My journey in adapting to remote working during COVID-19 in 2021
Hi! I’m Holly and I’ve been working as a Registered Dietitian (RD) in various settings for over a decade (since 2009) .
2020 –> Sometime during the rollercoaster of COVID-19 – the year when the world slowed down- I felt a spark inside me rise to the surface that made me want to document my life more intentionally.
Why? I have always tried to keep a journal since I was a teenager, and there is something about reading back entries that is incredibly powerful and priceless for self growth. As I got older and started weaving my web in the world, I no longer have time to document as much. So here goes. Maybe I will read this in 10 years and be glad I wrote it. For now though, I figured I would start, well , where I am now.
So without further adieu, this is my current working day in 2021.
I currently work in a level 1 trauma hospital in San Francisco as a RD on medical/ surgical units, and have been at my current job for five and a half years( which is the longest I have been in one job). I usually am based on site full time 5 days /week. In the Bay Area where I live, it is relatively common for some people- mostly those in tech- to work from home, however this has changed since COVID-19 as more and more disciplines are working remotely! This was my very first experience working from home( which was a very new concept for me!)
In April 2020 , my team was split into two groups and we alternative weekly – one group works remotely from home (via telephone and remote access to the medical charting system) and the other on-site as usual in the hospital. Then we swap the following week. Because it is essential to observe patients to gather some data i.e for nutrition focused physical exams , we are assigned a “buddy”, a colleague on site who I flag any nutrition concerns to ( eg. low BMI, concern for malnutrition, any person who would benefit from a on-site visit) and my buddy visits and assesses the patients nutrition and relays to me , and then I document the nutrition assessment and plan. At first it was challenging working from home as so much of my work is done in person, and sometimes it is easier to chat to the RN and other members of the care team in person, but I also feel working from home has benefits i.e patients are more focused on phone calls and able to relay more information. It is also personally beneficial , as I often feel more calm and focused on work from home days , where as working on site is often fast paced, with frequent interruptions and sometimes I get stopped in the hallway and asked to action things that were not on my list for that day.
I work in a team of 8 dietitians , split up between medicine/surgical/neurology floors (or units or wards for those in the UK ), ICU , paediatric/NICU, and the psych units. I cover 2 medical surgical units and a overflow emergency room unit ( overflow from the emergency department- often patients who are here for short term stays for planned operations i.e various procedures such as cholecystectomy/ irrigation and debridement, IV antibiotic course, alcohol withdrawals). I have been trained to cross cover every floor except paediatrics.
I generally wake up at 6:30am. I start the day with 10 minutes of physio exercises (for a past sciatica injury), sometimes 5 minutes of keyboard practice, and then get dressed, prepare myself for the day and grab my pre-made breakfast ( overnight oats, berries, protein powder) and fill my coffee flask with oat milk. Next I fill out the online screening questionnaire implemented since COVID-19. I’m very lucky to live a 5 minute walk from the hospital, and usually put on some music for the short commute. I put my mask on before leaving the house. I arrive to the hospital between 7:15-7:30 am. As soon as I enter the main door, I’m shunted into the online screening que, and get my temperature taken and receive a sticker to add to my badge that day. I head up the stairs and to my locker on the first floor, to drop off my rucksack, change into my lab coat and grab anything I need ( my binder, calculator, reusable cutlery before heading to the cafeteria to fill up my flask with coffee, maybe grab a orange or banana. All of my department receive a meal card of up to $20/day which definitely helpful and I use for coffee and lunch most days. Next I head upstairs , say good morning to my colleague. Sometimes no one says good morning as everyone is busy screening and in their own head space. I log into EPIC, the medical records systems, log into my 3 units and start screening my caseload ( up to 50 beds ) which can take between 20-45 minutes most days. Using our departmental screening policy I categorise patients into low( see within 4 days) , moderate, ( see within 3 days) and high risk (see within 1 day). I confer with the diet technician assigned to my floors to discuss any patients we have questions on. The diet tech will see all the low risk patients and the dietitian is assigned to the moderate and high risk patients. Next I review and sign off on any diet technician notes from the previous day which can take 15-30 minutes depending on how many were done the previous day. Next I go through the consult board for my floors and pull out any consults that were put into by the medical team or RN overnight . I make a list of all these patients and that is my list to see /complete nutrition care plans on today. Our team has a group secure chat on EPIC and if anyone has any extra time , we offer to help others see patients so that those who are more free can help balance those with many consult and a longer list.
Once I have printed my list, I start gathering data on the patients I’m going to visit today. I usually start eating my breakfast at this time, my team tends to eat at their desks which is not great practice ( and rather ironic given we are the nutrition department) , but it does help save me time for later in the day. I open up a blank nutrition assessment template for each patient and screen each medical chart for the pertinent information – which is generally the story of why the patient was admitted, weight, height, I scan the weight history for any significant weight changes, I look to see if the patient has any food allergies documented. I look at the morning labs and note any outliers , look at the medications, check if any GI intolerance ( nausea/vomiting) and when the patients last bowel movement was, and anything else that may impact the overall nutrition status.
I try to build a story of any pertinent events that has occurred since admission and list this under pertinent events. I do this for up to 6 patients. This is the most time consuming part of my day and usually takes me from 9am-12pm to gather all the information I need. I make notes on my list of any specific questions I want to ask the patients or RN . When I have gathered all my data, I generally stand up ( or sit down -depending on my standing desk situation) , stretch and wash my breakfast container and coffee flask , gather any printed nutrition education leaflets I need and get my safety goggles ( all staff are required to wear surgical masks and safety goggle for all patient visits). I head off to my units, stopping by my locker to drop off my washed breakfast container. I prioritize which units to visit first depending on my list – if a patient needs new tube feeding recommendations, or if a patient is due to be discharged later in the morning and needs new diet education , I will visit those patients first. If no urgent priorities I like to start at the top floor and work my way down.
When I walk on to the unit, I greet any nurses, and check which nurses are assigned to the patients on my list for that day. I try to lump together all my check-ins with the nurses as they are very busy and often multitasking and I want to keep my interruptions to a minimum. Sometimes I go directly to the patient, but if I have a concern or if I see a behavioural concern in the chart I usually approach the nurse first to check if it’s appropriate for me to visit the patient.
I try to visit patients at the tail end of their lunch as I like to visualise what they ate off the meal tray if possible to assess if any chewing/ swallowing difficulties/ poor appetite. Some examples of agenda I may have on my list are checking in on patients with poor appetite, reviewing tube feeding regimens, addressing food preferences , ensuring patient with wounds and pressure ulcers are meeting adequate nutrition needs, diet education for new diabetics, or on therapeutic medical nutrition therapy. I then liaise my findings with the interdisciplinary team, follow up with any recommendations and message the medical team to request sign off on any nutrition recommendations ( including oral nutrition supplements, therapeutic diet changes, tube feeding recommendations , parenteral nutrition, food insecurity). I usually visit patients until 1:50pm . The cafeteria closes at 2 pm , so I try to make it there before it closes. I’m a creature of habit and usually get a hot soup and Mediterranean salad to take up stairs. Half of my team takes lunch breaks and the other half tends to eat at their desks. Because I’ve crammed alot of data in my head from my morning visits that I have to document , I tend to sit and eat lunch at my desk while planning how to document my nutrition care plans. The remainder of the afternoon form 2-4:30pm i usually spend documenting and actioning any points that need taken care of before the end of the day. I rarely have any downtime , but if I have an extra few minutes, I spend it doing e-learning for annual updates which is required of every staff to complete before July each year. After I finish documenting , I review my list to make sure I actioned everything I needed to for the day. I then enter the number of patients I saw, documented on, and certain points of data that my team are collecting ( number of patients with protein calorie malnutrition , number of patients positive for food insecurity) in the QUAPI data sheet. Finally , I’m done! I log off for the day , wipe my desk down with sanitizer ( over night the trauma doctors tend to use the area and computers, so I try to make it clean for the next user) and sign out on the time sheet before saying good bye to any colleagues still in the office and leaving to go home.
Once I am home I usually decompress for 30-45 minutes before going for a 45 minute walk to try to reach my goal of 10,000 steps for the day. I listen to music, or more recently podcasts ( The Daily from New York Times is one of my favourites) if I feel like it. Sometimes I just observe my surroundings and enjoy being in the fresh air. I’m usually back inside by 6:30pm and finish off my exercise regimen by doing another 15 minutes of physio exercises whilst watching youtube videos of various people I follow .I then shower by 7:30pm and prepare what I’m going to make for dinner . My dinner slot is 8:15-9:30pm and sometimes I spend the hour cooking or just simply heating up leftovers. I try to play keyboard for 15 minutes or catch up on a course I’m doing after dinner. I have set my screen time limits on my phone and computer to shut down at 9:30pm , and I usually sign off anything I’m doing on the computer at this time and either chat with my partner or read on my kindle before lights out at 10-10:30 pm.
hollypeppercorn 