Topic 5: What to Expect as a Long-Term Care Intern by Jessie Donaldson

          At some point in your educational career as a dietetics student, you’ll likely serve as an intern in a long-term care facility. Some classes may even require you to gain supervised experience as a student before your dietetic internship begins. I recently had the opportunity to work with my preceptor, Doreen Rodo, in this capacity for one of my classes. This class taught me a lot about what to expect as I enter my dietetic internship, and I hope my insights can be of help to others as they enter clinical rotations.

What Makes a Good Preceptor?

          When selecting a potential RDN to work with, interns should consider the qualities that make a successful preceptor. RDNs who choose to serve as preceptors are typically drawn to it because they want to help. A good preceptor has a desire to foster growth and educate future RDNs. Patience is a clear virtue here, as students and interns will likely ask a lot of questions. The RDN may be busy but taking the time to answer questions will produce a better intern by the end of the rotation.

          Though an effective preceptor understands an intern is still learning, they will also encourage as much independence as possible. Giving some autonomy whenever possible allows the intern to adapt to a role they may be intimidated by, and this builds confidence over time. The RDN will always review the work of the intern, which offers the chance for feedback and corrections, and also serves as reassurance that the intern is learning under the guidance of an experienced professional rather than going it alone.

How to Be a Successful Student or Intern

          It is important for interns to consider the expectations of their preceptors and strive to meet them. As I touched on above, preceptors are typically happy to help students by answering questions, giving insights based on their experience, and offering guidance when judgment calls are needed. When the time comes that a preceptor corrects an intern’s work, a successful student will accept the feedback with appreciation and not defensiveness. It’s important for interns to not be embarrassed or afraid to make mistakes; the RDN doesn’t expect perfection. It follows, then, that the intern should view the RDN’s input as an opportunity for growth rather than criticism.

          Asking questions is not only okay, it’s expected of students. An intern who doesn’t ask questions may be perceived as either disinterested or irresponsibly overconfident. However, a delicate balance should be found between being a learner and being an active participant. Interns should find the confidence to assert themselves and take on projects or duties that may lie slightly out of their comfort zone, but that they are capable of. It would serve a student well to remember that they can alleviate some of the RDN’s workload by being productive rather than passively waiting for the RDN to give them assignments.

          Finally, all students and interns should remember the basics of being a good employee, especially those with little to no work experience. Always be punctual, dress in a way that’s appropriate for the setting, and be prepared with all of the resources you’ll need. And don’t forget to pack a lunch and some water! Being overly hungry or thirsty can undermine all of your other efforts to succeed.

Maintaining a Positive Preceptor-Student Relationship

          Both preceptors and interns can contribute to the success of their relationship by managing expectations. It may be helpful for both parties to discuss their expectations from one another before the rotation starts, to get started on the right foot. When it goes well, this experience can produce a collaboration where the student learns from the RDN and the RDN benefits from having an extra hand with their work and the fresh perspective that a student can bring.

An intern’s perspective: Series written by Jessie Donaldson (Part 1 of 5)


Topic 1: The Importance of Meal Rounds in Long-Term Care

          Long-term care RDNs rely heavily on observation to identify and address feeding issues in residents. As a student, I was surprised to find just how important meal rounds are. As I assisted my preceptor in meal rounds, I learned a lot about the feeding issues that older adults often face and the various tools an RDN may use to treat them.

          Among older adults living in nursing homes, it is estimated that 40-60% experience feeding difficulties.1 This is not surprising, given that an estimated 47.8% of nursing home residents have Alzheimer’s or other dementias.2 Dementia leads to many feeding difficulties, as it often leads to pocketing of food, increased energy expenditure due to pacing, food refusal, agitation, and forgetting to eat.3 What’s more, dementia and other conditions can cause dysphagia, which involves difficulties swallowing food and/or fluids. For residents with motor neuron diseases like Parkinson’s, the physical act of getting food from their plate to their mouth can be laborious. With a population susceptible to unintended weight loss and malnutrition, all of these feeding issues pose a very high risk. This is what makes meal rounds such a powerful tool for RDNs.

By observing residents as they eat, an RDN or intern may notice one of the following situations:

  • A resident coughs, gags, or sneezes between bites
  • A resident drools or loses food and beverages out of their mouth
  • A resident appears to be confused or agitated, and isn’t eating as a result
  • A resident has trouble holding utensils or getting food onto them, due to tremors or limited mobility
  • A resident complains of nausea or a lack of appetite

When one of these situations occurs, the RDN may take action by:

  • Requesting an assessment for dysphagia from a speech-language pathologist
  • Informing nursing that the resident needs assistance from staff with verbal cueing or physical assistance
  • Documenting decreased meal intakes and monitoring for weight changes over time
  • Requesting an assessment from occupational therapists to identify whether adaptive feeding equipment may help
  • Offering the resident alternative foods
    • Finger foods like cut sandwiches can be especially helpful for those with motor difficulties or confusion
    • Snacks like yogurt or cottage cheese and fruit can add much-needed calories and may be better tolerated than full hot meals
    • A daily menu of familiar items should always be available as an alternative to the daily selection
    • If the resident has a specific preference, the RDN will notify the foodservice manager so the item can be served daily or as per the resident’s wishes

When an RDN conducts meal rounds, their primary goal is to help every resident get adequate energy and nutrient intake. The golden rule is, “food first”. If, however, every option above is exhausted and a resident is unable to meet their nutritional needs (as evidenced by significant weight loss or other signs of malnutrition), the RDN has a few other tools to use. First, CNAs and diet aides can be instructed to always offer residents whole or chocolate milk with their meals. The additional calories and protein in milk can make up for deficits caused by feeding issues. If the resident refuses or it isn’t enough, drinks like Ensure or Boost may be warranted. After prescribing one of these nutritional supplements, the RDN will assess the resident’s intake of them at future meal rounds.

Students learn much in their classes about nutrition assessments and nutrition-focused physical exams. Another important tool for RDNs that doesn’t receive as much coverage, however, is meal rounds. During my time as a student-intern, I learned how critical of a practice it is to observe residents as they eat.


  1. Aslam, M. and Vaezi, M., 2013. Dysphagia in the Elderly. Gastroenterology & Hepatology, [online] 9(12), pp.784-795. Available at: <; [Accessed 10 April 2020].
  2. 2016. Faststats – Alzheimer Disease. [online] Available at: <; [Accessed 10 April 2020].
  3. Hilliard, MS, RD, LDN, CSG, CDP, L., 2013. Caring for Dementia Patients. Today’s Dietitian, [online] (Vol. 15 No. 8), p.64. Available at: <; [Accessed 10 April 2020].


Jessie is just completing her undergraduate work at the University of Alabama and will be interning with the University of Delaware this fall.

10 easy ways to connect with a RDN mentor:

1. Email Doreen Rodo at You can ask any RDN related questions. Specialty is LTC, writing and making videos for students.

2. Join the “Dietitian Mentor” Facebook group and post a question.

3. Join the Facebook group: “Dietitians on the blog” and visit their mentorship tab.

4. Volunteer to write a short article for a blog created by a RDN

5. Visit the Academy of Nutrition and Dietetics:

6. Attend a local dietitians meeting and network with RDNs in your area

7. Create a profile on LinkedIn and connect with RDN members

8. Comment on posts from RDNs and ask questions

9. Call a local hospital, food bank or a LTC facility and ask to shadow the dietitian

10. Participate in the RD mentorship program in Florida and Texas. Contact person-Kristen Hicks:


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