two down, ONE to go!

We were on campus again today, which marks the start of our FINAL rotations before we’re finished. T minus 38 days until graduation…it’s getting real, folks. Seriously.

I am, however, seriously dreading my 5:30 a.m. wake-up for the next 4.5 weeks to be at Buffalo General Hispital at 7, but at least it will be the warmest and brightest (well, if spring will ever arrive) of my rotations.

I spent the last 5 weeks learning the ropes at a long-term care facility (a.k.a. nursing home), and doing what felt like never-ending projects. I researched freelance writing opportunities, wrote blog posts, got involved in the Western NY Dietetics Association, wrote a script for a couple food-related segments for the campus television station (we film next week), made a plan to revamp the blog (more on that later), and wrote a 23-page business plan. And I’m sure I’m forgetting some others. I also had a job at the campus health center and provided nutritional counseling to students on Wednesday afternoons; now that I’ll be at the hospital all day, another student is taking over. We got paid as ‘student assistants,’ but this could lead to an actual part-part time counseling position this fall when we’re actually RD’s. We’ll see.

I think my favorite project this past rotation was my business plan, despite it also having been the most work. I designed a business in which I provide nutritional counseling at a local wellness center and can accept insurance reimbursement. It’s something I could definitely see myself doing. Again, we’ll see.

Hittin’ the hay early tonight, 5:30 comes early…especially when you stayed up the night before watching the season finale of The Walking Dead!

ECMC

Welp, my first rotation has come and gone, and I’m just now getting to blog about it. Can we say BUSY much?!

Between ‘working’ at one of our local hospitals and keeping my gym schedule, I was doing 12-hour days all week. So this is what a real job is like…

As a re-cap, I’m in my LAST semester of my LAST year, (PTL) which is broken into three month-long rotations. My first rotation was my ‘senior practicum,’ in which I shadowed a Registered Dietitian. Many of my fellow students chose specific areas of practice, such as pediatrics, long-term care or Bariatric Surgery. I chose to work with one of our existing preceptors at Erie County Medical Center in a more general hospital setting. Because I’m not planning to work full-time in acute care, I wanted to make sure I got some clinical experience before graduation. I worked with Jennifer Oswald, RD, on her medical and surgical floors, as well as some ICU work with another RD.

A typical day started with Jennifer giving me 4-5 patients who needed new assessments or follow-up assessments. Because there aren’t extra computers in the nutrition office, I usually wandered up to one of the floors and grabbed a computer at the nurses’ station, where I looked up each patient in the Electronic Medical Record and began charting.

After beginning their assessments, which included information such as their diagnosis, past medical history, lab values, medications and current diet order, I would track each patient down in their rooms and ask them a few questions. Most of the time, I discussed their allergies, GI function, last bowel movement, nausea, vomiting, diarrhea, constipation and intake prior to admission.After I saw each patient, I’d go back to a computer and finish writing up the assessment and provide a recommendation, such as:

“Recommend Heart-Healthy diet with Ensure supplement 2 x day. Monitor: PO (by mouth) intake, weight, labs/lytes, skin, BM, hydration.”

On one of my last days, I did a test tray from the kitchen. ECMC is beginning to implement an ‘on-call’ system for the kitchen, which is like having a short-order cook instead of set meals that go up on trays at specific times. I ordered an egg salad sandwich with chips and fruit. I checked the temperature of the hot and cold items, and filled out a questionnaire about taste, texture, appearance, etc…While at ECMC, I accompanied Jennifer to her outpatient counseling sessions on Wednesdays. I really like outpatient counseling, which allows you to go much more in-depth with each person and individualize the session to their needs. I also made a ‘craft’ to display nutrition labels for teaching:Overall, I was very pleased with my rotation. I was able to get a lot of clinical experience with both general medical and surgical patients, as well as those in the ICU and on tube feeds. Additionally, I was able to get some outpatient counseling experience. I absolutely HATED getting up and out in time to drive into Buffalo in the mornings (in the worst weather EVER), which just solidified the fact that I do not want a full-time, in-Buffalo, hospital job. It’s just not for me. I hated being away from the house ALL day long. I did, however, surprise myself with how much I liked the clinical atmosphere and the ICU. I could see myself working 1-2 days a week in a clinical setting to keep my skills sharp, but not full time.

mid-semester freak out

Yup, we’re there. All of us. All sixteen of us in the program are just balls of stress right now, for one reason or another. One girl’s dad has been in and out of the hospital for months now. Another girl–a dear one to me–is going through a break-up. Another is juggling multiple out-of-town trips this month, which tend to wreak havoc on school. Yet another has been in TWO car accidents in a week–neither of which were her fault. My carpool buddy just found out her senior practicum, the 5-week rotation we plan for ourselves in the spring, just fell through and now she has to start from scratch. All of this, in addition to working part-time jobs, dealing with boyfriends and families and kids and such.

I’ll say it again–going back to school is not for the faint of heart.

While this semester so far seems worlds better than last semester (the one in which I tried to hit the gym every morning at 5:30 yet didn’t go to bed early and thus crashed and burned halfway through), it’s certainly no walk in the park. We’re 6 weeks in (praise God!), yet I haven’t been able to stick to a bedtime (I have yet to get more than 6 hours of sleep, and lately it’s been more like 5), or the KISS eating plan of chicken and veggies I kept thinking I’d implement. Thankfully my workouts have stayed pretty steady, thanks to my pretty awesome schedule, which is probably the only thing keeping me sane right now. I’ve barely cooked a ‘real’ meal (oh well), barely baked anything (probably better for the waistline), and just realized I haven’t updated our dry-erase calendar from September to October yet…if I wait much longer, I might as well just go ahead and put November up there!

This week in particular has been a banner week in the Layer house. Due to evening engagements, Andrew and I have taken to corresponding via email–me writing to him in the a.m. while he’s still asleep and him replying (if I’m lucky) during the day. Other than yelling ‘goodbye!’ as I leave and a few phone calls and glimpses of each other, we pretty much roll into bed at night and manage to say ‘hello’ and ‘goodnight.’ It’s that kind of week.

But, on a positive note, school really is amazing. I’ve never felt more interested, excited and confident about what I’m doing. I absolutely LOVE walking around the hospital in my white lab coat, reading about my patient in the electronic medical record, and then coming up with their nutrition diagnosis. I just come alive when I do patient education–it’s so second-nature to me. We had a workshop yesterday on tube feedings and I loved it. We learned how to calculate the rate of a feeding and how to recommend everything. I’ve also got my senior practicum set–it will be clinical–and it’s exciting. I’ll get to experience both in-patient and out-patient, bariatric and general patients, as well as spend time in some of the ICUs and hopefully oncology and transplant units, too. I definitely did not anticipate this, but I’m so glad clinic has proven to be a good experience. Who knows what I’ll end up doing after I graduate at this rate?

On another positive note–it’s FALL and I’ve been stocking up on all the fall-scented goodies at Bath and Body Works like crazy! (Gotta love those coupons.) I’ve completely outfitted my gym bag with all the necessities, and used my ‘pumpkin pecan waffle’ shower gel at home yesterday. Amazing. I’ve never been more hungry taking a shower in my life.

With the long weekend, Andrew and I are looking to get some R&R, and hopefully I’ll have some time to catch-up on school work and start the week off right next week–AND implement that earlier bedtime routine!