The past several weeks have been extremely. . . interesting. I don’t mean for that to sound insensitive, it has just been interesting to see how different people are handling the COVID-19 pandemic. I only intend to speak to my own experiences as a dietetic intern who has observed some of the impacts on a small corner of our healthcare system in the U.S.
For anyone reading this who isn’t a dietitian or dietetic intern, in the United States, after dietetics students graduate with our undergraduate degree, we have a ~1-2 year internship program that rotates us through multiple sites (e.g. hospitals, WIC clinics, primary care clinics, dialysis clinics, etc). We have to meet competencies at our sites in order to complete the program and then be allowed to take the registration exam for dietitians.
For myself, and I’m assuming many other interns, our rotation sites are either not allowing us on-site (as is the case with my current rotation) or for some interns, universities/schools may not be allowing students to participate. Both cases are completely fair given the circumstances, but leaves me wondering how effectively I’ll meet the competencies and question whether I’ll be able to learn what I need to learn through simulated learning rather than hands-on experience. That being said, I’m making the best of it! (Like dusting off the old blog, and playing with our ferrets).
Observations at a Primary Care Clinic in Oregon
I was in a pediatric primary care clinic rotation when I started to see concerns of COVID-19 sweep through and it was about 3 weeks ago when I started to see it actually affect my internship. The project for my last day at the clinic was to sit in the lobby with an activity to do with the kids and talk to their families about nutrition while they wait for their appointment. My project got canceled (for obvious reasons) about 2 weeks before it was scheduled to take place. The day I found out it was canceled, we started having talks at the morning huddle with staff assigned to a task force that was put in place to help disseminate information and procedure changes to the rest of the clinic regarding COVID-19.
Like the dweeb that I am, I took notes and these are some of the procedures that changed and issues that came up during my last 2 weeks:
- Starting March 3, 2020 the staff began screening patients at the door into the clinic and sending any kids with respiratory symptoms and a fever to the back door of the clinic with a mask on. The back corner of the clinic with rooms near this door was being utilized for these screened “sick visits” and patients would ring a doorbell, then be roomed immediately (or as quickly as possible).
- Masks in the clinic were being conserved since there was a shortage and the staff was anticipating several weeks before being able to replenish their supply. Staff was to limit giving masks only to kids with symptoms, but this eventually expanded to relatives present with the patient who had symptoms. The only staff members wearing masks were providers when they were entering sick-visit rooms and for doing throat swabs on patients (to test for flu, strep, etc.). All other staff were to keep distance and stand to the side of the patient. For myself, I simply did not go in with any sick-visits (who really wants to talk about nutrition when they’re sick, anyway?).
- Providers were instructed to not only use a gown, gloves, and a mask when entering a sick room, but to wear goggles as well.
- Staff stopped taking blood pressures since the cuff can’t be adequately wiped down.
- They stopped measuring babies using measuring mats since the mats they have are not made to be wiped with sani-wipes.
- Staff limited the use of nebulizers to minimize aerosolizing saliva and also because if they do use them, the room would need to be closed for 2 hours before anyone could enter and wipe down all surfaces.
- Medical assistants were instructed to be more thorough with wiping down all surfaces in patient rooms with sani-wipes.
- The advice nurse was (and probably still is) triaging a huge influx of calls and encouraging anyone with common COVID-19 symptoms to stay home. If necessary, she was scheduling virtual visits with a provider. Parents of patients were asked to stay home and not go to a hospital unless their child’s symptoms were bad. If they did need to go, she instructed the parents to call the hospital ahead of time to warn the hospital staff of a potential exposure so they can prepare ahead of time for the patient’s arrival. Other staff members needed to be pulled from their normal duties to help the advice nurse with the massive call volume.
- Rooms were being filled quickly with sick visits causing multiple patients to wait at the back door, which was not ideal either and increased the need to encourage and setup virtual visits to limit the number of patients coming to the clinic sick.
- And of course, hand washing and hand sanitizing increased around the clinic as well, with reminders posted around the clinic at sinks and work stations.
- The clinic’s task force also stated Oregon Health Authority is in charge of testing and the clinic did not (I believe still does not) have access to the test, so if parents ask, that was their current knowledge of testing.
I had decided to take notes on these changes because I’d never worked in healthcare before this internship and having only ever been on the patient-side of the equation, I thought it was fascinating to observe how a doctor’s office handles a pandemic.
The next dietetic intern to rotate at that clinic reports they are still doing all these procedures and providers are continuing to do more tele-health visits.
What to do Now
I was supposed to start my food service management rotation this week at a hospital. Unfortunately, I was unable to due to the hospital limiting non-essential staff, including students. I’m working with my preceptor to complete what projects I can from home and trying to be creative with finding ways to be productive and work toward my competencies.
To other interns out there – look for opportunities to help your local food bank, brainstorm ways to meet competencies at home, and talk to your internship directors about how you can move forward if you’re not being allowed at a site. This is a perfect opportunity to let your adaptability, critical thinking skills, and creative side shine. Feel free to share your experiences here as well; I’d be interested to hear how other internships around the country are handling the situation and how rotation sites have been working to control the pandemic.
As many of us find ourselves cooped up at home, struggling with social distancing, I want to remind everyone we live in the age of the internet and there’s plenty to keep ourselves occupied. It only takes contact with one other person to continue the spread, so stay home if you can.
I also want to say thank-you to all the people and industries keeping things functioning while many of us hunker down: truckers, postal/shipping workers, utility companies, toilet paper manufacturers, all folks working at food retailers, food banks, and especially healthcare workers!!!! I’m sure I’m missing tons of people, but know you are appreciated.
Everyone, wash your hands.
p.s. – Part of my project at the clinic was going to be doing coloring sheets with the kids. I made one and you can download it here: Citrus Coloring Sheet (tag me on Twitter or Instagram if you use it. It will make me happy to know I didn’t do it for nothing) 😀
ASCEND’s Statement to Dietetics Students on COVID 19: https://www.eatrightpro.org/acend/public-notices-and-announcements/acend-update/acend-covid-19#info
Coloring Sheets and Kid-Friendly Recipes: https://foodhero.org/
Information on Coronavirus from the CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.html
John’s Hopkins Interactive Map: https://coronavirus.jhu.edu/map.html
A Lecture on COVID-19 from Oregon State University Professors: https://www.youtube.com/watch?v=X3XtVeSrq1g&feature=youtu.be