Nutrition Support Blog: Mentoring and Clinical Nutrition
August 26, 2011
I read an autobiography some years ago that commented on practices that contribute to success. The writer felt that his ability to objectively observe what works for other people and to adapt or improve the strategy and then incorporate this borrowed technique as part of his routine was instrumental to his success. Borrowing successful practices might seem like a relatively intuitive technique that everyone would adopt. However, I have noticed a reluctance to embrace change with certain traditions, especially if the idea comes from another field or requires a bit of innovation and effort to implement.
One successful strategy that I have observed is the way that nurses new to our ICU are paired with an experienced RN for an organized clinical orientation. Experienced nurses receive a 10 week orientation, while new graduates have the benefit of a 20 week orientation period. The orientation process begins with close supervision by the experienced RN, and then gradually increases independent activities of the new staff member as competencies are achieved. The one-on-one teaching during orientation allows the transmission of the collective wisdom and experiences (“distributed intelligence”), accumulated over the years and prevents the repetition of lessons learned the hard way. While an intensive orientation requires a substantial investment of precious staffing hours, I have no doubt that the unit reaps the rewards for this effort.
In contrast, dietitians at our facility have traditionally not had an extended orientation that focused on clinical skills. We have provided extended clinical orientations for relatively new graduates working on our nutrition support team and we have witnessed how this extended one-on-one training accelerates the transition from novice to expert practice. Over time, we have also realized that a structured orientation is valuable for the generalist RD’s and for those staff members that arrive with more extensive experience. One of our goals is to critically examine our RD orientation and to emulate and adapt portions of the nursing orientation so that our new staff will fully benefit from our accumulated experiences. Our past experiences have taught us that we need a more organized and consistent approach to orientation with clearly defined timelines, expectations and competencies so that all of the information is transmitted effectively. We hope to be able to share some success stories with you in the future as we undertake this process.
Undoubtedly, there is a wide variety of clinical staff orientation programs at various hospitals. However, my work experience (and our encounters with many other RDs through the years) suggests that after the tour of the facility and basic hospital orientation many RD’s are set loose for some OTJ (on the job) lessons. I would like to see our field embrace the art of mentoring less experienced staff so that all of the lessons learned in “the school of hard knocks” over years of practice will not be lost with each generation of clinicians. Improvement in the way that we orient and mentor clinical dietitians is something that we can all do advance our field and help attain the respect we deserve in the clinical arena.
“An invasion of armies can be resisted, but not an idea whose time has come.”
- Victor Hugo
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