Severely short staffed....What would you do?

[UGAZ]

We are a hospital with 250 beds and average census around 100-110/day. We usually operating 5 Rph/day. Got this new director on board. The guy came in, fired a full time pharmacist and a full time tech and reduced to 4RPh/day. The senior pharmacist who usually works in the morning couldn't handle stress...so he called sick last week and let us know he won't be back til Sep 10th. We know he's using up reserve sick or maybe up to something (quitting jobs?). But anyway, now instead of hiring new per diem to fill in, the new director told us to stretch out and cover. So you're talking about from 5Rph/day to 4Rph/day and now 3 Rph/day and no OT allowed!!!!. And this is extremely short staffed. All the per diems don't wanna work for this new director. Everytime someone calls for extra help, they turn down.

What would you do if you were in this shoes? I know pharmacy is a small world and people will find out who I am, after (heck, the boss might be even reading this). But still.... Just wanna see who is able to come up with a good advice for me.

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[owlegrad]

What kind of advice are you asking for? Obviously your choices are limited. Pretty much you can quit or get used to it. Of course you can also hope it is temporary or try to convince your boss that you need more help. Good luck.

 

[lord999]

So, what you do in this situation is not stress out and overextend, that's what the director wants you to do. I would set a pace, comfortably and without error keep to that pace. If there's work that's left over, well, that's just tough for the director who is responsible. Either the director fills in himself/herself or needs to hire someone else. If you are "forced" to complete it, reply that I guess he/she is "forced" to give overtime. Here's the other tip, don't worry about complaining, in fact don't until hospital management comes around to figure out what is going on. When they do, just concentrate and keep to that pace, they'll the get the message clear enough.

When you're up against a managerial sociopath who doesn't care about anything but himself or herself, you make it their problem not yours. If the director wants to shortstaff the hospital, he or she gets to damn well die by it against the bonus rules. If you are fired under these circumstances even keeping to a good pace and not doing anything actionable, it'll cost the hospital major in the long run as well as the short. When JC shows up, make it a point to pull aside one of their personnel and explain the situation if work is still falling beneath standard.

And work with the knowledge that you know what you're doing, you're doing things as fast and as safe as possible for your work environment, you've been around longer than the director, and you'll see the director out the door. Directors come and go (and usually by JC complaints).

And boy, does it come around. Even 'famous' pharmacy directors who become infamous for their practices become absolutely radioactive to hire once enough word gets around about their reputation:

https://www.linkedin.com/in/bonniesenst

This one in particular managed to get on the bad side of the University system, the major nursing union, got the pharmacists to unionize in each of the hospitals she has been director for due to her practices (!!), and her policies are taught as a management case study example on how not to run a pharmacy by the numbers. You live by the numbers, you die by them. Savings are legitimate, but not where it alienates the hospital, or fails JC, or becomes a labor relations disaster.

 

[MrBonita]

Hello there. Your Director is doing what is in his best interest and that is to make his employees get overworked and underpaid, so he can get a fat bonus and retain his job. As far as I can see, it is working. He presents the data to the owner of the hospital and gets a fat bonus. He is trying to push you out and hire some young desperate fresh grad who has more debt than he will make in 10 years time for a lower wage. This is all going as planned for him, but you need to do your best to make his life wonderful.

If you sit back and let him do this without saying a word then you are in trouble. You should gather all the pharmacist together and see if they can collectively agree with you. Talk to your director about your concerns. If that does not work then go work somewhere else.

Good Lucky my friend.

 

[Its Z]

Tell the director to grow some balls and tell the admin to stuff it or get more pharmacists. Ask him to help with staffing and process some orders.

Or just work at your pace and when order verification is 4 hours behind, just tell nursing and physicians you're going as fast as you can.

I would like to know who this DOP is so I can bitch slap him.

 

[BMBiology]

How hard do you want to play?

First, start looking for a new job. File a complaint with the Joint Commission and Board of Pharmacy with specific examples. You can do it anonymously.

You can also post comments on the hospital FB page (anonymously of course).


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[zelman]

Just work at a safe pace and let complaining nurses know that they should have their director complain about the pharmacy being short staffed. When the nursing director suddenly gets a complaint from every nurse they will go nuclear and go over the pharmacy director's head to fix it.

 

[confettiflyer]

Intentional work slow down is my vote, which means working as fast as you safely can and prioritize the high acuity/urgent areas.

Other than that...grind it out and wait until the director gets fired for blatantly putting patient safety and hospital operations in peril.

You don't get paid the big bucks to make any decisions. Don't be a hero.


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[Lnsean]

wow...looks like retail admin tactics are starting to trickle into hospital

 

[Sparda29]

wow...looks like retail admin tactics are starting to trickle into hospital

The difference is that this kind of administration doesn't last long and gets alienated fast and would never survive in a union hospital.

 

[Lnsean]

The difference is that this kind of administration doesn't last long and gets alienated fast and would never survive in a union hospital.

I hope you're right. This profession needs to stand up for itself.

 

[Dred Pirate]

The difference is that this kind of administration doesn't last long and gets alienated fast and would never survive in a union hospital.

it doesn't last long in a non-union hospital - if you are open 24 hours - ya - just keep plogging along at a reasonable pace - eventually the work load will be so back logged - the dop will have to do something - the RN's will complain, the MD's will, etc. If they force you stay late -(depending on state) you need to be paid accodingly

 

[gwarm01]

Your staff has the benefit of being more established than the new director. Take advantage of the relationships you may have developed with doctors, nursing leadership, and any administration that seems sympathetic or actually concerned with the people on the floor versus financial benefit. I would quickly mention the situation to any or all of these people whenever you see them in the hall. Let them know that something rotten is going on and to expect delays / possible med errors / safety issues. If the right people are made aware, things can change pretty quickly. Especially when the rank and file nurses all start complaining about late meds and you have already put the seed into a nursing administrator's head that the new DOP has enacted these terrible policies.

 

[lord999]

If you're going to feed wild animals, you don't hold your hand out to them. You throw them the food and they better fetch. Once that animal is domesticated, then you can think about hand feeding, but if you suspect the animal is rabid...

I'm genuinely surprised at how nice you all are. Talking and negotiation with management only works if you're dealing with someone who wants to improve and that the matter is an oversight on their part. This doesn't seem to be the case. If a director did that sort of crying game to me, that's all the communication I would need. He/she's not in it to do the responsible practice, do you think they intend to improve? Why tell that director your concerns when they can easily observe the matter for themselves and paint a huge "not a team player" target on yourself (if not "please fire me because I'm your threat")? You don't owe that director that regard as we're all pharmacists and we all should know what the responsible thing is. The whisper campaign works better sometimes, but the "this pharmacy is a mess" is the best argument. By the way, if you have problems like this and you call the Board or JC, you better have those problems. If you're all working grueling hours and you're still afloat, they'll remark that they have a director with a motivated pharmacist staff and what a great management job they are doing. You have to have dirty laundry (sometimes quite literally in the hospital context) in order for a regulatory group to do something about it.

You should help those who legitimately need the help, your patients and then those who ask. But it's not your cross to bear when your director is acting like a sociopath. The only way you can deal with sociopaths is to make it about them. The more attention a sociopath gets, the more likely they crumple as they can only fake being natural for so long.


Sigh, I wish we could teach more practical matters in our Pharmacy Management classes:
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[bacillus1]

The difference is that this kind of administration doesn't last long and gets alienated fast and would never survive in a union hospital.

Eh, not necessarily. My old hospital's DOP is still there. Despite being a union hospital, the union was not very good at representing the pharmacists, so no one joined. Another problem was that all the pharmacists were too nice, I couldn't even convince them to take lunch breaks with me because they wanted to work through theirs. Therefore I felt guilty about asking them to cover for me, so I conformed to their standards. Her bosses love her, since she is saving the hospital a lot of money. Meanwhile, I believe they lost maybe 9 pharmacists so far this year, and it's only August! One of my old coworkers that is still there did tell me that that got someone to notice so some changes are coming, but it took a really long time for anything to happen, and who knows what those changes will be.

 

[confettiflyer]

If you want an immediate financial incentive for a director/department to notice, start clocking tons of overtime...assuming your state, union contract, or site mandate 1.5x-2x hourly rate for OT.

Other than that...yeah I wholeheartedly agree, the more you sacrifice and get things done, the more the director looks great (twice the output, half the price, director you're a genius!)

Slow it down, wayyyy down. As a final backstop, shop your resume around, or at least update it.


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[confettiflyer]

UGAZ...no wonder you started the other thread about looking for a new job....what hospital in Southern California is this? Bet you Z knows this director personally (he knows everyone...EVERYONE!)


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[owlegrad]

Another problem was that all the pharmacists were too nice, I couldn't even convince them to take lunch breaks with me because they wanted to work through theirs. Therefore I felt guilty about asking them to cover for me, so I conformed to their standards.

I deal with the same thing now. I don't know what it is about pharmacist that they think they need to be martyrs. We are perfectly adequately staffed for everyone to take a lunch but frequently people make it seem strange that I want to go to lunch. No one goes so far as to say I can't take a lunch but there's strong peer pressure to conform to the standard of working through lunch. Wtf is wrong with people? Lol

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[confettiflyer]

I deal with the same thing now. I don't know what it is about pharmacist that they think they need to be martyrs. We are perfectly adequately staffed for everyone to take a lunch but frequently people make it seem strange that I want to go to lunch. No one goes so far as to say I can't take a lunch but there's strong peer pressure to conform to the standard of working through lunch. Wtf is wrong with people? Lol

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Eat something that smells like **** at your desk or work area


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[BidingMyTime]

A nurse once gave me some great advice, she said she had been working 20 years and had seen many nursing directors, some good, some bad, but all those nursing directors were gone, and she was still there.

Now, some workplace environments are so toxic, its not worth trying to outlast the director. Your workplace might get there, but it's not there yet. I agree with the others, do what you can safely do, and don't worry about what you can't get done.

 

[Its Z]

UGAZ...no wonder you started the other thread about looking for a new job....what hospital in Southern California is this? Bet you Z knows this director personally (he knows everyone...EVERYONE!)


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I don't know everyone. But I know your boss and that SOB owes me. I'm gonna kick hiss ass next time I see him. Just because he's ugly and does goofy things.

Now for the recommendation of reporting to TJC, BOP, or CDPH, they won't investigate this unless there's a patient harm involved or some sentinel event has occurred. They certainly won't respond to a whiny ass pharmacist who is pissed off about having to work harder. If that was the case, they would be in every pharmacy in the state both in and outpatient.

Turn around time will be CDPH > BOP...and I doubt TJC will ever come out as most TJC surveyors are highly paid consultants who have other full time jobs.

Also, TJC is an accreditation body, not a licensing organization.

And in my 25 years, I don't know that I have ever experienced or read about BOP/CDPH investigation of few FTE reduction in force in the pharmacy.

 

[zelman]

I don't know everyone. But I know your boss and that SOB owes me. I'm gonna kick hiss ass next time I see him. Just because he's ugly and does goofy things.

Now for the recommendation of reporting to TJC, BOP, or CDPH, they won't investigate this unless there's a patient harm involved or some sentinel event has occurred. They certainly won't respond to a whiny ass pharmacist who is pissed off about having to work harder. If that was the case, they would be in every pharmacy in the state both in and outpatient.

Turn around time will be CDPH > BOP...and I doubt TJC will ever come out as most TJC surveyors are highly paid consultants who have other full time jobs.

Also, TJC is an accreditation body, not a licensing organization.

And in my 25 years, I don't know that I have ever experienced or read about BOP/CDPH investigation of few FTE reduction in force in the pharmacy.

DOP FIGHT!

 

[Its Z]

Interesting...it's just dawned on me about within the past 2 to 3 months, I provided a reference for a DOP whom I mentored...who moved to a hospital with little less than 300beds... near LA.

He's one of the best DOPs out there. Quality and stand up guy. And he will be a rock star, if not already. Not saying that's the OP's DOP.

But I will say if he went in and made a staffing cut, I know the department was overstaffed. He would not jeopardize patient care nor go against his integrity to hurt the profession.

This changes the whole perspective and the tone of the thread, doesn't it.

OP, did you apply for the DOP position but didn't get it?

 

[UGAZ]

Interesting...it's just dawned on me about within the past 2 to 3 months, I provided a reference for a DOP whom I mentored...who moved to a hospital with little less than 300beds... near LA.

He's one of the best DOPs out there. Quality and stand up guy. And he will be a rock star, if not already. Not saying that's the OP's DOP.

But I will say if he went in and made a staffing cut, I know the department was overstaffed. He would not jeopardize patient care nor go against his integrity to hurt the profession.

This changes the whole perspective and the tone of the thread, doesn't it.

OP, did you apply for the DOP position but didn't get it?

Being a director is the last position that I want to be. It's a tough job and my personality doesn't fit it. I could have been one when the last guy left. But I chose not to. I am a workhorse at this hospital. I have never called in sick my entire career. I always help out when people need me to cover their workloads.
I am not trying to bad mouth my director either. He does what he needs to do because who knows... He's probably under a lot of pressure to reduce staff and rebudgeting the department. I don't hate the player... Nor the game. I just accepted the fact that changes are being made and riding along with them. Heck, some good friends even told me to call sick but I chose not to do that with our severe understaffed situation. I don't want others suffering. I do care about my workplace. Other pharmacists and techs are just like me... Who still need to work and bring home paychecks.
Thanks to everyone who contributed and gave me advices of what to do.

 

[Sparda29]

You need to start calling out sick and working slow as ****. Let the complaints from nursing start piling up. Tell the other pharmacists to start calling out as well, hell, why don't all of you just call out at the same time?

 

[Its Z]

Being a director is the last position that I want to be. It's a tough job and my personality doesn't fit it. I could have been one when the last guy left. But I chose not to.

One of which is I cannot see myself advancing further at my current position.

You do not want to get into management yet you mention that you cannot see yourself advancing. So, where would you like to advance to in your setting?

It sounds like the DOP position was yours to turn down.

 

[UGAZ]

You do not want to get into management yet you mention that you cannot see yourself advancing. So, where would you like to advance to in your setting?

It sounds like the DOP position was yours to turn down.

Advancing here means salary increase, raise. Just FYI. I just PMed you about the hospital.

 

[njac]

UGAZ...no wonder you started the other thread about looking for a new job....what hospital in Southern California is this? Bet you Z knows this director personally (he knows everyone...EVERYONE!)


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I know, I'm wracking my brain for where this is!


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[Its Z]

Advancing here means salary increase, raise. Just FYI. I just PMed you about the hospital.

Is an hourly rate between $70 to $75 reasonable with 6 weeks (33 days) of PTO?

 

[UGAZ]

Is an hourly rate between $70 to $75 reasonable with 6 weeks (33 days) of PTO?

Definitely.... That would move me in a heartbeat

 

[ldiot]

As soon as I have a new job lined up I'd tell the director to blow it up his ass. Either that or you can put your head down and grind through it until something hopefully changes for the better. Maybe it won't be this bad once you get your 4th pharmacist back?

 

[Dr Wario]

Is an hourly rate between $70 to $75 reasonable with 6 weeks (33 days) of PTO?

Something I have wondered is, when you say 33 days of pto, does that include holidays or are holidays a separate thing? (I'm a retail guy).

 

[njac]

Something I have wondered is, when you say 33 days of pto, does that include holidays or are holidays a separate thing? (I'm a retail guy).

In hospitals unless you're salary you're usually expected to work a certain number of holidays.

Through some magic calculation those are somehow supposedly built in to those PTO days.

So if I work Christmas Day, I make time and a half for those 10 hours. But I won't automatically get paid 10 "holiday" hours that week - they would be factored in as an extra PTO day to use another time during the year. If I don't work Christmas Day I will just get paid for the hours I work that week (plus any PTO I put in for), but I don't automatically get paid for Christmas Day as a holiday.


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[Its Z]

Something I have wondered is, when you say 33 days of pto, does that include holidays or are holidays a separate thing? (I'm a retail guy).

It includes 6 holidays; new years day, memorial day, independence day, labor day, thanksgiving, and christmas. To be exact, it's 265 hours.

Too often young pharmacists get caught up on hourly rate. Many hospitals have 2nd, 3rd shift, weekend, and holiday differentials that are significant. That's why the total compensation package must be thoroughly evaluated.

 

[Dr Wario]

It includes 6 holidays; new years day, memorial day, independence day, labor day, thanksgiving, and christmas. To be exact, it's 265 hours.

Too often young pharmacists get caught up on hourly rate. Many hospitals have 2nd, 3rd shift, weekend, and holiday differentials that are significant. That's why the total compensation package must be thoroughly evaluated.

This is really interesting because when I do the math, the pto at retail is not so different than hospital, hospital just makes it look like more because it lumps them all together. My leave looks like this:

Vacation: 176 hours
Holiday: 64 hours
Sick: Really strange system that is technically "unlimited" but if you take more than 1 continuous week you are put on short term disability at 60% pay for up to 6 weeks.

To be fair, I am at the highest tier for my company (excluding union) but it seems closer than I originally thought.

 

[Dred Pirate]

This is really interesting because when I do the math, the pto at retail is not so different than hospital, hospital just makes it look like more because it lumps them all together. My leave looks like this:

Vacation: 176 hours
Holiday: 64 hours
Sick: Really strange system that is technically "unlimited" but if you take more than 1 continuous week you are put on short term disability at 60% pay for up to 6 weeks.

To be fair, I am at the highest tier for my company (excluding union) but it seems closer than I originally thought.

that is a lot for retail (compared to what I usually see) - plus how often to retail rph's get to call out sick? I see hospital people do it ALL the time. I get 280 hours total time off compared to your 240 (not counting sick) - I have been here 8 years. My retail at the place I monlighted I would be at 120 hours vaca + 48 holiday = 168 total

 

[Dred Pirate]

In hospitals unless you're salary you're usually expected to work a certain number of holidays.

Through some magic calculation those are somehow supposedly built in to those PTO days.

So if I work Christmas Day, I make time and a half for those 10 hours. But I won't automatically get paid 10 "holiday" hours that week - they would be factored in as an extra PTO day to use another time during the year. If I don't work Christmas Day I will just get paid for the hours I work that week (plus any PTO I put in for), but I don't automatically get paid for Christmas Day as a holiday.


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at my hospital - if you work you get time and a half, if you don't work, you use PDO out of your bank to cover - we have assigned holidays (3 a year of out a list of 9 that we call holidays) - but you can trade and swap all you want

 

[UGAZ]

Updated : The same guy called in and let my director know he won't be back til end of October. The director is scrambling around to find coverage but per diems are now backing out too since they don't like him either. A mess now

 

[Lnsean]

Updated : The same guy called in and let my director know he won't be back til end of October. The director is scrambling around to find coverage but per firms are now backing out too since they don't like him either. A mess now

Good. Let this simmer for a bit...let everyone see what a mess it is....it will reflect on his shtty management skills.