and my fellow interns on our last class day of the internship

Although, I like to think I have always been pretty good at these skills, I definitely have the internship to thank for helping me fine-tune them and apply them to a work environment. These skills will be invaluable as I start my career. Between the nutrition knowledge and life skills I have gained through the internship, I am confident in my ability to succeed in any workplace.

Thursday, June 15, 2017

Shadowing a Wound Nurse


Nutrition plays a key role in healing wounds, and during my long term care rotation at Villa Rosa Nursing and Rehabilitation Center, I spent a morning peeking over a wound nurse’s shoulder as she assessed patients’ wounds. Although my time shadowing the nurse was short, I was able to watch her change the dressing of three different wounds: a sacral pressure injury, a heel pressure injury, and a scrape. It was my first time seeing a pressure injury in real life! We reviewed medications pertinent to wound healing such as “calcium alginate” dressings, which create moist healing environments for wounds, and “santyl” ointment which works to remove dead skin surrounding a wound. I also learned that wounds heal best at normal body temperature. Of course, we didn’t forget to talk about the importance of good nutrition to promote wound healing!
Here are a couple of nutritional components that I learned which aid wound healing:

  1. Increased Protein needs
It is recommended that healthy adults get 0.8-1.0 grams of protein/kg/day, while the elderly get 1.0-1.2 grams of protein/kg/day. However, in patients who have wounds or pressure injuries, or are at risk for acquiring them, protein recommendations can go up to 1.5-2.0 grams/kg/day in order to make up for any protein lost in wound exudate and to help synthesize new skin tissue. In the long term care facility where I rotated, protein supplements were often ordered for patients who had inadequate nutrient intake, in order for them to reach their increased protein needs. This need for increased protein can also be accomplished through eating foods high in protein, such as meat or eggs.

  1. Vitamins and Minerals
Getting enough vitamins and minerals can usually be accomplished through a balanced diet, however, a healing wound can often benefit from supplementation of certain vitamins and minerals. Specific nutrients that my preceptor at the long term care facility often recommended in patients with wounds were Zinc and Vitamin C. Zinc helps wounds because it plays a role in collagen and protein synthesis, cell proliferation, and immune function. It is important to note that Zinc supplementation should be recommended with caution because too much zinc can interrupt iron and copper absorption. Vitamin C is beneficial for collagen formation and its antioxidant functions.

  1. Blood Sugar Control
Sometimes patients have non-healing wounds due to elevated blood sugar, which is a concern in patients with uncontrolled diabetes. High blood sugar causes small blood vessels to become rigid, resulting in poor blood circulation. This prevents wounds from receiving the oxygen, nutrients and immune cells they need for skin repair. The healing process can take months due to this and can even lead to dangerous infections, which sometimes require amputations. Controlling blood sugar is an especially important task for anyone with diabetes and a wound.

As a dietetic intern, it was a great opportunity to see several wounds first hand! I now have a better understanding how good nutrition promotes wound healing.  

Monday, June 5, 2017

Let the Hunt Begin

With three weeks left of the dietetic internship you would think the stress levels have come down to an all-time low, right? WRONG. My next task is to take the CDR exam and secure my first job. I would be lying if I said that taking the first steps into the “real world” is not a bit scary. Luckily, I came across several resources that make finding and applying to jobs a little less stressful.

Employment Websites
Employment websites such as Indeed, LinkedIn, and Monster have become tremendously popular in the past few years. The concept is simple: businesses and organizations with openings post their listing to the websites; from there all it takes is a keyword search to find the perfect job. Employment sites are great because it allows anyone to easily see which companies are hiring. One of my favorite features is that you can create a list of jobs that you can access at any time, allowing you to apply immediately or at a later time. Since the listings are posted by the hiring business they are updated or taken down instantly and contain links leading to more information about the position and organization. I have taken advantage of an option which sends me email notifications about new openings related to my recent searches. I uploaded my resume to some of these sites where it will be reviewed by recruiters who may reach out with an opportunity. Employment sites are beginning to transition to phone apps, allowing the job search to continue from virtually anywhere. I personally take advantage of those few minutes before getting out of bed to scroll through job apps and see if there are any new postings.
Personal Network
One of the mantras given to us at the beginning of this internship was “think of this as a 10.5 month job interview.” This set the tone for networking during rotations and inspired me to create my own personal connections. What many do not realize is how connected practicing dietitians are to other dietitians in the field. Assuming some connections have been maintained from their DPD and dietetic internship, a dietitian typically has is a minimum of 10-15 contacts. I have been fortunate enough to establish and maintain a connection with a dietitian I shadowed for some time during my undergrad career. She has not only been immensely helpful as a mentor, but has offered to aide me in my job search by contacting clinical nutrition managers in her network. Whether it’s serving as a preceptor for dietetic interns or reaching out to a contact about a potential job opportunity, dietitians are more than willing to lend a helping hand. Luckily for us, establishing these connections can be easy as we are introduced to many of them through the course of our rotations.


Professional Organizations
One of the lesser known benefits of being a member of the largest professional organizations for dietitians, the Academy of Nutrition and Dietetics, is having access to their career resources. These resources include job boards similar to the employment websites, expert referral services aimed at those looking to start their own business, and a career development guide for those interested in creating a 10-20 year plan.  When you become a member of the Academy, you are required to select a state affiliation. Most state affiliations have their own websites with a job board and will host an annual meeting, which is the perfect place to network. In addition to helping me search for jobs, the Academy offers resume templates and online marketing tips to its members which I have used to the fullest extent. Finally, a good reason to pay a yearly recurring fee!

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These are just a few of the resources and methods I have been using to find jobs. Now if only I could get a call back from one of them…