By: Nikki Nies 
A few weeks ago, I completed my 12 week clinical rotation at MacNeal Hospital, Berwyn, IL. After recharging my batteries since that rotation, yes, it took a lot out of me, I’m able to say it was all worth it!
Prior to starting the clinical rotation, I had heard from several people to not have any expectations going in as each experience is different and every hospital’s different. To the best of my ability, I went into this rotation eager to be a sponge of learning and to take it a day at a time. I’m happy to say, ironically, MacNeal RDs and the entire hospital exceeded any kind of expectations I could have had going into this rotation (for me, no expectations means low expectation, I can’t have NO expectations!).
I learned so much, I want to share what I learned and perhaps paint a better picture of what it means to be a clinical RD.
1) I did choose the right field! Although I’m in the initial stages of my training, I’ve loved the whole process of learning, starting to “get it” and seeing the impact I’ve been able to make.
2) You’re more reliant on others than I(you) may like to admit. While a RD is considered the “nutrition expert” many of our recommendations require other departments help or inclusion for the recommendations to be carried out. i.e. If we ordered Ensure for a patient, I would physically walk down to the nutrition assistant’s office to make sure the correct flavor was in the fridge for the next meal and/or to notify the nutrition assistant of the diet change. Often times, the patient stated they didn’t receive ordered nutrition supplement or it was warm, which is very unappetizing.
Also, if calorie count’s had been ordered, one was reliant on a RN or a PCT to record the patient’s intake for the meals. To count a whole day’s calories, one needs intake record from all 3 meals, yet it was common for the night shift not to record dinner intake or only have a lunch record, which inhibited the ability of us to add up all the calories due to the incomplete data.
The most one could do was try to be present during breakfast and lunch to physically see the tray, but even with conflicting schedules and/or responsibilities, it’s not guaranteed a RD was able to get to the room prior to removal of tray.
3) A collaborative dynamic is not only crucial, but beneficial to give optimal patient care. As I mentioned before, we work alongside a lot of health professionals. Due to the current Total Parenteral Nutrition (TPN) shortage, RDs at MacNeal are not writing TPN orders, but that task is in the pharmacist’s hands. Since the pharmacist knows what’s on hand and what solutions are able to be made, it’s vital to be in constant contact with pharmacist when someone’s on TPN.
Additionally,often times, patients would transfer from unit to unit.i.e. From stroke to unit to ICU to rehab unit. RDs would follow with pt based on prior RDs recommendations and notes. It was beneficial to speak to previous RD in person to ensure clarity of patient’s current condition and for future recommendations.
With the set up of the nutrition office, it provided easy communication.
4) With enough passion and eagerness to learn, adaptability is feasible.
5) It’s unfortunate to admit how low on the totem pole RDs are in patient care. It was interesting to see how other health professionals responded to RDs presence. Not to say that RDs were disrespected, but often times people don’t know what a RD “does.”
6) Nutrition support (EN+PN) isn’t as daunting as the textbook makes it. Yes, there are a lot of considerations required and it’s a numbers game, but the more exposure and practice, I became more comfortable with ordering TF and adjusting if needed
7) Often times RDs were easily pulling 10 hr shifts+commute.It’s definitely not a 9-5 job, but one needs to be flexible with schedule and available for work at hand.
8) It’s evident patient care is #1 priority, yet they aren’t enough hrs in day to get everything done that one needs to, all you can do is your best and remember there’s always tom. You may need to ask for assistance, prioritize or delegate help
9)Learning never ends, although the rotation was 12 weeks, who knows what else I could have learned if I had continued a clinical rotation at MacNeal or at an additional hospital
As stated, I’m sure my experience was unique and others have had similar, worse and/or better experiences, but I’m happy my initial exposure to clinical makes me want to learn more about this inpatient setting. Thank you MacNeal RDs for your patience and helping me through my dietetic internship!
Other RDs and dietetic interns, what has your experience in the hospital been like?
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