In this article a pharmacist with overnight work experience provides insights on what it is like to be an overnight clinical pharmacist specialist.
Authored By: Salam Kabbani, Pharm.D.
Article Posted 15 December 2021
Being a nighttime clinical pharmacy specialist is a very unique and rewarding role. It is also highly variable from one institution to the next. Many pharmacists are attracted to the role because of the increased pay and the bi-weekly work schedule; however, before you commit to a position, it is imperative that you know what you are signing up for.
I have spent time working as an overnight pharmacist and would like to take this opportunity to describe the reality of the job versus my expectations. Let us delve into some common perceptions about being a nighttime clinical pharmacy specialist…
Expectation #1: You will have an active role in clinical committees
Though the role is clinical, many hospital pharmacists are hourly employees. Because night shift is typically coded differently, attending daytime meetings may result in overtime, which is typically frowned upon by management (as might be expected). In addition to budgetary restrictions, your schedule will be flipped, so attending a 2 pm meeting translates into attending a 2 am meeting for you. While this may be feasible initially, it is obviously not sustainable in the long run.
It is possible to have an indirect role and make suggestions; however, this will almost exclusively be done via email. As a result, interactions may be limited, thus not as rewarding nor fruitful as attending an in-person clinical meeting or being on a committee. Can you make an impact? Yes. Can you make an impact using the same strategies as people who work day or evening shifts? Probably not.
Expectation #2: You will have vacation every other week
Reality: Both Myth & Fact
This really depends on your body and your institution. Most hospitals schedule night time clinical pharmacists as 7 on, 7 off, making it very convenient to have time off without digging into your actual Paid-Time-Off (PTO). In some instances, as with the institution that I worked at, pharmacists were scheduled 8 nights on and 6 off, which slightly impacts that vacation time.
What is imperative to keep in mind is if you are truly wanting to have 6 days off (or 7 based on your institution), you will need to stay awake for more than 24 hours both your first day off and your first night back. This may seem easy at first, but becomes rather challenging when you do this every week. For some, this is not an issue, and does in fact provide an opportunity for a vacation every other week. What’s great about this schedule is when you do take an actual week of PTO, you end up with 3 full weeks of time off. Keep in mind, however, that your week of PTO will actually require 80 accrued hours. When you do get there it can be very rewarding, especially if you are looking to travel.
Expectation #3: You will independently be in charge of all pharmacy operations
If you are the only nighttime pharmacist as is often the case in smaller institutions, you are the pharmacy expert and specialist. You will need to be familiar with your institutional protocols on just about everything, and certainly know where you can find resources if you do not know the answer.
You become the emergency department and intensive care unit specialist, as you will be at every code. You may be compounding medications which can require vital knowledge about how to spike a propofol vial, how to prime a heparin drip on the pump, or which kind of tubing to use for an amiodarone drip. This aspect of nighttime pharmacy is very rewarding because you become a jack-of-all-trades. Contrary to the well known adage, however, you can master them.
If you cover more than one hospital (as was my position) you will also be expected to know standard operating procedures for every hospital you are covering, and this can become challenging. If you are jumping into a new role, one recommendation is to ensure your training period involves at least one day at every hospital you will cover so that you are oriented to the different units, pyxis machine locations, and other nuances specific to each hospital. You will also be required to know appropriate operations for downtime procedures, as these are usually scheduled on your shift. Knowing what is required on hand-written IV labels, where to find said labels, and how to go back and update these orders in the system is very crucial. Thus, take lots of notes and ask questions when you are training.
This can sound challenging, but do not let it scare you. You will have a handful of nights where there will be a lot of downtime and you can use this time wisely to get caught up on things you are not familiar with, so that you can be comfortable during the busier nights.
Expectation #4: You will develop close relationships with other members of the healthcare team
In general, most hospitals have less staff working at nighttime and you all learn to work together very cohesively. You develop great relationships with the providers, nurses, and any other members of the hospital. You learn to anticipate requests, and make a nurse’s day (or night in this case!) by being ahead of the game and having things ready. You may even receive phone calls from other units letting you know they have saved food for you in break rooms if it’s a holiday or special occasion.
The most important relationship you will develop is with your pharmacy technician, especially if you are the only pharmacy members every night. You become a single unit, anticipating each others’ needs, working in unison during code blues, and really tackling any unexpected issues that may come up. If it is a quiet night, you are by the technician’s side and should assist them in their tasks, which elevates the sense of camaraderie and helps you remain on top of your game as a pharmacist.
Given that you will be primarily needed in the emergency department and the intensive care unit, you end up seeing the heavy parts of our profession more frequently, like a neonatal code blue that was not successful. Having that closeness with your technician who will likely be at your side, as well as the physicians, nurses, respiratory therapists, etc, will allow you to slightly diffuse any emotional tension, thus allowing you to experience your humanness and simultaneously continue doing your job and tending to your next patient(s).
Expectation #5: Your whole life will need to be rescheduled around your work schedule
This is probably the most unfortunate reality of being a nighttime specialist. You may experience a decline in your social life, because (surprise!) no one wants to hang out with you at 7 am when you are leaving your shift, and when others have free time you will be sleeping or at work. Based on your institution, you may not have your weekends available, for example if you work week starts on Wednesday, you will only have 2 available weekends to spend time with family and loved ones every month.
Your mental health may struggle in the beginning as you wrap your mind around the fact that you leave a shift and come back for the next one the same day, every day. This was surprisingly a tough pill to swallow. While some exceptional individuals have no problem flipping their wake-sleep schedules, for most it is a challenge, especially when you are flipping back and forth every other week. You will likely need sleeping aids including but not limited to sleeping masks, black-out curtains, ear plugs, white noise machines, and medication, as going against your body’s circadian rhythm can be a persistent challenge.
You will need to modify your eating habits, as your GI system may be in a bit of a shock when your timing is changed, and this may take some adjusting to. All in all, your entire life will truly have to revolve around your work schedule.
I would like to reiterate that this article is not meant to scare anyone away from pursuing a nighttime clinical role. I did it for 7 months and it was one of the most rewarding roles I have had, as I was able to work very closely with prescribers and utilize the clinical skills I gained from my residency training, whether it was walking a provider through an amiodarone load, or making a recommendation on a sedative and paralytic combination during rapid sequence intubation.
Having said that, it took a strong toll on my mental health especially given the need for sleeping aids, and the deteriorating social life due to the nature of the job. I know a colleague who has been thriving in this role for over 5 years now, and she has gone on many trips, is in a committed relationship that started after her nighttime position, and is truly living her best life. With the right fit, this can be the best role that you have come upon, and I hope that knowing these facts will help you make an enlightened decision before stepping into a nighttime pharmacist role!
ABOUT THE AUTHOR
Dr. Salam Kabbani graduated with her pharmacy degree from California Health Sciences University in 2019. After completing her PGY-1 residency at Cleveland Clinic South Pointe Hospital she worked as an overnight clinical pharmacist at Providence St. Joseph Health in Eureka, California for 7 months. She then transitioned to being a pharmacy manager at Walgreens in Eureka, CA.
Her primary pharmacy interest is infectious diseases and she is currently working on her antimicrobial stewardship certification through the Society of Infectious Diseases Pharmacists in the hopes of rejoining the inpatient side as an antimicrobial steward when the time is right.
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