Transitioning from working as a community pharmacist to a full-fledged hospital pharmacist is a challenging life experience for many of us. I worked for Boots for three years before I finally made the decision that I wanted to get more out of my practice as a pharmacist and that the way to achieve this was through working as a hospital pharmacist.
Being on-call is one of the major changes that you have to face when you newly start as a hospital pharmacist. The experience from working in community does not always translate into management of acutely unwell patients requiring rapid interventions. You learn how to make quick, on-the-spot decisions affecting patient care and take responsibility for your choices.
Starting on-call is a stressful experience from the beginning. Thankfully, in my Trust there was plenty of support when it came to making clinical decisions, learning about how to manage your workload, and deciding when it was appropriate to go in. The help, however, is usually only available during the day and from my own experience, the most problematic cases will always pop up in the middle of the night, often with nobody else to help you. Trying to get hold of specialist colleagues at 3 am is probably not the way you want to start your work at the Trust, but sometimes the right answer is a matter of life and death for your patient.
For most of the pharmacists working in my Trust, on-call is a good way of boosting their income, given that the Band 6 pay is usually a lot lower than the community pharmacy equivalent. Sometimes, for people who refuse to locum in community, it is the only way of achieving a reasonable income as a new starter in secondary care. It is an experience that is extremely rewarding if you do a good job, however, it is also a tiring enterprise that often feels like a lot of work for very little benefit. In my Trust, we are usually on-call throughout the week, from the moment the pharmacy closes at 5:30 pm until 8:30 am. After that Monday-Friday, we get the weekend off. The following weekend is our weekend on-call, starting at 5:30 pm on Friday and being on-call continuously until Monday morning. There is an option of taking a day in lieu however, this significantly lowers your income from the on-call. Whether you spent the whole night in the hospital or went home at 5:30 pm and did not have a single phone call, you still have to show up to work for your shift the next day, often exhausted from the night before.
For most of the time we only get paid a stand-by fee of £1/hour and the full pay is only issued for hours we spend in the hospital and/or answering clinical questions on the phone. This obviously interferes greatly with your ability to live your life in a normal way (I cannot even recall the number of calls I had waking me up at night, dragging me out of my weekly shop etc.) and the pay for that level of inconvenience seems to be inappropriate.
Technical issues aside, on-call was always one of the most satisfying elements of hospital practice for me. Making the decisions on my own, tackling more complicated issues such as drug dosing calculations, making sure that patients get the best care available at any given time of the day or night. In my opinion, more work is required when it comes to building support networks for pharmacists doing on-call, supporting their clinical decisions, supporting their ability to address the issues they face during on-call appropriately and developing as independent clinicians.
By an anonymous hospital pharmacist
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