Jeremy Sasser - April 29, 2020
In this episode of OnScript with NHA, co-hosts Jeremy Sasser and Jessica Langley-Loep discuss interprofessional and interdisciplinary relationships between pharmacy technicians, pharmacy interns, pharmacists, and other healthcare professionals.
Joining the discussion are two pharmacy students from Husson University School of Pharmacy, Miranda Jandreau and Cody Moller. Cody is in his final year of pharmacy school, and Miranda is in her 2nd year of pharmacy school, but both were pharmacy technicians before deciding to pursue their PharmD degree. The importance of not only fostering strong relationships, but building trust between technicians, interns, and pharmacists cannot be overstated. Seeking to better understand the training and scope of practice of each role can help breakdown barriers that may exist.
Read the full transcript
Jeremy Sasser: Pharmacy Podcast Nation, thank you for tuning in to On Script, powered by NHA. This is your host, Jeremy Sasser, joined today by the radiant co-host, Jessica Langley. Always love having you.
Jessica Langley: I'm going to start... What am I saying? Start recording. We do record these, but he always gives me such wonderful compliments at the beginning of these. It's kind of nice.
Jeremy Sasser: I need to bust out the thesaurus and find some new adjectives. You're just, you have so many talents. I don't know how to describe them.
Jessica Langley: Once again, you're just spoiling me.
Jeremy Sasser: Very excited today...
Jessica Langley: I am too.
Jeremy Sasser: ... to be joined by some pharmacy students who prior to being in pharmacy school, we're pharmacy technicians. We are talking to two pharmacy students from Husson School of Pharmacy, Husson University School of Pharmacy in Bangor, Maine.
Jessica Langley: I think that why I am so excited about this episode is just like the example of where I came from, like in the world of radiology or even in general practicing medicine, they always say if you start out kind of at the bottom and work your way up, you have a better understanding and a true vision for what it takes for those individuals that maybe later on in your career are working below you or for you or with you beside you. And you kind of know like the ins and outs and the barriers that they face. So that's why I think this is a wonderful, wonderful episode today because we know so commonly pharmacy technicians work right alongside pharmacists, but even more so we don't maybe all the time realize that a lot of the time they're also working alongside pharmacy students.
Jessica Langley: Which many of them like the case today with these two individuals that we're going to introduce you to here in just a minute, were pharmacy technicians before, so they've kind of been in the trenches, right? They understand the environment and the culture and the role of technicians, the benefits and the challenges that they see in that role. And I'm pumped to figure out like how does that transition into kind of taking that step up and becoming a pharmacist and do their perceptions change when they switch roles like that?
Jeremy Sasser: Yes, and are they more likely as pharmacists to do things like take out the trash at night? Which sounds like a trivial thing, but it's something that pharmacy technicians can definitely recognize at the end of the night when we're trying to wrap up certain tasks and you work with some pharmacists and it's like, "Nope, that's your spot. Once you get done doing what you're doing, take out the trash." And then I've worked with plenty of pharmacists that roll up their sleeves right next to us and jump in and do whatever needs to be done.
Jeremy Sasser: So we're joined by two pharmacy students as we said, Miranda [Gendro 00:03:24] is a second year pharmacy student and worked as a pharmacy technician in a retail pharmacy, currently doing her pharmacy internship at a hospital and Cody Mueller is in his final year, both in the pharm D program. So Cody is in his final year, fourth year. Also began his career as pharmacy technician in a community setting and probably like so many had not initially planned on pursuing a career in pharmacy long term, but got into it and realized it was something that perhaps he was passionate about. So forgive me, I hope I didn't butcher any names. Welcome you two, great having you.
Miranda Gendro: Thank you for having us. I appreciate you wanting to speak with us today.
Cody Mueller: Good afternoon. I really do appreciate you having us here today.
Jeremy Sasser: You know the relationships both inter professionally within the healthcare milieu I guess we could say between pharmacists and doctors, pharmacists nurse, pharmacy technicians and MAs, you name it, sometimes there's a lack of understanding there of what everybody's role is. And that can oftentimes lead to maybe not the best communication experience there could be. But there's also sometimes this interdisciplinary gap between pharmacists, pharmacy technicians, and in the middle you have pharmacy interns, which are in an interesting spot getting their pharm D degree, oftentimes getting trained by pharmacy technicians on things like policies and procedures and the operations of the pharmacy while they're learning all of the clinical aspect of it in school. So it becomes an interesting dynamic and we like to put people in silos too often that this is your role. You know, this is your role and this is your role. But pharmacy the way it is, it's so busy. You have to have overlap, you have to have people working effectively together. There has to be trust. So how can we improve that relationship between all of those individuals?
Jessica Langley: Right. And I'd like to ask both Miranda and Cody, maybe we start out by just telling me what your initial experience was in being a pharmacy technician in those particular environments, whether it was retail or community and did that have an impact on you wanting to go further in education?
Miranda Gendro: So I started out my pharmacy experience I should say in the retail setting at a local pharmacy here in Bangor and prior to that I had never really had pharmacy exposure other than just walking into a store and say, "This is so and so may I pick up my prescription?" So right when I started out, I pretty much finished that training that pretty much every company and organization makes their new hires go through. And the first day I walked into the pharmacy and had never met any of the staff and they pretty much threw me in and told me to swim, which was not something I'm very used to in a work setting. But I appreciated it because it really made me learn a lot and forced me to kind of come out of my comfort zone and speak to the pharmacist and the doctors that we would be communicating with throughout my work day.
Miranda Gendro: But my hospital experience was a little bit different where I'm from Northern Maine, so I'm the intern there and I've been doing that since about the same time I started in retail. And that exposure was slightly different because of the work environment, but also I knew some of the staff already there because I come from a very small community. So I'm still the youngest one employed at that location, which is they don't make me feel that way and they don't single me out based on being the youngest or being intern because I did start out as a technician before I earned that intern title and they really just made me take, like kind of took me by the hand because that environment is so different than what I was exposed to and they showed me the ropes and now I'm pretty confident in myself in working in that environment on my own and completing tasks that normally wouldn't be asked of me just to take that extra step.
Jessica Langley: Awesome. What about you, Cody?
Cody Mueller: I initially started out as a technician in a community pharmacy back in New Jersey, my home state. I actually found my way to Maine through a friend of mine who graduated from the Husson University School of Pharmacy approximately three years ago now. I was given an opportunity in my store to move into a pharmacy technician position, in which case I was then licensed, went through the training and as I continued to give myself this opportunity and pursue it in its fullest, I found that I was trying to learn as much as I could. I found myself wanting to know not only what was the name of the drug, but what was the brand? What was the class? How did it work? I found myself fully immersed in my job and what really brought me to the next level to say, "You know what? I think I could pursue this as a career," was being able to help patients, being able to have conversations and aid patients that really needed help.
Cody Mueller: I'll never forget a case where a patient had come in, was having a very difficult time affording their medications and by the end of it and in short order at that, we were able to knock the cost down to something very, very affordable from something that was astronomical for them.
Jeremy Sasser: Now, Cody, I picked up on something you said there early on. So were you working in a store that also had a pharmacy but you were working somewhere else in that store before you moved into pharmacy?
Cody Mueller: Yes, I was. That is correct.
Jeremy Sasser: That's interesting because my retail experience that happened quite frequently. Because a pharmacy may be short handed and sometimes you just need somebody who is reliable first who can pick up and learn and is willing to learn. And so you sometimes get those people from produce, general merchandise, the bakery, wherever. So that's really great that you had that opportunity to get into pharmacy.
Jessica Langley: I would love to know from the two of you A, do you feel like your experience and starting out as a pharmacy technician, was the benefit to you prior and during your time in pharmacy school and as you continue to evolve through that program? And then how did your perspective on pharmacy technicians change or stay the same as you kind of moved from one role into the other?
Miranda Gendro: So like moving from one role to another, I learned to realize like how much we depend on technicians, they're the ones really getting everything together for us. And I got to see it in two separate ways as in the hospital pharmacists and pharmacy technicians kind of do something a little bit different compared to the retail side and seeing how I work at a compounding pharmacy that compounds IV's and chemotherapy. So seeing that is much different then the retail world. So being very dependent on your technicians and trusting in them that they've done something right and it's a very trust oriented work environment because the technicians will do something and the pharmacist isn't always like over your shoulder and they're just making sure that what you've done is correct and that the order is correct. I just think that working in the environment has like made me really appreciate starting from the bottom to the top eventually when I graduate.
Miranda Gendro: It's been very beneficial to me seeing both aspects because like I said, there are two very different worlds and from seeing both sides of experience, it's kind of swayed my decision into what type of pharmacy I want to go into. But starting out as like an intern and technician, it's kind of made me want to pursue further, like Cody said, and learn everything about it and it's just been like really important to me, especially when I started the pharmacy program because I kind of had that experience, like Cody said, again with the brand generic kind of what some of these medications are used for and my fellow peers, some of them had never even stepped foot in a pharmacy, so I felt like just knowing the brand names and the generic names really gave me a big foot up when learning about disease states or why things happen or why a certain patient would get this medication over a different one.
Miranda Gendro: So it felt good to me when I would sit in a classroom and have some sort of idea about what was going on even though a significant portion of the information was brand new to me.
Jessica Langley: Right. So you felt like you had an advantage going into that. Cody, did you feel the same way?
Cody Mueller: I can definitely agree with what Miranda just said. When it came to starting out as a pharmacy technician, overall I found that time that I've had, like you had said to be very beneficial. Not only was I able to pick up on drug class names quicker, but I was also able to take that experience and integrating myself in the overall healthcare profession and bring that forward to this day. Not only understanding the roles in health care, but also things like understanding how to navigate insurance, prior authorization. Even as simple as talking over the phone. As I near the end of my academic career, I look back and especially as my time during my APPE's where I got to work alongside and really learn from the pharmacy technicians I got to interact with, I found that my perspective really hadn't changed from when I was a technician in the sense that I take a look when I'm in say community pharmacy, what needs to get done, I will get done.
Cody Mueller: Like you had said before, taking out the trash. I'll roll up my sleeves and take out the trash. There's no work that I think, at least in my position is segmented or sequestered off that that's not mine to do. If it needs to get done, I will get it done. And for me it's almost a call back to my very first job. When I was a teenager in high school, I started at a restaurant and I didn't exactly have an official job title, I kind of just did everything. And so that ability to be flexible and have variability in what may be the day to day really helped me going forward because I really never sat there and went, "Ah no no no, that's not my role to play." I took part in everything. And so to sit there and say, "Oh well you know, here I am as an intern and I'm above a technician," I've never thought that way. I always prefer to think I'm working alongside.
Jessica Langley: Well and I love hearing that because of course when we think about healthcare, we never want to think about it as being segmented and working in silos. Especially now with the focus around the patient being the center of care and us working as a team to provide them the best care possible. That's ultimately what we want to do is to do what's best for the patient or the individuals that we're serving based on our setting. I would love if you guys could share a bit more about the relationship that pharmacy interns have with pharmacy technicians. So kind of give me an idea of during your process of going through a pharm D program, how much time do you spend with a technician? What types of things are they helping train you on or things like that? And I know it may be different for you all because you guys both came in with some background knowledge, but imagine the pharm D student, like you said, that walks in and has never even experienced anything related to pharmacy and how are they relying on technicians as they're going through their schooling?
Miranda Gendro: So I still currently work alongside my pharmacy technicians that I work with at the hospital and I think that their relationship that I have with them is very important because even though they've shown me how to compound IVs and fill Pyxis machines and deliver medications to the proper patients and nurses and floors of the hospital, I still have questions and medicine is changing so often that we need to rely on each other as a team and really make sure things are getting done and that we keep a good relationship with every person as part of that team. Like Cody said, I've never felt like he has not, like above the technicians that even though I'm considered an intern now, I'm still doing the same jobs as the technicians did. I just am gaining more knowledge with my academic career that I was if I would have not pursued this field.
Miranda Gendro: And I think it's really important that I'm able to rely on my technicians that I work with because like I said, we as a team always are always working together. The technicians are really compounding the medications, preparing that for the pharmacist to check and without having them to bounce my ideas off of or double check something before I compound it in the IV room, I could potentially be doing something wrong or harming a patient and we definitely don't want to go down that route. So being able to be close with them is something I find really important, not only as an intern, but an interrelationship between the technicians. And then once I pursue my career farther into being a pharmacist, all of those close work-related relationships are very important. .
Jeremy Sasser: Yeah. And it's, as I sit here and listen, I was reminded of a time when I worked with a person at a pharmacy for the first time and I listened in as she took a new prescription from a physician over the phone and when she got done and hung up the phone, I mentioned to her that pharmacy technicians, at this time I was working in Arizona, so pharmacy technicians in the State of Arizona were not permitted to take new prescriptions over the phone.
Jeremy Sasser: She says, "I know. I'm a pharmacy intern, I'm a fourth year student." So it's open mouth, insert foot in that moment. For the most part she was actually very, she could be at times very intimidating but from that moment on we actually had a very, a great working relationship. She continued on with the same company once she was licensed as a pharmacist. Loretta, if you're listening, again I apologize for assumptions, but misperception can go both ways and attitudes can be kind of negative going the other direction too. I think a lot of times pharmacy technicians can feel slighted when they feel like this person who's in pharmacy school day one, they cross the threshold, they get a license as an intern now their counseling patients, they're taking new prescriptions or doing all of these things and I'm over here training them in essence in how to work in a pharmacy.
Jeremy Sasser: And from a technician standpoint, I feel like it's easier, that's an easier transition if I'm working with a pharmacy intern whom I know was a technician prior to pharmacy school. I feel like it's just a better understanding between both parties about what each can do. And what's interesting about it, and I think you both had mentioned trust, we've been doing kind of some qualitative research talking to both pharmacists and pharmacy technicians, and one of the things that has come out of that research is that pharmacists would like technicians to think more critically and stop asking them questions so much. Yet those same pharmacists saying that have an inherent lack of trust in the abilities of their pharmacy technicians. So I think oftentimes pharmacy technicians are asking questions that they already know the answer to, just to make sure that after the fact they're not going to get reprimanded for not asking that question.
Jeremy Sasser: How do you feel that, let's talk about that trust a little bit more. Being a pharmacy technician or a certified pharmacy technician, definitely prior to pharmacy school, do you feel like you were better prepared to know what pharmacy technicians know? What they don't know? And because of that that gives you more trust in the things that they are doing?
Cody Mueller: I can certainly attest to having been there myself and having been a technician that when I now go out on my rotation, say I'm at my community rotation couple months ago I definitely felt more trust having been there myself and knowing what they know, like you had said, knowing what they don't know. I try to establish above all else dialogue and a sense of camaraderie. Yes, I'm only there for six weeks, but I try to get them to know me and I try to get to know them the best that I can because I really think that the first step to establishing trust is dialogue. If I feel comfortable discussing any matter with you and I make it very clear that I'm okay to receive feedback and criticism from you, the technician, I think that goes a long way.
Cody Mueller: I think that's very central to establishing that very initial spark of trust and going on from there it becomes a matter of recognizing what each party does or does not know and helping each other and I don't know if I would have reached that as quickly if I did not have that technician experience prior.
Jessica Langley: There you go. Yeah, I think that's the key there. Hey Miranda, what do you think and how do you feel about the current working relationship and what might need to happen to help improve that trust and relationships between technicians and pharmacists?
Miranda Gendro: I often think that some of the best pharmacists are the ones that have gone through being a technician and working their way up that ladder because they know what to expect and what is expected of them before they reach that pharm D or the pharmacist status. So I think being able, like Cody said, talking and that's very important, but a comfortable work environment is also really important because if a technician doesn't feel comfortable going to work or reaching out to their pharmacist or someone they feel comfortable with, it's going to make a very tense environment.
Miranda Gendro: So letting the technicians and the interns and your fellow pharmacists know that it's okay to bring up mistakes or points that need to change and kind of improve the workflow environment is also really important because without being able to say, "Hey, this really isn't working right," or, "Hey, I have a better idea for this," that might improve patient outcomes or the flow of the pharmacy to get prescriptions out in a manner that's still safe, but maybe more efficiently, without being able to do that I really don't think there's any more progress that could be made in the trust aspect.
Miranda Gendro: So being able to bring ideas forward, no matter who you are, what position you have I think is really important in any type of pharmacy or any work environment that you really have.
Jessica Langley: Oh I love that.
Jeremy Sasser: Yeah, yeah. I think you hit the nail on the head with creating a comfortable environment because I taught pharmacy technician students and one thing that I've always really tried to drive into them is to be comfortable enough in their own skin that they can admit when they made a mistake. Because a mistake doesn't become a misfill or an error if it doesn't get to the patient. I mean, you make a mistake behind the counter that doesn't get to the patient. You may be out an expensive medication or what have you, but that's a lot better than patient getting the wrong medication.
Jeremy Sasser: I'll never forget when I first started, I was filling a liquid promethazine with codeine prescription, ran out, went to the shelf to grab the next bottle, poured it in and it changed color. But then quickly became a uniform solution and I'm like, "Hey pharmacist, I don't think this should have been two different colors," and I didn't realize I grabbed promethazine BC with codeine and mixed it with promethazine with codeine. So that's a situation where I could have just as easily passed that amber bottle down the counter and maybe it would have got caught, maybe it wouldn't. Definitely if I hadn't said anything could've gotten to the patient. So building that trust and really a non-punitive environment around making mistakes is really paramount as far as trust goes and being willing to admit.
Jessica Langley: And just to build on that and kind of start to wind this down, this being your last formal question and you guys have done amazing and thank you so much for sharing your insights and you know with that trust, the hottest topic out there when we talk about the evolution of pharmacy technicians in the profession is around that advanced scope of practice and the introduction of advanced pharmacy technicians and allowing them to do more, allowing them to take on additional skills training, which would then in turn put more of a focus on patients or pharmacists. We'd love to get your guys' perspective on, I mean, I can imagine that you would support this notion as a technician and you guys are both two very intelligent young individuals that would, I'm sure grab it and go with it if you were still working in that role. But give me your perspective and where you think this is headed for technicians.
Miranda Gendro: Well, I think that the technicians, especially the ones I work with are very knowledgeable in the aspect of pharmacy even though they don't have the academic background in it. So when I feel like I'm kind of stuck with something, I feel like I have the confidence to go to them and that they're able to answer my question, which is something that makes me feel confident as an intern currently, but also as a progressing pharmacy student once I get there that I'm able to trust more activities with the pharmacy technicians.
Miranda Gendro: With that being said, I know that a lot of people are trying to incorporate med reconciliations more into hospitals, into retail settings and to community pharmacies and I think that's really important and I think that's definitely something that the pharmacy technicians have started to be incorporated into and that also walking into that patient room and introducing yourself and saying, "Hey, I'm Miranda from the pharmacy and I just want to sit down with you for a few minutes and talk about these medications that we see that you're on. Could you tell me a little bit about your medications that you're taking at home or the ones that you aren't taking or if you're having any problems?"
Miranda Gendro: And I think that having that technician go in, makes the patient you're accessing more comfortable to give out that information and be more confident in the pharmacist that they see when you walk into a Walmart or a Walgreens and the staff that's kind of behind the scenes in a pharmacy in the hospital and having that additional med reconciliation gives the pharmacy, the doctors the nurses all another leg up because they can actually see, "Oh this patient isn't taking this medication that it says that they're in their chart." Like maybe they don't need to be on this and this is another medication we can take off of their regimen, which decreases the pill burden, decreases the potential for adverse drug effects.
Miranda Gendro: So it's really good to just have those technicians get out there and kind of give them those extra activities and duties to do because being at that technician level they are more than competent and more than able to do that. And I think that's something that you can throw into the workday that kind of changes it up a little bit but also benefits everyone.
Jessica Langley: It's a great example with med rec. Cody, what are your thoughts on other skillsets like technician product verification, immunizations, point of care testing, things like that?
Cody Mueller: I'm overall very excited to see pharmacy move in this direction, especially in the scope of community pharmacy because as you had said, it opens up the pharmacist to have more patient interaction opportunities, so I'm excited from both aspects, from both points of view. As a technician, I'm excited that you have the potential for these advanced activities. If I were to think of myself in the technician role, I would feel empowered. I would feel I got to do more with my position in my role and having done some patient interaction as a technician to the limit of the scope of practice at the time. In addition to speaking on the phone, filling prescriptions and other duties to be able to do say more point of care, immunization, you have all of that going on. Advanced product verification.
Cody Mueller: I think that that's a very empowering notion for technicians and on the flip side, as a soon to be pharmacist, I'm very excited at the notion of additional patient interaction. That's really what I've found both well really as a technician, an intern, and as a student on my APPE rotations to be my bread and butter. To put it plainly, I enjoy speaking to patients and I think that I'm hoping that this is the direction that pharmacy is moving and I'm very excited that it very well is.
Jeremy Sasser: Yeah, that's a great point. And one of our earlier episodes, we had talked to a couple of researchers and Dr. Shane Decel at Toro University out in California, School of Pharmacy was telling us about the role of a pharmaconomist in where was that?
Jessica Langley: It was overseas.
Jeremy Sasser: Netherlands or something? At any rate, they were kind of like a mid level practitioner, but what that allowed pharmacists to do in that country, pharmacists sat down with every single patient that came into that pharmacy. That patient received some level of consultative services from the pharmacist every time they went in there. And when you look at our healthcare system and we know that the patient that goes to their primary care physician once or twice a year is the same patient that's going to their pharmacy 15 times a year, 30 times a year. That really gives them a good opportunity to have a good relationship with their pharmacist and gives the pharmacist a great opportunity if they have the bandwidth to sit down and actually talk to them. And I can't tell you just even in limited interaction, how many times I've witnessed pharmacists and even pharmacy students catch things, duplication of therapy.
Jeremy Sasser: We live in a world where patients are what we call cherry picking or going and getting this prescription at this pharmacy, this prescription at this pharmacy. They're seeing specialists, they're seeing, nobody's communicating effectively. So it's not uncommon that you have a primary care physician putting someone on Lisinopril and a cardiologist putting the same patient on Fosinopril and the thing that's common that connects us to needs to be the pharmacy. But you have to have time, you have to have bandwidth, and you have to have trust in your support personnel to do all of the other things so you can do that.
Jessica Langley: And like you mentioned, technicians are kind of that building block, that foundation for that to happen. And we've always talked about, with the big movement now for pharmacists going at the federal level to get provider status laws pushed through, it really has to be a tandem event that in order for that to happen, they have to know who their backup, what their backup plan is. And it's really the technicians.
Jeremy Sasser: And everybody needs to be ready and that's why it's important to get everybody trained up as well. So as we look to wrap this up, what I'd like to know from you is what is one piece of advice you would give any pharmacy technician or maybe pharmacy technician student listening to this podcast?
Miranda Gendro: I would say just try and learn as much as you can and involve yourself either with asking a simple question to a fellow technician about, "Hey, why is this medication used for this," or different things and I feel like that'll help you really flourish your knowledge and become more a part of the pharmacy team that you work with is you're increasing knowledge all the time.
Cody Mueller: I'd have to agree with Miranda. My piece of advice would be try to immerse yourself in your role and your position as much as you can and at the end of the day, I think what's most important above all else is to be able to sit down and reflect on the fact that you are a vital, central piece of the pharmacy.
Jeremy Sasser: That's perfect. Miranda, Cody, we can't thank you enough for joining us. Wish you all the best as you progress through your studies, Cody, you're almost there.
Cody Mueller: Almost.
Jessica Langley: Counting down the days I'm sure.
Jeremy Sasser: Congratulations to you before you know it you'll be studying if you're not already for the NAPLEX, so good luck with that as well.
Cody Mueller: I appreciate it, thank you.
Jeremy Sasser: Yeah, and for our listeners out there, we always want to hear from you. Feel free to email us at onscriptatnhanow.com. Share your stories, give us questions, maybe even topics for a future show.
Jessica Langley: There you go.
Jeremy Sasser: And you can listen to this episode on our blog. You can find it on our blog rather at www.nhanow.com/learning-leading. Not only will this episode be there, all of our previous episodes will be there as well, and you can also find us and subscribe and rate us if you like us on Apple podcasts as well under On Script.
Jessica Langley: Just another shout out to Husson University School of Pharmacy for collaborating with us today and Miranda and Cody for just being great representations of not only pharmacy technicians but pharmacists in training. I think it's just really key to hear your guys' perspective and what a great episode. Thanks so much for your time and your guys' comments today.
Miranda Gendro: Thank you so much for having me.
Cody Mueller: Thank you for this opportunity. Really appreciate it.
Jeremy Sasser: Awesome. Thank you guys and to our listeners, until you hear us again, Jessica and I wish you well.