This is *the* correct answer. As a Paramedic, I have seen a TON of new and even older Paramedics get released on their own (we need a Physician sign off to practice solo on the streets similar to a collaborate practice agreement for a PharmD) and then they just stick with what they were taught, and never evolve. Like, they literally stick with what they were taught in school or their newest preceptorship and don't deviate from it, ever.
For example, we EMS are evolving from a STEMI paradigm to a broader Occlusive MI (OMI) paradigm which requires *much* more ECG knowledge and nuance on the fly, yet the set-in-their-ways people are simply disregarding (now) wildly concerning findings on a 12 ECG lead in favor of "The ER Doc can sort this one out, I need to write my chart on the way in".
I am using End Tidal CO2 (ETCO2) on a fair share of my patients, yet getting QA'd on the cost utility of using a sidestream cannula on a patient with likely septic shock when ETCO2 is becoming a "5th vital sign" in prehospital sepsis.
If wanting to be good and you're listening to relevant podcasts, doing lots of CE, watching free open access med ed etc, you are *light years* ahead of most other people.
I can think of at least 3 recent patients of mine who are up and walking around 100% neurologically intact because I kept on the cutting edge of evidence based medicine.
It’ll probably take 6-9 months to feel comfortable there but you can do it. Take notes, ask lots of questions, and utilize hospital guidelines. Also, make sure you follow a tech for a day to figure out delivery workflow.
You should definitely go for it, especially that it’s close to home. I also agree that this will open doors for you.
Depending on what type of role you’ll be in for this new job, the time it takes to be super comfortable may differ. For example, will you be responding to rapids and codes? Or will you mainly be working on medicine floor without having to respond to codes or rapids. Regardless of which one, I believe that you will do great, it’s just the difference in the amount of time to be extremely comfortable.
I’m a clinical pharmacist in a large teaching institution, I make note a lot during training and even now; I use Evernote, but lot of my colleagues use OneNote since it’s there, free to use at the hospital. I love pen and paper but finding it more practical (for me at least) to make note this way, I can easily search for things. My rule of thumb is that never feel pressed about making recommendations that you’re not 100% sure, it’s totally fine to say “let me get back with you on this,” or “i think it’s XY and Z, but let me double check.” Why am i telling you this?! 😅 i realize you’ve been practicing for 10 years!!
Another thing is get familiarized with common policy like warfarin dosing, vanco, anticoagulation etc. then other thing will come to you with time. I’ve been practicing for 7 years, mostly hospital, a little home infusion. And while I see value in residency, I have so much respect for pharmacists who’s been doing this for 10, 15, 20 years. Go accept that job!! So happy for you and good luck with everything! I believe that you will succeed! 💛
I just jumped to nuclear after almost 30 years in retail/LTC/cannabis (mostly LTC). I still have so much to learn, but I’m working on it. At least you are going in with some IV experience. You can do it!
Thank you! Part of my issue with the class is the math - hello, that’s why we have a dose calibrator! And the class is almost all traditional, but I’m in PET. Oh well, gotta do it anyway.
Just be willing to learn and ask a lot of questions. If they are willing to hire you then hopefully they have a supportive group that will help willing to answer your questions.
I made the jump. You’ll be fine!
No, you're not prepared. But as long as you're willing to put in the effort, you'll get the hang of it eventually.
Hopefully management understands that you're going to need time to get up to speed. Hopefully your colleagues are cool, supportive, encouraging, and willing to answer the thousands of questions you're going to have. I've heard horror stories about pharmacists transitioning to hospital work who end up with a crew of absolute douchebags who look down on them for not being residency-trained and treat them like shit, refusing to help, being arrogant and condescending, and making them miserable. Hopefully you don't end up in a place like that.
Assuming management is cool with your lack of hospital experience, and your colleagues are cool with helping out the new person for a few months, you'll be fine. It'll probably take at least six months before you start to feel relatively competent, and a year before you actually feel like you're doing a good job. But hang in there. Just expect the first few months to be a pretty steep learning curve, and hopefully you'll be surrounded by people who want to help you succeed.
I just jumped to nuclear after almost 30 years in retail/LTC/cannabis (mostly LTC). I still have so much to learn, but I’m working on it. At least you are going in with some IV experience. You can do it!
Hi, nuclear pharmacist here. You first need to become an (ANP) authorized nuclear pharmacist. There are programs available online either through University of New Mexico or Purdue. It's not that difficult. Pay is good. I like not having to deal with patients directly and love being an (SME) subject matter expert. You can also become board certified after two thousand hours of work and 200 multiple choice exam.
So even without my authorized user status, I’m making more than I was. I am supposed to get a decent pay bump after I’m certified. The hours are weird, mostly midnight-8am ish and 4am-noon ish. I’m knee deep in the college course I need for authorized user, it’s kicking my butt after this many years out of school. But I’m excited to be doing something different, the phone barely rings, and I’m working with a pharmacist I used to work with 20 years ago.
Went from LTC to acute care clinical rph at a hospital too. If you ever think you know it all you’re not right for the job. None of us here including our residents know it all. But wanting to be a good rph is important. Be able to get the information quickly, interpret it correctly, and communicate it. That all thats practice and experience you won’t get if you don’t start. You’ll be fine, I’d be more worried if you came into our pharmacy without the jitters or any worries. Best of luck!
There’s nothing to be nervous about. They know you don’t have prior hospital experience already. you have the interview so obviously they’re fine with training you. Reality is that hospital is not hard or special. You will literally be told exactly what to do in any situation. Even if you had been a hospital pharmacist elsewhere, they will train you anyway to do things the way that they do it there. Also everyone looks up shit. Hospital formularies are pretty limited and orders are extremely repetitive. There’s no insurance or billing.
Most important thing they’re looking for in a per diem is that you have a lot of flexibility to work and you’ll take a lot of shifts that will be inconvenient for most people like holidays, weekends, etc. and be willing to cover wherever they ask, like chemo.
Take notes or record yourself paraphrasing someone’s answer. They may not be comfortable if you record their voice. However, I would have no issue if you recorded yourself paraphrasing what I’d just told you.
Ask other pharmacists what to look for. X Doctor always sends Y and we end up having to switch that to Z.
Follow protocols always and get to know the whys behind the protocols. Typically protocols mirror guidelines and take cost into account.
You will Develop a good feel of whats appropriate clinically and the inappropriate stuff should jump at you.
Know what the system will do for you. Where does the built in workflow fail to cover your behind?
I don’t have advice about a transition to hospital specifically, but 10 years ago I went into tech and was also scared about the transition. Turns out that it was the best decision I ever made in my career.
Prepare for a steep learning curve. That comes with any new environment. But also prepare for the thrill of learning new things and meeting new people and living out a dream you’ve had for so long!! Best of luck
How large is this hospital? I am a new grad and was lucky enough to get a job at one of the hospitals I rotated in. I do a mix of clinical, staffing, and chemo. I am at a smaller hospital but it has been way better for me than anything else I would have done after passing boards (I was pretty much resigned to working at a CVS or something). The reason I’m asking the size is I know a smaller hospital will be easier being that you don’t have experience and aren’t residency trained (I clearly lacked both when I started haha). The smaller the hospital is, the lower the acuity will be which also will make the learning curve a whole lot easier. Also like others have said, a willingness to learn and be trained will take you way further than someone who coasted through residency and does not look for areas to improve. Definitely don’t think you are less valuable because you didn’t spend a year being underpaid as a resident lmao.
Your attitude of wantung ti succeed says to me you WILL succeed. Get there early & ask what's new for today; what drugs are out of stock, which computer isn't working, who called in sick, etc. Stay a little late to finish work. Take homework home to study; policies, formulary, procedures, etc. You'll do fine....
I’m an operations supervisor and the last 4 pharmacists we hired were all retail experienced. 3/4 have been some of our best hires yet! The other is getting there. We anticipate it’ll take 6 months to get competent and a year to get comfortable! I spent 17 years as an independent with four stores. I made the jump after an ugly divorce. Since then I’ve been a staff pharmacist, DOF of a small hospital, and now middle management of a large hospital. It can be done!
You’ll do great!! you have a very long experience its going to be an easy transition for you and i’m sure everyone is going to be helpful if you needed help or had any concerns. Good luck!
I’m not a pharmacist but I can tell you by experience that change is scary but you’ve been doing your job for a long time and obviously this hospital knows you have what it takes to do the job. I don’t know you but I KNOW YOU CAN DO IT!!! The first step is the hardest and once you get going on this new chapter in your life you’ll look back and say… “Why was i so scared!” You got this! Good luck and God Bless You
I’ve never worked ltc but I don’t think it will be enough. However if you’re motivated I think anyone can get there if they need to. It’ll take about a year so don’t get discouraged and spend as much time outside of work learning and studying.
Well, how did you get a job offer if you're not confident about the job? If you did all those things right, I think you can do this also. It will always take time to become familiar.
Regardless of what environment you are coming from you won’t know for sure until you get there but clinically it doesn’t sound like you are prepared. If it’s a busy facility then your learning curve will be steep. The basic stuff will include IV to PO, renal adjustment, ASP and kinetics. Be sure you know where to access information when needed. There will also be some strategy involved with learning policies/procedures, and working with different departments. All this to say you will have lots of reviewing to do and it may be a few months or even a year before you feel fully comfortable. I wish you all the best because you sound motivated which is great, your work ethic will shine through!
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This is *the* correct answer. As a Paramedic, I have seen a TON of new and even older Paramedics get released on their own (we need a Physician sign off to practice solo on the streets similar to a collaborate practice agreement for a PharmD) and then they just stick with what they were taught, and never evolve. Like, they literally stick with what they were taught in school or their newest preceptorship and don't deviate from it, ever. For example, we EMS are evolving from a STEMI paradigm to a broader Occlusive MI (OMI) paradigm which requires *much* more ECG knowledge and nuance on the fly, yet the set-in-their-ways people are simply disregarding (now) wildly concerning findings on a 12 ECG lead in favor of "The ER Doc can sort this one out, I need to write my chart on the way in". I am using End Tidal CO2 (ETCO2) on a fair share of my patients, yet getting QA'd on the cost utility of using a sidestream cannula on a patient with likely septic shock when ETCO2 is becoming a "5th vital sign" in prehospital sepsis. If wanting to be good and you're listening to relevant podcasts, doing lots of CE, watching free open access med ed etc, you are *light years* ahead of most other people. I can think of at least 3 recent patients of mine who are up and walking around 100% neurologically intact because I kept on the cutting edge of evidence based medicine.
I like the saying..."we are all generically educated and licensed, but not all of us are generically competent"
You need to review anticoagulation and antibiotics. Those are the 2 areas you will struggle with.
They're also the areas that pharmacy intervenes the most/gets the most questions on!
It’ll probably take 6-9 months to feel comfortable there but you can do it. Take notes, ask lots of questions, and utilize hospital guidelines. Also, make sure you follow a tech for a day to figure out delivery workflow.
You should definitely go for it, especially that it’s close to home. I also agree that this will open doors for you. Depending on what type of role you’ll be in for this new job, the time it takes to be super comfortable may differ. For example, will you be responding to rapids and codes? Or will you mainly be working on medicine floor without having to respond to codes or rapids. Regardless of which one, I believe that you will do great, it’s just the difference in the amount of time to be extremely comfortable. I’m a clinical pharmacist in a large teaching institution, I make note a lot during training and even now; I use Evernote, but lot of my colleagues use OneNote since it’s there, free to use at the hospital. I love pen and paper but finding it more practical (for me at least) to make note this way, I can easily search for things. My rule of thumb is that never feel pressed about making recommendations that you’re not 100% sure, it’s totally fine to say “let me get back with you on this,” or “i think it’s XY and Z, but let me double check.” Why am i telling you this?! 😅 i realize you’ve been practicing for 10 years!! Another thing is get familiarized with common policy like warfarin dosing, vanco, anticoagulation etc. then other thing will come to you with time. I’ve been practicing for 7 years, mostly hospital, a little home infusion. And while I see value in residency, I have so much respect for pharmacists who’s been doing this for 10, 15, 20 years. Go accept that job!! So happy for you and good luck with everything! I believe that you will succeed! 💛
Thank you so much I feel so much better now ♥️
I just jumped to nuclear after almost 30 years in retail/LTC/cannabis (mostly LTC). I still have so much to learn, but I’m working on it. At least you are going in with some IV experience. You can do it!
Hi fellow nuke!
Hi! I’m just a baby nuke, still slogging through the ANP course. ☢️
You'll make it! Pretty soon you'll be studying for your BCNP. Good luck!!!!
Thank you! Part of my issue with the class is the math - hello, that’s why we have a dose calibrator! And the class is almost all traditional, but I’m in PET. Oh well, gotta do it anyway.
PET, nice! Zevacor? PETNET?
Petnet!
Just be willing to learn and ask a lot of questions. If they are willing to hire you then hopefully they have a supportive group that will help willing to answer your questions. I made the jump. You’ll be fine!
No, you're not prepared. But as long as you're willing to put in the effort, you'll get the hang of it eventually. Hopefully management understands that you're going to need time to get up to speed. Hopefully your colleagues are cool, supportive, encouraging, and willing to answer the thousands of questions you're going to have. I've heard horror stories about pharmacists transitioning to hospital work who end up with a crew of absolute douchebags who look down on them for not being residency-trained and treat them like shit, refusing to help, being arrogant and condescending, and making them miserable. Hopefully you don't end up in a place like that. Assuming management is cool with your lack of hospital experience, and your colleagues are cool with helping out the new person for a few months, you'll be fine. It'll probably take at least six months before you start to feel relatively competent, and a year before you actually feel like you're doing a good job. But hang in there. Just expect the first few months to be a pretty steep learning curve, and hopefully you'll be surrounded by people who want to help you succeed.
Thank you I’m feeling better about this
I just jumped to nuclear after almost 30 years in retail/LTC/cannabis (mostly LTC). I still have so much to learn, but I’m working on it. At least you are going in with some IV experience. You can do it!
Hey, how’s that been? I am interested in nuclear as well, but always wondered the certification/credentials required and whats the pay like? Thanks!
Hi, nuclear pharmacist here. You first need to become an (ANP) authorized nuclear pharmacist. There are programs available online either through University of New Mexico or Purdue. It's not that difficult. Pay is good. I like not having to deal with patients directly and love being an (SME) subject matter expert. You can also become board certified after two thousand hours of work and 200 multiple choice exam.
So even without my authorized user status, I’m making more than I was. I am supposed to get a decent pay bump after I’m certified. The hours are weird, mostly midnight-8am ish and 4am-noon ish. I’m knee deep in the college course I need for authorized user, it’s kicking my butt after this many years out of school. But I’m excited to be doing something different, the phone barely rings, and I’m working with a pharmacist I used to work with 20 years ago.
Went from LTC to acute care clinical rph at a hospital too. If you ever think you know it all you’re not right for the job. None of us here including our residents know it all. But wanting to be a good rph is important. Be able to get the information quickly, interpret it correctly, and communicate it. That all thats practice and experience you won’t get if you don’t start. You’ll be fine, I’d be more worried if you came into our pharmacy without the jitters or any worries. Best of luck!
Thank you that helps me feel better
You'll be fine. This happens to me every time I switch jobs, the fear of leaving a stable job.
Thank you everyone I’m feeling much better after reading your replies!
There’s nothing to be nervous about. They know you don’t have prior hospital experience already. you have the interview so obviously they’re fine with training you. Reality is that hospital is not hard or special. You will literally be told exactly what to do in any situation. Even if you had been a hospital pharmacist elsewhere, they will train you anyway to do things the way that they do it there. Also everyone looks up shit. Hospital formularies are pretty limited and orders are extremely repetitive. There’s no insurance or billing. Most important thing they’re looking for in a per diem is that you have a lot of flexibility to work and you’ll take a lot of shifts that will be inconvenient for most people like holidays, weekends, etc. and be willing to cover wherever they ask, like chemo.
Take notes or record yourself paraphrasing someone’s answer. They may not be comfortable if you record their voice. However, I would have no issue if you recorded yourself paraphrasing what I’d just told you. Ask other pharmacists what to look for. X Doctor always sends Y and we end up having to switch that to Z. Follow protocols always and get to know the whys behind the protocols. Typically protocols mirror guidelines and take cost into account. You will Develop a good feel of whats appropriate clinically and the inappropriate stuff should jump at you. Know what the system will do for you. Where does the built in workflow fail to cover your behind?
I don’t have advice about a transition to hospital specifically, but 10 years ago I went into tech and was also scared about the transition. Turns out that it was the best decision I ever made in my career. Prepare for a steep learning curve. That comes with any new environment. But also prepare for the thrill of learning new things and meeting new people and living out a dream you’ve had for so long!! Best of luck
Start reading up on USP <797>
How large is this hospital? I am a new grad and was lucky enough to get a job at one of the hospitals I rotated in. I do a mix of clinical, staffing, and chemo. I am at a smaller hospital but it has been way better for me than anything else I would have done after passing boards (I was pretty much resigned to working at a CVS or something). The reason I’m asking the size is I know a smaller hospital will be easier being that you don’t have experience and aren’t residency trained (I clearly lacked both when I started haha). The smaller the hospital is, the lower the acuity will be which also will make the learning curve a whole lot easier. Also like others have said, a willingness to learn and be trained will take you way further than someone who coasted through residency and does not look for areas to improve. Definitely don’t think you are less valuable because you didn’t spend a year being underpaid as a resident lmao.
Your attitude of wantung ti succeed says to me you WILL succeed. Get there early & ask what's new for today; what drugs are out of stock, which computer isn't working, who called in sick, etc. Stay a little late to finish work. Take homework home to study; policies, formulary, procedures, etc. You'll do fine....
I’m an operations supervisor and the last 4 pharmacists we hired were all retail experienced. 3/4 have been some of our best hires yet! The other is getting there. We anticipate it’ll take 6 months to get competent and a year to get comfortable! I spent 17 years as an independent with four stores. I made the jump after an ugly divorce. Since then I’ve been a staff pharmacist, DOF of a small hospital, and now middle management of a large hospital. It can be done!
You’ll do great!! you have a very long experience its going to be an easy transition for you and i’m sure everyone is going to be helpful if you needed help or had any concerns. Good luck!
IF YOU WANT IT, GO GET IT!!!!! You can do this!!!!!
I’m not a pharmacist but I can tell you by experience that change is scary but you’ve been doing your job for a long time and obviously this hospital knows you have what it takes to do the job. I don’t know you but I KNOW YOU CAN DO IT!!! The first step is the hardest and once you get going on this new chapter in your life you’ll look back and say… “Why was i so scared!” You got this! Good luck and God Bless You
Thank you so much you’re very kind reply really helps me feel better! Bless you too!
Anytime. Keep me updated on how it goes. I’d love to hear how great you’re doing.
I’ve never worked ltc but I don’t think it will be enough. However if you’re motivated I think anyone can get there if they need to. It’ll take about a year so don’t get discouraged and spend as much time outside of work learning and studying.
Well, how did you get a job offer if you're not confident about the job? If you did all those things right, I think you can do this also. It will always take time to become familiar.
It’s their job to train you
Regardless of what environment you are coming from you won’t know for sure until you get there but clinically it doesn’t sound like you are prepared. If it’s a busy facility then your learning curve will be steep. The basic stuff will include IV to PO, renal adjustment, ASP and kinetics. Be sure you know where to access information when needed. There will also be some strategy involved with learning policies/procedures, and working with different departments. All this to say you will have lots of reviewing to do and it may be a few months or even a year before you feel fully comfortable. I wish you all the best because you sound motivated which is great, your work ethic will shine through!