I'm about to finish my 1st of 4 weeks of staff relief and things are going better than expected. As I sit here writing this blog, I feel my heavy eyes attempting to close. My days are slammed-packed and I have a lot of responsibilities from 8am until 5 or 6pm.
I start my day looking at my unit and I print out my task list to see what patients I need to see for the day. I see patients based on Length of Stay (5 days in the hospital), database referrals (for wounds, eating problems >1 week, wt loss), RD nutrition consults (ex. failure to thrive, decubitis/ulcers, diet education, etc.) and clear liquid diets >5 days. I then make my list of patients to see which is typically around 8-10 patients. Because I am covering a unit for another dietitian, she would typically see my unit, in addition to two other units, so my 8-10 person task list (which takes 8-10 hours) is nothing compared to 15 or 20+ patients that the other dietitians see per day.
I then make my way upstairs and start my day by reviewing charts (physician orders and MD notes/progress notes, flow sheets) and the clipboards (which contain medications from the MAR, current flow sheets, the database and the skin sheet). It can often be a struggle to find and keep a chart when there are a dozen other people wanting your chart. The docs get the final say-so so I often have to turn over my charts when a doctor asks for my pt's chart. So when that happens, I stop what I am doing and try to find another chart for another patient.
Once I obtain the necessary info for the patient, I talk to the nurse to see how she/he has been eating and any other info that is necessary for my note. I then visit the patient to discuss specifics that will help my assessment/follow-up and to plan my interventions.
I will always ask about vomiting, diarrhea, constipation, diarrhea, any food allergies, current appetite (poor, fair or good), and difficulty chewing or swallowing and in the case of a follow-up, he the patient is tolerating tube feeding (typically the nurse tells me that) or supplements. I also ask about usual body weight, any recent weight loss/gain and anything else related to food, appetite and weight. Talking to the patients is my favorite part.
Often I have to gown up (with gloves) if the patient has MRSA or sepsis or another infection.
Once I gather my data I sit at the computer, look of the H&P to gather past medical history and the reason why the patient arrived at the hospital (I like that part as well, always an interesting story). I then look up labs (ex. hemoglobin, hematocrit, albumin/prealbumin, sodium, potassium, BUN, creatinine, A1C, glucose) and I am finally read to star my note.
I have a paper where I keep track of all the info so that I can properly type my note and address all issues.
I type my note on a program on the computer but I do my calculations (ex. figuring out estimated protein, calorie and fluid needs based on ht and wt as well as disease process, labs or tube feeding formulas) by hand on my paper. I have finally learned the proper lingo for an acute care dietitian (although I still get corrected here and there for better ways to saying things) and I feel much more confident with my interventions.
I can't believe how far I have come in the past 9 weeks at St. Vincent's Hospital and I have learned more than I have ever thought I would learn. This 3-year journey has been filled with lots of busy and exciting times but I have never felt so overwhelmed as I do right now. As stressful, time consuming and exhausting as it is to be in staff relief, taking the necessary steps to become a Registered Dietitian has been one of the best decisions in my life. I am so happy that I didn't postpone this decision for later in life and most of all, I am glad that I did the right thing to pursue the dietetic route in order to be qualified to give and prescribe nutrition advice.
3 more weeks to go...OMG, this is a super exciting time in my life and I can't believe it is finally coming to an end!!
Thanks for believing in me and for supporting me!