Case: The Night-Shift Pharmacist

Maggie is a night shift staff pharmacist at a large hospital. Staff pharmacists work in the main pharmacy with limited patient and physician contact and spend much of their time on computers verifying orders and checking the medication counters. Collaborative care pharmacists round with the medical team and visit each patient daily. They help with discharge medication counseling and teach pharmacy students. However, being on the night shift provides some unique aspects for work and job design; some of these are discussed next.

After a patient enters the emergency room, Maggie is in charge of the medications they receive. She hand-checks every medication that goes into the automated dispensing cabinets in the emergency rooms to make sure nurses have easy access to accurate, non-expired medications. When an order for an emergency medication comes through, she tells the entire pharmacy team that it is a top priority to get the medication to the emergency room as quickly as possible. When a patient is admitted from the emergency room, it is her responsibility to review the home medications continued by the admitting physician to find any discrepancies between what was ordered and what they actually take to prevent errors while the patient is away from their normal routine. When a code blue is called, she responds to the patients room with a medication cart. Maggie routinely passes along information to make sure nothing slips through the cracks during shift change. She has the responsibility to ensure that questions are followed up and also to report medication errors to the administration. In any given night, she might be found counting all of the narcotics being replenished in automated dispensing cabinets one second and attending pediatric intubation in the emergency room the next. She tries to read an article from a medical journal each day to keep herself abreast of upcoming changes that might affect her job.

Being on the night shift, she does not have the leisure to consult other physicians or pharmacists. If she has a question, she must research it and formulate her own opinion before consulting someone else. She prioritizes her own tasks. If our medication robot breaks down, she has to make the decision as to what the workflow will be until the issue is fixed. Working nights, however, makes it difficult to obtain feedback about her decisions. Without that feedback, she cant tell if her intuition was right, especially for decisions that must be made rapidly. Staff pharmacists are different from collaborative care pharmacists.

Five core job design characteristics of the Hackman-Oldham model:

1. Task Significance

2. Task Identity

3. Skill Variety

4. Autonomy

5. Feedback from the Job

Using the Core Job Characteristics from Hackman/Oldham Model, how would you assess her motivation and engagement? How might her organization improve her job design and what implications might this have?