At the meeting of a state association of Nigerian hospital pharmacists a few years back, one of the major topics of discussion centered around the supposed ‘threat of pharmacy technicians’, how they were pushing for autonomy and were threatening to ‘steal’ the role of pharmacists. Certain aspects of this argument were valid, what with some issues with the regulation of pharmacy technicians in the country and the prevalence of charlatans in the pharmacy profession. It was quite easy to understand these pharmacists’ sentiments from this point of view. The pharmacy technicians were moving for separation from the Pharmacists Council of Nigeria (PCN) and forming their own body and this was deemed insubordination to the authority of the PCN. However, these pharmacists’ reaction to pharmacy technicians reflected a serious problem that we have in pharmacy practice, particularly hospital pharmacy practice in Nigeria.
Sometimes one is tempted to liken this reaction of pharmacists to pharmacy technicians to the reaction of medical doctors to pharmacists in Nigeria (and even other health professionals), especially when the discussion is centered around pharmacists wanting to take the roles of doctors and ‘claiming’ to know things ‘only doctors should know’, when in actual fact the issue is not who is stealing whose role, but about each profession having unique and different roles that they can utilize collaboratively to add value to the patient.
Pharmacy has evolved over the years and pharmacists now take up roles never imagined. If pharmacists’ roles in developing countries are to grow at the same pace with that of pharmacists in developed countries, pharmacists will need to step into bigger shoes and develop greater competencies This also means pharmacy technicians stepping into roles that pharmacists are more used to performing in developing countries. In developed countries like the UK for example, clinical pharmacists take on advanced roles on the wards and lead pharmacy clinics, specializing in various clinical pharmacy areas. They can eventually take up posts as consultant pharmacists. In these settings, pharmacy technicians handle drug supply on some wards, carry out medication histories and data entry into the computer system. In the US, pharmacy technicians are starting to carry out immunizations (services that are not even being provided by most pharmacists in developing countries). For pharmacy in developing countries like Nigeria to advance, pharmacists will need to be willing to allow pharmacy technicians carry out roles they are conditioned to believe are solely pharmacists roles. An average teaching hospital in Nigeria has a ratio of pharmacists to pharmacy technicians of 10: 1 for example. And you would find pharmacists performing rote activities like the recording of daily prescriptions in combination with other roles like dispensing, and counseling, leaving them little time to go on their individual wards daily to carry out medication reviews, monitoring and follow up of patients’ drug therapy. Add to this the unfortunate fact that some pharmacists are not trained or confident enough to carry out this advanced clinical roles, and are comfortable to remain with these old roles (this is why the introduction of the PharmD in Nigeria is one welcome development). Pharmacy technicians can handle inputting of prescriptions into the electronic system, manual recording of prescriptions, arranging medicines on the shelves, compounding lotions, soaps and hand sanitizers. Pharmacists’ roles here should be supervisory and not to take sole ownership when there are other areas where their expertise is needed.
As pharmacy technicians are being trained and encouraged to be advanced in their contribution to pharmacy services, they can go on to be more equipped to go on the wards with pharmacists and work under their supervision to take medication histories. This relieves the work burden on pharmacists, gives them time to contribute in other ways to patient care, hence reinforcing their value to the healthcare team. In developed countries pharmacists carry out daily therapeutic drug monitoring, lead pharmacy clinics, and in some cases are based on the wards, while most of the dispensing is done by pharmacy technicians in the dispensary or for outpatients, contracted out to another pharmacy. Pharmacists also have time to go on home visits and follow up with patients.
We need to see the value of pharmacy technicians, and instead of seeing them as enemies, we need to allow them to take on more roles and let them see that we value their contribution. On a national level, we should have more training centers for pharmacy technicians, and they should undergo compulsory one-year internship in any pharmacy setting following graduation to enable them to develop hands-on skills and get a proper introduction to the profession. Recruitment of pharmacy technicians should be prioritized alongside recruitment of pharmacists. The results in the long term would inevitability be a better contribution to patient care by the pharmacy team as a whole.
Current practising pharmacy technicians should also be proactive and not be comfortable to just mark the daily attendance at their places of work and carry out the same roles they are used to. They should take up the challenge of new pharmacy technician roles. In all of this, their main aim should be to be a great assistant to the pharmacist and a key player in the positive outcomes of patient care.
Together we can advance the profession of pharmacy and retain our position as valuable members of the healthcare team on the global stage!