well the good news is that unlike many posts and posters who complain about a problem and expect others to do something about it-you are in a position to actually make a difference
best of luck
If empowered, I'd hope too.
I kinda do have a vision even if it's a tad far out... I've had a plethora of rotations and been in some innovative places. I know people like to talk trash about the VA, but when it comes to pharmacist services they're actually really good. I did 2 rotations with the VA, one in the inpatient psychiatric ward and one in the oncology department. The psych pharmacist saw patients, could prescribe drugs to help with their conditions. We'd have team meetings every day and we tailored their med regimen and tried to make it as safe as possible. We also caught some concerns like using certain anti psychotics in patients with heart problems and got to lead treatment team discussions with patients and counsel them on their meds, among other things. We did a lot of innovative stuff.
My last rotation was at an ambulatory care clinic for lower-income or uninsured patients. We had a clinical pharmacist specialized in ambulatory care on site and 2 NP's. As a student I got to do the physicals on the patients, assess their labs, modify their medication regimens and set them back on the right path again. I'd show my work to the NP for approval (since it at to be done under their name) and through my preceptor, but we were doing the work and doing it well. We were mainly managing chronic condistions while the NPs saw acute illness or had to do procedures like ingrown toe nail removals. We were fully trained and capable of managing their diagnosed conditions and doing it well, and it did turn out well.
My internal medicine rotation was a little different. We'd get assigned floors to review those patients charts and make recommendations on what was wrong (and there were many medication errors or improper meds). We'd catch medication errors and alert the prescriber, we'd manage certain things like anticoagulation (ordering labs and giving the drugs to anti-coagulate a patient).
My oncology rotation wasn't what I hoped it would have been, but we did see chemo patients and assess their health status and prescribe meds to help. Mainly anti-nausea meds or medications to help with bone marrow counts if their counts were going down. I worked with the stem cell transplant pharmacist later on and we worked mounds around what I did on this rotation.
My Stem cell rotation was pretty innovative too. The clinical pharmacist would round with the hematologist and their NPs. NPs would do the physical abd prescribed the meds and run their report by the physician. He'd make his changes and make decisions like changes in chemo regimen or if they think things were working. We would manage all the meds they were playing with and many times their secondary conditions. We'd manage the lab values associated with the meds, if meds were safe to use together, if one is better than the other... etc. We were a good resource that would change around doses of a drug based on how it's drug levels came back on a lab (we have to physically change tings and make adjustments under the NPs name). Not to mention counselling patients inpatient and outpaitnet.
In my first hospital I was tasked with discharge counselling for a full floor as well as working to make sure every patient was anticoagulated properly. And of course I was reviewing over every persons case on my floor each day to make sure it was all good.
I'll never forget though. One of our patients had chronic kidney disease, diabetes, heart failure, dislipidemia, and none of it controlled. Their meds were a ****storm and I spent an hour fixing him. This patient needed an ACE/ARB for their blood pressure and kidney function. They needed to be on a high intensity statin like with atorvastatin 40mg. They were already on motoprolol which was fine. However, they were on invokana which is a diabetic medicine that helps you pee urine out. With the patient having shot kidneys this drug was only hurting them and we advocated taking it off and adding another medicine for their insulin.
All what we did got shot down. The only thing to change was the metoprolol was swapped to carvedilol. I'll never forget that day.