Whew! My Friday work day had me falling asleep before 9 pm!
Going into Friday, we had to leave a few things to be determined. With two dietitians off, working through the weekend since it was a Friday, and a full outpatient schedule, we decided who was seeing who as the day went along. I was given inpatient initial assessments and inpatient educations at the start of the day. I greeted the work happily because I love being able to sharpen my inpatient skills! My cardiac rehab hours started in an hour though but I dug deep into my memory and recalled my 9 am slot wasn’t filled so I’d head over for the 10 am.
I was able to see three out of four inpatients before dashing off to cardiac rehab where both my 10 am and 11 am patients were waiting for me. My poor 10 am patient kept being interrupted with my pager. When I would ignore my pager, a nurse would slip into the office to give me a note to call a clinician. I apologized to my patient over and over and explained that this never happens and that I’ve covering various things today. As soon as I saw both of my patients and answered questions for another patient at rehab, I trekked back to my main office to squeeze in a 10 minute lunch before seeing my outpatient. My one outpatient turned into three outpatients to reduce the work load of the other dietitians.
As soon as my third outpatient left, I raced over to the hospital to see my last inpatient. They were down in lab-darn it! That’s generally what happens when you try to do both inpatient and outpatient. I walked over to my office to start charing on the inpatients. I was so relieved that I took detailed notes from the patients that I saw 8 hours ago! Once I charted on all 4 patients, I grabbed all three outpatient charts and the notes that I took on them. I finished a half hour after “quitting time.” I had my coat on and keys in my hand when I realized I forgot to enter a patient snack. I logged back into my computer and Meditech to send the order through. I figured since I was focused on the patient that I would double-check with the diet office about another special order for them. After that call I finally headed home. I will say that the day did go by fast and that I felt accomplished!
I went home to change out of work clothes and then met the boyfriend down at the local brewery for pizza and beer. I had my favorite vanilla cream ale!
People who aren’t crazy about beer will usually do this beer and enjoy it. I’m really waiting for their holiday spice beer to come out!
We ordered a pizza that we ate while being entertained by a one year old. No picture of either-sorry!
What felt like 10 pm was only 7pm when we left. Next on the agenda was to watch The Nightmare Before Christmas. I added it to my que after the boyfriend kept talking about wanting to watch it before Christmas. I had seen it before as a kid but it always scared me so I never could watch the whole thing. ( I’ll admit that Disney movies even scared me as a kid.) I managed to stay awake with needing to be nudged only once as my eyes were taking long blinks. Once it was over and the clock read 8:30, I was out for the night after my busy day.
This morning I woke up and was ready for a bowl of oatmeal and a run.
I had pumpkin oatmeal with raisins, cinnamon, honeycrisp apple, brown sugar, and sunflower butter. It stuffed me to the brim which means I need an ample amount of digestion time before my run. Running during the work week is difficult since it’s dark by the time that I leave work, so I’m eager to get out there before the weather turns cold.
Being a registered dietitian…
You’ve already studied and passed an exam that covers: food science, food safety, nutrition composition of foods, nutrition and support services, nutrition care process (assessment, diagnosis, intervention, and monitoring and evaluation), counseling and communicating, education and training, research, menu planning, foodservice purchasing, production, distribution and service, safety and sanitation, facility planning, human resources, finance and materials, marketing products and services, functions and characteristics, and quality improvement. The topics are all over the board.
After taking the CDR exam, most dietitians lose a large percentage of knowledge (no, I can’t give you every step of glycolysis off the top of my head anymore) and facts due to their specialty area. A dietitian who specializes in dialysis usually cannot complete a tube feeding order in minutes with 100% confidence. You wouldn’t expect your cardiologist to deliver your premature twin babies, would you? Asking a dietitian to do something out of their specialty may mean they need to refresh on that topic. We’re under a code of ethics that requires us to acknowledge when something is out of our scope of practice. You won’t find me conducting an eating disorder outpatient appointment any time soon because that’s beyond my scope of practice. Knowing what is out of your scope of practice makes you a good dietitian.
Dietitians don’t know about every food out there and cannot give the exact caloric amount of each food. It would be quite a waste of memory to know how many calories are in every food. We have too many reliable sources to determine that. Patients often ask me about new processed foods that I’ve never heard of before, so I teach them how to read the food label to assess the nutrition content. Patients will ask me about a certain (fad) diet. Do you know how many fad diets are out there to keep up with and how many more important things there are to keep up with? That’s what I don’t know about every non-ADA diet programs.
Dietitians don’t know what every food box looks like or know what each pill color and shape is. Patients sometimes tell me that they take the red pill. My thoughts, “Um..the red pill?” I have come to figure out that they usually are referring to metformin, but I still can’t assume that all the time. When I ask what milk a patient drinks, I often am told the color of the milk cap or vitamin D milk (almost all milk is fortified with vitamin D). And I sometimes am told about a peanut butter with a green cap. So my comment on Eat, Live, Run means, I wouldn’t be able to identify the description of a dried milk box if a patient were to be describing it by package looks alone. I am able to recommend how to use dried milk especially to gain weight though. I mean, I recommend Jevity for tube feedings but wouldn’t be able to tell you what the bottle looks like since they nurses hang it, but I still know the nutrition content and appropriate usage of it.
Happy Saturday. My digestion is under control after this long post!
Well spoken….er, typed… on scope of practice
Thank you!
There is a big difference between Jevity – medications administration by medical professionals – and something like evaporated milk. That’s a poor and pathetic excuse.
As a professional, you should learn to research and determine for yourself what is best for each INDIVIDUAL patient. Recommending a certain food or product to an individual to gain or lose weight without really knowing much about it is ignorant. Just because a professor or textbook or the internet tells you that means nothing. If we listened to the “norm” or the information I was given in my college Nutrition courses, then the focus would still be on low-fat diets. Although low-fat is fine, fats are not to be feared. (This is just an example).
Personally, I would be pissed if I went to a R.D who gave me the same generic crap I can learn for myself such as “Drink Ensure!” or “Cut back on carbs, (insert) whatever to lose weight.
It’s akin to an athletic or physical therapist telling their patient to do a certain stretch or exercise to help with an injury because that’s what they learned in school – but they actually don’t really know what the stretch is or what it involves.
Didn’t you just re-enforce what I just blogged about? I’ve been blogging about individualizing nutrition education/counseling to the specific individual. And I again covered that I know what dried milk is, I just couldn’t describe the box that it comes in. You wouldn’t be pissed with me if you had an appointment with me because I spend usually at least 15-20 minutes getting information from the patient before recommending anything. Glad we have the same approach towards this topic.
Evaporated milk isn’t the same thing as powdered milk. I think what you’re talking about is adding powdered milk to regular milk to increase calorie intake without increasing volume. Evaporated milk is kind of like condensed milk only I think it doesn’t have as much added sugar. At any rate, it comes in the same kind of can as condensed milk. Just thought you should know the difference in case you want to continue recommending this to patients.
Thanks Julie. I am aware of evaporated milk since my mom used it when I was younger. My patients would probably love to add that stuff to their food! I usually tell pts to add powdered milk to pudding, soups,mashed potatoes, etc.
I’m not a dietitian, but I do know that evaporated milk and powdered milk are two different things. I also know that most powdered milk is skim milk, so why you would recommend something with no fat to patients who are trying to GAIN weight is beyond me.
Sarah thanks for inquiring. I do know the differences between the two as well. Again I meant to state that I wouldn’t be able to describe the box of dried milk (as in what color or design to look for) rather than not knowing what it is. Also I don’t recommend pts to drink dried milk. I recommend to add it to foods such as pudding, cottage cheese, cream soups for additional caloric intake to what they are already eating. That’s one recommendation that I may give for wt gain.
With all of my schooling, internship, continuing education and work experience i can back up reasoning for all of my recommendations. I don’t give advice on things that are out of my scope of practice.
But the Eat, Live, Run post was about evaporated milk. And in that comment you said that you didn’t know what it looked like and were recommending it to patients. Did you just change what you were talking about? I think that’s why people are confused and asking questions.
On ELR I typed evaporated milk and did in fact mean dried milk. I’m usually doing 7 things at once in the morning and didn’t type the right milk. Don’t worry at work I’m not multi tasking like I was while typing “evaporated milk.” Thanks for pointing that out Julie.
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