Hospital/Acute care pharmacy management

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Lisochka

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What are the pro's and cons for managing a hospital/acute care/etc pharmacy ?
I've always felt that at an institutional setting there is a better control over C-2's, so losing your license over that issue is less likely than in retail...
What can you lose your license over if you are managing a pharmacy at a hospital or acute care facility?
What about your job?

What about pharmacy director vs pharmacy manager?

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In my opinion, the actual managing part of the job is generally easier than retail, however the politicking that must be done to keep your job or to get any budget for your department is unreal. I have seen/heard many more hospital pharmacy managers get fired (usually because of personality differences with nursing or administration, not because of job performance), then I have seen/heard retail pharmacy managers get fired. To be a successful hospital manager, you must be very good at schmoozing. Retail pharmacist managers have to be good at schmoozing too, but only once a month or so when their boss comes through. Hospital pharmacy managers have to do it every day.
 
As for losing your license, you can lose it in hospital for the same reason you can lose it in retail. You mention its easier to keep track of CII's in a hospital, but it really isn't. In both retail & hospital, CII's are locked up tight, but you still have to keep track of where they are going. For instance, in hospital you have to keep track of all the different departments who are using CII's, and how are they documenting their wastage. It shouldn't happen, but reality is it does, anesthesia will give 1ml of a 2ml fentanyl vial, (what happens to the other 1ml????), then later when they are documenting their waste, ask another nurse to sign that they saw it wasted, and the other nurse will, even though s/he didn't. Or, they document they gave the whole dose when they didn't, or they don't document the wastage at all, and as pharmacy manager, you have to go through the next day, try to track down what actually happened (or make sure your staff pharmacist is doing that), and then try to lecture the people involved enough so that it won't happen again....but don't lecture them too much, or they will complain to their manager, and then you've lost schmooze points.
 
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As for losing your license, you can lose it in hospital for the same reason you can lose it in retail. You mention its easier to keep track of CII's in a hospital, but it really isn't. In both retail & hospital, CII's are locked up tight, but you still have to keep track of where they are going. For instance, in hospital you have to keep track of all the different departments who are using CII's, and how are they documenting their wastage. It shouldn't happen, but reality is it does, anesthesia will give 1ml of a 2ml fentanyl vial, (what happens to the other 1ml????), then later when they are documenting their waste, ask another nurse to sign that they saw it wasted, and the other nurse will, even though s/he didn't. Or, they document they gave the whole dose when they didn't, or they don't document the wastage at all, and as pharmacy manager, you have to go through the next day, try to track down what actually happened (or make sure your staff pharmacist is doing that), and then try to lecture the people involved enough so that it won't happen again....but don't lecture them too much, or they will complain to their manager, and then you've lost schmooze points.


Ive worked in a hospital before pharmacy school and the managers kept quitting...The pharmacy director was there for years, but managers kept stepping down...is it common for other hospitals?
Would the administration press on you if you are spending too much money at your department? Or would they push you to increase the profit?
I guess, what are you responsibilities if you are an institutional pharmacy manager vs pharmacy director? What do they do? Besides going through the C2 discrepancies?
 
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Ive worked in a hospital before pharmacy school and the managers kept quitting...The pharmacy director was there for years, but managers kept stepping down...is it common for other hospitals?

Yep, we've been trying to recruit a clinical manager for months now, and no one wants to apply. Too much politics.
 
Can you guys elaborate? Or may be give a couple of examples?
 
Can you guys elaborate? Or may be give a couple of examples?

Yes, you will be pressured to increase profits/keep costs down....but this is made impossible because of the politics involved. OK, lets say you have 1 physician who insists on expensive drug A, even though slightly cheaper drug B works as well and every other hospital physician is happy using slightly cheaper drug B. But this 1 physician brings in a lot of patients and is head of the P & T committee. So, you speak out about how drug B is more cost effective than Drug A, so the 1 physician is upset, and the other physicians really don't care one way or the other (not enough to defend you at any rate), so of course, the physician gets his way, and Drug A is added to the formulary. But that's not enough for the upset physician. The upset physician goes to the CEO and goes on and on about how you aren't a team player and how he won't admit his patients to a hospital where they don't get the best of care. The CEO promises him he will "keep an eye on you." So now the CEO sees you as threatening hospital business. Now because Drug A is so overpriced, you pharmacy drug budget is out of whack, so now in the CEO's eyes, not only are you unprofessional in making a valued physician upset, but you can't even keep to a basic budget. So now the CEO is triply "keeping his eye on you." Now you as a relatively intelligent pharmacist, pick up on the frozen cold vibes emanating from the CEO and the hospital's favored physician at you....you realize you have 3 choices, wait to get fired, voluntarily step down, or leave and get a different job.

This is one example. I'm bored, so I'll give you another. Let's say there is 1 floor where nurses have a secret stash (OK, we all know its not just 1 floor, in reality it is all the nursing floors.) There are different ways nurses get the extra drugs to keep in their secret stash, which they use to give (in their minds) "stat" drugs without having to wait to get the order verified by a pharmacist. So, you find out about their secret stash & you do the right thing and confiscate their secret stash. Now nursing is mad at you. The nurses start to complain to their manager about everything they can dream up. They complain about how they were forced to keep the secret stash because pharmacy wouldn't verify orders fast enough, they complain about having to keep a secret stash, because they don't want to open up the crash cart because pharmacy takes to long to replenish it, they complain that they have to keep their secret stash because pharmacy won't make and deliver their "stat" IV's quick enough. Never mind if none of this is true, you and your pharmacy department are vastly outnumbered by the nurses. The nurse manager takes the complaints to the CEO, the CEO is sick of hearing of these complaints s/he also realizes that its just you against say 1000 nurses, so s/he sees the easiest way to make the nurses happy, is to get rid of you. You start getting the cold vibes, and quickly realize your 3 choices.

OK, so lets say you realize their secret stash makes them happy, so you decided to ignore it and let them keep it. Maybe you'll even unofficially give them a couple of KCL vials to keep in their stash, that will really make them happy. Nurses are happy, all is good. Until JCHO shows up, finds their stash and cites you for major violations. Now the CEO is mad at you, the hospital can't afford to lose their JCHO certification, nursing claims that you told them it was good to have a secret stash and that you had full knowledge of it and everything they had in it. The CEO sees you as vastly incompetent and wants you gone. You get the cold vibes, and realize you now have only 2 choices, get fired, or quickly find a different job.

I could give you a ton more examples. This is the life of a hospital manager/director. The politics of keeping all these different groups happy, when these groups want opposing things from you.

I'm not sure why you keep bringing up CII counts, this is a manager responsibility, but a pretty small part of their job compared to the rest of it. Personally, I think being a retail pharmacy manager is slightly easier than being a hospital manager/director, but neither job is easy, which is why most pharmacists are content to be staff.
 
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I thought I would add in 1 more point before I go to work, lest you get the impression that all you have to do is keep the CEO happy.

Let's say the nurse manager is best friends with the trophy wife of the hospital board president (who believes everything his wife tells him.) Even if the CEO is 100% on board with your following JCHO requirements and is happy with your budgeting ability, nursing is not happy with the lack of their secret stash. The nurse manager tells her friend that she can hardly stand to work at the hospital anymore due to the "incompetence" of pharmacy and the CEO, the wife tells her husband, the husband talks to all of his friends on the board about how nursing is so unhappy with how the CEO runs things, next thing you know, the CEO has "resigned" or "left" and a new CEO (who has been warned about the trouble making pharmacy manager) is in charge. Which is another thing that makes the politicking so difficult, its very hard to tell who has the "most" power at any given time, and therefor is the one that you most need to impress.

Balancing this kind of politicking is a skill that I don't have.
 
I have toyed with the idea of applying for some hospital manager positions because it seems like it would be "easier" than being a director and a good stepping stone in between staff and director (plus I basically end up acting as manager in the role I have now anyway).

This thread definitely makes me rethink this idea! Lol. Soooo accurate...(except for the part about giving nurses vials of KCl, oh hellz no). I love being a hospital pharmacist, but there are definitely a lot of politics involved. And you get really used to dealing with all kinds of weird and power tripping personalities.
 
I have toyed with the idea of applying for some hospital manager positions because it seems like it would be "easier" than being a director and a good stepping stone in between staff and director (plus I basically end up acting as manager in the role I have now anyway).

This thread definitely makes me rethink this idea! Lol. Soooo accurate...(except for the part about giving nurses vials of KCl, oh hellz no). I love being a hospital pharmacist, but there are definitely a lot of politics involved. And you get really used to dealing with all kinds of weird and power tripping personalities.

Especially the mid-level nurse "managers". You know, the overweight old nurses with their clipboards and their daily "meetings". They seem to have more power than the pharmacy director. I've seen them "tell" our director how to deploy the pharmacists. And the director gives in 80% of the way. Just no fighting them. You are outnumbered.
 
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What are the differences in dealing with the problems if you are a pharmacy manager vs pharmacy director?
Isn't it true that if you are a manager then you deal more with pharmacy tech issues. If you are a director then you deal more with pharmacist issues and budgets/profits?
Sorry guys, my questions are probably very stupid...
 
If you are the manager, you have to deal with the needs of your staff while at the same time having to deal with the wants of the director. It's middle management and can be made hell if you don't have a good director.
 
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