I really enjoyed working in my first hospital. I was hired by an older gentleman. He was the Director of Pharmacy. I believe he liked the suit that I was wearing. He was very knowledgeable and very soft spoken.
He was also very close to retiring. I think he was close to seventy years old when he hired me. After he retired, he volunteered at the hospital, but not in the pharmacy department.
The person that replaced him as Director of Pharmacy, worked at a small, local hospital. He was hired and became the only management person working in the pharmacy department. Everyone else— the pharmacists, the pharmacy techs, the stock clerk, and the secretary— were all union members.
As much as he would have liked to have had an Assistant Director of Pharmacy, he did not hire anyone at that time. This was because:
- Since he had just started the job, he had not been in the position long enough to request an Assistant Director and
- No one on the staff was qualified to take the position. My boss wanted someone with the education, the experience, and an advanced degree— which the staff sorely lacked.
But the Director of Pharmacy had a goal. He was determined to hire and mentor an Assistant Director of Pharmacy.
Offering The Position
My boss called the most senior pharmacist into his office.
“Have a seat,” he said.
He continued, “There are many tasks and reports that I need to do. But I’d like to show somebody and teach them what to do.”
“What kind of tasks?”, asked the most senior pharmacist.
“Tasks like gathering data in order to prepare antibiotic reports. Things like walking around the department and preparing a wholesaler order— so we can get medications. I’d also like to teach someone how to prepare an annual budget. And I want to show them how to draft a proposal, so that we can start certain projects”
“And these things would become my job?”
“Some of them would,” replied my boss, “but it’s more than just gathering data. I really want to train a person how to compile these reports and complete these activities.”
The most senior pharmacist did not appear happy. He did not speak for a short period of time.
Finally he asked, “how much money am I going to get, to compensate me, for completing these additional tasks?”
My boss paused. He shook his head.
“I’m sorry, but I can’t pay you any additional money at this time. Or give you any perks or promises for that matter. But instead, think of this as a mentoring process. It’s a chance to perform something new. Something you might not have had the opportunity to learn. Something that you will find helpful in your career.”
The most senior pharmacist rose.
“No, thank you,” he said, “I’m not interested.”
“Excuse me,” responded my boss,” but I just want to make certain that you understand.”
The most senior pharmacist stopped in his tracks.
My boss spoke, “This is a golden opportunity for whoever undertakes this responsibility. Yes, there will be a great deal of work involved. In addition, there won’t be any monetary compensation. And I can’t make any promises about the future.
Now I can’t force these tasks on you. And you do have the option to say ‘yes’ or ‘no’. But if you say ‘no’ and walk out that door— there’s no turning back. Especially if another person says ‘yes’.”
The most senior pharmacist stared at my boss. Then he turned and walked out of the office.
Working As A Pharmacist
I wasn’t the most senior pharmacist. I wasn’t even the second most senior pharmacist. I was number three.
I had been a pharmacist for a total of three years. And to be honest, I was bored with what I was doing. I went to school to become a pharmacist. I graduated and got my license. I even had a good paying job.
So what was I doing as a pharmacist? Typing labels, filling prescriptions, and bagging them so they can be delivered to the nursing units. That’s what I did for a good part of my day.
I was judged on how many prescriptions I filled a day. If I filled a lot, I was a good worker. If not, I was a bad worker. (I was always a good worker.)
This was pharmacy? This is what I struggled to get through school for? What a disappointment!
Thus, when my boss approached me and asked if I’d be willing to learn additional tasks, I jumped at the chance. No perks? No problem. No pay? I would have paid my boss to teach me these new responsibilities. (No, I didn’t tell him that.)
Eventually, I went back to school. Several years later I had my advanced degree, my education, and my boss’ mentoring. My boss made me the Assistant Director of Pharmacy. We worked together for eighteen years.
Assuming The Acting Director Position
My hospital hired a new Vice President of Professional Services. He was responsible for several departments. The pharmacy was one of them.
My boss and this Vice President never got along. Perhaps it was that the Vice President was younger than my boss. My boss often said that he didn’t like taking orders from “some young guy”. Or maybe it was because the Vice President did not have that much experience with the pharmacy department.
But regardless, the Vice President and my boss clashed from the first day they met. Unfortunately, my boss left on less than desirable terms shortly thereafter.
Which made me the acting Director of Pharmacy. I hated this role for several reasons:
- I never wanted to be a Director of Pharmacy. I was always happy in my number two role and
- I was sensing some animosity from the Vice President. I’m sure that he knew about my allegiance and appreciation that I had for my boss. I thought I might be treated like collateral damage and be terminated after a new Director of Pharmacy was hired.
The Vice President was going to hire a new Director of Pharmacy. I was not going to be considered for the position (which was fine with me).
I extremely disliked being the acting Director of Pharmacy. But I realized something while in this role. I couldn’t be terminated while they were searching for a new Director of Pharmacy. Because, after all, who would be the Director of Pharmacy then? Yes, the Vice President could make my life miserable, but he couldn’t push too hard. Or else he would have no one.
I have found that between the time that a position is vacant until the time a new person is hired and starts working is about three months. This is because the process involves advertising for the position, setting up interviews, bringing in the candidates to interview, meeting with Human Resources and other decision makers, hosting second interviews, offering the position, and having the newly hired employee give notice to their old position. Only then can the new person start the new position.
This process can sometimes take longer if there are any unforeseeable issues.
Thus, I had three months to prove myself. I needed to become someone who would be perceived by both the Vice President and eventually, the new Director of Pharmacy as a valuable asset.
Which was very difficult. For one thing I was still linked to my previous boss. I had to show my loyalty to the Vice President while performing tasks that benefited the pharmacy.
The second problem was with the nurses. The Vice President put a great deal of faith in their comments and complaints. This led to the nurses being very manipulative in their actions. The Vice President was being used and he didn’t even realize it.
Breaking Down IV Bags
The Vice President constantly took the nurses viewpoint when it came to any argument. He also sided with the nurses any time that they had a complaint.
And the nurses knew that. They would complain and he would jump. The nurses were always right and the pharmacy was always wrong.
The head nurse of the neonatal unit called the Vice President to complain that they did not have any dextrose IV solution. The Vice President called the pharmacy and spoke to one of my pharmacists. The Vice President stated that he would be right down to find out what the problem was.
I doubted that the neonatal unit was completely out of dextrose IV solution. I decided to go to the neonatal unit and find out what was happening.
I arrived at the neonatal unit and went to their store room. On the shelf were two large blue bins. The first bin held about twenty bags of dextrose IV solution in a 500ml size. The second bin was empty. It would have held bags of dextrose IV solution in a 100ml size.
It was apparent what had happened. The pharmacy breaks down the larger size dextrose IV bags into the smaller size dextrose IV bags. The nurses had used the last 100ml size IV bag and didn’t inform the pharmacy that more bags needed to be broken down.
Instead their head nurse called the Vice President, blamed the pharmacy, and said that they were out of them.
I picked up the entire bin with the twenty bags of dextrose IV solution and headed back to the pharmacy. When I arrived, the Vice President was already there. He was furious. I walked in carrying the bin full of dextrose IV bags.
Normally, I’m not one for theatrics. But in this situation, I felt I could use it to my advantage.
“Look at this,” I screamed as I threw bags of dextrose IV solution on the table.
“Look at all these dextrose IV bags that I found,” I yelled.
The Vice President paused. His anger quickly subsided. In fact, he looked momentarily confused.
“Where did you find those IV bags?”, he asked.
I continued flinging bags on the table. I tossed a couple on the floor as well.
“You see this bin? It’s from the neonatal unit. It’s filled with dextrose IV bags,” I exclaimed. I switched to speaking in a more sarcastic tone.
“But they don’t have any!” I yelled as I tossed bags in the air.
I continued, “They’re out of them! Let’s call the Vice President and make him run down to the pharmacy to see what the problem is!”
The Vice President said nothing. He knew he had been had.
I continued,” So here’s my question. What exactly were you told by the head nurse? Did she say that they had no dextrose IV solution? Or did she say that they had a bin full of dextrose IV bags that needed to be broken down? Which was it?”
“She stated that they had no dextrose IV solution,” answered the Vice President quietly.
“How about that?” I replied, “Well, it’s a shame they don’t have any! I guess I’ll take this bin full of dextrose IV bags and go ask my staff to break them down.”
I gathered the IV bags on the table and picked up the ones from the floor. I threw them into the blue bin. Then I headed off to the IV room and had my pharmacists break down the dextrose IV bags.
Duplicating The Wrong Drug
When a patient suffers a heart attack, they are admitted to the cardiac care unit (CCU) of our hospital. They are also placed on a regimen of medications. For simplicity sake, I’ll call them drug A, drug B, drug C, and drug D.
One of the CCU nurses contacted the Vice President. Her patient only received three of the four medications. She wanted to know why.
It’s quite unusual for a Vice President to stop what he’s doing and contact the pharmacy because a patient did not get their medication. But he still catered to the nurses' every request. And thus, he called me to investigate.
I was still the acting Director of Pharmacy. I was still trying to make a good impression in order to keep my job.
I went to CCU and opened the patient’s chart. It was the 1990s, and physicians’ orders were written on three-part NCR carbonless paper. This was where the physician had to press down while writing his order on the top sheet, so it would go through and appear on the other two sheets below.
Nevertheless, I found the regimen of medication orders for the patient. I also discovered why the patient only received three of the four medication orders.
Instead of writing for the four medications, the physician wrote “drug A, drug B, drug C and drug A”. In other words, instead of writing for “drug D”, the physician wrote for “drug A” twice. Drug D was never prescribed for this patient.
Obviously this was a mistake. I knew what the doctor wanted to write for. He meant to write for drug D, instead of writing for drug A twice. But he didn’t. And the rule is that— what is written is what matters. Nobody can fill what one thinks the physician meant to write for.
Thus, the patient did not receive drug D, even though everyone knew that that’s what the physician meant to prescribe.
I showed this information to both the Vice President and the nurse. They both agreed with my findings. Eventually, the physician wrote for drug D. The patient received their medication.
The Vice President was pleased how I resolved the situation and was happy with the outcome.
Becoming A Valuable Asset
Three months had passed and I was still employed. There had been several additional situations dealing with medications during that time. The Vice President was pleased with how I addressed them.
The Vice President eventually hired a new Director of Pharmacy. I reverted back to the Assistant Director of Pharmacy role. The new Director of Pharmacy and I worked well together. I could not have been happier.
Daniel Shifrin, R.P., M.S. is a recently retired pharmacist who enjoys sharing his insights about hospital pharmacy. He is proud to own one of the largest collections of Pharmacy Stamp First Day Covers.