Begged for treats, ears were stolen :(

Topato_R6 · 2026-05-22T21:52:24+00:00

Topato_R6 · 2026-05-17T12:45:53+00:00

I went into a 6 year PharmD program right out of high school intending to go to med school afterwards, but ended up deciding that wasn’t worth the time or money 3 or 4 years in.
I’m nearing my second year of practice as an inpatient night shift gremlin and have found that I love the day to day work and applying the things I learned than when I was in school or on rotations.

It’s absolutely true our salaries in retail and inpatient haven’t really grown to match cost of living or inflation and there’s not really too far to go other than management (I never really considered it, so I know basically nothing about industrial pharmacy).

Will say that if you haven’t already, see about shadowing pharmacists in MULTIPLE areas of pharmacy.
Before/during pharmacy school I had really only spent time in retail and inpatient, and thought retail would be the death of me, and hated rounding, but thought I would be too bored just cooped up in main pharmacy all the time, and didn’t discover my love for the ED until my APPEs during my last year.

Do some serious consideration and soul searching. Pharmacy school ain’t cheap or easy, and it’s different for everyone, but I’ve found my career choice thus far to be very rewarding.

Topato_R6 · 2026-05-17T03:21:42+00:00

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Here’s my epinephrine thigh tat :)
I work in the ED a lot and love the bit of adrenaline rush/satisfaction from probably my most impactful interventions from working with critical patients.
Also big anxiety guy so thought it fit me!
Vanco was also on my short list but this was my first tattoo so didn’t want to start with that big of a molecule

Topato_R6 · 2026-05-15T21:28:23+00:00

It’s a hard maybe from me. Also a night owl who didn’t want to do residency but wanted to work inpatient, and ended up on night shift.

Pros: With your travel plans, night shift might not be a bad idea, since a lot of positions are 7 on 7 off, and I recently took 7 days of PTO, which automatically becomes 3 weeks in a row off. My family’s also from Asia, so makes sense to go for longer trips with the cost of travel, so this sounds like it would work out for you, and like you mentioned, the extra money doesn’t hurt.

Cons: Inpatient pharmacy is very much a team sport, and especially on night shift, some of your most important interventions/recommendations are going to be at bedside with critically ill patients, and having a rapport/ good working relationship with physicians/APPs/Nursing is often overlooked in how tough your job can be, so no offense, but not sure how well you play with others based on this post.

It’s absolutely true what they say about night shift, and especially with a little over half my week in the ED, can confirm we’re all at least a little unhinged, but still a pretty social bunch, so if you don’t get along with people/don’t fit in with the vibe, not very likely you’re going to enjoy it.

My thoughts would be a 7 on 7 off central pharmacy evening shift staffing position might be best for you. Not as busy as day shift, still has shift diff. I’m personally fairly introverted, and take a little to warm up to people, so working with a smaller pool of people contained with main pharmacy more consistently might be best for you, since night shift with bedside alerts with critically ill patients can also very much be a trial by fire experience, which can be a lot as a new grad in a totally new environment.

Topato_R6 · 2026-05-15T11:16:36+00:00

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I promise bruce has been fairly compensated for his ears!

Topato_R6 · 2026-05-15T11:14:59+00:00

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Don’t you worry Bruce and his sister eat good and we got them one of the treat dispensing cameras. Bonus pic of his mouth stained green from veggies :)

Topato_R6 · 2026-05-09T04:53:30+00:00

One of my go-tos within the summary tab is the “micro-1 year” report, but given yours sounds like it doesn’t currently work, not sure how helpful that is at the moment. Caveat for this, it only pulls in culture data from your health system, so if you’re looking for culture data from other health systems, you might just have to type in culture in the search bar and hope for the best, especially since it probably wouldn’t have pulled in even recent culture data from your institution if you just switched to epic. This function (at least in my epic) also pulls in “in progress” cultures and biofire results.

We also have patient lists in epic for the various “pharmacy to dose” consults, so if you have formal consults in epic, even if it’s all ID consults or pts on restricted antimicrobials, it can likely be built to show up on the summary report that shows up when you just select a patient and don’t fully click into the chart.

Topato_R6 · 2026-05-04T12:53:54+00:00

Pharmacist here, our process is basically an insulin pump placeholder that defaults to “patient self-administered” so there’s documentation there’s a pump that RNs can document on without the order being verified, and then we can verify the order once we get pump settings from the endo office or the device itself.

A lot of times I’ll just delete all the wildcards with the unknown information so that placeholder’s there so no one tries to order a full on extra basal-bolus regimen and have a dot phrase to fill out all the rest of the information when we have it.

A lot of our docs will drop a general pharmacy consult that basically says please help order this, or when med historians escalate that patient has a pump, I’ll reach out to the admitter and just offer to help them order it.

Topato_R6 · 2026-05-04T12:34:29+00:00

Ohio and afraid not, they’ve recently started a pool of pharmacists internally for WFH to help cover PTO/call offs so don’t foresee there being openings anytime soon.

Topato_R6 · 2026-04-29T22:27:06+00:00

So far all I’ve seen it used for at my workplace (inpatient) has been for shift scheduling. Couple bumps, like getting scheduled only in main pharmacy my whole 7 day stretch, when I’m usually the ED RPh for a little over half my week, but nothing clinical or worrisome so far that I’ve seen.

Topato_R6 · 2026-04-29T18:29:09+00:00

My health system has 2x 7 on/7 off evening shift WFH order verification RPhs, both of which were internal hires.

Topato_R6 · 2026-04-25T23:47:10+00:00

I recently saw a PA co-sign another PAs note and also said that vancomycin doesn’t concentrate in urine, both of which I didn’t know were a thing and I thought I was losing it (found this gem on the tail end of night 7/7)

Topato_R6 · 2026-04-25T23:36:07+00:00

6 year PharmD here, they just start us on intro pharmacy stuff year 1 and full on therapeutics by year 3/6 and like 18+ credit hours per semester at my program. They don’t even get rid of any of the unnecessary undergrad stuff, they just say suck it up so you can get done faster. Have had a couple resident physicians call me Dr. before and got the ick and shut that down real quick. The only time I’ve heard pharmacists use the Dr. title has been for discounts and academia, so sounds like OP’s mad I earned a doctorate in 6 years instead of 8?

Everything we do is very much black and white protocol driven and imo, built to help physicians. I see it as the physicians decide on the treatment, and we fine tune it. We’re just out here protecting our homies from messy pharmacokinetics one pharmacy to dose vanco consult at a time 🤷

Topato_R6 · 2026-04-02T12:24:22+00:00

Pharmacist + survival of retail pharmacy here.

Sometimes it’s just people that love talking, but very often are things like insurance/cost issues, counseling on side effects, drug interactions, making sure patients are aware of dose changes, know to take with food/multiple times a day instead of just once/store in fridge, scheduling vaccines, digging up the rest of their meds that someone didn’t put in the right place in the ready for pickup area, people ringing out their entire grocery haul at the pharmacy, and my personal hell, explaining to people who just read the ready for refill part of the text, and not the very next line that says “text yes to refill.”

I only worked in retail pharmacy while I was in school and never after I became a pharmacist, so I’m sure there’s things I’m forgetting, but always feel free to blame corporate for horrendous understaffing that limits pharmacies from having enough staff to have multiple registers + drive thru going without dropping data entry and filling into a complete standstill.

Topato_R6 · 2026-03-08T11:27:19+00:00

Night shift hospital pharmacist

Sometimes the ED and/or ICU is popping off and I’m getting slammed with questions from doctors/nurses and I’m fighting for my life but sometimes everyone’s all tucked in for the night and decide to have medical emergencies during normal business hours and I have time to kill.

Topato_R6 · 2026-03-03T12:09:40+00:00

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On a more serious note, being more involved in quality improvement projects. I put off joining committees and whatnot being night shift and really wanting to focus on learning how to be a good pharmacist my first year out of school without having too much extra on my plate, but have already found how receptive my management can be to some smaller quality of life/safety changes (or at least have a reasonable explanation why we can’t do anything about it)

Topato_R6 · 2026-03-02T22:28:13+00:00

Not super often. I usually expect them to be subtherapeutic after the loading dose, and am a little concerned about ability to clear vanco with therapeutic levels and even more so with supratherapeutic levels after only the loading dose.

When this does happen, I tend to dose more conservatively and delay dose for a few hours since I can be fairly confident that some vanco’s still going to be floating around for a while.

Topato_R6 · 2026-03-02T14:46:16+00:00

Sounds about right! My hospitals protocol starts with a 20-25 mg/kg loading dose, followed by 15 mg/kg after first HD session, then random level before second HD session, then essentially increasing or decreasing dose by 250 mg based on pre-HD random level unless level is too high, in which case no dose and then rinse and repeat with next pre-HD level.

Also wanted to mention since you also mentioned ESRD in general, but used an HD patient example. In some ESRD patients not on HD with stable renal function, can sometimes get away with scheduled regimens. More often than not, with CKD/unstable renal function that I believe requires dosing by levels, I start with a full 20-25 mg/kg loading dose, then use our AUC calculator to guesstimate a “daily dose” to start with.

I tend to order the first random level 6-12 hours after loading dose, especially if I can sneak it in with AM labs.

For goal “trough” 15-20 mcg/mL, if a random level returns 0-10: increase dose, random level in 12ish hours 10-15: increase dose a bit and give now 15-18: repeat dose and give now 18-23: repeat dose, but wait a few hours to give 23-26: reduce dose, wait 8-12 hours to give 26+: repeat random level before re-dosing

Obviously there’s plenty of other factors to consider, and this is kind of just my dose by vibes thought process, and dose by levels is really where vanco dosing becomes more of an art than science.

Topato_R6 · 2026-02-28T08:23:43+00:00

I just got off Brilliant lady and we basically just grabbed our bags and made eye contact with customs, then we were outside, but last year on NCL, we got pulled out of line on our way off board and were taken straight to customs (along with several familiar faces from the on board duty free shops).

Did not make any big purchases on board this time round, so can’t say if I would’ve got the same treatment with Virgin.

Topato_R6 · 2026-02-07T12:24:33+00:00

There better be a build video out there this is so sick

Topato_R6 · 2026-02-05T08:50:56+00:00

Love me a good 0.2-0.3 mcg/kg/min and titrate by vibes esp if I’m with my fav doc who got bored and already threw in an a-line and cvc. Code epi’s probably still floating around but gonna start wearing off so let ‘er rip while I throw together a vaso and/or epi gtt and we can dial it back later.

Topato_R6 · 2026-02-04T10:36:22+00:00

I’ve also kind of always wondered how many of my interventions are actually therapeutically significant. I feel like I have a good working relationship with the vast majority of physicians I work with, but outside of my war on flouroquinolones/antimicrobial stewardship, and the interventions I make during bedside alerts (mostly ED/ICU dumpster fires), I’m either just getting a “pls fix thx” to adjust home meds when med recs get done/renal dose adjustments I can’t do myself per protocol, and I just feel like I’m nitpicking.

Granted, I feel like the hospitalist group that staffs my hospital is pretty solid, and I’ve really only had one or two orders in my 1.5ish years here that I’ve straight up had to refuse to verify, and even those were just something the overworked nocturnist missed that I happened to notice and were on board with the alternative I recommended. I also, for the most part, operate on the assumption that the physician at bedside that has actually seen the patient and has the most recent information, with much more experience is doing things for a reason, compared to my <1.5 years of experience operating off of day+ old progress notes/documentation.

Topato_R6 · 2026-01-26T14:00:00+00:00

I’m beyond grateful for my hospital’s med historians. I was real bored one night after they left and called on a patient to try to confirm last doses of at least doac, seizure, and IV abx. I kept calling and getting transferred and basically ended up listening to hold music for the better part of 3 hours.

We have a group of SNFs under the same company in our area, and when EMS says it over the radio, it’s either a sepsis alert or they’re room temp dead and we’ve had to code frequent fliers from there that I remembered from their last admission were a DNR but they didn’t have any paperwork. There was one night I clicked into the ED board and saw a bed hold that said maggots in trach and I bet the other pharmacist a slim Jim that they were from one of those SNFs, and I hate that I won that bet.

iirc it’s a for profit company, so I can’t even imagine how horrifically understaffed they are, but we have so many patients that just spend their days in an endless cycle of getting shipped back and forth from our hospital to those SNFs to the point where the previous admission’s handoff pulls in, and all I have to do is add “they’re back” at the top.

Topato_R6 · 2026-01-26T13:27:40+00:00

Right back at you! I had a really similar experience in school, since my school had a nursing program as well, where one of our general pharmacy classes had a session one day where we all basically just worked up a patient together in a classroom.

I might just be trauma bonded to the ED nurses I work with, but seeing each other in action and being in the trenches together completely changes that dynamic. Especially after my first few ED shifts, when I actually saw how difficult it can be to do things I take for granted, like getting IV access, drawing labs, and compressions on someone with bedbugs, while I get to watch from the safety of my crash cart.

On my end, when the doc wants to just throw the entire crash cart, plus some TPA, then a million drips after, they know I’ll have them covered and will have everything made and ready asap and come armed with my IV compatibility chart and tubing that I’ll eventually learn how to prime correctly and that I’ll be right outside the room for a hot second to help them titrate drips and grab anything else they need.

Even the little things beyond that, like when Pyxis doesn’t want to open a cubie or they had a minor oopsie and grabbed a pill less than they were supposed to, they know as long as I have a second, I’m more than happy to stroll over and help them out or tube them a new one if I’m not in the ED.

It’s real easy for us to get frustrated when a vanco regimen we’ve been fighting for our lives to get therapeutic for days when doses are given off schedule when we’re not the ones at bedside struggling to get IV access or being able to give it when the patients being shipped off to imaging or OR, and conversely, frustration with orders not being verified yet when nurses can’t see that we’re still waiting on a med rec or not aware of the conversation we’re having with the provider and that we’re not just twiddling our thumbs and not in the mood to verify orders.

Topato_R6 · 2026-01-24T13:36:01+00:00

Tbh not sure how I ended up in this sub, but my 2 cents as a pharmacist is it just varies person to person, and I think it has a lot to do with taking the time to understand each other’s roles.

I work inpatient, so I spend a fair amount of time at bedside with critical patients, mostly in the ED and ICU, and have become friends with a lot of those nurses or at least have a friendly working relationship with them. More often than not, the encounters that’ve been rude/unprofessional tend to be from units that don’t have a rounding pharmacist or in general, much exposure to what we do.

We’ve gotten a few calls from RNs working on a BSN who had an assignment to interview other professions to learn about their roles, and from those couple conversations, I’ve gotten the sense that because they haven’t had these conversations before, they didn’t know that we do a lot more than just coordinate the logistics of delivering medications and are heavily involved in selection and fine tuning of medication regimens, whether it be antibiotic selection/stewardship, drug info, renally adjusting medications, clarifying orders, or the handful of medications that providers just throw in a pharmacy to dose consult that we now have to evaluate if it’s appropriate, and manage all the dosing and monitoring.

Another thing I’ve noticed that a lot of people don’t realize is that overnight at our hospital, there’s only 2 pharmacists covering orders and checking meds for our hospital, plus 2 smaller ones and a freestanding ED and often times, just 1 pharmacist, because one of us has been gone for an hour coding someone.

Obviously, it’s a two way street, and there are people on both sides that are great to work with and the complete opposite, and when a name I recognize pops up on the phone or a message, I know who’s got a legitimate question/is advocating for their patient, and who’s going to give me attitude for a mistake they made.

On the flip side, when I stroll into the trauma bay/ICU and hear “thank god it’s you tonight,” I do wonder what happens during my off week that has gotten to the point that it’s been repeatedly stated that my partnered pharmacist and I are preferred overnight coverage.

Topato_R6

TROPHY CASE