Kristen Balano, PharmD, AAHIVP, associate clinical professor, North Bay APPE program director at University of California in San Francisco, highlights the significant challenges facing rural pharmacies, particularly around recruitment and retention of quality pharmacy staff. She emphasizes that rural pharmacists often have to juggle multiple roles and areas of expertise, leading to high levels of burnout, workload, and stress. To address these issues, she discusses the value of implementing strategies to support student pharmacists in rural settings through interprofessional collaboration.
**Pharmacy Times:** What are some of the challenges to creating a sustainable pharmacy in rural areas or areas with low resources?
**Kristen Balano:** I think the challenges are primarily around recruitment, retention of quality pharmacy staff, and just the fact that expertise may not really be readily available in the area, and pharmacists there have to carry a number of expertise in the process.
**Pharmacy Times:** How does the workload and stress level of rural pharmacists compare to those in urban settings?
**Balano:** Burnout, workload and stress is something we're all dealing with, for sure, although my experience in working with our pharmacists in rural settings is that they're wearing more than 1 hat. I've seen pharmacists who are working in a community setting, plus a hospital setting, plus in working through some of the long-term care settings. They're across it, or a pharmacist in a hospital who's working in the infusion plus the ICU. So our rural pharmacists are wearing multiple hats. You can also put on it like our stress comes when we have a lot on our plate. Well, imagine you also have 5 plates, and the pharmacist is trying to juggle all those plates along with the loads that are on them.
**Pharmacy Times:** How can interprofessional collaboration help to improve patient care and sustainability of pharmacy workforce in rural areas?
**Balano:** In my experience, this has been the biggest value that we've been able to implement in our student pharmacists along with our pharmacy growth in our suburban-urban border in Northern California, in Santa Rosa, where what we're doing is recognizing that pharmacy is not alone in having multiple stresses and workloads, and by having everyone rise to their highest level of expertise and training now we can all work together to get the work done. So I've been able to approach chief medical officers, attending physicians, and say, "Hey, how would you like to have some student pharmacists working with you?" And they are thrilled. They are "this is wonderful." It both helps our trainees, the medical residents, nurse practitioner, PA residents, in addition to supporting the quality health for our patients. Our students get an interprofessional chance to work, or our learners, if they're residents as well, get a chance to work in an interprofessional collaborative team building their interprofessional team skills. They practice that role of being the pharmacist on the team.
They're supported. I just want to be clear to say the students aren't out there alone. As a pharmacy faculty, it is my job to ensure that the interprofessional team who is advising and supporting those students is knowledgeable about the appropriate activities and responses of a student, pharmacist, I have one-on-one interactions, knowing exactly who the physicians, nurse practitioners, PAs are working with our students and building their skills as a preceptor for our pharmacy students, and students should always have the opportunity to ask a pharmacist for support and questions, but the pharmacist doesn't need to be elbow to elbow. Better that our learners, who are extending and helping to extend what pharmacy do are elbow free and are out there working in a supported environment with our inter professional teams.
**Pharmacy Times:** Is there anything else you would like to add?
**Balano:** One other thing I want to mention as a challenge in our rural areas has to do with some of the natural disasters that seem to primarily that have a large impact on these communities. I can speak in Northern California, in particular, the fires, and the wildfires, have an impact on our communities, but in particularly on our health systems. The hospitals need to get going. People still need to get medications, and the continual nature or repetitive nature, further stresses the resiliency of the community. So when we're talking about burnout and work and overload, I think that's another factor that can really impact the pharmacy delivery systems and the support of safe and effective medication use in the rural areas.