Is Being a Renal Dietitian Right For You?

By Joyce L. Hornick

My first thoughts about being an RD who works in a dialysis center are completely wrong. I thought that specializing in renal nutrition would be pretty much the same as any RD working in the clinical setting of a hospital. The only difference would be that you only deal with people who have End Stage Renal Disease (ESRD) and not many other issues. There would be the occasional help with diabetes and blood sugar control, but not much else.

Four days of working with an RD at a dialysis center with approximately 140 patients showed me how wrong I was. Renal dietitians work in a very clinical atmosphere and are very clinically oriented. Patients with ESRD are on many medications. Most of these medications are directly related to their nutritional status, especially with their phosphorus, potassium, sodium, calcium, and vitamin D levels. They need to take phosphate binders to prevent phosphorus from building up in their tissues and blood. If a patient takes them incorrectly, they may not work efficiently. They can also cause upset stomach, vomiting, and constipation. All of their medications depend on their diet and the dosing of other medications. Dosing needs to be fine tuned on a regular basis. The RD is in charge of these dosing recommendations.

The renal dietitian works very closely with their patients. They know who is good at following their diet and who is not. They know who likes a lot of technical information about food and who doesn’t. One question by a patient about hidden phosphates in salad dressings created an investigative and educational project for all of the patients in the center, complete with a handout, a brief education, and a taste test of ranch dressings with pretzels.

If you think being a dietitian at a dialysis center would be too technical or clinical for you, think again. Even though it does involve these aspects, it involves so much more. You get a lot of personal interaction with patients and get the opportunity to help them over a long period of time.

The Art of Writing a Resume

For our latest class day, my fellow interns and I listened to advice on how to write a solid resume from Phyllis, our internship director. This presentation sparked my thought on a few topics.

First, resumes are ever evolving. The resume I had after graduating high school isn’t the same one I had after graduating college. And similarly, my resumes will change each time I work at a new job or accomplish a new skill. As a person professionally progresses, information that was relevant before becomes clutter on the page; it’s now something that can be removed for new information to enter. Resume sequencing also changes with experience. When you’re first starting out, listing education at the top of the page was the best idea. As you gain experience, it’s more fitting to list skills and work related experiences at the top of the page.

Second, your resume should convey your strengths quickly and briefly. Phyllis had us fold mock resumes in half and explained that the first half of the page has to grab the reader’s attention and hook them into reading the rest. Therefore, the most relevant and important information should go at the very top of the page. But deciding which information is most important and listing it in a brief yet effective way is quite a challenge!

Third, resumes should convey an applicant’s personality, but should also be very conservative. It’s never a good idea to submit a resume on pink paper, or use “creative” font. In order to convey my personality trait of being highly organized I’m going to make sure my resume is formatted crisply and consistently without clutter.

Finally, there is no one right way to compose a resume. Everyone has different opinions and tastes when it comes to writing and reviewing resumes. A smart applicant will try to tailor their resume as much as possible to the tastes of the person or company reviewing it. But at the end of the day it’s important to put out a resume you’re happy with and proud of.

Happy resume writing!

From Floppy to Cloud

Does anyone remember the days of the floppy disk? Now I know I wasn’t using computers when floppy disks were actually floppy, but I do remember having to carry around that little rectangle wherever I went if I wanted to print anything at school. Then as the years went on, we all started emailing ourselves documents that needed printing. I even remember the first time my dad bought me a 560 MB flashdrive and I couldn’t believe that a tiny thing like that could do what it did. Now, as technology seems to be surpassing itself, a relatively new type of storage is emerging: cloud storage.
Cloud storage allows you to upload all of your documents onto an internet host that can be accessed from any computer. Zoho and Dropbox are just two of many cloud storage centers that anyone can use, free of cost. We as dietetic interns are always working on multiple projects at a time, not only by ourselves, but with each other. Being able to upload, share, and modify documents on the internet allows for ease of access and collaboration from all parties. While floppy disks are well in our past, who knows – maybe flashdrives will be too!

The World of Outpatient Pediatrics

This rotation marks the last of my clinical rotations, with two-weeks of pediatrics at Children’s National Medical Center. I am currently in my outpatient section and it is truly a different world compared to the average in-patient setting that I am used to.

One of the main differences I am encountering is that compared to my previous clinical rotation the only challenge in meeting with patients was trying to find the chart or if the patient was out of the room for a test. However, in the world of outpatient nutrition, it under the discretion of the client if they are going to attend the nutrition assessment or follow-up meeting and in the many cases I have seen this week…they do not attend. This can be frustrating but is a reality for outpatient dietitians, where the day is spent waiting on the arrival of clients.

Some of the other differences I am noticing are:

• You can reach people in a more casual and less acute and stressed moment
• Ability to create more long-term goals
• Build a stronger bond between yourself and the client and increase trust
• Give continual guidance and education on topics
• Counseling strategies take a much higher role

Overall, I am enjoying the rotation and learning a lot. Pediatric dietitians have a very crucial role in the health and improvement of many conditions that affect children while in the hospital and after they head home.

“Don’t sit on the back of the plane”

I am currently in my 3^rd week of clinical at Anne Arundel Medical Center. I know that I have several more weeks to finish my 1^st clinical rotation and I have already learned a lot and been able to do many things during my rotation. At the same time I am not trying to say I don’t love my clinical rotation but as we all know clinical rotations do demand a lot from us. So far my clinical rotation has been a great experience and an everyday learning process. Before I started my clinical rotation, I was searching for books, and magazines that can give me ideas on how to make my clinical experience better. It was not easy to find books as I imagined it. I was not able to find any books that I was interested in so the next think I did was to call my dad. I knew that my dad will find something for me. Indeed my dad found a book called “The Power of Positive Deviance” by Peter Block. The book explains how to become a “positive deviant”. After reading this book I was inspired to write my own list for making my clinical rotation experiences “better”. Here are some tips that have worked well for me thus far.

1. Introduce yourself to everyone. Of course, in the beginning of this internship program we were taught to always introduce ourselves to anyone we meet during our rotations. This is obviously important. But how often do we take the time to introduce ourselves to the other team members ? How often do we just walk up to someone and ask them for something, without introducing ourselves first? I’ve learned that an introduction can go a long way. Getting to know someone by asking them a more personal question is also a fabulous way of making friends, not to mention making the hospital more of a fun place to be.

2. Flying the plane: In every situation that you encounter during your clinical rotation imagine that you are flying the plane. When your preceptor starts to write nutrition intervention or assessment asks if you can help so that you can learn from them. Be reasonable and stay engaged. If it is not an appropriate time to be assertive, stay in the game mentally by asking yourself what you would do if you were making the decisions. Write down questions that were not clear and you can ask when it the time is appropriate.

3. Stand out. Standing out can come in handy in many ways. It’s not even always an intentional thing. But when it comes to making good impressions on your preceptors, nurses, doctors and patients, standing out can be a great asset. Not to mention when it comes to getting letters of recommendation down the road. Know what is unique about yourself, and use that to your advantage.

4.Smile. A smile can be worth a million words. I always try to smile at people as I pass by. When I walk past a patient’s room, even if I don’t know them, I give them a friendly smile. Obviously, there are times when a smile is inappropriate. But for the most part, a friendly smile can brighten someone’s day, make them feel more relaxed, and show them that you care. Even if you’re tired and have had a hard day, try to spread some joy with a nice contagious smile.

5. Get your money’s worth. You’re paying a lot of money to be trained and learn from your clinical rotations. Even though you’re expected to do a lot of work, you’re paying for the experience! Learn as much as you can, and remember that the point of the rotation is not to be tortured or to just “make it through.” You are there to learn, and you’re paying money for that privilege! You’ll never have this kind of experience again, so make the best of it!

My Volunteer Philosophy

By Sasha B. Bard, MSN (Dietetic Intern)

I’ve always had a philosophy that it is good to live in a place where other people vacation. Washington, DC, for example, is host to visitors from all over the world, every single day. This is one reason that I feel fortunate to call it home.

1st philosophy: It is good to live in a place where other people vacation.

I recently started thinking that a similar principle could be applied to employment and I developed a new philosophy.

2nd philosophy: It is good to work at a place where other people volunteer.

The idea came to me while completing my community rotation at Food & Friends. Food & Friends is a non-profit organization that provides nutritional counseling and delivers meals and groceries to men, women, and children living with HIV/AIDS, cancer, and other life-challenging illnesses. Food & Friends was started in 1988 with the support of 20 volunteers. In 2011, they estimated to have 11,000 volunteers.

I was amazed by the number of volunteers that I saw filter through the facility during my two-week rotation. In addition to the long-term volunteers, some who have been working at Food & Friends for more than two decades, groups of volunteers from all over the country came to lend a hand. This month is an especially busy season for volunteers because college students come to DC on “alternative spring break” trips. I had the privilege of working with students from Michigan, Pennsylvania, and Tennessee during my last week at Food & Friends. Everyone came with a smile and a good attitude. And thanks to many hands, the work was a breeze.

One of the staff members at Food & Friends told me that groups of volunteers schedule to come help up to a year in advance. Unfortunately, they even have to turn away volunteers at times because there is such high interest. This is what prompted my new theory; it must be great to work at a place where so many people eagerly work for free. How will this new theory affect my job search? We shall see! The end of the internship is fast approaching...

Meals Planned Around Vegetables

As dietitians, we often promote meal planning as a way to eat healthier and gain control of our food choices. Historically, meat has been the focus of our meals, and meal planning usually begins by choosing which type of meat we will plan the rest of our meal around. According to MyPlate and the 2010 dietary guidelines, the “protein” food group accounts for less than a quarter of your plate. So why do we make it our primary focus?

The other week I attended an all-day conference in which lunch was provided. I had to choose ahead of time whether I wanted “turkey, tuna, or vegetarian.” Since I don’t claim to be vegetarian and I was nervous about the tuna being mixed with a full fat mayo, I chose turkey.

As I ate my bland turkey sandwich that came with a side of potato chips, an apple, and two cookies, I looked over at the person next to me who had marked “vegetarian.” The vegetarian option consisted of garlic roasted eggplant, a beautiful tabbouleh salad, hummus with pita chips, and a gourmet chocolate cupcake for desert!

I suddenly wondered whether all meals would be more exiting if their main focus was vegetables. Vegetables are supposed to make up the bulk of our plates; so why don’t we give them more credit in the meal planning process? Instead of saying “what vegetables will complement our pepper crusted steak tonight?” Why not say “what protein source can complement this fresh baby spinach and cherry tomato salad?”

Is Your Plate in Shape?

By: Rachel Coury

Today not only marks the beginning of March but also the start of National Nutrition Month! In honor of our new healthy eating icon, MyPlate, the Academy of Nutrition and Dietetics decided to make this year's theme "Get Your Plate in Shape." So just how can you make sure your plate is up to par? The Center for Nutrition Policy and Promotion has released several great tip sheets on how to make your plate a MyPlate. The hospital where I am currently interning has decided to have a table in their cafeteria devoted to proper portion sizes. We are using household items to help visualize serving sizes as it can often be difficult to eyeball them. Here are some of my favorite representations:

• Baseball (~1 cup): 1 serving of vegetables
• Golfball (~2 tbsp): 1 serving of peanut butter
• Small Postage Stamp (~1 tsp): 1 serving of butter/oil
• Computer Mouse (~0.5 cup): 1 serving of fresh fruit, 1 serving of frozen yogurt
• Nine Volt Batter (~1 oz): 1 serving of cheese

National Nutrition Month is a great time for all of us to reflect on our current dietary habits and learn new tips on how to become healthier. For more ideas on how to get your plate in shape make sure to visit: ChooseMyPlate.gov.