The Interviews with Claire Irlam

Claire completed a bachelor's degree in Dietetics at Coventry University before gaining experience in a variety of areas across three acute hospitals. She now works within a community palliative care team, volunteers with a BDA branch and writes freelance articles in her spare time. A more in-depth reflection about moving from a dietetic department to a multi-disciplinary team is available to read in the December 2020 issue of NHD. There are upcoming opportunities for dietitians both within the palliative care service and the BDA branch so please message @ClaireIrlamRD on twitter if you would like to find out more. What roles have you worked in so far as a dietitian?

My first role was in a district general hospital which I loved as it was a lovely friendly environment and I was lucky to work within a supportive team. It also enabled me to gain my confidence quickly after qualifying as there was a period of short-staffing including being one of only two acute dietitians during some periods over the Winter where pressures were heightened. I also contributed to some audits and service developments. I then moved to a larger city centre hospital with the hope of furthering my knowledge of other conditions which I certainly got! I experienced working in many areas including respiratory, vascular surgery, orthopaedic and maternity. Something which I loved about this role was the complexity - there was plenty of opportunity to review a lot of patients with challenging medical and social circumstances which I would not have accessed so easily in a local hospital. Some memorable cases there include advising upon ornithine transcarbamylase deficiency during pre-, peri- and postnatal care as well as patients presenting with complex social and safeguarding concerns regarding enteral tube feeding.

I then continued within this role by transferring to another hospital in the same trust. This hospital had that similar friendly and local atmosphere as my first role but boasted some specialist regional departments such as a specialist respiratory service. This post was really exciting for me as it was split between the general dietetic department where I continued to work in a variety of areas, and the specialist cystic fibrosis service. Working with the cystic fibrosis team was a great opportunity to take part in close multi-disciplinary team working and also build close rapport with a steady cohort of patients. This then prepared me well for a new role within the community palliative care team.

What does the role of a Macmillan Dietitian involve?

My role within the community palliative care team is really varied! We see people with many different life-limiting conditions including different cancers, neurological conditions and respiratory diseases. In terms of the dietetic work, I therefore support people with nutrition support, managing stoma output, implementing texture modified diets, providing guidance about pancreatic enzyme replacement therapy and supporting patients and their support networks with emotional concerns around weight loss or nutrition towards the end of life.

As I am based within a multi-disciplinary team, I also work a weekly shift where I triage any telephone queries coming in and new referrals to the service. I also contribute to advanced care planning conversations with patients, deliver nutrition training to the rest of the team and attend meetings with district nurses, hospital teams and GPs.

Despite the sad nature of your role, do you find it rewarding?

I actually don't find my role too sad most of the time! There may be certain patients whose situations can be more upsetting than others' but this was true of all the roles I've undertaken previously too.

The main difference that I've found in this job is that because I'm not only advising on nutrition, it allows much more flexibility with which patients I can review. Providing input within this role doesn't need to be solely nutritional so long as I am adding some value to that patient's care, which suits my holistic style of working. When managing large acute caseloads, there were some cases where I had helped patients with non-dietetic concerns but was unable to continue building rapport with them unless they met specific criteria for more nutritional input. Palliative care may not be for everyone but I personally found this much harder than working within my current service. Another thing which makes it easier for me is that you get to find out how each patient journey ends. I have found this much more rewarding compared to when you could make great clinical progress or build a great relationship with a patient only to be completely unaware whether they may have died soon after discharge or continued to live well for much longer. I feel it is a great privilege to get to know people and their families during significant periods of their lives.

Something which I love about the team I work with now is that due to the nature of our service, we are used to debriefing about emotional situations and supporting each other. There is always somebody ready to bring a brew, a treat and a have a chat to cheer you up if you're having a tough day!

What things have you got up to as chair of the BDA North West England and North Wales branch?

Taking on this role was a huge challenge for me, not least because I had only just started my first post-graduate role at the time, although I had previously sat on another branch as a student rep which had prepared me well. It was a difficult period for the branch as it had been inactive for a while beforehand and a lot of the committee were also new at the same time as me! It took us a while to get to grips with all of the basics of running events so we all contributed to booking venues, speakers and sponsors as well as improving our social media presence. We have now increased the numbers of followers across all platforms and in 2019 hosted an event with almost 150 attendees!

Going into 2020, we paused event planning for a while due to the covid-19 restrictions. It is important for me as chair to check the welfare of the committee as we all continue to work in our day jobs which have been particularly testing this year.

We are currently planning a virtual event which will see the next committee election to allow a more democratic process for any of our current committee to continue and hopefully see us welcoming some fresh faces!

What advice would you give to newly qualified dietitians looking to gain more experience?

​When you first qualify, there are opportunities to learn new things every single day. It is worth volunteering to assess patients with conditions you are less confident with - just make sure to research and discuss your plan with a colleague first. CPD events, shadowing, peer support and journal clubs are all great but reflecting upon these experiences will help to consolidate your learning and apply it to future practice. It's also really important to set boundaries with your free time. I found it really difficult to switch off at home when I first transitioned from university life to full-time work as I was used to doing independant work during the evenings and weekends. It is worth discussing with your supervisor whether any protected time is available for development. While it's great to take extra opportunities and enrich your learning, you won't be able to reach your full potential if you're tired and stressed so make sure you schedule in some time to completely switch off.

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