Clinical Notebook

Carly Lehmann

Date
2/10/2016
2/17/2016
2/24/2016
2/26/2016
3/2/2016
3/4/2016
3/5/2016
3/13/2016
3/21/2016
3/23/2016
3/25/2016
3/26/2016
3/27/2016
4/1/2016

Day
Wednesday
Wednesday
Wednesday
Friday
Wednesday
Friday
Saturday
Sunday
Monday
Wednesday
Friday
Saturday
Sunday
Friday

Time Log
Time In
Time Out
Total Hours
3:30 PM
4:30 PM
10:30 AM
2:00 PM
10:30 AM
2:00 PM
11:00 AM
1:00 PM
10:30 AM
2:00 PM
10:30 AM
3:30 PM
10:15 AM
11:15 AM
10:15 AM
11:15 AM
12:00 PM
2:00 PM
10:30 AM
2:00 PM
2:00 PM
4:00 PM
10:15 AM
11:15 AM
10:15 AM
11:15 AM
12:30 PM
2:30 PM

1
3.5
3.5
2
3.5
5
1
1
2
3.5
2
1
1
2

I have worked at a nursing home for about eight months. My boss has been very
accommodating with my busy schedule and letting me come in for short amounts of time as I
have been able to. She seems to have been happy to have had the help with some of the things
that her job requires her to do. It has been an interesting experience to work behind the scenes of
my regular job and see that there is a lot more that goes on than I ever truly realized. It has also
given me the chance to get to know some of the residents a little better as well, since there are
some things that we, as dietary aides, do not ever really need to know about them. The entire
experience has given me a new appreciation for everything that goes on within the facility.
2/10/16: 3:30pm-4:30pm (1 hour)
I went in mainly to get some days and times set up to shadow and was not intending to stay very
long but my boss ended up going through the discipline policies and a little bit about menu
planning with me. Even though I mostly knew the discipline policy since I work at the facility,
there were a few things that I had never really paid attention to before. Different offences are
worth different amounts of points and once a certain number of points are reached, you will be
terminated. Clocking in late or clocking out early is worth 1/3 of a point and even though that
does not seem like a huge amount, it can add up quickly if you are not careful. I also did not
realize that to call off, it is supposed to be done two hours in advance, which would be pretty
tricky to do if you work any of the morning shifts. Calling off is worth an entire point if you
cannot find someone to cover the shift for you. My boss also briefly went through the cycle
menu and explained substituting items out and how difficult that can be because she has to make
sure that the substitution matches the nutrition quality of the intended item. She plans to go more
in-depth about the menu in my future visits.
2/17/16: 10:30am-2:00pm (3.5 hours)
When I first got there, the GFS truck had also just gotten there and my boss was in a meeting.
For about 20 minutes or so while she was in her meeting, I put away stock. After she was done
with her meeting, I went around the kitchen with her to do a checklist, the Food Safety and
Sanitation Audit, to make sure everything is up to the standards. Things on the list included
making sure the employees do not wear any jewelry aside from plain ring bands, no nail polish,
cleanliness of various items, making sure food is stored off of the ground and not too close to the
ceiling, dishwasher temperatures being accurate, thermometers being in all of the refrigerators
and freezer, as well as many other things. After that, my boss did inventory of dry, coolers, and
freezer stock so she could do the order later in the day. She uses the upcoming menu to make
sure we have all of the items that we will need to make the meals that will be served in the next
several days. If we are low or out of things she orders it and the amount depends on whether it
will be in the main meal or an alternate option. It also depends on, in general, how often the
product gets used. Things such as ice cream, milk, and yogurt get ordered for every delivery
because we go through them so quickly. Once the inventory was completed, my boss showed me
how to the use the GFS ordering system. I thought it would be fairly simple, but it ended up
being pretty complicated and time consuming because she has to go through a third party that
manages the transactions of GFS. Once you are where you need to be to order, there are various
options to search for foods. The most common way is to use the number associated with each
item; however, certain items do not have numbers and have to be looked up by name. Looking
items up by name can be a little tricky because there tend to be several items that come up with
very similar names and choosing the correct one is a little difficult.

2/24/16: 10:30am-2:00pm (3.5 hours)

Today, one of my bosss tasks was to determine exactly how to make thickened beverages. Ever
since I have been working there, we have always had nectar and honey thickened beverages
come in cartons than we just pour right into the glass; however, due to cost concerns, it has
recently been decided that we are only ordering the powder to thicken drink ourselves. My boss
is trying to make this a little easier by having pitchers ready so we do not have to constantly
thicken everything since that takes a lot of time. To do this, some trial and error were needed. It
took a significant amount of time and do-overs to figure it out, but we were able to get pitchers
of water, orange juice, and milk to the correct consistencies for nectar and honey thick. It makes
a little more difficult, too, since when using the powder, it tends to thicken more as it sits. So
something that was supposed to be nectar might end up being honey. Also, it takes less thickener
powder to thicken water than it does to thicken heavier beverages, such as the orange juice. The
GFS also came again today, like it does every Wednesday and Friday, so I helped put away stock
again as well. My boss also went over the basics on how to place a bread order since the order
will not be the same each time, depending on what is on the menu in the upcoming days. She is
going to have me help her with one in one of my future shadowing days.
2/26/16: 11:00am-1:00pm (2 hours)
Unfortunately, I did not really get any true shadowing done today because of some unforeseen
circumstances. When I got there, I realized immediately that My boss was working a position.
An aspect of being a manager that many people do not realize is that they sometimes have to
work shifts there is nobody else available. There had been a call-off the night before and my boss
forgot to let me know she would not be able to do any of the manager-type things with me today
since she was going to have to cover the shift. A downfall of the manager having to work
positions is that they do not know them as well as the people who routinely work the shift and
are therefore a bit slower at them. Not only that, but because she is a manager, she gets called
away from time to time to deal with other issues. When I got there around 11am, my boss was
still trying to get everything ready for lunch; most of which should have already been done at
that point. So I got recruited to help her finish getting everything ready so the tray line could
begin on time. While she was working the tray line, I put away stock. So overall, this was not
really a day I got to do anything new, but it was a learning experience in that the managers job
is much more than it seems. They sometimes get stuck having to do the grunt work as well.
3/2/16: 10:30am-2:00pm (3.5 hours)
The main thing I worked on today was my customer service satisfaction surveys. I surveyed five
of the residents that live at this nursing home to see how they felt about the food service that they
receive there and how they feel that it could be improved. Each survey took anywhere from 1025 minutes as some of the residents had more to say, or simply wanted to keep talking. As an
employee, I was not overly surprised by their answers and I would love to be able to correct
everything that they complained about. By far, the biggest complaint was that the service is not
fast enough; and unfortunately, I would have to agree. We strive to provide fast service, but we
do fall short sometimes for various reasons. My boss and I also discussed the technology aspect
of our department today. We talked about what we have available and what she wishes we had
available to effectively and efficiently deal with things like ordering stock, inventory,
scheduling, as well as other items. Another thing she did today was go through the new menu

with me. They are starting a new cycle menu at the end of April, so she is currently working out
the details for that. One thing she is working on is how much and what kind of bread she will
need to order each time the delivery comes based on what kind of bread will be needed for the
days following the delivery. She went through the menu and showed me how to tally up the total
amount of bread needed.

3/4/16: 10:30am-3:30pm (5 hours)

The first task that my boss had when I got there was to interview a new resident. Anytime a new
resident is admitted, my boss has to do a brief interview with them to determine their likes and
dislikes and find anything out about their diet preferences that she can. This patient is 22 years
old and is there recovering from surgery. My boss had me go with her, but unfortunately he was
sleeping when we got to his room. When we got back to the kitchen, we decided it would be a
good time to work on the bread order for the new menu. She let me do it myself and I made it
through the first three weeks. Of course, she is going to double check my work later on to make
sure I did it properly. It is a lot more time consuming than I would have expected and pretty
tedious as well.
My boss also had several interviews today, which she let me sit in on. After the interviews, she
told me that it was nice to have another person in the interview to be able to offer input into
whether or not the applicant would be a good fit for the position. She explained that sometimes
in an interview that it is easy to hire the first person that walks in because she just wants the
position filled; however, this can easily lead to a high turnover rate which is not any more fun
than working short staffed. We then went back to the new admits room to get his interview and
he was awake this time, although very tired. My boss let me conduct the interview, which was an
interesting experience. The questions were pretty general, but he was very cooperative in
providing useful information in regards to his dietary preferences. He was not shy about his likes
and he was even less shy about his dislikes.
During all of this, the dishwasher started shooting sparks out. So when we got done with the
resident interview, my boss had to help the dishwasher deal with that problem while the
maintenance man worked on the dishwasher. Fortunately, the dishwasher was not completely
broken, but it required a bit more effort to make sure everything was getting clean. It was pretty
crowded in the dish-room during this time, so I helped the cook with a few small tasks, such as
labeling and dating the afternoon snacks. I also worked on the bread order a little more, but it
was difficult since my boss was busy and was not really available to answer my questions.
3/5/16: 10:15am-11:15am (1 hour)
I was able to work on the bread order for the new menu some more, but I only got about half way
through. I think I finally started to get a grasp on what I was doing, but it is definitely a lot harder
than I would have imagined it to be. I assume that it gets easier the more you do it, but you have
to pay attention to detail while doing it, so it is a little difficult and definitely time consuming.
3/13/16: 10:15am-11:15am (1 hour)

I finally finished the bread order for the new menu! Having to go through each meal for every
day for six weeks and figuring out how much of every bread product they will need to
accommodate all main meals, alternates, and sides is something that I have always
subconsciously known took place, but actually doing it kind of gives you a new appreciation for
it. I gave my work to my boss and she said she would double check everything, fix it if
necessary, and go over anything I might not have done correctly so I understand why the changes
were necessary.

3/21/16: 12:00pm-2:00pm (2 hours)

Today I talked to my boss about who I was going to do the stay interview with. There were a few
potential options, but I went with an employee who has worked at there for several years. She
left for about a year when she had surgery done and has now been back for a few months. I
spoke with this employee to make sure she agreed to being interviewed and she did. I then spent
some time coming up with the questions for the interview because I wanted to make sure my
boss would approve of them. I did not want to step on any toes by asking inappropriate
questions. Unfortunately, I did not get a chance to interview the employee because she had to
leave, but I will be doing that the next time I see her.
Since I did not get a chance to do the interview today, my boss had me help her go through the
new menu to screen for any discrepancies. Mistakes can happen, so it is important to double
check your work and to have another person look it over as well. I helped go through the first
three weeks of the six week menu and it was just about as tedious and time consuming as the
bread order was. She also briefly talked about the technology that we have available for our
usage, but there really is not a lot to speak of, unfortunately.
3/23/16: 10:30am-2:00pm (3.5 hours)
Today, I got to help put stock away once again. After that was done, I got to talk with the
dietitian for a while, who is at there every Wednesday. She was doing a Food Safety and
Sanitation Audit to make sure everything was up to the standards. This was the same thing that
my boss had me do on one of my first days of shadowing. The food service manager does it once
a month, but the dietitian does one as well and is a bit more thorough with her inspection. She
had me follow her while she did this so I could see the things that she was looking for, that
maybe we would miss, such as dust buildup and opened containers. After that, she did a test
tray during the tray line. This is where we went with one of the hall carts when it was delivered
and checked to make sure the temperatures were still good once the food made it from the
kitchen to the residents rooms. Fortunately, the food was still hot.
Once I was done following the dietitian; I went back to my boss and she began discussing
budgeting, funding, and controllable costs with me. Some of the information was pretty familiar
to me, but some of it went a little over my head at first. I am realizing more and more, though,
that this not something I would want to deal with. There is so much work for a food service
manager to do, and I do not want to have that kind of pressure, especially when it comes to the
budgeting. Pressure is one thing; pressure when it comes to money is a little terrifying. I am sure
that it would not be that bad once I got used to it, though. She also talked to me about scheduling

and the budget we have to follow with that, as well as the food and supplies budget. We are only
allotted a certain amount of hours, but we tend to go over that. To make up for it, my boss has to
work shifts in place of her staff, since her hours do not count as a salaried employee.
The last thing we did was experimented with thickened liquids again. We still have not come up
with a good solution because the consistency has not been great with it and there have been some
complaints. Now, we are trying a gel formula instead of a powder to see if we have any more
luck with that. We spent some time mixing up pitchers of water, juice, and milk so we could
determine the correct amount of gel to mix in with the drinks. I am not sure if we quite have it
perfected yet, but it is getting closer.
3/25/16: 2:00pm-4:00pm (2 hours)
I spent some time going through the employee handbook and learning more about the
disciplinary point system and the different classes of offenses and what it takes to be terminated.
I knew about some of it already to a certain degree since I am an employee, and we have
discussed it somewhat it in past shadowing days, but I never really noticed the extent of it.
My boss also was working on the menus in the computer for this weekends meal and had to
change some things around, so she showed me how to do that. It is a process, like everything
else, where you have to start out on one page, change everything individually, which takes a
while, save it, leave that page, then go to another page entirely before you can print it. I actually
told my boss today that it was surprising to me how much she has to do, because as an employee,
I do not see at least 50% of the things her job requires of her. This experience has definitely
given me a new appreciation for it all.
Finally, we spent some time looking through new applications and discussing whether or not we
thought they would be a good fit for the job. Unfortunately, the people from the interviews that I
sat in on a few weeks ago did not work out and we are still in the process of looking for a couple
of new employees. My boss has been pretty busy lately working positions, though, due to some
call offs, and has not had a lot of time to schedule or hold any more interviews. She had me sort
of pick apart the applications to see if I could determine any faults that might be a red flag in
hiring the applicant. There were a few things I noticed, but the main thing I caught was that in a
response to a question on the application, one applicant stated that she would love to work at a
nursing home that was not ours. The statement stood out to me immediately. We talked about
how it is important to make sure you know the company you are applying to, otherwise it is a
turn off to potential employers since it may seem like they are not serious about it since they
apparently do not even know where they are applying to.
3/26/16: 10:15am-11:15am (1 hour)
I conducted my stay interview with one of the dietary staff members today. I also looked
through the new menus some more to continue checking for possible discrepancies between each
diet and each day. Each diet needs to get every nutrient, but diets such as puree and renal cannot
have the same thing as a regular diet, so it just needs to be reviewed. I was also checking to make
sure the same food item was not scheduled too closely together to add more variety.
3/27/16: 10:15am-11:15am (1 hour)

I finished checking the menu for inconsistencies, but I really did not find too many. There was
one day where the main meal and vegetable was completely left off of one of the diets. That is
important to correct since it was a special diet and we want to make sure that those residents get
the food that they are supposed to have. I also went through the handbook a little more, but I did
not really find anything I had not already come across.
4/1/16: 12:30pm-2:30pm (2 hours)
My boss added a few new residents to the computer system today, but the main thing we did was
put together the weekly menu binders for the new menu that starts at the end of this month. So
we went through the binders and took them apart, removing all of the old menus and recipes,
replacing them with the menus and recipes for the new menu. The last thing we did during was
her evaluation of my performance during these 32 hours of shadowing her.