Clinical Nutrition · Life

a day in the life

I get asked very frequently by people who are interested in becoming dietitians or who have no idea what I actually do, “So what does your day look like?” For some reason, it’s always a challenge for me to describe my day. Usually, I try to explain that every day is different, but it’s also the same. Confusing? Basically, what I mean by that is that the work flow of every day is the same, but either my patients are different, or the needs of my patients that I’m following consistently are different.

On Friday I paid extra attention what I ate to outline what my day actually looks like. So here’s Friday, from the beginning to the end 🙂

6:00 am- Wake up, get ready, pack up my lunch.

6:40 am- Out the door, drive to work. I’ve started taking the more scenic route to work because it really doesn’t take any longer and Oregon is beautiful. Plus I get better gas mileage when I’m not driving fast on the highway.

7:30 am- Arrive at work, clock in, get coffee from the cafeteria, heat up my breakfast.

IMG_8548

Last week I ate quiche for breakfast, so I didn’t eat until I got to work. Sometimes I eat on the road, it all depends on what I’m eating. I was HUNGRY by the time I got to to the hospital! Sometimes if I’m hungry before I leave I’ll eat at home. It all depends on the day.

7:45 am- Screen all the new patients in my units. I’m currently doing maternity leave coverage for the Intermediate Care Unit (IMCU) and the Neuro/Trauma Care Unit (NTCU). Once I have the new patients screened, then I build my list for the day and determine how many patients I have, and if I need any help.

8:00 am- Start my chart reviews and start prioritizing patients. I always see my nutrition support (enteral and parenteral nutrition) patients first and start off with a chart review in my office. Then later during the day I’ll do initial assessments and the after that, my follow up assessments. Once I finish my chart review, I head out to the floors to talk to nurses/see my patients.

10:00 am- Snack time!

IMG_8551

For some reason I wanted something sweet, so I went down to the cafe and bought this cereal. I snacked on it as I charted on some of my nutrition support patients.

12:30 pm- Lunch time! The RD crew always eats lunch together, which I love. It was nice on Friday so we ate our lunch outside.

IMG_8553

I buy my lunch about once a week at work. To me, the menu items are really affordable for what we get, but I know some people think they’re a little pricey. I usually go for one of the made to order entrees, and Friday just happened to be taco salad day! I had chips on the bottom, a pile of lettuce, shredded chicken, cheese, olives, jalapenos, salsa, and a pile of guac. I’m not a salad person at all, but I love taco salads!

This lunch was super filling and kept me full for a few hours. Lunch was full of lots of laughter on Friday, I just love my coworkers. Although it may not always be easy to work on a team, I’m lucky that there is a solid group of us that consistently collaborate, respect each other, and have each other’s backs.

1:15 pm- Return from lunch. Friday was a busy day, I didn’t actually get to start on my initial assessments until after lunch. My usual routine is to do a chart review, write down some key details, and then go speak to the patient.

One of the big roles of RDs in the hospital is identifying malnutrition. We no longer use BMI or labs like albumin as a marker of malnutrition, but instead we identify it by weight loss, poor intake, and a nutrition focused physical exam (NFPE). My initial assessments always include these components. I find myself asking “were you eating normally prior to admit?” “have you had any recent weight changes?” and “what is your usual body weight?” alllllll day long. I have learned that it’s important not to ask leading questions (“weight changes?” vs “weight loss?”) since the role of a clinical dietitian is often confusing for some people. Rapid weight loss paired with poor intake in the presence of an illness is not a good thing, and I find myself explaining that all the time to patients. I found that if I ask about weight loss, it’s mistaken as me suggesting that they need to lose weight. In the hospital, I want to see my patients maintain their weight!

I also do non-invasive NFPEs with most of my patients to assess for any muscle or fat loss. I typically looks at their clavicles, scapula, triceps, neck, and temporal muscle to determine if there is any wasting present. I’m getting much better at the NFPE, it takes a lot of practice to know what you’re looking for.

4:00 pm- I would normally be leaving work, but Friday was extra hectic, so I was still working.

IMG_8556

I ate my snack and continued to chart away! I had some canned tropical fruit (pineapple & papaya) with fresh strawberries.

5:15 pm- Finally able to leave work! Drive home.

6:00 pm- Arrive home. Immediately pour myself a glass of wine because of the chaos of the day.

IMG_8558

Not a huge fan of this sangria, but it’s not bad.

6:45 pm- Dinner!

IMG_8562

Cooked Trader Joe’s mini ravioli’s and mixed them with spinach & feta chicken sausage, white beans, and spinach that I had sauteed. Topped with cheese & pepper.

7:15 pm- Clean up from dinner and relax. I worked the weekend, and Friday was actually my Monday, so my evening consisted of catching up on Grey’s Anatomy (um, what is happening this season!?) and going to bed early.

9:15 pm- Bed time!

 

Life · Mindful

“want” vs. “should”

IMG_8462.JPG

I was so ambitious at the beginning of the year! But news flash, grad school + working part time + other volunteer things + making time for a relationship = not a lot of time to do anything else. Luckily, I started my LAST term of school EVER in April, and I’m only taking 3 credits. I’m also working full time back at the same hospital that I’ve been at since 2014. Finally, things are starting to settle a little bit and I feel like I have time to do the things that I want to do instead of having to dedicate every waking hour of the day to something school related.

During the last few months I kept writing down “blog” as a goal in my bullet journal and would feel a lot of guilt every time that I pushed it off. I made a goal to blog more this year and have realized that I need it as an outlet in my life. When I wanted to blog there wasn’t time and when I had time I wanted to do other things. It took me about a month of feeling really guilty about it to realize how silly I was acting. Blogging is something I “want” to do, but not necessarily something I “should” be doing.

I had the “want” vs. “should” conversation with so many of my clients when I was working as one of the dietitians at the university health center. Almost every single time I would meet with someone the phrase “well I know I should [fill in the blank]” would come out of their mouths. The more and more I became aware of it, the more I realized how this mindset impacts individuals. I’ve also realize that I hear people “should” ALL THE TIME!!! The more I hear it, the more I become aware of the tone of the conversation surrounding it. When you feel that you “should” do something and then don’t it, often brings up a large amount of guilt and a feeling of failure.

IMG_8284

Now obviously, there are a lot of responsibilities that we all have and that we “should” do, like going to work and paying our taxes, but I’m not talking about those things. I’m talking about the things that I hear more often, like “I should work out more” or “I should meal prep on the weekends.” The problem with that mindset is that if we don’t follow though on our “shoulds” then it automatically turns into a failure. It’s “I should have worked out, but I didn’t, so I failed.” Or it’s, “I know I should have worked out, but I was just so tired, so I didn’t. I need to start just going!” Maybe that isn’t the case for everyone, but I literally hear it ALL THE TIME.

Now think how it would sound if we just turned “should” into “want.” It feels way different to say “I want to work out more” or “I want to meal prep on the weekends.” When we “want” things instead of “should” them there is less guilt when life gets in the way and doesn’t let us follow through on all of our plans. To me it’s more like goal setting. It’s identifying something as important, prioritizing it, and then expressing your desire to do it. Plus, if for some reason your “want” doesn’t happen, it’s easier to say “I really wanted to do this, but it didn’t happen” and not feel guilty about it.

I used to be one of those people who would “should” on everything. I created rigid structure and expectations for myself and looking back I realize that made me so unhappy. I was unhappy because every single time one of those “shoulds” didn’t happen, I felt like the biggest failure. I would get really down and sometimes even felt like I wasn’t worthy of being a dietitian if I couldn’t even follow through on the behaviors that I counseled patients on. Those kind of thoughts are unhealthy and make me realize how obsessive we can become when we make so many things a “should.” There’s nothing fun about an overly rigid life and feeling bad for choosing a dinner with friends over working out. Life is too short for that!

IMG_8448Grad school has been one of the biggest blessings in disguise because it completely flipped my routine life upside down. A lot of my crazy “shoulds” turned to “wants” as I realized that there was not enough time in the day for everything that I thought I should be doing. It’s taught me a lot about grace and being more compassionate towards myself. It’s made it ok for me to say no to a workout when I’m tired or yes to eating out when I have school taking priority over cooking. It doesn’t mean I’ve let life go out the window and be a free for all, I’ve just got more wiggle room. And guess what, the wiggle room make me happier!

So try it. The next time you “should” something, think of it as a “want.” That doesn’t mean you’re making it less of a priority or giving yourself an excuse not to do it, it just means that if life gets in the way there’s no guilt, no hard feelings, no beating yourself up over it. It just means that “want” will wait until a better time.

Life

A New Year, A New Direction

img_8206It’s been a while, hasn’t it? Almost 2 years to be exact. My last post was in MARCH of 2015. To be honest, there have been countless times that I’ve wanted to get back to this blog. It lost direction after my dietetic internship and there was no way for me to keep it going. I’m a different person now than I was back then. Looking back at some of my posts, which date back to 2012, makes me cringe. I was in a really bad place for a large portion of time that I wrote this blog. To me it shines through in a lot of the posts. Before I publish this post, I’m going to go back and block a lot of those old posts. They say things that I don’t stand by anymore as a dietitian.

So where am I now? Well, I’m almost done with grad school. I decided to go back to school and started my masters in public health in the fall of 2015. It’s been rewarding so far, but I’m ready to be done. I’ve continued to work at the hospital on a per diem basis. I’m working more this year than I did last year. I’ve got grad school more under control now so I have the ability to do that I guess. I’m also working on campus at the health center as a graduate assistant. I do get to see clients once a week, but I don’t do as much as a dietitian as I do at the hospital. I’m not quite sure what I’m going to do after I graduate.  I’m just going with the flow until graduation and then I’ll start to panic if I need to!

So, what was the motivation to restart this blog? Well, I’ve become very inspired by some fellow RD bloggers in the last few years. Inspired by women who challenge me to look at nutrition from a different lens. Who fearlessly share their lives for the sake of inspiring others. Even though I know I’ll never have a blog of their caliber, I really just want to have an outlet. I want to able to write down the things that inspire me and if I help one person in the process, that’s awesome. If not, I know that I’ve helped myself.

Here’s to the new adventures of 2017!

img_8169

Clinical Nutrition · Life

6 Month Job Update + Life Lately

15ddb97722812003985c308b15bac6d7

Wednesday was officially 6 months at my clinical dietitian job at the hospital and 10 months ago today I had my first day at the hospital as an intern.

Time. Flies.

I just read back through my 3 month job update and it’s absolutely insane how much I’ve grown since then! I still learn something new every day and know that the learning never stops, or at least it shouldn’t!  I’ve also become much more detail oriented and haven’t had any more incidences of accidentally missing someone or something important. I truly think sometimes it just takes making mistakes to learn.

In November I had the opportunity to apply for a full time position that would include my own area in the hospital. Unfortunately, I didn’t get the position. I feel really fortunate because as much as I really wanted the position and my own area, I’ve been able to see the positives of continuing to float and spend time building skills in different units with different types of patients. Plus the girl who got the position was more than deserving of it. She was a classmate of mine in undergrad and a fellow intern last year, so I’m excited to see her succeed as a young RD and be rewarded for all her hard work.

3 months ago I had just started working in ICU and since then it’s become more of a regular unit for me to work on. We have 7 full time RD positions that split the ~15 units of the hospital, but 2 of those RD positions cover ICU.  The ICU is a 30 bed unit and one RD covers 19 of the ICU beds and the other covers the remaining 11 beds plus the 18 ICU level bed on the cardiovascular care unit (CVCU). Those ICU patients on CVCU are mostly open heart surgery patients or those with serious cardiac arrest that has required CPR and left them with potential brain damage due to lack of oxygen for a period of time. For the most part, the ICU level patients on CVCU don’t require nutrition intervention but there are always a few that are having a difficult recovery and are requiring tube feeding.

In the last few months I’ve covered the ICU + CVCU position a lot. The position may have a lot of beds, but the RD rarely has more than 10-12 patients on their list, which is manageable. I’ve really grown to love the critical care setting which is funny because as an intern I was totally and completely terrified by ICU. It amazes me how much knowledge I have now compared to then and how comfortable I am with more complex situations. I still find myself asking for help pretty frequently but I’m more confident making simpler decisions on my own now. I cover ICU for ~2 weeks in February and I’m really excited! But also a little nervous!

Anyways, I still completely love my RD job. I love the hospital and I love my coworkers and I love helping my patients. Yesterday I had 6 educations, which is a lot, and every single one of those patients was super excited about nutrition. Yesterday was definitely the exception since nutrition is often not the favorite topic, but it was so nice to spend time helping my patients set goals about their health and see them so genuinely motivated. I was so busy yesterday and stayed almost 2 hours late, but those educations made every single second worth it!

As for my January so far:

013

I successfully donated blood for the 8th time last week and I’m now officially a gallon donor. If you can give blood, please do! It’s so important and only takes an hour of your time. Go to the Red Cross website to read about the eligibility criteria and find a blood drive near you!

014

I bought these beautiful Alex and Ani bracelets for myself as a late Christmas present and I am obsessed. Don’t mind my dingy looking lab coat sleeve…

022

I got to spend time with some church friends on Wednesday and play Clue and drink tea. It was a rager! Haha. But seriously, there is nothing more fun that bundling up on a cold winter night and playing a classic board game!

028

My BirchBox (<–referral link) subscription continues to be one of the best decisions I have made in the last 6 months. I love opening these every month! Plus I’m obsessed with the “Let’s Do This” slogan for 2015.

029

This Buzzfeed quiz had me laughing so hard. I literally just told someone the other day that I could never be vegan because I love cheese too much. 035

This is how my day started yesterday, with my coffee leaking everywhere. I got to work to find a puddle of coffee in my cupholder. Only on a Friday…

Hope you all have a wonderful weekend!

Life

Hello 2015!

How did this happen? How is it already a new year?

I apparently decided to take a hiatus from blogging for a little over a month. I think I needed it, honestly. Somehow this site still managed to get a fair amount of traffic during that time period which surprised me, but I’ll try to start posting more often now. This blog turned 2 years old on Thanksgiving but if feels like I’ve been blogging for so much longer than that!

The last 5 weeks haven’t been too incredibly exciting, just working a lot (what’s new), cooking when I can, and trying not to go crazy in this tiny town. There has been no one here since the university is on winter break and a lot of my friends are from out of state and have traveled home for the holidays. People will be returning this weekend and I’m super excited to be surrounded by humans again! My family came up to Oregon for Christmas which actually ended up being a lot of fun! I was worried since my apartment is so small and they stayed with me on Christmas Eve and then all of Christmas Day, but it ended up working out. They ended up staying a few days longer but my parents stayed in a hotel so my apartment wasn’t so cramped!

I had to work on Christmas Eve and December 26th and they were some ridiculously crazy work days! I’m pretty sure I consumed way too much caffeine both days but it helped me stay productive! Red cups for the win!

034

I bought an artificial tree this year and after my parents arrived and we put out all the presents it looked so small!

043

And of course Miss Ruby tagged along and was up to her usual antics.

046 071 097 099 125 130

I just love her so much!

I’m pleased to report that I actually stuck with my New Years Resolution in 2014. My faith has always been an extremely important part of my life but during college I found a way to make excuses and let it slip to the side. I still was active in bible studies and church but I wasn’t living like a Christian. In the fall of 2013 I started making some good changes in my life and by the new year I wanted to make 2014 a year of spiritual growth. I bought the devotional Jesus Calling and challenged myself to read all the way through it in 2014. And I did it! Intentionally reading through the Word on a daily basis was life changing for me this year and I would highly recommend this devotional to anyone whose looking for an easy way to ease back into reading scripture!

I didn’t really do much for New Years this year. In fact, I was in bed at 11:00 PM and fell asleep before midnight. I won’t get into specifics as to why that happened, but I think it was a good thing for me. I definitely did not intend to spend my New Years Eve the way I did, but that’s okay 🙂

This year I’m making 2 resolutions. The first is to read the She Reads Truth #365DaysOfTruth. Unfortunately they are having some technical difficulties with their WordPress site today so I can’t actually begin it fully right now, but once I’m able to access it I will. They have an app too, which is great! Check it out, both the site and the app are fantastic!

Yesterday when I was listening to the radio on my way to work they were talking about choosing one word and focusing on it all year long. I decided that would be an awesome resolution as well, so I’ve chosen my word for 2015: LOVE.

002

I think this verse, 1 John 3:18, really shows what I mean when I say I want to focus on “love” this year. Not the romantic love, although I wouldn’t be opposed to that (haha), but truly loving people and living out my life in a way that shows I care deeply about those around me. I would also like to work more on accepting love and allowing others to love me. I truly think that what this world needs is more love and people living like they love each other. Isn’t that what God put us here to do, anyways?

Besides contemplating how I can better myself in 2015, I also got to do some cooking today! I got a new food processor for Christmas and I got to use it for the first time today. I’ll post the recipe later this week, it was a super simple vegetarian soup. I’ve been eating a lot of meat lately so it feels good to get back to a meatless diet!

I hope you all had a wonderful New Years Eve and have had a great first day of 2015! I’m so excited to see what this year has in store!

Life

3 Month Job Update

cc45c2298b4f606c68d12b4d56893b6b

On Tuesday I hit the 3 month point at my new job and next week I’ll have been an RD for 2 months! Where the heck is the time going?

I started working on my own doing at the beginning of the September. I started off working as the float dietitian, covering for dietitians that work med surg floors, and covering for the dietetic technicians. At the end of September I started training in ICU and now I’ve also worked ICU a few times on my own. I keep thinking this job will get easier but it is still such a challenge for me almost every day!

I’ve learned so much in the last 3 months it’s incredible. Obviously, most of what I’ve learned is about dietetics itself but I’ve also learned quite a bit about myself too.

One of the most difficult things for me has been being confident in what I know. I have learned a lot but I’m not yet confident making recommendations unless I check them with a reference of some kind first. Luckily, I have access to a lot of fantastic resources but I think I’ve been wasting a lot of time double checking what I already know. It is beneficial though because if I have to talk to a doctor at least I can reference to resource during the conversation.

Another thing I’ve learned is to be very thorough ALL. THE. TIME. This is usually something I excel at in my everyday life because I tend to be an extremely detail oriented person. There have been two instances now where I was too rushed at the end of the day and ended up looking over something extremely important. The first time, someone else had to deal with it after I overlooked it. The second time, which was yesterday, I ended up having to stay an hour late and deal with my mistake. Let’s just say I will always be double and triple checking that everything is done before I leave from now on!

I’ve also learned a lot about myself too. I am actually a really shy person when I’m in an environment where I don’t know a lot of people. It’s taken me a long time to get comfortable calling doctors, talking to nurses, and feeling comfortable sitting at the nurses stations and charting. I’ve really been trying to interact with more people and I’m slowly building a group of acquaintances in different disciplines.

Overall, the first 3 months have been great. The team of dietitians is amazing and so supportive. I know I always have people to turn to if I need help and I love that. I also had my first intern last week and it was such a surreal experience to be precepting when I just finished the internship myself a few months ago! I’m going to find out if I can take the preceptor class that the hospital offers next month so that I’ll be better prepared to be a preceptor. I’m only precepting a few times a month, but I want to make sure I’m having a positive impact on the interns.

I’m excited to see how much I’m going to grow in the next 3 months!

Breakfast · Dessert · Life · Snacks · WIAW

WIAW: Not My Typical Dinner

Hello and welcome to my first “What I Ate Wednesday” post! This is something I have been wanting to do for a very long time but I honestly just haven’t had the time. Wednesday nights are not the best for me to post because my small group from church meets and typically we get done a little later and I go straight to bed. I toyed around with the thought of doing a “Food Friday” post or a “Meal Monday” or something like that, but I realized that all my days have the potential to be busy and I need to just choose one and commit!

So here we are!

Even though Wednesdays are usually a later night for me, I realized that they have the potential to be my most exciting eating day of the week. My tribe (which is what my church calls small groups) typically meets around 6 pm and we always start with dinner. We have a theme each week and everyone pitches in to contribute something to the meal. 

Tonight was salad bar and ice cream bar.

I was really excited because I bought lunch at work today and actually remembered to take a picture (woo!) and then realized once I got to tribe that I was basically going to be eating ice cream for dinner. As an RD I would like to be a role model for those around me- ice cream for dinner may not be the best way to start!

I want this blog to be real though. Yes, I am a registered dietitian. No, I am not perfect. Sometimes I eat too much ice cream at dinner. 

021

Breakfast: My breakfasts are pretty standard. I eat an English muffin with some kind of nut butter before I leave for work. I drink my coffee on my commute so that I’m ready to go when I get to the hospital. This meal only holds me over for a few hours, so my morning always includes a snack since we don’t meet for lunch until 12:30.

015

Mid-morning Snack: Lately I’ve been snacking on vanilla Greek yogurt topped with fresh strawberries and some granola. I used to buy the individual yogurts but none of the ones I like have been on sale lately (Tillamook Greek marionberry flavor = heaven in a cup), so I’ve switched to this for the time being. The Greek yogurt usually does a good job keeping me satisfied until right before lunch.

085

One thing I immediately loved about the RD/DTR team at the hospital I’m working at is that they all eat lunch together. As an intern this gave me a chance to get to know everyone and now as an employee I see how important it is because it gives us all a chance to de-brief if we need and ask for a little extra help if we’re feeling overwhelmed or offer help if we’re nearing the end of our list. 

The cafeteria at the hospital is amazing and today they were serving chicken quesadillas made to order at the grill. Now, I know I’m trying to be vegetarian and all, but this baby was calling my name. The quesadilla was stuffed with cheese, fajita veggies, chicken, corn salsa, and pickled jalapenos and served with salsa, guac, and sour cream. It was delicious, messy, and it filled me up!

087

Afternoon Snack: I ended up leaving work early because my patient list was super short today, no one else needed help, and I’m having some sort of allergy problem right now and my red, itchy eyes were drawing too much attention! I normally pack myself a snack for the drive home but today I ended up snacking once I got home. Banana, peanut butter, and a small glass of almond coconut milk. Yum!

088

Dinner: As I said earlier, our theme for dinner at tribe tonight was salad bar and ice cream bar. I topped my pile of lettuce with corn, ham, garbanzo beans, carrots, croutons, avocado, and a french vinaigrette dressing. My salad was about half gone when I finally snapped this photo, I promise I ate more!

089

And this is my weakness: ice cream. Admittedly, I took too much. But I honestly rarely indulge like this and once in a blue moon is not going to make or break my overall eating. Also, this chunk of ice cream is not as massive as it looks, it was flat and perched on the smaller scoop below.  

I think it’s important to remember that once in a while it’s okay to totally fall off the wagon and eat a shameful meal. The important part is to move on, get back on the wagon, and resume a healthy eating schedule after. Tomorrow I don’t work so I’ll do a morning work out and eat normal meals. I won’t try to compenstate for this calorie bomb of ice cream by restricting my intake or exercising twice as much. I’ll acknowledge that this was too much ice cream and move on. 

Eating healthy is all about balance.