07:00 – Morning routine

On a normal day working in the hospital, I wake up around 7:00. I have my breakfast by 07:15. My breakfast changes depending on the season and on what I have in the house. Now that tends to be frozen berries (which I defrost in the microwave) with some plain natural yoghurt, cereal and some nuts/ seeds. I always have a coffee with my breakfast, and a small glass of orange juice.

08:00 – The morning commute

I get to work by cycling. I live about half an hour cycle away from work, it is always a nice way to get a bit of exercising in the morning. It gets my blood pumping and gets me ready for my day.

08:30 – Getting into work and set up for the day.

When I get into work, I take off my cycling gear and put on my uniform. Then I put on my bleeps, which I carry around on my lanyard. I carry my bleep to make sure that I am always reachable. We do not have mobile phones working in the hospital here, so if someone needs to contact me, then they can type in my number and their number on the hospital phone system. Then I can call them back on whatever phone they are closest to. If I am also covering for another dietitian that day, I will grab their bleep and put it on my lanyard as well. Depending on the day, I may have one to three bleeps.

08:40 – Checking my emails

I then start my day off by having a little look over my emails. My emails are a great way to stay in touch with colleagues about projects. I might also get new referrals via email from the consultants or other dietitians from other hospitals.

08:50 – Reviewing my lists

Then I would have a look over my lists. I work as a dietitian in nephrology or kidney disease, so I have some patients who come into hospital three days a week for their dialysis. Then I might also have some inpatients who are on the ward. So, I have two major lists I need to look at: my inpatient list and my dialysis list.

08:55 – Prioritising my patients for the day

Prioritising dialysis and ward patients

I might look at which dialysis patients are due their review and see who’s coming in that day. I will prioritise those patients then based on their risk for malnutrition, their blood results and the length of time since I last saw them. One of the biggest things you start getting with experience (and something we spend a lot of time training our students to do) is prioritising. I’ve got 7.4 hours in my day to do my work, so I need to make sure I see the patients who most urgently need to be seen.

Unfortunately, for me that’s actually been more complicated than usual because I now also have some very acute ward patients (since COVID-19 hit, our caseloads have shifted somewhat, and I now also cover some general medicine). Because of this, my dialysis patients are a little behind on their reviews. And so, they start becoming more urgent as time goes by. However, because they are more chronic and they tend to be in hospital three days a week, I try to see those whenever I get a chance. My ward patients who require artificial nutrition (such as tube feeding) or who may just have come out of ICU may need to be seen more urgently.

Prioritising when and where I will see these patients

So, before I truly start my day, I make a list of who needs to be seen most urgently that day. I try to prioritise my dialysis patients in the morning and then see my patients on to the ward towards the end of the day. This has helped me to keep my uniform “clean” (less chance of being covered in Coronavirus) for longer, and hence helps me to reduce the risk of spreading it towards the office.

Prioritising service development when needed

Of course, amid the prioritising of patients, I must also plan in time for project work. I work as a senior dietitian, and so I have responsibility over service development. This includes making sure that our service is the most efficient it can be and that our patients are getting the right care. If any new information or evidence comes out, we are responsible for making sure this is being applied in real life!

For example, one of the projects I have been working on recently is getting a kidney menu started in the hospital. This involves talking to catering managers, talking to dietitian managers, talking to other dietitians. We are working hard to adjust the kidney menu to include more variety and to meet the nutritional needs of patients with higher calorie needs.

09:00 – Working coffee break.

After prioritising my patients and projects for the day, I go for a quick coffee with my colleagues. Normally I also use this time to do bit of brainstorming about patient cases or projects. We may check between ourselves if anyone stuck for time or if anyone’s caseload has grown beyond their safe capacity. We might then spread out our caseloads if needed during coffee time if any of us are able to help.

09:20 – Seeing my dialysis patients

In this post, I’ll go through an average of what I do with a dialysis outpatient and a ward-based inpatient. I normally try to see about six to nine patients a day but will only share one of each of my types of patients with you.

Gathering relevant information

As a result of COVID-19 precautions, I am mostly sticking to phone-based reviews for my dialysis patients at the moment. Firstly, I look at their recent blood results on the hospital system and collect any medical information. For our kidney patients, we have their medical history and weights updated on an electronic system. I will check the system to see if they are gaining or losing weight. At times, kidney patients may be gaining excess weight between dialysis sessions (which might mean that they’re drinking a little bit more water or not passing as much urine as usual), so I often so some calculations based on their weights to asses for this.

Phone call review with the patient.

Then I would talk to the patient themselves on the phone. I might ask them how they are feeling and review their appetite. I may ask if they have noticed any swelling on their ankles, or excessive itchiness (which may be a sign of high phosphate levels). I would ask them to run through a normal day of eating for me. This helps me to calculate their nutritional intake and assess if there are any food groups missing or consumed in excess.  I might ask about their medication, checking that time-sensitive medications are taken correctly (for example around mealtimes). And I guess because I’ve known these patients for several years now, I might ask how their dog is, or their family member – it’s really important to build rapport as this can help build trust (and improves my job satisfaction).

Shared goal setting

Based on all the information that I’ve collected; I might then ask the patient if they feel that they want to work on any particular area that day. They may look for some additional education or ask for me to give them ideas on how to further improve their adherence to the kidney diet. We then set certain goals together to work on before our next review. Often, my plan also involves talking to the medical team to advise them of any concerns I have identified, and to request further blood tests or to start/change medications.

Medical note writing

I would then write a medical note on the electronic system and send out any diet sheets that the patient is interested in receiving. I tend to do three to four of these assessments on a usual morning.

13:00 – lunchtime

 After seeing a few of my dialysis patients in the morning I will go for lunch. I usually buy my lunch in the staff canteen, which serves meals similar to those served to the patients.  Most lunchtimes, I try to eat with a few of my colleagues. To be honest, it has been lovely having a big gang of colleagues to catch up with daily. They were the people I spoke to most during the COVID-19 lockdown, and I really feel that we helped each other to stay sane throughout the tense hospital days.

14:00 – Ward patient time

After lunch I usually head to the wards to see my inpatients. Again, I will run us through a usual ward patient review, of which I would do approximately 3-4 daily.

Medical information gathering

Firstly, I would gather all the information from their medical notes. I would then review their blood results on the hospital computers. The nursing files also provide me with a wealth of info, including what medications the patient has been receiving, any new weights and information on their bowels.

Speaking with the patient

Then I would speak with the patient. I may ask them how they are feeling, how their appetite is and what we can do to help them eat better. Often, the more unwell patients are not able to eat and so they may be artificially fed. For these patients I may ask them how their stomach feels, whether they’re feeling hungry/ thirsty or if they have any questions that I could help them with about their nutritional care. For the patients who can eat but who are not eating enough to meet their nutritional needs, I may suggest specific nutrition supplement drinks or raise the idea of starting artificial nutrition such as tube feeding.

Speaking with the multidisciplinary team

After collecting information from my patient, I might talk to the doctors who are looking after the patient. I may also speak with the nurses, physiotherapist, speech and language therapist or the occupational therapist to get a broader picture of how the patient is doing.

Making a plan

Then with all this information in hand, I try to identify some key nutrition issues that might need to be addressed.  I will decide on a plan to address these key issues. keeping the patient’s wishes in mind at all times.

Writing my medical note

After deciding on a plan, I will again write a detailed note in the medical chart. I often I feel that dietitians write the longest notes of all the team members. However, our long notes clearly highlight the many factors that may be affecting a patient’s nutritional intake. Also, it is great to have a summary of their care to date, so that when I review them again a few days later, I will only have to review the chart notes since that date.

16:30 – Project work and updating my lists

So, by the end of my day I would have seen possibly 6 to 9 patients. I then go back to my desk, and if I have time, I will try to do some project work. Towards the end of my day, I would spend time updating my patient lists. I always try to keep my lists up to date with the most important details about a patient (such as their name, where they are, their weight history, their relevant medical history and my plan). The lists are important to keep updated, as they will allow a colleague to take over my caseload if I call in sick or am on holidays.

16:55– Updating my statistics

At the end of my day, I update my statistics on the hospital system. We keep statistics about which patients we saw, how long we saw them for and what our intervention were with these patients. These statistics can then help the dietitian manager to better plan our service. For example, if she notices that dietitians are seeing significantly more patients under a certain medical discipline, then perhaps more resources need to be brought into that area.

17:00 – Home time

After I do my stats, I take off my uniform and wrap it in a bag (ready to be washed at a hot temperature at home). Then I put on my out of office and head on home on my bike.

17:30: Exercise, cooking and SLEEP.

Normally after work I try to squeeze in some exercise (if I’m not too wrecked after my cycle). I used to head to the gym on my way home, but with COVID-19 lockdown, I now try to do a home workout go for a walk. After exercise, I jump into the shower and then try to cook a dinner (or forage the freezer for bulk-cooked leftovers). Most evenings, I quite literally collapse into bed. Sleep comes easy after another exhausting day working as a dietitian in the hospital.

Hope you enjoyed a sneak-peak into my average working day as a dietitian in a hospital.

If you have any questions on any aspects of my usual day, please don’t be afraid to let me know in the comments section below! Make sure that you subscribe to my Youtube channel! And  if you hit that little bell button on my channel page, you will get notified when my next video comes out. I hope to catch you on my facebook, instagram, twitter and pinterest pages, where I’ll keep the conversation going until my next post!