A DAY IN THE LIFE OF . . .
A ROTATIONAL BAND 6 DIETITIAN Sophie Johnston Registered Dietitian Salford Royal Foundation Trust Sophie has worked as a Rotational Dietitian in a variety of clinical areas at Salford Royal Hospital since 2015. She has a particular interest in stroke medicine and enjoys service development.
For the past year, I have been working as a Rotational Band 6 Dietitian at Salford Royal Foundation Trust. This has involved working within the gastro, community, neuro and renal teams, with quick transition between each role. This has required me to be adaptable and open to new clinical areas and ways of working, which at times has been challenging. However, I feel that it has given me invaluable experience and ultimately made me a more holistic practitioner. My article here is more of an overview of the work I do rather than 'a day in the life', as all my days have been so variable depending on each rotation. I wanted to write this as an encouragement for others to try rotational working beyond a Band 5 level. OVERVIEW OF ROTATIONS
I initially worked within the surgical gastro team which mainly involved managing the ward lists and seeing patients post upper and lower gastro intestinal surgery. I also had the opportunity to support the team on the medical gastro wards. This broadened my clinical knowledge and enabled me to see more complex patients, with support from experienced team members. I have since come across such patients in the community, for example, those with high output stomas or inflammatory bowel disease, and felt confident in managing multiple co-morbidities. Due to departmental need, I rotated into the community team within a few months. I had to adapt quickly to the different style of working, additional systems used and a new team. I worked with patients with a variety of medical conditions and oral and enteral nutritional needs in their own homes, nursing homes and in clinics. This was a real step out of my comfort zone, as all of my experience since graduating had been acute based. Although I was only in the community team for a few months, I feel that this time supported me in becoming a more holistic practitioner 46
www.NHDmag.com May 2018 - Issue 134
with the ability to develop realistic, patient-centred care plans for home. I am now much more aware of the community services available to my patients and our responsibility for appropriate prescribing in the NHS, which I incorporate into discharge plans. I also found this experience useful to build professional relationships and support team working across acute to community. I subsequently moved to the neuro team, leading on stroke and providing cross cover with trauma, neurology, neuro-oncology and neurovascular patients. This was an area I had enjoyed working in as a Band 5, so I welcomed the challenge of a step up to a Band 6 level, seeing patients from high dependency up until rehab. During this time, I was able to deliver some staff education sessions, which is something I look forward to building on in the future. Since November, I have been working in the renal team. This has been my longest rotation so far and I have appreciated having the chance to settle into a different clinical area and team. My role involves covering the renal, urology and medical high dependency wards, advanced kidney care clinic, young adult clinic and a satellite dialysis unit in Wigan. I work with patients with varying levels of acute and chronic kidney disease, pre and post commencing dialysis, and those who opt for conservative care. I also contribute to regular advanced kidney care and bone mineral management multidisciplinary team (MDT) meetings.
I have particularly enjoyed the strong focus on optimising quality of life during this rotation, as well as getting to know the patients. I am due to rotate back into the neuro team for 18 months to lead on stroke, in addition to providing cross cover. I am looking forward to coming back to an area of familiarity, and putting my wider skills and knowledge into practice. PROS AND CONS OF ROTATIONS
Overall, I have found my rotational post to be an extremely positive and rewarding experience. However, there have been challenges and I don’t think this way of working would be suited to everyone. There is a lot of time spent feeling out of your comfort zone which can be daunting. Focusing on the opportunities for development, rather than the threats, is key. Working in different areas helps you explore interests and ideas. I have ended up working in areas which I wouldn’t necessarily have chosen to, but I have enjoyed and gained knowledge from them all. I also feel I have been able to identify skills I didn’t know I had, as well as areas to work on. It can be difficult to meet the additional expectations of working at a Band 6 level, as opposed to Band 5, when you are working in an unfamiliar clinical area, and it is always important to be aware of your limitations. For example, you may not have the answers to clinical questions from a more junior team member. I have been lucky enough to work with experienced highly specialist dietitians in each area, who have been generous with their time and support. I have also enjoyed learning from other MDT members, such as by shadowing specialist nurses. It takes time to get acquainted with new procedures and skills, and can leave you feeling like a hindrance in an already over run and busy department. However, looking at the bigger picture, once you are trained up and confident to work autonomously, you are more able to support with cross cover. It is worth the team putting the time in to encourage your learning for the longterm gains for the department. I am by no means an expert or specialist in the areas I have worked in for a few months, and I still have a lot to learn. However, I now feel confident in assisting any team during times of leave or sickness, and this
is something I enjoy and feel contributes to staff morale. In the current NHS climate, I feel it can only be of benefit to have a team of staff who can provide cross cover in different specialities, minimising gaps in service, or need for locums. Adapting to management styles and supervisors has also been a learning curve for me. I have found a positive attitude and an open mind have supported me through these transitions. I feel I have learnt many non-clinical skills from different supervisors, for example, dealing with challenging patients, sharing caseloads and documentation styles. It can also be difficult to set specific objectives for appraisal systems if you don’t know where you will be over the next year. I found setting general long-term goals and agreeing more specific aims with individual supervisors upon rotation overcame this. Finding opportunities to be involved in service development projects and audits can also be a challenge when you are only in one area for a short period of time. I have ensured continuous professional development by attending education sessions and volunteering to take part in other non-clinical work, such as student training, leading on health promotion weeks and charity work. My overall job satisfaction has improved as I now feel like a more well-rounded, holistic and ultimately useful employee. I definitely haven’t experienced boredom (although does anyone in the NHS with current staffing pressures?!) or job ‘burnout’, as I am constantly learning and improving. I don’t know which area I will end up in the long term, so far I am enjoying them all! However, I hope that my rotational experiences have equipped me for exciting opportunities in the future. www.NHDmag.com May 2018 - Issue 134
47
NEW Low Protein foods for every day with Mevalia! TRY OUR NEW TASTY TREATS Our super soft and tasty sliced Pane Casereccio bread containing herbs given it a distinctive taste can be eaten straight from the pack or toasted for a tasty snack or meal. Experience a little indulgence with our Chocotino bars individually wrapped, and made with the finest cocoa taste. A delight for all chocolate lovers!
Mevalia Pane Casereccio 220g
You can find our full range of products and lots of delicious recipe ideas including pasta, flour mixes, bread and sweets online at
www.mevalia.com
220g PIP CODE: 405-7857
Mevalia Chocotino 100g (4 x 25g)
Give me a try!
100g PIP CODE: 405-7592
Email: info@mevalia.com Tel: 0800 988 2488 Fax: 01925 865101 TO REQUEST YOUR FREE SAMPLES
In partnership with