I had the opportunity to intern with Keegan & Associates, Inc. full-time this summer (2014). I got the chance to see several different long-term care facilities and small rural hospitals in WV. I spent a lot of days traveling to facilities located in Buckhannon, Elkins, Philippi, Belington, Kingwood, Berkeley Springs, Thomas, Weirton, Chester, as well as St. Clairsville and Shadyshide which are in OH. I definitely learned so much about different conditions and diseases while working in long-term care facilities especially due to all of the problems that these elderly residents had. It gets sad seeing people in such states where they can no longer take care of themselves! I can still remember, and probably always will, my first day in a clinical setting and sitting down to first observe the RD I was with and thinking, "Wow, there is so much to know and remember to make notes on while charting on each patient/resident". I thought there was no way I was ever going to remember everything to include in my progress notes let alone the correct order of it all! The next thing I know, I have started to obtain my own little method in remembering how to chart/order everything into a progress note. I definitely have seen an improvement in myself from when I first began these rotations and working within a clinical setting. The 'real life' experience is a lot different than what you can learn from classes and coursework. I really did not expect to like long-term care, but it really hasn't turned out to be as bad as it may sound. I really liked what one of the RDs that I followed with Keegan & Associates, Inc. said about long-term care, "I really like it because you actually get to follow residents and see how recommending diet changes and giving nutritional supplements, etc. really effect an elderly individual and their overall health status. You don't get that chance in acute care or outpatient counseling. It really makes you feel good about the work that you do when you see the benefits it really does provide."

I spent a good amonut of time for my acute care medical nutrition therapy rotation within a smaller hospital, Preston Memorial located in Kingwood, WV, that does not have a regular, on-staff Registered Dietitian. Therefore, Keegan & Associates, Inc. also maintains a contract with them to provide them with a dietitian once or twice a week. For the acute care rotation, I felt there were some differences, but not too much. The progress notes are fairly similar. I think you have more time actually visiting with patients because most of them are more open to talking with  you than in long-term care facilities. You still have many elderly patients in acute care, some of which are regularly in a nursing home, but had to be transported to an acute care hospital as a result of a sickness or such. You do also have some younger adults and every once in a while a young child. These indviduals may be there for surgeries, accidents, sickness, etc. That is one thing that is more pleasurable about acute care is that you have a range of people and you never know the kind of people and/or the reason you may be seeing someone. So I guess I can say it kind of keeps you on your toes more! One thing I did not realize until doing my rotation with this hospital is the amount of bariatric surgeries that occur. I did not think that was such a common procedure, but we often saw in just one day a week three to four post-surgery patients!