Clinical Dietetics: An Intensive Care Unit Dietitian’s Perspective
Hello there! My name is Bonnie and two weeks ago, I was completing my final days of my clinical rotation at Santa Barbara Cottage Hospital (SBCH).
As I think back on the 10 weeks of my clinical dietetics journey, there were many new experiences and learning opportunities, as well as personal growth and development that I went through. One of the highlights was spending a week in the Intensive Care Unit (ICU) with my preceptor, Dena Green, RD, CNSC. As a registered dietitian (RD) for both the Surgical ICU and the Medical ICU, she is an expert in her field. She is also a kind, down-to-earth, and supportive individual who greatly enriched my time at SBCH.
Dena started her career at SBCH about 15 years ago as a dietary technician. She completed her Dietetic Internship through Utah State University distance program where she completed her clinical hours at SBCH. After passing the RD exam, she worked as a clinical dietitian in a hospital with a booming bariatrics unit in Northern California. Just shy of two years into her time there, SBCH contacted her about an opening for an RD. Dena was hired and has been with SBCH ever since!
Dena starts every morning by rounding the floor with the entire interdisciplinary treatment team. This includes the physicians, pharmacists, nurses, social workers, and occasionally surgeons. Dena explains, “The collaborative environment of the ICU is one of the best aspects of being an ICU clinical dietitian. Everyone is approachable, from the physicians to the environmental services staff, they all ask questions and are helpful in answering questions from others.” I witnessed this when I attended rounds with Dena and watched the treatment team huddle near each patient’s door and discuss openly with each other how to best care for the patient. “The dietetics profession is really valued here,” Dena adds. She explains how rewarding it is to know that the physicians listen to her recommendations and appreciate her expertise. Dena credits this attribute of the hospital as one of the factors that has kept her here for a significant amount of time. She also shares that since SBCH is a teaching hospital, the environment of learning encourages the teamwork vibe as all professionals are able to learn together.
After completing rounds, Dena begins visiting patients and their family members. I observed Dena’s compassionate approach and how she spoke with a family of a patient on comfort care. Dena has explained to me that she believes the engagement one makes with patients is what makes an impactful dietitian. She says, “Loving what you do will translate to your work, you will have the desire to look things up and go the extra mile to make sure you are doing the right thing for the patients.” This valuable sentiment will stick with me as I continue on in my internship, as well as in my career.
Once Dena has visited her patients, she is able to begin charting for each patient. Dena explains a difference in clinical dietetics from other dietetics fields. “We deal with the acute phase of the disease state, sometimes we don’t get to see the follow-up or progress of a patient,” Dena explains. She adds that the ICU is unique to the rest of the hospital because she handles extreme cases of tube feeding and often times she will see immediate progress in the patient’s lab values once nutrition support is initiated. She identifies the importance of a clinical dietitian needing to be familiar with medical terminology and disease states. Dena explains that one of the most enjoyable aspects of her job is “the science behind it, it’s calculated and exact. In the ICU setting there can be immediate gratification from what you are doing.”
It is common for Dena to have a new census of patients from day to day because patients may not stay in the ICU a great length of time. She shares that one of the challenges of working in the ICU is “the feeling of not getting to see the long term progress, or have “closure” because once they leave the ICU I don’t get to see them again and I don’t really get to know what has happened to them.” She explains that this side of clinical is difficult for some RDs to handle if they are the type of person who needs this form of closure.
Since Dena has been a clinical preceptor for several years, I asked her opinion of what makes a successful clinical intern. “The quality of care they show and how one connects with patients, having a good rapport with patients, those interns will be the most successful,” she states. Her advice for clinical interns is to review medical nutrition therapy (MNT) and look at diets and disease states. She recommends saving resources from MNT classes to refer to throughout the internship. “You will have a real person in front of you someday, not just a “case study” from a textbook,” she adds.
Dena explains that one of the biggest challenges interns face will be “information overload” that interns must triage to find only that which is relevant to the nutrition plan of care. This was evident to me as I scoured charts and medical data on a daily basis, feeling like the majority of it was going over my head. Dena assured me that once an intern learns how to pinpoint only the nutritionally relevant data they will find success in clinical dietetics.
Dietetic professionals have a unique opportunity to be in a field where there is always something new to learn. Dena offers this advice to help strengthen your role as an RD to be: “It’s easy to feel stagnant and stale and you have to stay engaged and keep learning and every day will be something new." I greatly value this advice from someone as well-established as Dena, and I am grateful for the opportunity I was given to interview her and learn from her in the clinical setting.