healthcare

Weeks 29 – 36: The FINAL 8 in School Nutrition Management

Well, it’s been a long road, but I can finally say with pride rivaled only by exhaustion that I have COMPLETED my dietetic internship!

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School nutrition management was my final rotation, and it was an experience unlike most of the others. Something I enjoyed was getting to work with a team of managers who worked in non-nutrition disciplines. For most of my 8 weeks, I spent time with our Food Service Director, a Manager in Training, our Associate Director, and worked closely with our head chef and catering manager as well. My rotation took place at San Francisco State University.  As I may have explained in previous posts, my internship was completed (love putting that in the PAST TENSE!) through Morrison Chartwells, a subset of Compass Group. Compass Group has a multitude of sectors, which provide food and nutrition services to establishments from hospitals, to schools, to business and industry settings. Morrison is the sector of Compass that serves healthcare establishments, which is where I did my clinical rotations. Chartwells is the sector that serves schools (and Chartwells Higher Ed, to further categorize, serves college campuses). My experience was unique in that I was working with Chartwells Higher Education, which works on college campuses – most other interns in my program were rotating in K-12 Chartwells accounts.

 

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Now that that’s out of the way….

 

My school nutrition rotation taught me a lot about management, and working with a team in which you are often the sole nutrition representative. I did have the opportunity to work with the Regional RD, Laura, who oversees Chartwells Higher Ed accounts. However, this was a long distance relationship, and  Laura did not have a scheduled trip out to SFSU during my time there. She was always available by phone and email, and was a large part of my learning experience in this rotation. Not having an RD present at the site on a daily basis taught me many times over to be proactive and independent.

Chartwells at SFSU incorporates a concept called Balanced Kitchen, which I was so excited to be a part of. Balanced Kitchen focuses on wellness on college campuses. At one point, I conducted an audit to ensure the dining center was meeting the wellness criteria for this concept – and our SF State champs did very well! I remember being a freshman in college, and staying well with healthy foods was such a challenge. It is great to see higher education moving in a direction that promotes the importance of a healthy lifestyle.

 

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Some of the criteria for Balanced Kitchen (aka Balanced U), and what the dining center strives to promote.

 

This was a project-centered rotation. In these 8 weeks, I think I completed upwards of 10 projects – and all of them took some serious time commitment! Some highlights:

 National Nutrition Month Activities:

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Me, beaming in the presence of my food models. Typical.

 

Nutrition Educations:

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Weird shadow on my face… But here I am giving a lesson on eating local and seasonally. My favorite educational tool right now is my local foods wheel. Ask me where you can find one!

 

Participation in Sustainability and Real Food Events:

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IMG_7790 A real local food-focused event!

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Put on a Farmer’s Market

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Enjoyed soo much delicious local produce.

 

Stress Reduction Fair:

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Focused on how to use good nutrition to keep stress in check! So much fun talking to students – and I met someone I’ve communicated with in the blog world! Amazing.

 

and Staff Trainings, and Food Service & Sanitation Audits (not pictured, because not that exciting – bein’ honest, folks).

 

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By the end of my rotation, I had made some strong connections with Compass employees at SF State, and I feel this rotation was the best opportunity to get to know some of the higher-ups who work for corporate! Getting to know some of the big wigs who manage entire regions was not only inspiring, but also allowed me to make an impression, shake some hands, and learn more about Compass as a whole.

 

As this blog is about honesty, I don’t want to leave out how much I struggled to get through this last rotation. With 8 weeks standing between me and RD eligibility, the to do list seemed forever impending. It’s not that the rotation was extremely challenging – I have been SO grateful to be done with clinical, and the stress level was NOT THE SAME here. But I did feel often paralyzed when I looked down at the list of projects to complete, and it even took me a few weeks to get started on some. But as of posting this, my assignments are COMPLETE, and I am awaiting the OK to sign up for my RD board exam (eeek!). This is a good reminder for me that it will all get done if I work toward it, but I have to remember to stay calm, get focused and organized, and just keep moving forward.

 

Well, folks, that wraps it up! Thank you to everyone who continued reading through my experience! I hope I was able to shed some light on the experience of dietetic internships for those of you embarking on this path. If you have questions, or just want to let me know how I’m doing (or how YOU are doing), please drop me a line below, or shoot an email over to thenourishedsoulblog@gmail.com.

 

This may be the end of my 1240+ supervised practice hours, but don’t you worry – there is still plenty of living, studying, and trying not to have panic attacks that I’ll be continuing to write about. Stay tuned, beautiful people! The best is yet to come over here.<3

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Weeks 23-28: Long Term Care and Community Nutrition

 

 

Every time I realize my clinical rotation is completely behind me, I feel completely shocked. Clinical rotations were something I had been anticipating since I came to understand what exactly happens in a dietetic internship. I am so excited to be moving down this path so quickly, and can’t believe the speed at which it’s flying by.

 

Immediately after my clinical rotations, I began the next two weeks in long term care, at a place called St. Paul’s Towers in Oakland, California.

 

Long Term Care: St. Paul’s Tower’s, Oakland, CA

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Older picture, but it’s still this HUGE!

 

St. Paul’s Towers is what is referred to as a Continuing Care Retirement Community, or a CCRC. By definition, CCRCs offer living facilities across all levels of care, which include independent living, assisted living, and skilled nursing (aka SNF). Here is a link to a basic description of each level of care: Long Term Levels of Care.

One of the jobs I worked before starting my dietetic internship was as the Dietary Director of a skilled nursing facility. With this under my belt, I felt I had already gained a fair amount of exposure to the job of a dietitian in a long term care facility. As it turns out, I was correct, but of course had volumes more to learn.

Fortunately for me, St. Paul’s happened to be going into mock survey during my first week there. Mock survey is something that, to those with a bit of knowledge of regulations in skilled nursing, sounds very scary, but is actually a positive thing. To start, I will explain the dreaded SURVEY. Every skilled facility has a survey “window” – for example, the SNF that I worked at had a survey window from April through July, if I recall correctly. What this window means is that any time during these months, surveyors who are usually sent from the state or federal level can show up at a facility and will audit everything from nursing to medical records to dietary and nutrition, looking for any errors  — anything at all you’ve done incorrectly or inadequately over the last year. So, survey itself is definitely SCARY. But MOCK survey is a company’s way of preparing for the true surveyors. During mock survey, the overarching company that runs the facility will send their own representative to audit all of these areas, and act exactly as a surveyor would. It is still terrifying, as each department (very much including nutrition) is looked at on such a microscopic level, that you can basically expect that any mistake you made over the last year will be found, addressed, and acted upon to correct. But, while this induces every self-critical voice in a young dietitian’s mind, mock survey is a good thing, as it is not put in place to get everyone in trouble, but to catch mistakes and assign them a plan of correction before the actual survey happens. Because the thing about a true survey is that if they catch too many mistakes, or just a small number of mistakes that show to cause harm to a large number of residents, the facility can have major penalties, and even be shut down completely.

 

So, it was great to have exposure to this process. When I was at my SNF about a year ago, I never had the… pleasure… of undergoing survey – but we were all constantly on edge, prepping for them to walk through the doors at any moment, so I was familiar with how to prepare for a survey. But getting this additional opportunity to hear everything from the preparation phase through the exit conference where the mock surveyor shares all of her findings with us was very beneficial.

 

A large portion of the week was spent shadowing and observing, but I also got a ton of hands on experience doing kitchen audits, dining room observations, and clinical assessments. My favorite part of my 2 weeks here was how creative my preceptor liked to get to bring a little extra joy to her residents. Mondays she took a little time to make hot chocolate and deliver a cup to any resident who was interested. One day per week she also would deliver fresh baked cookies to each resident. All of these practices that the RD implemented were a great way to add a little excitement to each week, boosted morale for employees (who got sweeties too!) and also acted as a great method for sneaking in some extra calories for those residents experiencing difficulty with weight maintenance!

 

Overall, my Long Term Care rotation was a great experience, and allowed for some unexpected new exposure. Next up was Community Nutrition at WIC!

 

Community Nutrition: WIC (Women, Infants, and Children)

The day after LTC was completed, I jumped in my lil’ Kia Sportage, and enjoyed a solo roadtrip down the California coast to spend the next 3 weeks at Normandie WIC near downtown Los Angeles. WIC is a supplemental nutrition program that serves low income families, assisting with food and providing nutrition education and counseling. The program serves pregnant mommies-to-be, and continues to assist as long as the family remains eligible until the child is 5 years old. Additionally, if the mother miscarries, services are still available up to 6 months after end of pregnancy. Different food packages are provided to these families, a picture of which is below (my WIC rotation was done in California – this is a picture of Florida WIC’s food packages, but they are similar):

 

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Supplemental Food Breakdown

 WIC will provide supplemental nutrition for the mother while she is pregnant, and will continue to do so after her pregnancy if she is breastfeeding. As the image above indicates, food packages vary based on whether the mother reports she is completely breastfeeding, mostly breastfeeding, or only providing some breast milk, or none at all.

 

WIC provides special WIC checks which can be used at participating stores for to obtain these foods. Participants can tell if a store will accept their WIC checks by looking for this image:

 

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During this rotation I learned so much more about the challenges that come with breastfeeding your child – although at the same time, I was reminded of all the incredible benefits both mother and baby receive when breastfeeding is made a part of the child’s first year. I was so happy to be reminded of the preventative benefits of breastfeeding, like decreasing disease risk and risk of obesity and cancer for both mother and the baby. Additionally, the emotional bonding that occurs between mom and child from skin-to-skin contact is truly amazing. And, of course, the nerdy nutrition girl that I am, I would be remiss not to mention the nutritional benefits of breastfeeding right away. WARNING: If you do NOT wish to get nerdy with me, please skip ahead to the next paragraph. Hello? Anyone left? Awesome, I knew I could count on you… So, later on in pregnancy, the mother’s body does begin to produce breast milk. However, the milk at this stage is what is referred to as colostrum – it is a substance that is a bit more yellow in color, and is made up of mostly protein. When you feed your baby right away with this early breast milk, they tend to see an array of benefits. Also, it just so happens that the nutritional makeup of colostrum is just EXACTLY what the infant needs at that early stage of life – now it’s pretty hard to dispute nature in all her perfection, am I right?

 

Now, if you’re just joining us, let me assure you of what a fun time we had in science land…

 

During this rotation, I was required to be very proactive in making sure I got the experience I needed/wanted. It was difficult to gain hands-on experience with counseling and educations due to a few limitations. Firstly, I did not have access to the computer charting system, since I was only at this site for 3 weeks. The computer was pretty imperative in conducting a counseling session, so most of what I did was observation, while providing input when it came time to conducting educations. The second and very significant challenge and limiting factor here was the language barrier. With only 3 years of high school Spanish under my belt, I knew I would not be able to have intellectual conversations about nutrition, nor convey all the information and passion I normally feel capable of communicating. I had been warned that when working at WIC, it is HIGHLY beneficial to be bilingual (at the very least), but I must have underestimated just how beneficial. It took me a few DAYS to be able to even observe anything because everything was being conducted in Spanish, Armenian, Russian, or Korean (and then some…). It was only later in my rotation that I mustered the confidence to decide that I could at least observe in Spanish, at which point I learned that I had a basic enough understanding of the language to at least follow along (although I was correct in feeling I could not communicate on my own…).

 

Given these significant limitations, a lot of the benefits that came from this rotation came in the form of projects that I asked my preceptor to be a part of. I requested to be given assignments, like creating handouts, which I could work on during the day as I was waiting for a counseling or education class in a language I could understand. During the course of my 3 weeks, one handout I created deals with what is safe to eat during pregnancy.

I also got to work on a presentation that I gave to the staff on my last day on a topic of their choosing. The staff requested dietary carbohydrates, weight loss, and calories in food – so I chose to address carbohydrates, and encompass the other two within.

A link to both of the projects is availabe on my online portfolio (click it, click it!!!).

My WIC rotation was a nice break from the hustle that was my clinical rotations. And I so enjoyed my time in Los Angeles, where I got to experience being a nutrition professional in my hometown, and got to spend three whole weeks with family and old friends.

 

Reminder from Mom...

Reminder from Mom…

Surviving 3 weeks of LA traffic, and remembering to BREATHE

Surviving 3 weeks of LA traffic, and remembering to BREATHE

Spending time with some of my oldest friends...

Spending time with some of my oldest friends…

...and the best family.

…and the best family.

And takin' in all the beauty.

And takin’ in all the beauty.

After WIC, it’s hard to believe, but I’m on to my next and FINAL rotation: School Nutrition Management. With about three weeks left at this point, you can expect the summary of that rotation shortly.

 

And a QUICK NOTE to those of you who went through the dreaded DICAS match these past few months: if you matched, CONGRATULATIONS! It’s an incredible accomplishment, and you have many challenges and some incredible learning experiences ahead of you.

 

If you didn’t match, just remember how AMAZING you are. As a reminder, I did not match my first time applying either. And as it turns out, not matching put me exactly where I need to be in my life in so many ways. If you’re lookin’ for a pick me up, check out this post I wrote the night before my first, unsuccesful match, and reposted a year later. And if you just need to remember that the world is good, please view this Buzzfeed post on baby elephants learning to use their trunks — I promise it will at least make you smile.

 

Thanks for tuning in, everyone. And stay tuned for my next and FINAL post as a dietetic intern!

 

Love Yo’self.

Week 1: Orientation

Week 1 of my dietetic internship has officially been completed. This past week has been filled with too much information, not enough sleep, and some seriously tasty Southern BBQ (note: if ever in Atlanta, go to Bone Lick!). I also had the opportunity to meet and get to know my incredible fellow Morrison Chartwells interns. While there is some sadness about having to leave, and not getting to spend more time with new friends, I have no doubt that we will remain a strong support system for one another.

Here, an abridged recap of the week:

Day 0: My flight arrived into Atlanta from San Francisco at 9:00pm Monday night. Completely out of chronological whack, I remained awake late enough to meet my roommate for the upcoming week as she arrived around 1am (which felt like only 10pm). After some extended introductions, we turned in, both eager and terrified for what the week had to bring.

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Ready to go…

Day 1: The morning went leisurely, as we did not begin orientation until noon. Little did we know how much we would long for the liberty of having those morning hours back throughout the week. Our first day was… let’s face it… basic and boring. All logistics–things we all know, but need to hear again. Adjourning at 5pm, my roommate (who I already miss!) and I joined some of her local friends for a Braves game (they won! … don’t shun me, Dodger fam), and the BEST BBQ and jalapeño-bacon mac & cheese I have EVER had. My introduction to the Southern United States did not disappoint.

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Outfitted in Business Cas for Day #1

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Still surreal…

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Everything in moderation–including beer!!

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OH! And did I mention they put us up on the JUMBOTRON??? All we had to do was agree to air guitar when relief pitcher Kimbrel walked onto the field, as Welcome to the Jungle was played. Check out the video here! Embarrassing? Yes. Worth it? Totally.

Day 2: Wednesday captivated our interest just a bit more–and also managed to spike our cortisol levels significantly. Today we learned more about our School Nutrition Management rotation, of which I will personally not have the pleasure until mid-February. Chartwells is the sector of our overarching company (Compass Group) that oversees K-12 school accounts. Throughout the day we heard lectures from a number of accomplished (and YOUNG!) people in the field of dietetics who happen to be a major component of the Morrison Chartwells program. We were introduced to the inter-workings of the company, and taught who does what from Directors to Regional RDs to Resident Dietitians. We had the pleasure of being introduced to the Morrison CEO, followed by an introduction to the Cornell Plate Waste Study through the university’s B.E.N. (Behavioral Economics in Child Nutrition Programs) Center in which we will be participating. Cue 35 Type-A stress-induced heart attacks. As we learned about what would be involved in this study, and what our responsibilities would include, many of us began to panic at the sheer magnitude of information we would need to be collecting. The study basically focuses on how much food is being thrown out in schools across the country. After a solid hour-and-a-half or so of rapid-fire questions, and confusion-inducing answers, we were reassured that, as important as our contributions were, we were but a “data point” on the B.E.N. Center’s graphs, and an error did NOT in fact indicate epic failure. After learning as much more as we possibly could about our School Nutrition Management rotation, we headed back to the hotel to freshen up for a group dinner at Sage. We looked forward to some fun after such a rough day!

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Our yummy desserts… And the “Sage” in the olive oil above is written in Balsamic!

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Me, with the best roommate ever!

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Day 3: Thursday was the day I both looked forward to and had been dreading. It was the much anticipated CLINICAL NUTRITION DAY! Bright and early at 7:30am, we all met at the office, and began guzzling down mediocre coffee (sorry, Compass group–it is what it is). Each of us had worked LONG hours completing to the best of our abilities four clinical modules: General Medicine, Cardiovascular, Endocrine, and Renal. Although a thorough review was expected, we were greeted with a game of clinical nutrtion Jeopardy instead! Fortunately I am a total Jeopardy (and nutrition) NERD, and didn’t mind this at all. We concluded the day with FOUR HOURS of information from Abbott Labs, the company who provides many of the enteral nutrition (tube feeds) and supplements that are often used in clinical as well as non-clinical settings. Some of the products we learned about and/or had the opportunity to taste included Ensure (we tried Clear and Complete), Glucerna, Vital, and Pediasure.

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Above squiggly line: end of day. Below: new day. The difference between tired and awake.

We adjourned slightly early around 4:30pm, at which point most of us headed out to the vans that had been transporting us throughout the week. I stayed after for what I thought would be a few minutes to chat with the internship director, Karen. Unfortunately, a situation arose that could have been easily avoided with the implementation of the BUDDY SYSTEM, and I was left behind!

Karen politely offered to take me back to the hotel, and it turned out to be a great opportunity to get to know my director a bit more in the short time we had together.

That evening, four other interns and I decided to experience Atlanta the best we could during our limited stay; we hit the town with some friends of one of the interns, learning some more about the city’s delicious food and nightlife!

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A beautiful Southern evening.

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On our way!

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5 of us at a great taqueria–amazing fried pickles and jalapeños!

Knowing how much we might regret our decisions to be out late the night before our travels home, we gladly owned our choices, and arrived back to the hotel just in time for a solid 4 or so hours of sleep.

Day 4: Our FINAL DAY commenced around 6:30am, as we needed to pack our bags, check out, and make it to the office in casual Friday wear for some last-minute information by 8:00. After scarfing down my last complimentary breakfast (courtesy of Staybridge Suites), we crammed those of us remaining at the hotel into a van along with each of our sets of luggage, and enjoyed one last ride together.

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Still unclear on the reasoning for limes at the breakfast buffet, always next to the coffee… Insight, anyone?

We learned about our Long Term Care rotation, and had a nice long lecture on wellness coaching and motivational interviewing. We were able to close things up early around 1:30pm or so, at which point we all said our goodbyes and migrated to MARTA (Metropolitan Atlanta Rapid Transit Authority) to head toward the airport.

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On the way we got a solid last peak into the ways of the urban south, as we were graced with a man shouting the gospel at us on the train (rather inaccurately, per my friend who knows the Word pretty solidly). Fortunately, we were all rescued by this guy:

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We made it to the airport, and said last goodbyes as we boarded our respective flights, and I prepared for the long hours I would spend sitting in a seat in the sky.

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I like to make fun, but seriously SO GLAD I bought this…

After a long half day of travel, I finally made it back, safe and sound, to my very favorite place: home to San Francisco. I have wrestled with some regret over applying to a distance program, and feeling as if I may be missing out on the “real” dietetic intern experience. But after this week, learning what an incredible program I am lucky to be a part of, I could not be more excited to get to remain in the first place I have truly loved living, and have felt as if I fit. I love this city, and all of the diverse experiences it offers. Sorry, San Francisco–you’re stuck with me!

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And made it home just in time for the uncharacteristically beautiful weather! And also for a date night with my favorite guy on the planet :).

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Sandals? What??

Now, time to get myself re-situated, and ready to begin my clinical rotation at Alta Bates Summit Medical Center in Oakland TOMORROW!

Stay tuned for updates on what I am sure is to be an eventfully crazy week.

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Great group! Morrison Chartwells 2013-2014

P.S. My Instagram is @realfoodisthebest. Follow for more like this blog!