By Anna Ziegler
One of the highlights of my 10-week clinical rotation at the University of Maryland Baltimore Washington Medical Center was spending two weeks in the Intensive Care Unit (ICU) with my preceptor, Amy Hurd, RDN. The ICU is unique because compared to the rest of the hospital they handle extreme cases of tube feeding, which allowed me to explore a more complex yet intriguing part of the field. It’s an ever-changing and fast-paced environment, so I had to learn to be quick on my feet. Here are a few of the many things I learned about the important work of an ICU dietitian and how I grew through these new learning experiences.
As I began my first day in the ICU, I was nervous; I wasn’t sure if I would remember enough from my medical nutrition therapy class. Amy, like the other preceptors I had during my clinical rotation, pushed and challenged me, which helped me build confidence in myself as I was taking on more clients in the ICU . I’ve always loved the quote “teamwork makes the dreamwork” and this is exactly what I saw in the ICU. Every morning we started by rounding on the floor with the entire interdisciplinary treatment team. This includes physicians, pharmacists, nurses, social workers, and occasionally surgeons. During rounds the treatment team huddles near each patient’s room and discusses openly about how to best care for the patient. On the first day, Amy told me to pack a snack for rounds, and she was right because rounds would last up to three or more hours because of how thorough they were with each patient and listening to everyone’s input. It is such a collaborative environment in the ICU and everyone was approachable and helpful in answering questions from others.
After rounds, we began visiting all of our patients. It was common for Amy to have a new census of patients from day to day because patients may not stay in the ICU for a long period of time. At first, I was anxious because I was not used to interviewing patients that were critically ill and being tube fed. As I observed Amy, I noticed her compassionate approach and how she spoke with all of her patients, even if they were unable to talk back due to their acute disease state. She taught me that engagement with patients is what makes an impactful dietitian. You have to have the desire to go the extra mile for your patients, even if that means you have to spend twice as long with a patient as you planned.
Once we visited all the patients, we began charting for each patient. The ICU is unique because unlike the rest of the hospital, they handle extreme cases of tube feeding and a lot of the patients are intubated. Therefore, in the ICU there is more math than diet education. We had to take account of labs, disease state, height/weight history, medications, bowel function, and nutritional needs when deciding what form of nutrition intervention the patient needed. Then calculating each patient’s nutritional requirements and comparing them to what nutrition they’re receiving. At first, I was rusty but with practice, I became confident with my recommendations for tube feeding. It was rewarding that after only a few days in the ICU, the nurse practitioner came to me for my input on what tube feeding formula I would recommend for a patient.
All of my hard work was paying off and I felt welcomed in the ICU! Every day I met several ICU team members and learned something new from each of them. I was able to meet the ICU speech pathologist and observe her doing a bedside swallow exam on a patient. This was helpful because I was able to understand more clearly how they diagnose dysphagia diets and how they work with registered dietitians. Another one of my favorite experiences in the ICU was being able to observe a bronchoscopy procedure for one of my patients. I was alongside a PA student and PT student as the doctor explained the procedure and answered our questions. It was a great feeling when I noticed how all of the health professionals were always willing to teach one another and were easy to approach for advice.
As I reflect on my experience, I learned many skills that will carry with me for my future career. The one that will always stick with me is that to be a successful dietitian, you have to be a successful team member. This means being able to actively listen, ask questions, communicate, bring positivity and look at situations from different perspectives. Working together as a team is important when taking care of patients because everyone has their strengths and knowledge to help make the best care plan. In my future career, I will take this skill with me and will remember to not hesitate to seek advice from other health professionals. I greatly value all the advice and skills I took away from my clinical experience.