Transition to hospital staffing

[baronzb]

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if one is to make the transition, what is the best way to prepare for the inpatient drugs, the most common issues, and most common clinical presentation? How about NICU and general peds and labor delivery?
What are good sources to reference and resources to learn?

 

[Xarelto-10]

Global RPH will be a very good starting point.
Get familiar with:
1. Renal dosing of antibiotics( Hospitsl should have protocol for some you can auto adjust)
2. Review spectrum of coverage—gram positive to MSSA to MRSA, pseudomonas to anaerobes
3. Know how to dose Vanc and aminoglycosides and how to order the labs and appropriately adjust dose based on lab results
4. Know your critical care area fluids: I.e. levophed, epinephrine, dopamine, dobutamine, and vasopressin, insulin drips, fentanyl drips. Also make sure you know standard concentrations of these drips. Depends on hospitals and based on clinical stare of patients. I.e. how to concentrate drips in fluid restricted patients etc
Also know appropriate dosing for those. You can find some reference on global RPH too
5. Know common abx used to treat common infectious diseases such as UTI, CAP, HcAP, cellulitis, meningitis etc
5. Know how to dose kcentra and altrplace, mucomist etc commonly seen

Don’t try to grasp everything all at once- somethings take time to grasp and depends on individual pace of learning.

These are really things I can think of right now that you can familiarize yourself with
Good luck.

 

[ornithoptor]

My answer to you is twofold: If you hired by the hospital already, your employer usually provide you month long training to bring you up to the speed. Clinical, operational, IV making...... Also depend on your shift or position. The formulary is also specific to your organization only. Understand of order sets will be tremendous help to speed up your process time.

On the other hand, if you are preparing for interview, suggestions above post works well. However, when we conduct interview for pharmacist, we typically focus on your skills and personalities but not your knowledge. We probe you with question on problem solving and decision making process for our candidates. We do not give you disease state and ask about treatment algorithm. If you are license, we treat you like a professional, and expect you to pick up what you don't know.

 

[jjcayce123]

One of my favorite go to resources is "Gahart's intravenous medications". The book is only like $45 and I use it all the time. Very good resource for IV dilution and administration info. Like the previous poster said, Global RPh is another good resource.

 

[jjcayce123]

What is the size of your hospital? What ICU's do they have. That also is going to be a factor.

 

[Xarelto-10]

Off course for this aspect of hospitsl pharmacy there is no resource for preparing- and perhaps no one will mention this to you. But, hospital pharmacy “politics” - is very purvasive and malignant. You’d think “politics” is not bad and may even be useful for all involved. But NO, they like to call it that only to legitimize and sustain the culture, it should be a “high school drama”

To be honest I don’t believe every institution is engaged in such a culture to the same degree, yet not a bad idea to watch for it and wise up.

 

[jjcayce123]

Off course for this aspect of hospitsl pharmacy there is no resource for preparing- and perhaps no one will mention this to you. But, hospital pharmacy “politics” - is very purvasive and malignant. You’d think “politics” is not bad and may even be useful for all involved. But NO, they like to call it that only to legitimize and sustain the culture, it should be a “high school drama”

To be honest I don’t believe every institution is engaged in such a culture to the same degree, yet not a bad idea to watch for it and wise up.

Whatever this drunk ***** above is saying...avoid

 

[BidingMyTime]

Off course for this aspect of hospitsl pharmacy there is no resource for preparing- and perhaps no one will mention this to you. But, hospital pharmacy “politics” - is very purvasive and malignant. You’d think “politics” is not bad and may even be useful for all involved. But NO, they like to call it that only to legitimize and sustain the culture, it should be a “high school drama”
To be honest I don’t believe every institution is engaged in such a culture to the same degree, yet not a bad idea to watch for it and wise up.

This. This can't be highlighted enough. OP, you may think you have worked in a job with politics before, but you really haven't until you've worked hospital. Most hospitals don't reach the level of being completely toxic (but some do), but all hospitals do have politics.

1) Be friendly to EVERYONE. But not overly friendly to anyone.
2) Do not share anything personal other than very general details. Assume that anything you say or do will be broadcast to the entire hospital, and it will be misconstrued/taken out of context.
3) Do not talk about previous jobs or how they compare to your current job. (even if it's a positive comparison)
4) Do not talk about previous co-workers or how they compare to your current job. (even if it's a positive comparison)
5) Don't believe everything you are told about the job (unless it's by a supervisor)
6) Don't believe anything you are told about another employee (even if it's by a supervisor)
7) Do not say anything negative about anyone, even if all your co-workers are ganging up on another co-worker.
8) Always take your breaks/lunch with your co-workers (unless you are scheduled on them by yourself....I mean don't go off and do your own thing at break/lunchtime, you need to socialize with your co-workers at this time.)
9) If you are invited to do anything with co-workers after work, always join in. (But do not get drunk, even if they are getting drunk.)
10) Do not let yourself get drawn into shift politics, but be empathetic when your 1st shift co-workers blame everything on 2nd shift or vice versa. Or when they both blame everything on 3rd shift.
11) Observe very carefully, so you can learn the work personalities of your co-workers, and who can be trusted or not trusted (to stab you in the front or in the back.)
12) Always ask questions about anything you aren't sure about....but write down the answer so you never have to ask the same question again.
13) Don't get emotional at work, but don't be surprised if certain of your co-workers get emotional about everything.
14) Don't make first impressions. The most friendly co-workers you meet the first day, are likely to be the ones who will stab you in the back and/or be gossipers. The most quiet/standoffish co-workers you meet, are likely to be the ones you can trust, once they have decided they can trust you.

 

[Sabril]

This. This can't be highlighted enough. OP, you may think you have worked in a job with politics before, but you really haven't until you've worked hospital. Most hospitals don't reach the level of being completely toxic (but some do), but all hospitals do have politics.

1) Be friendly to EVERYONE. But not overly friendly to anyone.
2) Do not share anything personal other than very general details. Assume that anything you say or do will be broadcast to the entire hospital, and it will be misconstrued/taken out of context.
3) Do not talk about previous jobs or how they compare to your current job. (even if it's a positive comparison)
4) Do not talk about previous co-workers or how they compare to your current job. (even if it's a positive comparison)
5) Don't believe everything you are told about the job (unless it's by a supervisor)
6) Don't believe anything you are told about another employee (even if it's by a supervisor)
7) Do not say anything negative about anyone, even if all your co-workers are ganging up on another co-worker.
8) Always take your breaks/lunch with your co-workers (unless you are scheduled on them by yourself....I mean don't go off and do your own thing at break/lunchtime, you need to socialize with your co-workers at this time.)
9) If you are invited to do anything with co-workers after work, always join in. (But do not get drunk, even if they are getting drunk.)
10) Do not let yourself get drawn into shift politics, but be empathetic when your 1st shift co-workers blame everything on 2nd shift or vice versa. Or when they both blame everything on 3rd shift.
11) Observe very carefully, so you can learn the work personalities of your co-workers, and who can be trusted or not trusted (to stab you in the front or in the back.)
12) Always ask questions about anything you aren't sure about....but write down the answer so you never have to ask the same question again.
13) Don't get emotional at work, but don't be surprised if certain of your co-workers get emotional about everything.
14) Don't make first impressions. The most friendly co-workers you meet the first day, are likely to be the ones who will stab you in the back and/or be gossipers. The most quiet/standoffish co-workers you meet, are likely to be the ones you can trust, once they have decided they can trust you.

Thanks for this very useful list of advice. I try to avoid politics by avoiding the troublemakers at all cost but it seems that this won't work for hospitals. "Keeping your enemies closer" seems to be the way to play the game here. What's the best way to handle being written up or having to write someone up?

 

[gwarm01]

Thanks for this very useful list of advice. I try to avoid politics by avoiding the troublemakers at all cost but it seems that this won't work for hospitals. "Keeping your enemies closer" seems to be the way to play the game here. What's the best way to handle being written up or having to write someone up?

The most skilled troublemakers won't make themselves known until they are twisting the knife into your back.

 

[Hels2007]

Yes, politics is the main reason I never wanted to work in a hospital. My drug info rotation was such a textbook example of everyone smiling to everyone's face and stabbing them in the back... still makes me shudder after all these years. That was the only C I have ever received in my entire college career, too. Undergrad, PharmD and Masters included.

 

[Apotheker2015]

This. This can't be highlighted enough. OP, you may think you have worked in a job with politics before, but you really haven't until you've worked hospital. Most hospitals don't reach the level of being completely toxic (but some do), but all hospitals do have politics.

1) Be friendly to EVERYONE. But not overly friendly to anyone.
2) Do not share anything personal other than very general details. Assume that anything you say or do will be broadcast to the entire hospital, and it will be misconstrued/taken out of context.
3) Do not talk about previous jobs or how they compare to your current job. (even if it's a positive comparison)
4) Do not talk about previous co-workers or how they compare to your current job. (even if it's a positive comparison)
5) Don't believe everything you are told about the job (unless it's by a supervisor)
6) Don't believe anything you are told about another employee (even if it's by a supervisor)
7) Do not say anything negative about anyone, even if all your co-workers are ganging up on another co-worker.
8) Always take your breaks/lunch with your co-workers (unless you are scheduled on them by yourself....I mean don't go off and do your own thing at break/lunchtime, you need to socialize with your co-workers at this time.)
9) If you are invited to do anything with co-workers after work, always join in. (But do not get drunk, even if they are getting drunk.)
10) Do not let yourself get drawn into shift politics, but be empathetic when your 1st shift co-workers blame everything on 2nd shift or vice versa. Or when they both blame everything on 3rd shift.
11) Observe very carefully, so you can learn the work personalities of your co-workers, and who can be trusted or not trusted (to stab you in the front or in the back.)
12) Always ask questions about anything you aren't sure about....but write down the answer so you never have to ask the same question again.
13) Don't get emotional at work, but don't be surprised if certain of your co-workers get emotional about everything.
14) Don't make first impressions. The most friendly co-workers you meet the first day, are likely to be the ones who will stab you in the back and/or be gossipers. The most quiet/standoffish co-workers you meet, are likely to be the ones you can trust, once they have decided they can trust you.

You nailed it. Ugh... stab me in each eye with a hot butter knife, please. LOL

 

[Pharmacy Kid]

This. This can't be highlighted enough. OP, you may think you have worked in a job with politics before, but you really haven't until you've worked hospital. Most hospitals don't reach the level of being completely toxic (but some do), but all hospitals do have politics.

1) Be friendly to EVERYONE. But not overly friendly to anyone.
2) Do not share anything personal other than very general details. Assume that anything you say or do will be broadcast to the entire hospital, and it will be misconstrued/taken out of context.
3) Do not talk about previous jobs or how they compare to your current job. (even if it's a positive comparison)
4) Do not talk about previous co-workers or how they compare to your current job. (even if it's a positive comparison)
5) Don't believe everything you are told about the job (unless it's by a supervisor)
6) Don't believe anything you are told about another employee (even if it's by a supervisor)
7) Do not say anything negative about anyone, even if all your co-workers are ganging up on another co-worker.
8) Always take your breaks/lunch with your co-workers (unless you are scheduled on them by yourself....I mean don't go off and do your own thing at break/lunchtime, you need to socialize with your co-workers at this time.)
9) If you are invited to do anything with co-workers after work, always join in. (But do not get drunk, even if they are getting drunk.)
10) Do not let yourself get drawn into shift politics, but be empathetic when your 1st shift co-workers blame everything on 2nd shift or vice versa. Or when they both blame everything on 3rd shift.
11) Observe very carefully, so you can learn the work personalities of your co-workers, and who can be trusted or not trusted (to stab you in the front or in the back.)
12) Always ask questions about anything you aren't sure about....but write down the answer so you never have to ask the same question again.
13) Don't get emotional at work, but don't be surprised if certain of your co-workers get emotional about everything.
14) Don't make first impressions. The most friendly co-workers you meet the first day, are likely to be the ones who will stab you in the back and/or be gossipers. The most quiet/standoffish co-workers you meet, are likely to be the ones you can trust, once they have decided they can trust you.

Great advice, I agree with everything except #9. You don't have to hang out with coworkers outside of work.

Do you work where I do?

 

[BidingMyTime]

Thanks for this very useful list of advice. I try to avoid politics by avoiding the troublemakers at all cost but it seems that this won't work for hospitals. "Keeping your enemies closer" seems to be the way to play the game here. What's the best way to handle being written up or having to write someone up?

You are a new employee, don't write anyone up. Don't even say anything negative about another employee to your supervisor. If the environment is toxic enough that you see illegal and/or dangerous stuff going on, then get a new job (because that stuff was going on long before you took the job, and nothing you say will change it, it will just get you put on the fired list for complaining.)

If you are written up....as a new employee, this would be a very bad sign. Either you are a completely incompetent pharmacist, or you work in an extremely toxic environment. So start looking for a new job. Formally, at least for the first 90 days at most hospitals, you will considered in a training period--where you aren't going to be written up, you will be taught/coached/whatever. Even after that, most places aren't going to write you up the first year unless you do something completely egregious, rather the situation will be informally discussed with you.

Great advice, I agree with everything except #9. You don't have to hang out with coworkers outside of work.
Do you work where I do?

With #9, it can depend on the workplace. If you aren't hanging out with co-workers outside of work when they get together, rest assured they will be talking about you and dissecting everything they don't like about you (including the fact that they will probably think that you are arrogant for not hanging out with them.) If you have a reasonable excuse (family obligations, 2nd job, classwork), then they are more likely to excuse you and not call you arrogant, but they will still be talking about you after work. The ideal job won't have co-workers gathering together outside of work (or at least gathering together very infrequently.)

As for, do I work where you do? It is scary how similar hospitals are alike, when it comes to politics and backstabbing. I doubt I am currently working with you, but possibly I've worked at your hospital in the past (unless you are in CA, I have never worked in CA and plan never to.)

 

[jjcayce123]

10) Do not let yourself get drawn into shift politics, but be empathetic when your 1st shift co-workers blame everything on 2nd shift or vice versa. Or when they both blame everything on 3rd shift.

I have worked first, second and third shift at two different hospitals and its just as common as nurses losing every med under the sun. Each shift has their own issues so its really not a good point to complain about another shift. Overall, I prefer 3rd shift 7 on 7 off.

 

[owlegrad]

You don’t have to work at a hospital to get the shift politics. I’m pretty sure that’s universal to every job that has shifts. Even cashier jobs blame everything on the other shift, lol.


Sent from my iPhone using SDN mobile

 

[JustAnotherRph]

Didn't you just barely get a job in a PBM that you asked about frequently? Why the sudden change so soon?

 

[baronzb]

Off course for this aspect of hospitsl pharmacy there is no resource for preparing- and perhaps no one will mention this to you. But, hospital pharmacy “politics” - is very purvasive and malignant. You’d think “politics” is not bad and may even be useful for all involved. But NO, they like to call it that only to legitimize and sustain the culture, it should be a “high school drama”

To be honest I don’t believe every institution is engaged in such a culture to the same degree, yet not a bad idea to watch for it and wise up.

Could you elaborate on this? I'm a social guy, but the work realm isn't always as organic. What should I be aware of and how should I hand these issues? Message me if necessary.

 

[jjcayce123]

I worked as a tech in a hospital before pharmacy school and then as an intern and ultimately as a pharmacist at the same hospital. Knowing how to make IV's, how to deal with pyxis issues and knowing where everything was in the hospital was a huge benefit. Especially when you are a night pharmacist and you might be dealing with new techs who arent familiar with everything.

 

[BidingMyTime]

Could you elaborate on this? I'm a social guy, but the work realm isn't always as organic. What should I be aware of and how should I hand these issues? Message me if necessary.

Hospital politics are equivalent to High School politics. Everyone will know everyone else's personal business, gossip is a constant and can run from the mundane to the malevolent, bullies will be ignored by the teachers.

Know also in the hierarchy:

Teachers=CEO, upper level management, doctors, nursing management
Seniors = nurses,
Juniors = nursing aids, RT, OT/PT, dietary, radiology, possibly lab in some hospitals
Sophomores = pharmacists, HR, accounting, administrative assistants/secretaries, medical records, possibly lab in some hospitals
Freshman = security, housekeeping, maintenance, groundskeeping, operator

If you were good at high school politics (or at least good at fading into the background), and if you are OK with knowing that it's extremely unlikely you will ever advance past the Sophomore level, then you will do just fine in a hospital. Obviously, most pharmacists in hospital can handle the politics just fine, otherwise they wouldn't be employed in a hospital. But other people can not work in a perpetual high school environment, so they are not happy being a hospital pharmacist. The politics is definitely my least favorite part of being a hospital pharmacist, but every job has aspects one doesn't like.