There is no longer a single career structure for hospital pharmacy. Instead, there is a myriad of possibilities. Importantly, specialisation in one area does not bar pharmacists from posts in other areas.
Newly recruited basic grade pharmacists rotate through the various sections of the typical hospital pharmacy department, gaining experience of the different specialties. Although most basic training is conducted in the course of normal working, there is usually also the opportunity to study for a clinical diploma or MSc and a commitment to continuing professional development. As your career progresses and you are promoted, you will need to decide in which area you wish to specialise and, possibly, which sub-specialisation within that area.
Clinical pharmacy forms a large part of hospital pharmacy work. Clinical pharmacists are part of the health care team on the ward, working with medical and nursing staff and the various therapy professions. Within the team, they are the experts on drugs and their advice is sought by the other members. Clinical pharmacists work closely with both prescriber and patient. They often attend consultant ward rounds where they can influence prescribing, rather than react to it later.
Some pharmacists are also heavily involved with outpatient treatment in clinics such as anticoagulant, rheumatology and gastroenterology clinics. Clinical pharmacy is very patient-centred and allows use and updating of all the knowledge that has been gained at university. In the majority of grades in most hospitals, clinical pharmacy is part of your job. However, at the highest grades, clinical pharmacy either tends to be a full time occupation or there is little, if any, practical involvement.
A sub-specialisation of clinical pharmacy is palliative care. Palliative care pharmacists work closely with hospices and community pharmacists to ensure that the last days or months of terminally ill patients are as comfortable as possible.
Drug information departments provide great support for clinical pharmacists. Drug information pharmacists critically assess claims made of drugs by their manufacturers or in clinical trial reports. Literature searches have been transformed by the use of computers and the internet. This information is also of use to formulary pharmacists who work closely with local drug and therapeutics committees to ensure that prescribing is rational and cost-effective. Helping guarantee this are audit pharmacists. Monitoring the use and effectiveness of drugs and techniques is very important in today’s environment where resources are limited and the introduction of clinical governance has raised the profile of clinical audit.
In recent years there have been moves to cut both the workload of and the hours worked by junior doctors with the result that pharmacists now carry out some of their duties.
Intravenous additives are now more likely to be produced in a pharmacy aseptic unit than on the ward, as are cytotoxic drugs, where the extra dose check by pharmacists leads to improved patient safety. Indeed, studies have shown that it is significantly safer all round if intravenous drugs are prepared in pharmacies. However, working in an aseptic unit involves more than just IV additives.
If the unit is licensed by the Medicines Control Agency for production, a wide range of products will be manufactured which can include injections and eye drops. There can also be involvement in the preparation of products for use in clinical trials and research is often required in order to produce a stable formulation. Production units also make creams, ointments, lotions and suspensions.
Frequently, commercial manufacturers have details of oral liquid formulations of drugs which they do not market because limited shelf life significantly reduces the commercial viability of the product. This information can be used to prepare the product extemporaneously for use within individual hospitals. Quality assurance pharmacists not only make certain the final products are acceptable, they assess every step in the production process to ensure quality is built in at every stage.
Radiopharmacies are specialised production units which manufacture a range of radioactive therapeutic and diagnostic preparations.
Increasingly, clinical pharmacists are becoming more involved with admission and discharge processes. In the latter, this can range from checking that discharge prescriptions are accurate and clinically optimised to actually writing discharge prescriptions.
From the ward, prescriptions are delivered to the dispensary. Many hospitals have moved away from central departments towards satellite dispensaries in the busiest patient areas, but others retain central dispensaries. In the dispensary, prescriptions are dispensed, checked and returned to wards so that treatment can continue or patients can go home. The dispensary manager’s job is to ensure that prescriptions are completed accurately and timeously so that treatment or discharge can proceed smoothly.
Not all specialties can be found in every hospital. Grades within hospital pharmacy range from A to H, with the latter being the most senior. Specialisation usually begins at grade C and extends through to E or F grade (current salary £32,980 to £38,643 pa), although area or regional specialists are often graded G or H (currently £36,755 to £45,250). Generally, the higher grades are in pharmacy management, where you would be responsible for a pharmacy department within a hospital or trust, although in some trusts pharmacy managers are on the National Health Service senior managers pay scale instead.
In conclusion, hospital pharmacy is not static and new specialisms are being introduced all of the time. Who can tell what hospital pharmacy might be like in 10 years time?
Colin Rodden is a senior pharmacist working in Gartnavel general hospital, Glasgow
Citation: The Pharmaceutical Journal, January 2000, online | URI: 20000190
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The editors of Pharmacy Times would like to keep the positive energy flowing by sharing more stories from readers who told us how truly happy they are to have found their calling. With the hectic holiday season in full swing, it's easy to lose sight of why you chose to become a pharmacist in the first place. As you tackle day-to-day challenges behind the counter, we hope reading these pharmacists' stories will help you remember what drives you.
Be sure to tell us your own story in the comments!
"Why I Love Being a Pharmacist" Contest: Honorable Mentions
Kathleen Jane Cross, PharmD
I was a young mother with 2 small children when I decided to change from an art to a pharmacy degree. Maybe it was because I spent a lot of time at the pharmacy picking up asthma medication for my older son, Michael, or seizure medication for my younger son, Matthew. In my heart I believe it is because that pharmacist was compassionate and caring to a young mother of children with asthma and epilepsy, and it was my turn to give back.
I love being a pharmacist because of a young man whose pain medication I refused to continue to refill as I told him I was concerned for his health with long-term use. I told him to get a second opinion and suggested some options for him. He came back 2 years later to thank me and to tell me that he was off medications and able to work again.
I love being a pharmacist because of the burly old man whom I talked into having his feet checked at one of my diabetes days. His father had a history of lower extremity amputations. He told me later that I saved his life.
I love being a pharmacist because of the young woman whom I convinced to stop her laxative abuse because electrolyte abnormalities could lead to major health issues. She was so thankful to find someone who cared.
I love being a pharmacist because my education taught me to recognize that the old man in the deli was having a stroke, and I was able to get immediate attention for him. When I visited him in the hospital, he was doing well.
I love being a pharmacist because of the young woman who brought her new antidepressant prescription to me and told me she was scared to take it because of what others would think. We talked about social stigma and counseling. She left with her prescription filled and a smile.
I love being a pharmacist because of the woman with anxiety issues who was comfortable enough to bring her dog’s ashes to the pharmacy because she couldn’t stand to leave them at home. Although I admit I really didn’t want to see how the shingles on her “backside” were healing when she lifted my gate and came into my pharmacy to show them to me.
I love being a pharmacist because of the woman whose husband had Parkinson’s disease, who thanked me for writing down a number off the radio about a new study for patients like him. She wrote a very nice letter in my honor which helped boost my morale.
For me, being a pharmacist is about neither salary nor prestige; it is about giving back, but in doing so I have received so many rewards. I love being a pharmacist because of the lives I have touched, but most importantly, because of the lives that have touched me.
Erin Smith, RPh
I think the pharmacy profession chose me as much as I chose to be a pharmacist. I would love to say that it was a decision that was given the amount of time that it truly deserved but rather it was my fascination with seeing the neatly arranged bottles in pharmacies as a child and my desire to help others that led me to believe, “Hey, I could do that”. Not necessarily the way that most might fall into their profession, but it has never been a decision that I have regretted for one day (not even during the worst of biochemistry or at the beginning of the year when all patients are starting over with new insurance).
It is cliché, but I love being a pharmacist because of the impact that I can play in my patients’ lives. I have been blessed to work in community pharmacy and have been given the opportunity to become so much more than just one that “licks, sticks, counts, and pours.” I have attended baby showers and funerals. I have been invited to high school graduations and seen pictures of new grandbabies. I have discussed vacation plans and hospice care and everything in between. I have made home deliveries not because it was expected but because it was the right thing to do for that patient at that time. I have worked with patients to determine what medication therapy will not only be most effective for them but will also fit their pocketbook. I have been given the opportunity to become directly involved in my patients’ lives, not just in their health care but in every part of their lives and I believe that makes me not only a better pharmacist but a better person.
I think it would be difficult to find a different profession that garners the immediate respect from the community that a health care profession offers. However, community pharmacy is unique among healthcare professions as our accessibility naturally allows us the opportunity to do more than just counsel on the proper use of amoxicillin. It allows us to become a problem-solver, a confidant, and a friend, and in that it allows us to do the rest of our job so much more effectively. We are the front-line of health care and that is a responsibility that I take very seriously. Our interactions with patients can truly change and save lives.
I am grateful not only for the opportunity to indulge my obsessive-compulsive side and neatly arrange bottles on the shelf but also for the opportunity to touch patients in a way that is so much more meaningful than I ever would have imagined. What a great live, to spend every day making a difference for people. Whether it is just a hello as they walk by the counter or a lengthy discussion about the proper use of inhalers to manage their child’s asthma, what is not to love?
I can sum up my love of being a pharmacist in one word really: opportunity. I am not just talking about the financial or career path opportunities. I am talking about the social, cultural, educational, and enriching opportunities that can otherwise be easy to miss in everyday life.
I am fortunate enough to work with a multidisciplinary team that teaches me something new each day. Pharmacists are a trusted link between patients and their doctors. This position affords us a unique perspective into many facets of healthcare. I, literally, learn something new every day and I am so appreciative of that.
I work with patients from any background imaginable which allows me, and forces me, to learn and practice cultural sensitivity. The population is becoming more and more diverse. Healthcare needs to adapt to this by embracing and responding to differences in patients’ expectations based on their culture. As a pharmacist, I am in the perfect position to strengthen the healthcare message by tailoring my recommendations to patients.
I also have to make decisions in my work each day that can have a real impact on patients’ lives. I evaluate drug interactions to avoid patient harm. I evaluate lab results and blood pressure readings, an extra safety net for clinicians at my organization, which allows me to recommend therapy changes to improve patient health.
Sometimes the patients are aware and thank me, sometimes they are not and don’t, but it is always a satisfying feeling when I have an impact.
The extraordinary thing, all of this is just the tip of the iceberg. I work in one segment of one organization where I get to have all of these experiences. I can only imagine what I could learn. There is so much more out there to explore, and as a pharmacist, I will always have that opportunity.
Carrie Burke, PharmD
When I first read the question "What do you love about your job," I thought this would be easy. I would list off all the things that I liked about being a pharmacist, put my name on the top, and cross my fingers. That couldn’t have been further from the truth. Later that evening I sat down at my kitchen table with a college-ruled notebook and a green pen that I had borrowed from my daughter and started to write. I got as far as my name.
“Why do I love my job?” I asked myself. Was it because they pay me? That wasn’t a good enough reason. There were other jobs. Because I like my boss? That wasn’t a good reason either. After an hour of sitting there, staring blankly at that lined page, I realized I wasn’t going to come up with anything. I put the notebook away, and decided that I just wouldn’t do the essay.
But the question kept bothering me. I would spend the day just thinking about it, trying to come up with just one good reason. I would wake up at three in the morning, saddened that I may have wasted my life on a job I would never love, that I would look back on my life in thirty or forty years and think “God, what have I done with my life?”
I thought about what I wanted to be when I was ten. More than anything else I wanted to be a hero, like Captain Kirk or Nancy Drew. But that realization didn’t help at all. Now instead of being enthusiastic about my future, I was scared of my past. I was so scared of having betrayed my ten year old self, settling for something she wouldn’t have wanted. The TV didn't perform its magic of lulling me to sleep that night.
Two days (of an existential crisis) later, I was sitting in one of my nursing homes when a doctor came up to me. He started arguing with me over a recommendation I had written in regard to one of his patients. I had wanted him to consider lowering the dosage on a patient’s medication, and he didn’t want to. How infuriated he was that I kept solid in my recommendation. Sometimes it crosses my mind whether feeling passionate about something is worth the cost. But I believe in the impact my insight has on the medical team, and more importantly, my patients. I believe that every benefit has a cost and sometimes that means standing firmly in my conviction. He stormed off. An elderly woman sitting nearby wheeled herself over to the nurses’ station where I was sitting. She had been a patient of this nursing home for almost as long as I had been coming there, and we had talked a few times over the years.
Clearly she had been making note of the exchange between the physician and me. “Carrie,” she said, and I came over to her chair. “What was the doctor yelling about?” I told her it was nothing. Then she handed me a red paper flower. She had made it as a thank you. "For what?” I asked, but she was already wheeling down the hallway and I had work to finish.
That night my youngest daughter, who will be going to college next year, asked me how hard pharmacy school was; I wanted to know why. She just looked at me like I was stupid, and said “Because you help people, and I want to be like you.” She smiled, and went back to making a sandwich as though nothing had happened.
So I’m sitting at the kitchen table again, with a green pen and a notebook I borrowed from my daughter, writing this after all. Because now I know what I love about being a pharmacist. I love helping people, I love keeping them safe, being their advocate and improving their quality of living. And most of all, I love knowing that in my own way, I am the hero that my ten year old self always knew I would be. I am a consultant pharmacist, and I wouldn’t change that for the world.
Ed Pitz, RPh
Sorry mom, I can’t make it to the wedding. We are short staffed this weekend and I have to help out, and oh by the way, remind dad to take his medication tonight at least an hour before dinner.
Honey, I’ll be late for our get together tonight. There’s been an emergency trauma admitted and I’m helping out in their ICU. Please give Bill and Ann my best and remind Ann to see her doctor, I think the fever may be drug related.
Hey Tammy, dad won’t be at the cheer competition today, the computer at work has crashed and it’ll take quite a while to catch up, and tell mom to try adding Tim’s medicine tonight to some ice cream so it will taste better and not hurt his tummy.
There are two common threads in the tale above. One is that the pharmacist in this story misses out on a lot of family activities. The second is that through the disappointment, that same pharmacist is not languishing in a pity party, but rather thinking of the well-being of family and friends.
In my nearly 40 years of service I have had the extreme pleasure and the equally extreme disappointment of experiencing the highest highs and roughest lows this life can pass out. Missing out on those family and social moments has occasionally left me with doubt about my chosen profession. But seeing the results of my efforts in a room full of family and friends who have overcome a variety of illnesses due in some small way to my help and intervention refills my spirit and casts out those doubts.
Pharmacy has been a unique blessing to me. The missed life events have made me more acutely aware of the value of family and friends. The often overlooked role my colleagues and I have played in the world of healing and care is a constant source of immeasurable peace and comfort to me in times of internal turmoil. Every time I see a grandchild born, or I see a friend undergoing the ravages of chemotherapy, I know in my heart that at some point the intervention of a caring pharmacist will ensure their safety and security, and I am comforted by that thought. I have laughed, I have cried, and I have lived with my patients. As deeply as I have touched their lives with my pharmaceutical skills, they have touched my life with their stories and their battles.
So I guess that if you ask me why I love being a pharmacist my best answer is that pharmacy is not just a job or a profession, it is an all-encompassing lifestyle. It is for the strong of will and conviction and for the soul tender enough to appreciate the deep-rooted pain of human suffering. Pharmacy has nourished my mind and my soul. It has made me a more caring, considerate, and tougher person. Pharmacy has not been my chosen career, pharmacy has been my life.
Matthew Bledsoe, PharmD
When I graduated pharmacy school in 2008 I stood with my classmates as we recited the “Oath of a Pharmacist” in unison. There is one particular vow that stood out to me as we recited the Oath and I embrace this vow, “I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients.” I love being a pharmacist because it allows me to use my knowledge, abilities, and talents to improve patient outcomes in the community hospital in which I am employed as the pharmacy clinical coordinator.
Being a pharmacist is more than dispensing medications to the ultimate user. Being a pharmacist means that I can ensure medications are being used appropriately to achieve optimal patient outcomes. I am heavily involved in the improvement of the medication-use system in the facility at which I work. In the few years I have worked as a pharmacist I have developed a pharmacy residency program, pharmacy technician based medication reconciliation program, and a medication safety team. I have worked hard to develop these programs since they greatly impact patient outcomes and improve the safety of the healthcare we deliver as pharmacists.
The profession of pharmacy gives me the knowledge and ability to discuss medications with patients and their families. I enjoy the one-on-one conversations I have with patients in their rooms on a daily basis, not only the talks about medications but the important debates like ‘Krispy Kreme’ or ‘Dunkin Donuts’. The admission into the hospital is a very stressful time for patients and their family members. A lot of the stress comes from not understanding the treatment they are receiving. As a pharmacist, I can help decrease some of the stress of the hospitalization by explaining the treatment regimens, potential side effects, desired outcomes, and what to expect throughout the hospitalization in terms of medication therapy.
I am also able to utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists. I enjoy training future pharmacists and pharmacy residents at Bristol Regional Medical Center and watching them deliver compassionate care to our patients. The students and pharmacy residents bring new perspectives and talents while continuing the honored tradition of providing high-quality care of the professionals they follow. Mentoring students and pharmacy residents at Bristol Regional Medical Center has given me further opportunities to demonstrate the importance the profession of pharmacy has on improving patient outcomes.
My lifelong goal was to find a career that would allow me to work directly with the public and make a difference. I enjoy seeing the impact that I have, as a pharmacist, on the quality of care our patients receive. I enjoy seeing the fruits of my labor and how my work pays off in achieving optimal patient outcomes. I love being a pharmacist!
Michael Ostrowsky, RPh
My love affair with pharmacy began over 40 years ago when I volunteered for a three-year enlistment in the United States Army. I was sent for an intensive 20 week course in pharmacy. I loved watching soldiers, their wives and their children coming in sick and walking by a short time later, well. It gave quite a rush to think that we in the pharmacy had a part in this transformation!
Later, I applied to and was accepted at the then Philadelphia College of Pharmacy and Science. Six years later after marriage and a child, I got my first license and was finally a registered pharmacist!
Now, after many years practicing as a community pharmacist, I feel I can finally verbalize why so many of us so love our profession. We make a real difference in people's lives. We literally save lives by warning physicians about potential problems and outright mistakes.
We are the entry point into the healthcare system for the innumerable people who can't afford or don't trust ERs or walk in clinics.
We perform triage on a daily basis, taking histories and recommending OTC products where appropriate, insisting on physician visits when indicated.
We routinely assist physicians in recognizing potential cost/compliance issues in seniors and uninsured patients by contacting them and letting them know about less expensive, therapeutically equivalent drugs.
We help 'doctor shoppers' avoid serious problems by alerting their physicians to overuse or inappropriate combinations of drugs.
We are trusted. We are respected. People are grateful for the drug information we supply. We help fight drug abuse. We make a difference in people's lives and are a force for good in our communities. Despite the frustrations of insurance problems, out-of-sorts patients, and all the other things which may come our way, its nice to leave after our shift knowing we have practiced our profession and in all ways, lived up to the Hippocratic Oath to which we all swore.
Space does not allow the mention of all the reasons I love the practice of pharmacy. These are just a few that come to mind. See what you can add!
My name is Michelle Gualtieri, maiden name Nerch for all of my college buddies from Duquesne University's class of 1991. I grew up in a small town in PA and was exposed to illness at a very young age. My father had a stroke when I was eight years old. I felt helpless as I watched him learn to walk, talk, and feed himself all over again. I felt even more helpless when I was the unfortunate one to find him having seizures on two separate occasions. The reason for the stroke was untreated hypertension. The reason for the seizure was an improper discontinuation of one of his medications.
I realized that I needed to help my dad and my family as I was deciding on a career. Pharmacy seemed a good choice because given the knowledge I would learn in this profession, I could inevetibly help my family and possibly help others from going through the same medical nightmare my family went through. This is why I chose the pharmacy profession. I get to meet new people every day who may be on the road to the destruction of their health because of their lack of knowledge about their medical conditions and the uncertainty of why they are being prescribed medications and the proper way to take them.
It is not just the material we learned in school that makes a good pharmacist. It is having the compassion to listen with a caring and concerned ear to let a person know that how they feel matters to someone. Being in the middle of the medical triangle of doctors, insurance companies and pharmacies enables the pharmacist to utilize the "middle man" position to the benefit of the patient. It gives me the opportunity on a daily basis to intervene for the patient where they may have otherwise fallen through the cracks unnoticed. In this instance I enjoy being the middle man (girl) and take the opportunities to help people very seriously. I find that this is one of the aspects of the profession that makes my job enjoyable and rewarding. I, as a pharmacist, learn so much more from listening to people and sharing the stories of their lives.
Although the profession may change as the years go by, the reason I became a pharmacist remains the same. I will always do my best to make a difference in the lives of the people I encounter every day.
My dad has been deceased for almost 5 years but he helps me every day in my profession. He always said you can learn more with your ears open and your mouth closed. It holds true in the profession I enjoy so much. I took his advice as this: Always listen with an open mind and heart to what someone has to say and if you can offer them anything that can make a positive difference in their life then by all means, tell them. This is how I practice as a pharmacist!