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Kristen N. Gardner, PharmD
Clinical Pharmacy Specialist – Behavioral Health
Kaiser Permanente Colorado

Starting your first job after finishing residency is typically associated with mixed emotions of feeling both excited and nervous. You feel accomplished after completing so many years of schoolwork and training and are excited to share your knowledge with the world and finally be independent. On the flip-side, you are nervous because you are never 100% sure whether you are going to be successful or whether the position is going to be a good fit until you just “dive in.” It has now been 1.5 years since I accepted my first (and current) position as a Clinical Pharmacy Specialist in Behavioral Health (BH) at Kaiser Permanente Colorado (KPCO) in an outpatient Behavioral Health Clinic. I joined a team of two exceptional, clinically focused psychiatric pharmacists. I didn’t leave my assimilation to chance and I am happy to share with you the plan I implemented to ensure my successful integration.

Be proactive in creating your onboarding plan

A strong onboarding plan is critical for a smooth transition. Ask for frequent 1:1 meetings with your supervisor at the beginning of your position and then decrease the frequency of meetings as you acclimate to your new role. Ask to shadow others with whom you are expected to frequently interact. This allows you to understand their practice and workflow, appreciate cross-over between settings or specialties, build relationships, and also learn tips and tricks from everyone! Make sure to shadow in pharmacy operations so you can advise on prescribing in accordance with med use policies/procedures to increase efficiency and prevent dissatisfaction/frustration.

Seek to understand the valued attributes of the past pharmacist and understand your teams’ clinical skills and personalities

Was the past pharmacist (if applicable) effective? If not, why? If so, what was it about their clinical or non-clinical skills that the clinic staff appreciated? This allows you to be proactive and modify your traditional approach if needed to be successful in your position. On the other hand, if possible, seek input from the previous pharmacist regarding clinic staff. How would the exiting staffer rank staff clinical skills, what are common questions they asked, preferred consult methods (e.g., in-person, virtual, phone calls, instant messenger)? In doing this, I learned that I needed to quickly understand insurance benefits and resources, brush up on medication use in pregnancy and lactation, learn which psychotropics are formulary, understand the process for reviewing non-formulary medications, and gain a better understanding of ADHD medication management.

Get and stay organized

I recommend maintaining an electronic and hard copy onboarding folder to store helpful resources that are sent/shared with you so you can continue referring to those over the course of employment. This minimizes asking the same questions of others on multiple occasions. Save any notes you took while shadowing and answers to any questions asked. Consider working extended hours in the beginning, if needed, to get "up and running." It takes more time than you would expect to get systems access, set-up your phones, familiarize yourself with email, contacts, EMR, health system locations/hours/services, policies/procedures, organize your office, acquire office supplies, bookmark helpful websites. Understand clinical resources to which you have access that can help answer drug information questions including health-system guidelines, policies, FAQ sheets, etc. If you are instructed to attend regular meetings be sure to clarify your role and expectations going into those meetings.

Seek out feedback early and often

Ask for feedback during every 1:1 meeting with your supervisor. Check in with "customers" for informal feedback after 4-8 weeks of starting the position. Customers may include clinic staff (physicians, nurses, therapists, medical assistants, front desk staff, pharmacy colleagues, your supervisor, etc). This will allow you to course correct early on and will go a long way in achieving respect. Additionally, while learning the new computer system and workflows, feel free to check-in more frequently to ensure you are following normal workflow.

Build, Build, Build Relationships

Stop by and ask your clinic staff about their day, whether they have had any interesting patients, bounce clinical questions off them, get to know them personally, have lunch with them, etc. Spreading out your questions amongst as many people as you can is appropriate so that you can meet new people/build relationships and avoid question burnout from colleagues. If someone sends a helpful email and you have not yet met them, reply to their email with a “Thank you. I look forward to meeting you in person.”

Identify a mentor

As part of my onboarding, I was assigned a mentor within my health-system. The mentor even had their own checklist of what was supposed to be reviewed/discussed throughout the first 90 days of employment. If you are not automatically assigned a mentor within your new employment, ask for one. You may even consider identifying a mentor outside of your place of employment as well.

Create a professional development plan and stick to it

It was challenging to devote extra time to keeping current with the literature for the first 6 months as I was busy acclimating to a new position and enjoying free time/non-residency work hours! I recommend starting small with professional development goals (e.g., 1 hour weekly) and adding calendar reminders to hold yourself accountable.

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25 Years!