I’ve written several articles for The Happy PharmD. Most of them have been adversarial: Me and my pharmacy vs. the doctors. Me and my pharmacy vs. the nurses. Me and my pharmacy vs. the hospital’s administration.
Most of the time I’ve painted these groups as the bad guys. They’re wrong and I’m right. They’re the big, bad, Goliath person, while I’m the underdog David just trying to do the right thing.
I’ll admit every administrator, nurse, and doctor that I’ve met are not that bad. I’ve worked with a lot of outstanding individuals in my thirty-nine year pharmacy career.
Reflecting On My Career
My father was a teacher, a guidance counselor, an assistant principal, and a principal. He also had a career that lasted thirty-nine years. He worked in the same school system during his thirty-nine years.
Things have changed though. Most people don’t stay in the same job or with the same company for all that time.
I didn’t. I worked for my first hospital pharmacy job for eighteen years. As I was leaving, it faced massive mismanagement and bankruptcy. It closed shortly thereafter.
My second hospital was my favorite. I worked as a hospital pharmacy manager. I would have continued working there, but they decided to outsource the pharmacy department. The outsourcing idea worked well with other areas of the hospital, such as dietary, housekeeping and the fitness center. So they decided to try it with the pharmacy.
In order to outsource the pharmacy, the outsource company paid the salaries and benefits for the Director of Pharmacy, the Assistant Director of Pharmacy, and other management positions. The company also paid the salaries and benefits for the clinical pharmacists. All other staff positions (pharmacists, technicians, clerks, secretaries) had their salaries and benefits paid by the hospital.
The outsourcing company brought in their own management team to run the pharmacy. I was gone, as was the team that I had assembled.
In addition, the outsource company paid and owned the pharmacy drug inventory. Plus they oversaw the operation of the pharmacy within the confines of federal, state, and local laws.
This outsourcing of the pharmacy must have been a successful venture. The outsourcing company has been running the pharmacy for several years.
I, then, became a pharmacy supervisor at my next job. And soon after that became a Director of Pharmacy at another facility.
While I was working at my fourth hospital, I was hired by a county college to teach a pharmacy technician class. I was an adjunct instructor for six years.
Eventually I left hospital pharmacy and worked for a career school. For four years, I taught classes full-time to individuals who wanted to become pharmacy technicians.
Then, I migrated over to the career services side. There I assisted graduates of various programs in helping them find jobs within their respective disciplines.
Implementing New Policies
My second hospital was literally housed in two separate buildings. The main hospital had the patients and various departments. While across the street were the administrative offices with all the vice-presidents. The chief financial officer (CFO), the chief executive officer (CEO), and the president of the hospital were also there. Thus if one wanted to see an administrator, they would have to leave the main hospital building, walk across the street, and go to an administrator’s office in the other building.
I knew a street separated the two buildings. But sometimes, I thought the two buildings were in two different worlds.
I remembered many times how rules, policies, and programs were developed by administrators. Then the rules, policies, and programs were communicated to us in the other building. Many times I wondered what these administrators were thinking when they came up with these ludicrous rules.
I envisioned the administrator sitting in his office across the street. Quite often I thought that the administrator had no concept of what was happening in the main hospital. But they needed to get something done so they sent out a memo with a new policy.
Many times I just shook my head when I received these new procedures. Just one time I wished that these administrators would leave their ivory tower offices (and come down to the “trenches” to see what was happening) before they came up with their ideas that had to be carried out.
They never did, though.
Admiring Mr. F
One of the administrators that I did admire was Mr. F. He was the Chief Financial Officer (CEO) of our hospital. If you listened very carefully, he had a midwestern drawl.
Mr. F was an impeccable dresser. He was very down to earth. And had a great sense of humor.
Mr. F was in charge of hosting the bimonthly department manager’s meetings. He kept everyone abreast of what was happening. He ran the meeting and introduced vice presidents, nurses, and other administrators who had pertinent information to discuss.
My Vice President, my boss, the clinical pharmacist, and I regularly attended these meetings. We always sat in the last top couple of rows on the right hand side of the auditorium. It was a theatre designed auditorium with tiered seating. There weren’t any assigned seats; that’s just where we liked to sit.
I remember, one afternoon, we decided to sit on the left side of the auditorium for a change. Mr. F was talking about the hospital’s budget. It was a very serious and important meeting. He had just advanced to the third slide.
In the middle of his presentation, he looked up at my Vice President, my boss, the clinical pharmacist, and me and said, “What are you guys doing on the left side?! You guys always sit on the right side! You can sit there today, but next time I expect to see you back on the right side!”
He laughed. We laughed. Everyone in the auditorium laughed.
And next time, we were back sitting on the right side.
Although Mr. F was well-versed in the world of finance and money matters, he also knew his managers, directors, and vice-presidents in the hospital. He knew that we were experts in our own respective fields. But he never expected us to be experts in the field of finance.
In fact, he didn’t want us to worry about the money aspect at all. For he often said, “When it comes to the patient, if you do the right thing, the money will follow.”
And he was right. When we (and our departments) made sure that the patient was properly taken care of, the money aspect always worked out.
Remembering Dr. O
Remember when COVID first started? Remember how scared people were at first?
I used to wash my shopping cart with disinfectant each and every time. I cleaned the plastic wrap and paper covers on my food products after I got them from the supermarket.
I was afraid to touch the elevator buttons with my bare fingers. I used my sleeve, or my keys, or even carried a pencil to push the buttons. I even remember some company that sold a wand so people could press buttons, and touch things without having direct contact with them.
I remember not pushing the traffic light buttons (did they ever really work?) that changed the light so that I could cross the street.
This was how I dealt with COVID. And back in the 1980s, I dealt with AIDS.
AIDS was a scary thing back then. And even though I knew that my chances of getting AIDS were minute, I took every necessary precaution. Some of them, like COVID, made no sense. But I did them anyway.
I wouldn’t go up to the AIDS nursing unit to meet with doctors, nurses, or patients. I wore gloves while preparing medications for AIDS patients (Why?). I avoided the AIDS nurses in the cafeteria. I tried my best not to deliver medications for AIDS patients (most times I switched assignments). And I would never sit next to the head nurse of the AIDS unit at the department managers' meeting.
I remember when this physician (Dr. O) first came to see my boss and me in the pharmacy. I was reluctant to meet with him at first (he was an AIDS doctor). But I eventually agreed.
Dr. O was one of the first physicians to work with AIDS children in the 1980s. He recognized AIDS as an illness— he never referred to it as a disease.
Dr. O demonstrated that AIDS could be transmitted at birth to his pediatric patients. Through his tireless work with AIDS, Dr. O transformed AIDS from an almost fatal illness, to a chronic, but manageable one. As his work and treatments became more and more widespread, Dr. O became known as a major voice when it came to pediatric AIDS.
But it wasn’t only his treatments that were innovative, it was how he dealt with his AIDS patients. It was not unusual to find Dr. O walking around the unit; holding his pediatric patients on his lap, and playing games with his patients.
I wouldn’t go near the AIDS nursing unit for fear of catching AIDS. Yet Dr. O would be seen hugging his patients while they climbed all over him.
This was the image that Dr. O wanted to portray. Dr. O felt that AIDS could not be transmitted by coming in close contact with his pediatric patients. Thus, he encourages his staff, family members, and everyone who worked in the hospital to touch, interact, and hug his pediatric patients.
Eventually, I lost my fear of coming in contact with Dr. O’s pediatric patients. I attended parties and celebrations up on the unit for Dr. O’s patients. I even brought them to the pharmacy so they could see where their medications were made.
I remember writing an article for the hospital newsletter. In my article, I said it was more likely to catch a cold from a person who was sneezing and coughing, rather than catch AIDS from a pediatric patient.
Dr. O changed the image of pediatric AIDS in our facility. Not only with his unique treatments and dynamic therapies, but with how he cared for his patients. He insisted that everyone who came in contact with his patients had a true understanding of their needs. His patients were no longer ostracized or feared. Instead they were treated with the dignity and respect that they deserved.
Appreciating My Night Staff
We had three different shifts of pharmacy staff members in my pharmacy department: Days (7am-3:30pm), Evenings (2:30pm-11pm) and Nights (11pm-7am). Although all my staff members were hard working, dedicated individuals, the night staff members were the unsung heroes of the department.
My night pharmacy staff members were a special breed of individuals. They knew what needed to be done and they did it. And they performed their tasks with almost no direct supervision from the managers.
They made their own decisions, interpreted the rules, and were basically on their own throughout the night. They formed strong alliances with the nurses, physicians, and other hospital night people to get things done. And they didn’t get bogged down in all the pettiness that usually erupted on days or evenings.
My night people also hardly ever called out sick. And it wasn’t because I would yell at them if they did. It was because their fellow night workers would give them a hard time. A night staff member had to be near death not to come to work. No case of the sniffles or a mental health day kept a night person from coming to work.
Why? Because my night staff knew that if they weren’t coming in, that they weren’t going to be replaced that night. Thus their fellow workers were going to be short-staffed that night.
So my night shift staff was always there for one another. They covered each other’s sick days. They worked additional hours and shifts so that each other could take time off. They divided up the nighttime assignments to make certain the work got done.
My pharmacy night staff was a very close knit group. They did their best and always went out of their way to help the patients.
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.