Clinical Nutrition Confidence: 2 steps to build some fast

Let’s say you’re starting your clinical rotations and you’re nervous.

Or maybe it turns out your preceptors are kind of demanding or even a little mean. And now those nerves are turning into complete overwhelm and anxiety.

Here are three suggestions to help you build some confidence. Even if you’re stuck with less-than-helpful internship resources.

1. Writing Clinical Nutrition Notes:

When you have established dietitians who are assigned to review and sign off on your notes, it’s normal that they’d want those notes to reflect their voice and clinical decisions. 

The tricky part is when you’re criticized or judged for using different language or making different evaluation decisions.

With preceptors who are ultra-picky, especially about language, there’s only one way to manage that.

Just let them correct you.

Then open a word doc, and take notes on exactly the words they used.

Anytime you review your preceptor’s past notes or get feedback about how you write yours, write that language down and re-use it the next time you have a patient in a similar situation.

This is really useful for PES statements and when it’s time to write assessment summaries.

PRO TIP:
If you have multiple preceptors, make sure you keep track of who wrote what.

It’s not uncommon to have one preceptor tell you something is wrong and immediately have another tell you it’s the only correct way. Labeling each re-usable statement will save you a lot of headaches down the road.

Keep in mind…

This isn’t a recommendation to help you learn clinical or give you a better understanding of how to do your job well.

In truth, tt’s the exact opposite of what you’ll be doing as an RD in the real world.

But if you’re struggling with preceptors who need things to be precise, it might help you get through your clinical rotations in one piece.

2. Feeling Lost and Getting Confused:

It’s easy to feel lost or confused about the best way to manage a patient’s nutritional needs.

It can get harder when you’re giving instructions on something one day and the next a preceptor is advising you to do something completely different.

Sometimes this comes down to skill. As you’re learning, it’s easy to overlook small differences in a patient’s chart.

This is why you’re in your internship — so you can start noticing more of these small but crucial health identifiers.

Other times, it might simply be miscommunication between you and your preceptor. It could be no one’s fault, but it’s still frustrating.

So how can you manage this?

Ask very specific questions. 

General questions will give you a general answer. These are great when you want to understand an overall concept or health condition. 

But in most cases, you want to know exactly why this specific thing happened.

AND why your preceptor is providing this specific type of care.

Here’s an example of a specific question that will get you a clearer answer:

“Yesterday you said to give Ensure to only people who are losing weight. This guy is weight stable, why did you recommend it for him?”. 

Here’s another example:

“I’ve never used Juven before. Can you tell me how you use it here?”. 

It might take some guts if your preceptor is harsh or just mean. But it’s their job to explain things to you.

And if they want to treat you like unpaid labor, they need to train you like an RD.

3. Managing Medical Issues You’re Unlear About:

The only way to get better at dealing with changing medical conditions is by getting better at talking to doctors. 

And the more you talk to doctors, the more confident you’ll be in your ability to stand by your nutrition decisions.

Yea, they can be intimidating. 

But remember, most MDs don’t know much about nutrition. Especially residents who are in the middle of the learning process, just like you are. 

The big difference is they aren’t being trained in nutritional interventions like you are.

What they do know is medicine and medication.

This means, when you get stuck on the status of a medical condition, doctors are your best friend.

If you don’t understand something in a medical chart — like let’s say, the status of acute kidney failure — the best thing to do is ask the doctor. 

Asking a quick “how are their kidneys?” will give you an answer you can refer to in your note and will go a long way to helping you work out your patient’s nutritional needs.

A lot of interns and new RDs worry asking a question like this will make them sound stupid. Or as though they’re showing how little they know.

Actually, the opposite is true. 

When you confirm with a doctor or even a nurse about the status of a medical condition or get the doctor’s opinion on an ongoing medical situation, it shows you’re paying attention. 

It also reminds the rest of the care team that you’re playing an active role in your patient’s care and gives them a face to go along with the name they see floating around in their chart.