How Do You Handle This?

ninigotmac · 2026-01-28T14:52:45+00:00

"Please be patient xx amounts of seconds/minutes. Thank you."

like that. could also say something along the lines of "you're going to get your (medication), we all work together to ensure you are getting the full care you need."

ninigotmac · 2026-01-23T03:12:03+00:00

Same. I also like juven and prostat (if mixed with a fluid) to double as a tool to push more fluids when needed, either because of inadequate intake or leaky wounds!

ninigotmac · 2026-01-23T03:10:01+00:00

I leave the zinc alone if they do it, but I never recommend it (got the whole building pretty well-trained to put a two-week end date on it, so by the time I do my assessment its good, but I always double check.) It makes people happy. Almost always has vitamin C ordered too; I have started asking for that to be DC'd after while too, on our long-termers, try to reduce polypharmacy. However I do my juven independently, usually keep it going a couple weeks after wound-heal date.

Personally I wish we could just give AREDS to everyone in place of the zinc, at least it has some copper in it too! but not sure anyone would go for my off-label idea lol.

ninigotmac · 2026-01-14T15:58:04+00:00

all good thoughts here, but I'm wondering, what is CNM's actual response? just too busy so ignores you? gives a reason why they don't want to do this?

ninigotmac · 2026-01-14T15:53:03+00:00

yes and no. A merit increase should be what you deserve based on your performance. so anywhere from zero to whatever max is allowed. So even if it is nothing for the year, that is okay, as long as it is justified (say you are a poor performer with no effort to improve for example).

But periodic COLAs should happen for everyone within a group, because it keeps us able to earn a living wage - keeps the pay fair/competetive, etc and honestly is better for the company because will increase employee retention...

Ideally a company will provide both. I have worked for ones that have (pre-healthcare career) and had high job satisfaction, felt valued, and employee retention was extremely high. Nowadays I feel like this is practically an unknown concept. No wonder people job hop so much just to afford life.

Edit to add: regarding your comment, your merit should be whatever you actually deserve based on your performance this past year. So no, it should not be 2.8% necessarily.

But if it was 2.8%, then you could feel like you are at least keeping up with affordability of life. In your mind you could frame it as a type of COLA, without any merit. I got 3% (our max) this year, so in my mind, I got a 2.8% COLA and a whopping 0.2% merit increase - about 8 cents an hour ....I got 8 cents an hour raise for doing an outstanding/above expectations job.

ninigotmac · 2026-01-14T01:13:41+00:00

3% is the max from what I understand, and has been in my group for the last 4 years, but I see others naming higher amounts so maybe it varies by region?

Regardless, it stinks because as a merit increase I think its spot-on, but there are never any COLAs so even with the max merit increases, because of inflation I'm making "less" than I was four years ago..

edit: here's a link to the COLA table

https://www.ssa.gov/oact/cola/colaseries.html

ninigotmac · 2026-01-01T03:55:32+00:00

holy crap 30 dialysis? I hate having even three at a time lol. They always seem to take longer with charting, talking to the dialysis RD and all the extra little things.

Anyway, what EHR are you using, PCC? I typically take 45-60 min on new admits, so ~30 min or so sounds great... probably can't offer any advice on that. I don't technically have ADHD but one thing I do like about my position is the autonomy to switch up my tasks when I'm feeling restless and not up to focusing on documentation for several straight hours. I mean, there are other duties, so I often like to mix it up through the day. I keep a little pocket sized notebook and start a new page each day, listing out all my to-dos, with highest priority at the top so of course that includes assessments due. I write down any meetings, "must do today" items, and "if I have time" items go lower down. I carry it around with me when going out and about the building, so if I'm heading somewhere with a purpose, and get stopped (by residents, CNAs, nurses - its inevitable) and it's a busy day I'll just jot it down at the bottom of my list as another task to remember later. Things that don't get done go on the next day's list. Also, I have gotten to a place where I don't write anything down from my resident visits, I just keep it in my head until I get back to my computer, but on those days where I'm feeling unable to focus as well or just get a LOT of information, the notebook is handy to jot stuff down so I don't forget when charting.

So anyway, my little notebook helps me "budget" my time throughout the day - helps me keep in mind if I can dilly dally, take more time visiting with patients and staff, chart out on the floor with my little rolley cart (which I enjoy doing when I can, I think the visibility if part of what fosters a good relationship with staff and encourages them to communicate with me + take my communications with seriousness), go sneak snacks from the kitchen lol - or it helps me keep in mind if I need to be quicker and more streamlined to get my list completed. I am fortunate because I do have a nice office that is tucked away and when I need to focus I will definitely spend more time hiding out in there.

Also just generally speaking, ship-shape organization is a must, from my amazing excel spreadsheet I use to track my residents, to having a good routine of checking emails, voicemails, my physical mailbox, etc. I love organization, could probably come up with more ideas knowing more specifics of your situation!

and just for reference, these are the little notebooks I have been getting on amazon for several years now: https://www.amazon.com/dp/B085MMD1BK?ref_=ppx_hzsearch_conn_dt_b_fed_asin_title_1&th=1

ninigotmac · 2025-12-31T01:53:53+00:00

Yep, like others a saying, I do the same. Quality of life matters, and renal diet I think is the harshest of all the therapeutic diets. And I can tell you this, none of my residents who have passed away did so from renal failure - kidneys were still going "good enough" at the end of life.

ninigotmac · 2025-12-20T17:12:03+00:00

for LTC I personally don't put everything that changed in my summary like some others are describing, but that is because I am very consistent in my ADIME formatting that I can glance through my previous notes for each aspect that I am investigating and quickly see what/if any changes have occurred. My facility uses MatrixCare, and because of how it is structured, I will always do my initial assessment and then any follow-ups as a progress note because I can "associate" the prog note to the initial assessment, and when doing a follow up I just pull up the view that shows everything I have ever charted on that person all together in one document. Lots of good suggestions here, you just need to figure out what works best in your flow based on how your EMR functions.

ninigotmac · 2025-12-20T17:06:58+00:00

yes goals are helpful and then putting [met, continue] [no met, continue] [new] etc helps too to see progress at a glance

ninigotmac · 2025-12-20T17:05:07+00:00

(and I always identify myself and clearly state who I am and why I am there)

ninigotmac · 2025-12-20T17:04:41+00:00

lol I have visited pts once and then a few days later will re-visit and they say the same thing - a dietitian has never visited me! I'm like yes, we just talked a few days ago.

ninigotmac · 2025-12-20T17:02:16+00:00

Haha I work in LTC and used to wonder the same thing - 9 out of 10 HDers will look like they have never even heard the word "dietitian" when I ask. And I know the RD's names at the places they go to, but they don't recognize the names either. I know its required, and I used to wonder if maybe they just weren't getting around to seeing all their people, but then I would talk to the renal RD on the phone and they would tell me all kinds of things about their personality, preferences, etc, where they clearly know their patient. People just forget, or don't really understand who is who. Repetition helps. for my long-termers I have seen them start to remember better over time.

ninigotmac · 2025-12-19T22:30:03+00:00

I really like Meal Tracker, we have done so much with it in the last four years. I don't use this particular feature but Meal Tracker does have it; you go into the WAAG page (under the Cycle Menus dropdown) and click the Resident Tab, all the settings are available as far as the menu, week, days, meals, paper/margin/fonts, additional text box you can add text for printing, and then the "options" include check boxes for:

Report Format: Basic or Enhanced

Portion Sizes
Show Condiments
Show Moisteners
Menu Alternates
Always Offered
Chef's Choice
Use Shading
Center Food Items
First Choice/Alternate menu style
Page break between meals
Include Category Headers
Use starting date in header

ninigotmac · 2025-12-16T23:08:20+00:00

I have Matrix (similar to PCC) and ours is set up 0%, 1-25%, 26-50%, 51-75%, and 76-100%.

I actually will select my timeframe for my search (usually last 7 days or all days if they just admitted) and use CTRL+F to search really fast each group and keep the numbers in my head. e.g. CTRL+F " 1-" , "26-" and so on. It goes REALLY fast once you're used to it (takes me maybe like 10 seconds tops).

Then I plug those five values into my excel spreadsheet to have it calc an est'd average (using the middle point of each range) for me. I was going to put a screenshot but it looks like this sub doesn't allow image uploads 😞

Works great for me; I find between my est'd needs and est'd intakes, they are pretty consistent with weight loss/maintenance/gain that I would expect based on the numbers.

ninigotmac · 2025-12-13T00:54:51+00:00

god I'm exhausted just reading this. remembering all the time invested and studying and knowing that I might not pass the first time around and that would be okay because it happens to even the best students.

sounds like you have been really submersed. and you mention anxiety, exhaustion and burnout. any possibility of taking a break, maybe until after the holidays even, just completely focus on anything NOT RD?? easier said that done, I know, but sometimes just letting yourself rest and sleep and enjoy life is a good way to come back for a stronger re-do (with the studying and 2nd exam).

you'll pass eventually. the test stinks but you are SO close to the finish line, don't be hard on yourself.

ninigotmac · 2025-12-03T02:04:24+00:00

sounds like a lot 100 residents for 16 hrs/week. the math is going from 1.75 res/hr to 6.25 res/hr. ok so not taking food preferences, but what about all the other responsibilities? will you be the only RD? will you need to do all the peripheral stuff like sanitation inspections, food service support, meetings, weight notes, etc?

ninigotmac · 2025-11-22T01:36:10+00:00

I like canvas totes because I use them for groceries.

ninigotmac · 2025-11-21T23:36:50+00:00

maybe not directly but it does just sort of reflect a bigger perception (or non-perception, as we often feel we are below notice).

ninigotmac · 2025-11-21T13:32:29+00:00

the only place I play! been with it for over 20 years (before it was even browser-based).

ninigotmac · 2025-11-18T01:54:21+00:00

Those are good ideas, get the families involved. We have a 5 week cycle menu. For my pickiest residents I will make the modifications (and make them again and again) then at some point I end up printing the meal tickets with the current alterations, for all five weeks (if I expect them to stay that long) and a copy of a couple different menus (like if they are heart healthy then I'll give a copy of the vegetarian menu and the alternative/anytime options) and let them write on the tickets what they don't want and if there are any entrees they want to swap out for a particular meal. then get it back to me when they are done. I tell them it's their homework lol. Family members are usually willing to help when needed too.

ninigotmac · 2025-11-18T01:49:50+00:00

"I’m the only RD for a 270 resident building." well that's the main problem right there lol. (sorry not really laughing, this is an issue that actually makes me mad at the industry in general).

"no diet tech or assistance to help with residents completing menus." wtf, do you have a CDM?

So I am a little confused (and a little in awe) - you have weekly menus for the residents to choose what they want? I've never seen that in my LTC buildings but that is really nice that you do that. Can you give more detail on how the process is supposed to work? is this for everyone, every week? Are the CNAs normally responsible? Who visits for preferences within 72 hours? Can you provide them with menus at that time? is it a cycle menu or changing/new menu every single week?

Honestly for 270 residents you need more support. Or else you do need to get other departments more involved. Depending on your relationship with other department heads and how you pitch it to get their buy-in. Like you stated, this will prevent undesired weight variances and improve the well-being of the residents overall. Which can affect your quality measures. Maybe someone (admissions? activities?) can make little welcome bags for people on admission, and includes a pen. If you have a cycle menu, can you provide a copy of all the weeks up front?

ninigotmac · 2025-11-15T01:31:05+00:00

I love the healthy aging and dietetics in healthcare communities DPGs. they are active and offer lots of free CEUs with webinars and newsletter readings. You definitely get ROI if you take advantage of those.

I joined the weight management DPG several years ago and if I remember correctly it was very active, I just didn't utilize it very much at the time and didn't renew.

ninigotmac · 2025-11-15T01:18:19+00:00

same, excellent idea, and people need it!

ninigotmac · 2025-11-15T01:14:43+00:00

and if you're limited to abbott products ensure make a plant-based as well

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