Patient Services: Week One

Week one of rotations is officially crossed off the list! I've learned so much this week: in classes, my rotations, and through others I've met along the way.

Monday and Wednesday are class days. Our first day was a total breeze. Our professor for two of our classes wasn't there, so we were handed our syllabi and scooted out the door. Easy enough! We also took a test on all the topics we've covered so far: enteral/parenteral nutrition, diabetes, the nutrition care process, and nutrition assessment. (It was really nice to have "pre-classes" before we got into the clinical rotations so that all the interns are on the same page as far as expectations from the hospital are.) Wednesday we had our first real day of classes. I'm taking two Nutrition Research classes, but from looking at the syllabus, I am pretty sure it's going to be very similar to Nutrition Counseling. And, I loved that class, so bring it on!

On Tuesday I was able to meet my preceptor, Ray. He is a native Spanish speaker, so when he gets really excited about something, you REALLY have to pay attention! (Our internship director always yells at him, apparently, "Ray! Spanglish! You're speaking Spanglish!")  Because he is the director of the A La Carte Patients Services area, he is a busy man. This rotation focuses mainly on the management aspect of dietetics, so my first projects were attending meetings, evaluating cycle menus, and reviewing food safety with supervisors.

Patient Services is somewhat unique in that the way patients receive trays is by means of a call center. Patients receive a menu and are then instructed to call down to order their trays. My favorite project is evaluating patient trays. I get to be a "secret shopper" and call down to the call center, order whatever I want off the menu, and fill out an evaluation of my experience. I rate the friendliness of the employee, food texture, temperature, quality, and if everything I ordered was on the tray. I have experienced both ends of the spectrum when I get the tray I ordered. The first day I did it, I was sent a ground chicken sandwich instead of a grilled chicken sandwich. Ground chicken is usually saved for people who have swallowing problems (i.e. dysphagia diet!). Needless to say, it wasn't the tastiest thing I've ever eaten. The next day though, I ordered a bean and cheese enchilada with fruit and cottage cheese---much better!

Another project I have been working on with another intern is recipe standardization. We chose a recipe (from Iowa Girl Eats, of course) and are turning it into a recipe that can be made in larger batches. Basically, what we do is make the recipe one time exactly how it says to on the recipe provided. As we go, we weigh out all ingredients on a food scale, and record them. The reason for this is to make the recipe CBORD-compatible. CBORD is a computer program that holds all the recipes at the hospital in a standardized format. From this program, it is really easy to switch to a recipe that serves 80, rather than 5. It also provides nutrition information for the recipes. Because hospitals are held to standards for the amount of fat, carbohydrate, sodium, etc., it is important that the recipe we make provides proper amounts of everything. If it doesn't we will have to make the recipe again and make it fit into the standards. After all this is taken into account, we make changes to the recipe according to how it tasted the first time. For example, the first time we made our recipe, there was an overabundance of cumin, and very few vegetables. The second time we made it, then, we tripled the amount of vegetables and cut the cumin amount by two thirds. This time, the food tasted SOOO much better! We still have more to work on (like putting the recipe and weights into CBORD), so we will continue with that tomorrow.

I was also really lucky to attend a number of meetings with my preceptor's boss, Doug. He invited me to go along with him to a meeting for "higher up" management (the CFO and COO of the hospital were there!). I sat between him and Laurie, my internship director, and they introduced me to a number of other people they collaborate with on a daily/weekly basis. The meeting was two hours long (so long, in fact, that part way through, Laurie turned to me and said, "This taking foreverrr...so...what's your new last name going to be when you get married?") and covered topics like patient satisfaction, employee awards, the release of the new menu for patient services, construction of the new Children's Hospital, the grand opening of Iowa River Landing (the new outpatient clinic), and where to park on Hawkeye game days (since the stadium is right across from the hospital). Interesting stuff. A lot of it went over my head, but it was still nice to be included and introduced to some hospital big wigs!

So far, working at UIHC has taught me to expect the unexpected. In school, a lot of topics were skimmed over because "you won't see patients with (insert complicated condition here) hardly ever". They forgot to add "...unless you are working at the largest teaching hospital in the state of Iowa"! That just means that I'm learning a TON. Slowly, but surely. I am absolutely loving my internship, and I would be happy to give any undergrads a tour ;)

Real or not real: One week closer to being an RD!

These past few weeks have been a whirlwind of exciting things happening. First and foremost, Josh and I got engaged!! Words cannot describe how happy and blessed I feel to spend the rest of my life with this guy...

Also, I started my dietetic internship at the University of Iowa Hospitals and Clinics. The other interns (I would say girls, but we are super lucky and have a BOY in our program!) are all so awesome and we're having a great time getting to know each other. Plus, it's nice to get nerdy about nutrition with people who are equally as nerdy about it! 

We spent the first week talking about nutrition support (tube feedings), diabetes, the nutrition care process, diet histories, and writing chart notes. Most was a review, but I finally learned how to calculate tube feeding regimens! I spent the entire last semester stressed and angry (and not doing well on tests) because I could not get the hang of it, and in one day it's totally clear. So my advice to other dietetics students in the same position as me last year is--don't worry! You will have someone teach you in your internship! :)

This week begins real classes, tests, and rotations. I begin my rotations in the hospital in Patient Services. This is a management rotation, and I am actually pretty excited about it. I'll admit, I once dreaded all management rotations because I haven't really liked food service in my field experience. As long as I remember that I will be playing the role of dietitian, rather than a dishwasher or head cook, I will definitely be able to handle it! I will keep you updated on any interesting things I learn about.

Here is a video, totally unrelated to dietetics or being engaged. I just love the song. I heard it in church yesterday, and I forgot how powerful it is. One of those you-can't-help-but-raise-your-hands-'cause-God-is-so-awesome kind of songs :)

The Pros of Menu Planning (+Black Bean Burgers!)

As many of you know, I have a total OBSESSION with the blog Iowa Girl Eats. I use it often, especially when I'm planning a dinner menu for the week.

Menu planning is the best thing I have done for organization at our house since we moved in. I know it sounds tedious, but taking 30 minutes to make a menu for the week certainly beats out the ol' "What should we have for dinner?" question every single night. All I do is list all the days of the week and choose a recipe for each day. I do this at the same time I'm making my grocery list, so I am sure to remember everything I need. For example, tonight I'm making black bean burgers. I take out the recipe for them and see that I don't have panko bread crumbs, so that goes right on the list.

Easy, right?

It also helps to have the final list on the fridge. That way, I always know what to pull out of the freezer in the morning (or night before, if needed) before heading to work. Honestly, if you haven't tried it yet, you should really start menu planning!

Now on to the yummy stuff: black bean burgers!

I altered the original recipe a little, by omitting the chipotle pepper in abodo sauce, because we didn't have any and I thought it might be expensive to buy. The good news is, the burgers turned out just as delicious without it!

Ingredients (serves 4-6)

• 1-15oz can black beans, drained & rinsed
• 1/4 small white onion, roughly chopped
• 1/2 teaspoon cumin
• 3/4 cup corn kernels (canned, fresh, or thawed)
• 1/4 cup bottled chunky salsa, plus more for topping the burgers
• 3/4 cup panko bread crumbs
• 1 egg white (or 3 tbsp Egg Beaters All Whites)
• 1 avocado
• garlic powder
• salt & pepper
• 2-3 whole wheat tortillas, cut in half
• 4-6 slices provolone cheese

Instructions

• Combine half the black beans in a food processor with the white onion, garlic powder, cumin and salt. Pulse until nearly smooth, scraping the sides if needed. (Alternatively you could mash the black beans with a potato masher and mince the onion, combining with the other ingredients.) Remove mixture to a bowl then add remaining black beans, corn, salsa, panko bread crumbs, and egg white, then mix well with a spatula. Mixture will be wet.

• Heat a large flat-top skillet over medium heat then generously spray the skillet with non-stick spray. Shape the bean mixture into four patties then cook the patties for 5-6 minutes a side, or until firm and golden brown.

• Meanwhile, mash the avocado with garlic powder, salt & pepper in a small bowl. Place the cooked burgers on tortillas, then top with the mashed avocado, cheese, and extra salsa, if desired.

P.S. I have to show you guys what helped me do the cooking tonight. My Aunt Vicki sent Josh and me a housewarming gift--totally adorable, right!?