Episode 158: Career transitions within pharmacy – from community (retail) to hospital pharmacist and from staff to clinical pharmacist

In this episode, I’ll discuss how to transition from community (retail) to hospital pharmacist and from staff to clinical pharmacist.

How to transition from retail to hospital pharmacist

Back in 2002, I transitioned from being a community pharmacist to a hospital pharmacist. It took me about 6 months in this role to feel comfortable, and another 6 months to feel confident.

Find a mentor

I received a lot of help along the way from a mentor – an experienced hospital pharmacist who “took me under his wing”. He was “Grandmaster T” (a.k.a Andy) and I was the “Grasshopper”. I didn’t seek out a mentor-mentee relationship, it just happened naturally. But reflecting on the experience I understand it was Andy that helped shepherd my transition from retail to hospital pharmacist.

Know what you don’t know

Early on, Andy taught me what I now refer to as Pharmacy Joe-ism #1: “Know what you don’t know”. I had a few near misses before this sank in. Two in particular that I remember:

1. Assuming that if haloperidol can be given IV despite the label saying “IM only”, then hydroxyzine must be OK to give IV too (It’s not due to the risk of hemolysis with IV hydroxyzine).
2. Not realizing that an early rash with lamotrigine meant the drug should be discontinued out of concern for Steven’s Johnson Syndrome.

In both cases, Andy was there to help me correct the misinformation and recognize that I needed to “know what I didn’t know” while I was learning my new role. Although these events happened 15 years ago, I remember them as if they happened yesterday.

Andy helped instill in me a robust self-awareness of what I don’t know, and a determination to close that knowledge gap before giving a recommendation to another clinician. I highly recommend that when you are transitioning to a new role, you actively seek out a mentor-mentee relationship with someone experienced in your new role.

How to transition from staff to clinical pharmacist

A few years later I transitioned again – this time from staff to clinical pharmacist, and began to specialize in critical care. Again it took me about 6 months in this role to feel comfortable, and another 6 months to feel confident.  Knowing I needed a mentor, I found one through a program at the Society of Critical Care Medicine.

Use continuing professional development

In addition to seeking out a mentor, I knew that I would need to have a more focused effort to get up to speed in the specialty of critical care. I used the principle of continuing professional development to accomplish this. I would continually self-reflect on specific areas that I wanted to increase my knowledge in, and then make and execute a plan to gain the knowledge. For example: As a staff pharmacist, one of my roles was to fill requisitions from EMS personnel to replace the medications they used on patients they brought to the hospital. It dawned on me that I thought of myself as a medication expert, but the person that drove the ambulance had a better knowledge of the dosing and effects of lidocaine, atropine, and sodium bicarbonate than I did.

The area I chose to increase my knowledge in was Advanced Cardiac Life Support (ACLS). The plan I made to gain an ACLS certification was: renewing my Basic Life Support certification, learning how to recognize life-threatening ECG rhythms, and taking and passing the ACLS class.

One of the major points of adjustment I had to make coming from a staff to clinical role was this: As a staff pharmacist based in the central pharmacy, only a slice of the patient’s record was available to me. As a unit-based clinical pharmacist, the patient and their whole medical record was accessible to me, and I was expected to take this into account before giving a recommendation to another clinician.

I’ll never forget one of the first medication histories that I took…I noticed the patient was on lisinopril at home, and I asked the provider if they wanted to reorder it in the hospital. The provider said “I don’t know, what is the patient’s blood pressure? What is the creatinine? What is the potassium?”.  After I recovered from this face-palming moment, I realized that I was expected to review all the relevant patient data available to me – not just what I had access to from the central pharmacy.

Develop relationships with providers and nurses

Another tip that I learned in my role as a new clinical pharmacist was that it is essential to deliberately cultivate relationships with the providers and nurses. This is actually extremely simple and requires only following up with them on patients that you have cared for together.  Asking “How is Mrs. Smith doing with her new olanzapine dose?” or “Did that patient’s tremor stop that we discussed last week?” lets the provider or nurse know that you are there to help them take care of the patient, and makes future interactions with them easier.

Even now as a more experienced pharmacist, I make it a point to have some follow-up conversations with each new provider I meet. In addition to making future interactions easier, the relationships that develop mean that providers take the time to answer questions and teach me new skills.

If you know someone who is going through a similar career transition, please share this episode with them. If you are transitioning to the field of hospital pharmacy and would like to develop your critical care, infectious disease, emergency medicine, and general hospital pharmacy knowledge and skills, consider joining my Hospital Pharmacy Academy.

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If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.

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