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
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):
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:
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.
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!