Understanding of the role

Realising the reality of the profession occurred for most of the participants whilst on the early pre-registration training placement. Some felt that their summer placements had also helped prepare them for this:

“I think summer placement prepared me really well” #6, p2.

None thought that university teaching or the compulsory work based learning placements had really prepared them for the reality of the role:

“In university they do sort of make out as if it’s a nice world out there and I don’t think they prepare us mentally” #2, p26.

Participants realised that the job involves long hours which often included unpaid overtime, with very little or no reward:

“I found it really hard […] It was just when it was too long and I was on my feet all day”

“We were supposed to finish at half five but then the dispensary was too busy we had to stay back till seven or half past six […] We were meant to get our lieu time back but we still haven’t got that back” #2, p17.

Participants often approached the pre-registration training placement with the assumption that all pharmacists and pharmacies would be similar. They also often did not appreciate the responsibility of the role. This explains two of the subcategories of this major category; spectrum of professionalism and

responsibility of the role, which describe why participants began to realise the

reality of the profession. These will now be discussed in more detail.

8.1.2.1. Spectrum of professionalism

In the first interview, participant #1 used the term “spectrum” to describe the variations in professionalism. This was a powerful statement and quickly produced the in vivo initial code spectrum of pharmacists:

“You don’t realise that OK there’s gonna be this spectrum.” #1, p10.

These sentiments were echoed again and again by different participants:

“I mean some people just want a job so you go in there and you come out and just get your money and that’s it […] But then there’s other people that sort of do actually want to help people, do want to make the most of people’s medicines and do want to give them advice” #2, p13.

“Like locums I’ve had that just sit there and check and they can clearly see that you’ve got a whole pile of red baskets but they’re not helping you dispense because they’re a pharmacist and they just want to check […] And I don’t think that’s, that’s not the right attitude to have and yes I don’t think they’re very professional because you’re not there to just check. That’s not all a pharmacist does is check and when they don’t speak to patients or give patients any extra information.” #4, p18.

“Yes I’ve been […] really fortunate to work with […] really good pharmacists […] the reason why I call these pharmacists high quality pharmacists is because I’ve had the opportunity to work with pharmacists that you wouldn’t necessarily consider you know high quality” #9, p13.

Consequently, there can be said to be a spectrum of professionalism:

“I think they’re both professional in different aspects […] they both speak to patients properly, like professionally and I think […] the second pharmacist was more professional with the staffing team […] I think the first one was very professional to patients but wasn’t as professional with the team.” #14, p29.

Also the same pharmacist could exhibit professional and unprofessional behaviours, depending on the situation, for example one participant spoke about a pharmacist who was always late:

“She had a very good rapport with all of the customers ‘cause she’d been in that pharmacy for like 30 odd years so you know, all the customers are fine with it and said oh we’re just waiting for [the pharmacist] and were like oh it’s okay it’s [the pharmacist], it’s fine so, but I do think you need to be on time like you’ve got to be on time for stuff. It’s not really fair on the customers or the staff” #5, p21

This realisation prompted participants to reconsider their personal definition of professionalism. They all found it difficult to give an exact definition of what professional or unprofessional behaviour entails, and expressed confusion about this:

“It’s still possible to push the boundaries in other less severe ways and I suppose there’s an undefined line there as to whether you are professional or unprofessional.” #8, p21.

“Like if they’re really late all the time it means that they don’t think, they don’t think it’s important to be timely […] they could still do a really good job but it’s hard, difficult one that actually.” #7, p21.

“Because you know obviously you can’t do anything until the pharmacist is there so I mean that’s the responsibility that you’ve got […] being responsible is part of being a professional so yes I’d see that as unprofessional […] you’ve definitely got to have the whole package.” #9, p19.

Despite the uncertainty all participants felt they had successfully identified examples of both professional and unprofessional behaviour when they saw it:

“I used to always look at him and think that’s the kind of pharmacist I want to be. I wanna go that little mile extra not just do the basic job.” #1, p7.

“I want to sort of, in the hospital I’m working at I want them to think you know, yes she does, she can deal with the questions, she can look, she can use and make the use of the resources we’ve got […] (not) she’s a pharmacist that doesn’t know, doesn’t have the clinical knowledge, doesn’t have the knowledge of what a pharmacist is meant to have.” #2, p17.

“If you see…how people…are detrimentally affecting the staff environment […] obviously you think to yourself oh, I don’t want to be like that […] I want to be like the other people who are respected and not… disliked shall we say, for good reason.” #8, p14.

8.1.2.2. Responsibility of the role

The second aspect of participants developing their understanding of the role was the responsibility of the role. Many of the participants commented that they had had no idea of this before going on placement:

“I did that mistake, I thought there must be so much responsibilities for pharmacists. It’s quite hard, like it’s really stressful especially every single decision.” #3, p21.

“I felt I should double check my work […] it is (the) pharmacist responsibility to check everything before it goes out” #13, p22.

Participants realised that patients trusted them, and if they were unprepared, did not have the knowledge, or were unprofessional, they could have a serious impact on a patient’s wellbeing:

“If you got them wrong like you give the wrong dose to a patient and that patient […] could die or come become severely ill […] the amount of responsibility that you have as a pharmacist is a lot” #4, p31.

“It’s important when it happens in real life because you know that there is a direct harm to a patient” #6, p20.

The subcategory patients as people will now be discussed in more detail in the following section.

8.1.2.3. Patients as people

Participants often had a fairly sudden realisation that patients were vulnerable and trusted them to give them correct information and advice:

“You never imagine like they’re so vulnerable like that and everything you say they just trust you, like everything you say.” #3, p26.

“She treated them all differently because you know, they’re all, they’re all very vulnerable and so she knew how to speak to them and she knew how sort of prise information that she wanted out of them and so she also knew how to speak to the families” #10, p10.

Many participants described a specific moment when they realised that patients are real people:

“I think when you’re doing like your degree you don’t realise, like you do realise that oh it’s patients, but when you actually go into practice it’s like a whole different scenario. You think oh my god these are patients. I’m gonna be looking after these soon so it definitely helped, placement yes.” #1, p7.

“I was caring for the patient. I was really scared about something happens to him […] I couldn’t stop crying and you know, when you feel that if something happens to a patient it’s your fault […] It makes it more like personal”. #3, p13.

“I learned like that they’re [alcoholic patients] not just like drunk in and out patients . Like you kind of get to know them quite well and I think that’s good.

Right and is that something, would you have said that before you went on pre-reg or do you think that’s something you managed, you picked up really when you were there?

I think I had an idea but like I didn’t understand how much time they actually could spend with like one set of family or one patient at all.” #11, p7.

This was totally different to seeing cases in teaching at university:

“Them situations can’t be mimicked at university or like in a lecture you can’t teach that […] It’s not real, you’re not in a real pharmacy, you’d be in a mock university pharmacy […] you’d know the patients aren’t real as well” #4, p12.

“I think it’s important when it happens in real life because you know that there is a direct harm to a patient […] So you would take it more seriously.” #6, p20.

The ability to empathise was mentioned by several participants as being an important aspect of the placement. They were seeing patients who were obviously ill and this made them feel differently about them:

“You’ll do the drug history but some pharmacists forget to ask them how they’re actually feeling. Are these medicines even helping?” #1, p8.

“About recognising whether the patient wants to talk or doesn’t want to talk or whether they’re happy for you to give them this extra information or if somebody’s not interested at all – it’s about reading that.” #4, p23.

This was not always viewed positively by participants:

“Some patients when we first got were really awkward patients and I thought oh my god, and then when it actually comes to the point where […] they pass away or whatever you actually feel a bit sad for them. Yes, it’s not nice. Like having them there every

day and then they’re not there anymore, it’s quite strange yes.” #11, p7.

This empathy in turn made participants consider what their duty as a pharmacist was:

“That’s your job role and if you can’t do that then that’s not good is it?” #2, p9.

One participant even went as far as to say she had dedicated her life to patients:

“At the end of the day you’re taking this career on. You’re not, it’s like you’ve dedicated your life towards patients, that’s how I look at it anyway. I know it’s really extreme to say that but I think that’s what it is.” #1, p16.

Participants became more careful with their dispensing and checking after making an error that had an impact on a patient, in an effort to avoid patient harm:

“After that dispensary mistake […] I changed everything. I changed the way I checked products and labels” #3, p13.

One participant was afraid that she would go to prison if she made a mistake but the rest of the participants talked about the potential harm to a patient and the effects it would have.