Irina Usherenko Assistant Director of Pharmacy Long Island College Hospital October 9Th, 2007 Subject: Pharmacy Technician Issues Within an evaluation period of about 2 months, and with particular focus on activities over the last 2 weeks, creeping problems with the non-professional staff have thwarted efforts to provide optimal patient care within the hospital. Outlined within this memo is not just specific examples of failings of the technician staff and messengers to cover assignments adequately, but also addresses an underlining motivational problem within the staff which need to be addressed in order to prevent the Pharmacy from having to overcome increasing numbers of events which are truly symptoms of the same motivational problems. The non-professional staff, from top to bottom, fails to accept or understand the supervisory role of the pharmacist and their submissive organizational position. Likewise, this impression on the part of the non-professional staff is reinforced by a refusal of some of our pharmacist to adequately use their authority or to supervise activities in the pharmacy. This later issue will be discussed at a later time. Here I'd like to focus on the first problem: IE non-professional staff insubordination. Previously I've documented for the Pharmacy Management staff specific failures including failures in the stocking of the Emergency Departments Medication Rooms and the IV antibiotics. I've needed to stock the ER med rooms myself. In addition, I discussed with Mike the particularly upsetting incident involving Diva in the morning when she clocked in, spent a half hour in the locker room while the phones were ringing, and then when I tracked her down and asked her if she clocked in yet (it was 8:30 in the morning) she said, "Yes she did and what's it my business." Since then I've had a number of other incidents including Amy questioning my enforcement of pharmacy policy with regard to the ER, repeated loading of software on computers used by technicians, the refusal to go to the ER by Barry to check the status of tetanus toxoid with Diphtheria sotres stating that it was the day shifts job, a clearly stated reluctance by Barry to help fill a few hours of emergency drugs for the 9th floor when they locked themselves out of the medication rooms, refusal of Jackie and Amy at different times this week to prepack IV antibiotics on my direction in the final hours of their shift causing me to have to make them in the middle of the night, and finally, the battle to get the overnight technicians to make the delivery schedule as expressed by Suzanne, especially when I have 2 techs on duty. Overall, the foot dragging is exasperating, the refusals to take instruction simply unacceptable, the inappropriate comments frustrating, and particularly Jackie is spending a lot time while on the clock having secret conversations within the Pharmacy with Barry, and with Amy and others gossiping over who knows what, but evidently focused on some kind of lack of job satisfaction. Often Barry and Jackie can talk for a half hour before he actually works, and Jackie never ever does any significant work in the final hour plus of her shift. Coupled with this, specifically, there is an impression among the non-professional staff that that they have locked in job descriptions and a set limited number of tasks, beyond which they will not take instruction or do extra duty. This Pharmacy has more than enough work to be done, but the end of shifts finds technicians watching movies on the computers, gossiping as a group, and leaving important tasks which are not part of their specific routines to be left undone. On the overnight shift, for example, Barry is almost solely focused on the cart fill and a regimented amount of bulk packing of IV's and crash cart filling (along with the narcotic inventory). And while filling that cart is important, I need him to proactively respond to a whole plethora of other critically important activities. Most importantly the technicians must be an extension of my eyes, ears and arms in the pharmacy and on the floors. If it is deemed appropriate, I need the Pharmacy Management to help change the expectations of the non-professional staff and to forcefully make clear the expected role of such staff. Additionally, on the overnight we are obligated, to my understanding, to make deliveries overnight every 2 hours. That would be a schedule of 12AM, 2AM, 4AM, and 6AM. The technicians, especially when there are two technicians on duty, must make a midnight and 4AM delivery, in addition to making a 2AM delivery those times when the hospital transport is unable to comply reasonably to the schedule. I need a memo to this affect from the directors office or from one of the assistant directors. Secondly, a memo is needed addressing the general authority of the professional staff to direct non-professional staff as needed. Such a memo should state something to the affect of, "State Law and hospital policy gives a fiduciary responsibility to professional pharmacists in the running of the hospital pharmacy. Non-professional staff, Pharmacy Technicians, Messengers and others, while working on the pharmacy floor, are expected to consider requests and instructions from any Pharmacist as supervisory instruction as it would if it came from the Pharmacy Managements office. Technicians, in addition to their unit assignments and work schedules, are expected to support the Pharmacists in their professional duties in a fully cooperative manner. In addition, the comings and goings of non-professional staff, when going on breaks, lunch, or heading to floors, should be done with the coordination of the Pharmacists working on the floor, and not independent of them. Any conflict resulting from this policy should be later addressed to management after complying with any reasonable directive, reasonable being defined as any order which is issued within the scope of state law, patient safety and hospital policy." Thank You for your attention to this matter Ruben Safir RPh LICH Staff Pharmacist Brooklyn, USA