Jack of All Trades

Through the Eyes of Pharmacy Students: A Day at a Rural Hospital APPE Rotation

In a rural hospital setting, pharmacists are a jack of all trades. Pharmacists in larger institutions will often specialize and become an expert in one area, since there are sufficient staff, resources, and training opportunities. However, in small and rural hospitals the staff and resources are significantly reduced while the roles and responsibilities remain largely the same. This results in each member of the pharmacy staff assuming multiple roles including administrative, operational, regulatory, and other specialties. An Advanced Pharmacy Practice Experiences (APPE) rotation at a small/rural hospital is an incredible experience as the student will get to observe almost every potential role and responsibility of a hospital pharmacist due to the increased responsibility of a pharmacist in this setting.

• Welcoming: Because of the intimate setting, typically both patients and medical staff at the hospital are very welcoming and saying hello as I pass by. Upon entering the central pharmacy, I am made to feel right at home being introduced to the friendly staff, getting a tour of the department, and then settling in at the workstation for the day.
• The Experience: The pharmacists are always very considerate about what the individual student wants to get out of the rotation, and they strive to tailor the experience to that student’s interest and goals.
• Variety of Experiences: Students are able to attend a variety of activities such as: infusion rounds for the ambulatory oncology clinic, operations rounds for the inpatient side of the hospital, administrative and regulatory/compliance meetings with executives from the hospital, and also work on several projects across various therapeutic areas and specialties.
• Interprofessional rounds: Rounds take place on the hospital floor and may include providers, nurses, pharmacists, physical therapists, speech and language pathologists, social workers, and other healthcare professionals that may be involved in patient care. This is a wonderful opportunity for students to observe and engage in productive discussion and teamwork that directly benefits patients. The pharmacist answers any follow-up question before entering orders and interventions in the electronic health record (HER).
• Other Activities: Much of the day is then spent interacting with others - discussing patient care, hospital procedure, and topics that are interesting. There are many opportunities to work with and observe other members of the pharmacy team and healthcare providers throughout the hospital.
• More Other Activities: The day is broken up by opportunities to observe committee meetings, listen to webinars, participate in journal clubs or any other activities that may be taking place throughout the hospital or health system along with intermittent patient emergencies that need to be responded to.

Take-Away Messages:

• Students have a broad experience: Students participate in so many experience in rural hospitals because the pharmacy preceptors are a jack of all trades. They must be ready for any event - from a Code Stroke, to a trauma patient or to a medication delivery issue. Each pharmacist then dives a little deeper in to their personal and professional interests passing on some of the key pieces of wisdom that they have acquired over the years of being a practicing pharmacist.
• Unique Opportunities: Every day of an APPE is unique and provides numerous opportunities to learn something new each day. In addition to direct oversight and these teaching opportunities, there is always an opportunity to work on side projects (i.e., institution REMS policy, antimicrobial stewardship, literature searches/drug information requests, etc.). A typical day at a small/rural hospital is truly anything but typical from the perspective of a pharmacy student that has primarily worked in larger/urban institutions up to this point, but this atypical nature is what allows these institutions to individualize their APPE experiences and teach each student as much as possible.