if i may ask...what do you feel are the advantages and disadvantages of working in clinical settings from your experience as opposed to retail?
Thanks for your input...still considering if retail is right for me..🙂
Ok - I'm back
🙂 You may be sorry you asked me this question!!!
😛
So...what are the advantages & disadvantages of working in an inpatient facility - that is what I perceive your question to really be - forgive me if I'm wrong. I'll give you some & others will chime in I'm sure on things I've misrepresented or left out. My experience is only my own - there are as many different inpt, acute settings as there are hospitals.
For an inpatient, acute care facility, there is nothing if not energy, stimulation, the feeling as though you are continually needed - which you are. The experiences range from the acuteness and intensity of the ICU to the frustration and wonder of the mental health unit. There are some places where oncology is large (mine is not, thankfully) and others that are a tertiary pedi faciilty. If you've never been in a hospital, either as a patient or with a family member, you may not be aware that these are really, really sick people (except the normal, uncomplicated OB/newborn). We used to keep people in the hospital for a week to 10 days & when I first started, we'd keep them routinely for 1-2 weeks. Now, if a pt is in for that long, that person is very, very sick. So, you see & participate in the aspects of caring for that person which involve some of the most complicated types of drug therapy. You must be very, very knowledgable in whatever area you work (which is why we don't cross over to specialities we aren't familiar with, for the most part). I would say, the absolute best part is the intellectual stimulation you get. You also get to know your prescribers, the nurses, therapists, etc very well....so you see them in a different light - and they, you. Depending on the culture within the hospital and your department, there are lots of avenues of interest you may follow or which are open to you.
The pharmacy dept within a hospital is large - both in budget and manpower (Zpak can speak to this better than I can). So, you must be good at working with a lot of people. You cannot be fussy about only working with this tech or that pharmacist - you work with everyone - period. You must also be flexible in working in the different areas you're capable of working, even though you have your favorites.
So...now to the disadvantages. There is no way we will ever get around the dispensing aspect of our job. We are there for a product as well as knowledge - this is where some people fall out. If it were knowledge alone,, they'd call us all Micromedex since everything we know can be found somewhere - we're just very, very good with having it all at hand & being able to rapidly put it all in perspective. But, the product must get from the pharmacy to the pt. That in some way will involve a pharmacist. It may be that it is you at order entry, or some pharmacists still check drugs as they're sent to units, IV's must be checked, some IV's will be prepared by pharmacists in some areas. But, it may be your part of dispensing will be the development of protocols for a particular kind of therapy - tpn or anticoagulation or chemotherapy emesis or the periodic alteration or inservicing of these protocols. Likewise, your part of the dispensing process might be your input in hospital committees such as P&T (pharmacy & therapeutics) - which is where forumulary decisions are made, M&M (morbidity & mortality) - which is where cases are reviewed which have caused morbidity or death, or just unit specific - drug education for mental health patients prior to discharge, etc....
So...we are tied to the product - always. I don't see this as a negative, but some do. A huge negative is the staffing/scheduling aspect of acute medicine. Hospitals are open 24/7/365. A pharmacist will be expected to be there at least 2/3 of the time & in many circumstances all the time. If a pharmacist is not there, someone is on call. That means - someone works Christmas Day, Christmas Eve, Yom Kippur, Fourth of July, your son's birthday, your anniversary, the day your dad is buried - every single day. Someone has to be there. You cannot & will not have each & every holiday off. You will be expected to trade & do your part. There are times you feel you must beg, borrow & steal to get a particular day off. It will wear you down, but I've always kept saying to myself - I'm on this side of the sheet so I'm better off than that guy....which led me to make my Christmas Day working the absolute best day I could - for myself, the pts I had to take care of & their families - because none of us wanted to be there if there was any other way.
Staffing is bad in hospitals too. Many folks don't know this & think only commercial corporations can take advantage of you. Think again - nonprofits (hospitals) can & do this as well. I actually quit a job I held for 20 years over staffing. I was put in a position in which I felt my decision making capabilities were being taxed and frankly, I did not want to end my career with a malpractice mistake due to overwork. Now - it took me 3 years to get to that point....so I didn't go there lightly.
Finally, hospital pharmacy has a very repetitieve component to it. The first CABG orders you enter will be exciting and so will the 10th & the 20th. But, by the time you've entered the same orders for the 300th CABG pt - yeah - the uncomplicated ones are all the same. The techs mix the same IVs over and over and over & you must check those same IVs. There are times when things get a bit exciting - you'll get a tpa & need to get the drip calculated & mixed...but, the routine is always there. In fact, the routineness & repetitiveness of hospital pharmacy is one of the major reasons for drug errors by pharmcy personnel.
Now, I know I said finally, but I've got one last thing (at least for now) to add. One reason I chose to change my focus from primarily inpt to do both is the lack of patient interaction. When I started in pharmacy, decades ago, pharmacists counseled patients on their discharge medications. This meant, we not only help start & stabilize the pt (lets say on warfarin) while an inpt, we also counseled that pt & the family on taking warfarin at home. Today, there is no time for that to happen. Pts go home too fast. The hospital does not fill the discharge medications - the pts family takes it to their local pharmacist to be filled. If you've ever been discharged from a hospital or has had a family member who has - you know its normally a family member who gets the rx filled & we don't counsel the family or friend on the drug - its a HIPAA violation. But - the pt hurts, is tired & just wants to get home to his/her own bed so the counseling just doesn't happen. A big, big mistake in our field, IMO>
This is where some of these errors can happen & I can see why. Take the two examples on 20/20 - the diabetic medication filled in place of phenobarbital for the child & the error of the warfarin strength. We don't know the details, but one tremendous aspect was missing in both cases - the pharmacist who can see the inpt record is not the pharmacist who fills the outpt rx. Had that been me 20 years ago...I could have seen on the inpt record that woman's last dose of warfarin was not as high as was apparently written or typed. That's not to say these errors would not have happened anyway. But, this is a big area that in our healthcare system we have a huge gap - that seamless transfer of knowledge. Our Canadian counterparts are far ahead of us in this game.
Ok...enough for now....I'll come back & tell you the advantages & disadvantages of outpatient (& another pet peeve - outpt does not always = retail
).
Caverject is really, really going to come down hard on me, I just know it!
🙄
