The Interviews: My Renal Rotation with Natalie Briggs

November 1, 2020

Hi everyone! Firstly, thanks to Emma for having me on this blog, my name is Natalie Briggs (Instagram: @balancebybriggs) and I graduated from Cardiff Metropolitan University in May with a BSc in Human Nutrition and Dietetics. I am now a band 5 dietitian working at the University Hospital of Wales (Cardiff) in a rotation scheme. This means I get to work in and experience specific specialities- each lasting approx 9 months long. This bringing us on nicely to part of this blog where I will chat about working as a renal dietitian as I have just rotated into the Renal rotation!

Congrats on qualifying as a new dietitian! How did you find studying and placements?

Studying a BSc in dietetics is definitely hard work do not get me wrong. I myself had already completed a BSc degree before embarking on Dietetics, therefore I had the university life engrained into me- constant referencing, living in ‘not the best’ accommodation, balancing lectures with part-time work and a social life… BUT me and my cohort we made it through- and we learnt a lot of interesting and insightful information along the way, which helped shape us to become the band 5 dietitians we are today. Placements are first of all not a scary as you think! For anyone about to embark on them or already in the middle of one I would just encourage you to ask all the questions and show your enthusiasm. You are not expected to know everything- you literally learn something new every day and that is the case whether you are a student or a senior dietitian (so I have heard ha ha).

How are you enjoying your new role so far?

I love my role. I enjoy the fast-paced working environment, the constant learning and working with such an enthusiastic and kind team. I have actually written a blog on working as a new band 5 dietitian where I delve into a bit more detail- you can find this on: thedieteticstudent.com or the link in my Instagram bio- if you are interested!

Why do dietitians have an important role for renal patients?

So, renal dietetics is HUGE! In a nutshell, renal dietitians help educate and encourage patients with varied kidney conditions to make appropriate food and drink choices that will support their health.

It’s a very interesting area for dietetics as it involves a myriad of conditions: acute and chronic kidney disease leading to dialysis or kidney transplant (to name a few). Now if you would like to learn some more detailed information regarding kidney disease and my profession keep reading 😊

Kidney disease is broken down into stages 1-5. This is mainly identified by the level of kidney function (you will see this is called ‘eGFR’). Basically, the higher the stage and the lower the eGFR, means the more severe the kidney disease. To give an example: ‘normal’ eGFR is usually >90 compared to a Stage 5 eGFR which may be <15 (kidney failure).

In my role I work with patients who fall in stages 4-5. This is through a pre-dialysis clinic (stage 4) and the dialysis unit (stage 5). There is a lot of information surrounding these stages of kidney disease- of which I am still learning about.

Specifically, for a dietitian we focus on:

Nutritional Status / Potassium levels / Phosphate levels

Fluid Status / Salt / Malnutrition Risk / Quality of Life

What a patient eats and drinks can affect all of the above topics which is why our role is so important!

The reason they are focused on in the first instance is because when patients are in stages 4-5 it means the kidney is not working well at all. It doesn’t filter out waste products from the blood and can mean an imbalance of certain electrolytes- such as potassium and phosphate. This can be fatal for patients both in the short-term and long-term and yes there is medication to help but diet is a top priority in certain patients like this.

A dietetic example may be a patient in a pre-dialysis clinic who has a high potassium level of >5.5mmol:

It would be my job to educate and advise this patient of a low potassium diet. This involves discussing foods that potassium is found in e.g. potatoes/coffee/chocolate/fruit+veg and then further advising on portion sizes/cooking methods and realistic ways to reduce/avoid these foods in order to have a positive effect on the patient’s potassium levels moving forward.

It is great as unlike other dietetic specialities looking at a patient’s bloods can identify if they have been implementing your advice or not! (This is not always the case as other factors can affect bloods but you get the jist).

I will not ramble on any longer- as you can see there is A LOT to consider for renal patients and I have not touched upon half of this here. There is a lot more information online such as Kidney Care UK and the BDA specialist group so take a look if you want to know more (I will also post some more renal based things on my Instagram).

What other rotations and specialities would you like to go into?

So far, I have touched on respiratory, spinal and trauma. To be quite honest I am not 100% sure! I already really enjoy renal (which has surprised me) and next I will be rotating into gastroenterology which I am definitely interested in! I also would love to work with the ‘general population’ amongst my acute NHS work at some point!

Have you found any barriers to starting a new job during COVID?

As I have previously said I have written a post on starting my role- of which some touches upon starting in the middle of a pandemic. Overall, I have found certain barriers in regards to patient contact both in clinics- as everything is over the phone at the moment which can make things slightly harder- for example communication/body language. But, on top of this communication on the wards with my patients is definitely trickier with a mask and visor on! I do always smile- then remember they cannot see it so I tell them I am smiling under my mask which they enjoy to hear 😊. To be quite honest, working among Covid is the new norm- as a hospital and health board there is a real unity and togetherness- which is humbling to work within.

Thank you SO much for taking part, Natalie! It really interesting to hear all about what you’ve learnt so far and can’t wait to see you progress in this dietitian’s world!

Emma x

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