Pharmacist Q&APharmacy

20 Questions: Karla N. Turney, PharmD, Clinical Pharmacist

Karla N. Turney, PharmD, is an inpatient pharmacist for the Veterans Affairs Medical Center in Iowa City, Iowa, where she has been employed since 2006. She is also an adjunct faculty at University of Iowa College of Pharmacy. Turney has a bachelor’s degree in biology with a minor in psychology from Illinois State University (2001), and her doctor of pharmacy degree from University of Iowa (2006).
Prior to her work at the Veterans Affairs Medical Center, Dr. Turney had several professional practice experience rotations at sites including Osco Pharmacy, Crawford Diabetes Education Center, Fifth Avenue Pharmacy, Liberty Pharmacy, Wal-Mart Pharmacy, Siouxland Medical Education Foundation, University of Iowa Hospitals and Clinics, and University of Iowa College of Dentistry. In addition, she completed two pharmacy internships, one at Iowa Medical and Classification Center (2003-2005), and one at Iowa Drug and Information Services (2003-2005). Dr. Turney has presented on treatment of chemotherapy-induced nausea and vomiting in oncology patients and treatment of depression in oncology patients at University of Iowa Hospitals and Clinics, mumps at the College of Dentistry, oral diabetes medications at Crawford Diabetes Education Center, the new insomnia treatment Ramelteon at Siouxland Medical Education Foundation, and the Iowa mumps outbreak at the Iowa Pharmacy Association annual meeting.
When did you first decide to become a pharmacist? Why?
I received my bachelor of science in biology from Illinois State University (ISU) and it was during my last year at ISU that I decided to pursue a career as a pharmacist. I knew that exploring a career in pharmacy would fulfill my dream of becoming a health care professional. After much research I realized the profession would have great job security due to the baby boomer generation. I also saw potential in the wide variety of job opportunities created by national health care reform. I graduated from the University of Iowa’s College of Pharmacy with my doctor of pharmacy degree in 2006. I have enjoyed my work as an inpatient clinical pharmacist at a Veterans Affairs hospital since graduation.
How/why did you choose the pharmacy program you  attended?
I chose the University of Iowa’s College of Pharmacy because it was a well-respected and distinctive program. It is the fourth oldest state-supported college of pharmacy and is consistently ranked as one of the top pharmacy programs nationwide. When my dad and I visited the campus and the pharmacy program, a professor named Dr. Lloyd Matheson (associate professor emeritus) gave us a tour and took the time to sit down and answer all of our questions. The time he spent with us immediately assured me Iowa was the perfect fit for me. The University of Iowa was also located a couple hours from my hometown.
What surprised you the most about your pharmacy studies?
I was surprised (and disappointed) that therapeutics did not start the first year. Looking back I understand the necessity of the pathophysiology and biochemistry classes first. I appreciate how the first three didactic years were planned out for me.
Why did you choose to specialize in clinical pharmacy?
I chose clinical pharmacy in order to have the biggest impact on my patients. I wanted to work with other health care professionals as part of an interdisciplinary team. This clinical pharmacy setting fits the vision I have always had in my mind.
If you had it to do all over again, would you still become a pharmacist? (Why or why not? What would you have done instead?)
I would absolutely become a pharmacist if I had to do it all over again. I love the profession I chose. I may have changed my undergrad major to chemistry from biology or double-majored if I had known I wanted to be a pharmacist back in high school.
Has being a pharmacist met your expectations? Why?
Yes, I feel like being a pharmacist fits me perfectly and helped me find my niche in the health care field. I am proud of my profession, my colleagues, and the veterans I serve.
What do you like most about being a pharmacist?  Explain.
The biggest reward is when a patient thanks you for helping them understand their medications. It gives me great satisfaction to know that I have helped to make someone feel better. I also enjoy sharing my knowledge of medications with an interdisciplinary health care team of physicians, nurses, social workers, and dieticians in an effort to find the best treatment plan for the patient.
What do you like least about being a pharmacist?  Explain.
The biggest challenge of my job revolves around drug shortages because that impacts our ability to provide good patient care. Another challenge is finding ways to reduce drug waste and save money.
Describe a typical day at work—walk readers through a day in your shoes.
My typical day is spent reviewing medication orders for appropriateness. I review why the patient is admitted, their past medical history, and labs to determine whether a drug is appropriate for them. I answer questions from many different members of the health care team. I review labs for patients on antibiotics and anticoagulants in order to determine if the medication and dose are appropriate. If not, I suggest a new medication regimen to the team of physicians.
In my facility, every patient who is admitted has a pharmacist interview them regarding their use of medications at home. The goal is to compile a current list of prescription, non-prescription, and herbal medications a patient takes as well as document medications a patient has stopped and the reasons why. This process may require contacting family members or outside health care facilities to ensure an accurate list is obtained. From that current medication list, all providers are able to compare a patient’s outpatient medication list to the medications that they receive in the hospital – a process called medication reconciliation – to ensure that patients are receiving all indicated medicines. If a patient is transferred within the facility, medication reconciliation is performed again to make sure all the correct medications are ordered in their new location. Once a patient’s discharge plan is finalized, medication reconciliation is completed a final time before a patient can be discharged. This is important because it allows us to clearly communicate all medication changes made during hospitalization. Medications changes are detailed in the discharge summary and a final medication list is sent home with the patient.
My day also involves a variety of other functions that include preparation of intravenous chemotherapy products, verification of medications that will be filled in our automated dispensing cabinets throughout the hospital as well as our community based outpatient clinics, committee work, education of pharmacy residents and students, and formulary management. Formulary management requires me to evaluate a patient’s medication therapy and to make clinical and cost-effective decisions on whether or not to approve certain medications that may have other alternatives already available in the hospital.
On average: How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take?
I work 40 hours per week. I rarely work over 40 hours unless a colleague is ill. My co-workers and I are in a rotational schedule. Every eight weeks I work one week of evening shifts (2 p.m. to 10 p.m.). I have days off during the week to compensate for working Saturday and Sunday shifts. I get between seven and nine hours of sleep per night. I take three weeks of vacation most every year, but have earned enough vacation for six weeks this year. I can carry over a maximum of 240 hours of vacation from year to year at my place of employment.
Do you have family, and if so, do you have enough time to spend with them?
Yes I have a husband and two young sons and I do feel I spend enough time with them. At times I have “mommy guilt” when I have to miss a midday music program or cannot eat lunch with my child due to work, however I feel like I am a better mother because I have a career I enjoy.
How do you balance work and life outside of work?
My work does not come home with me. I am not able to work from home which helps separate my work life from home life. Any pharmacy activities in my home life are for my own enrichment.
Do you feel you are adequately compensated?  Explain.
Yes I feel adequately compensated.
If you took out educational loans, is/was paying them back a financial strain?  Explain.
I am still paying back loans, which I consolidated after graduation. My goal is to have them paid off by 2020. They are not a terrible financial strain, but I will definitely be happier when they are paid off. The pharmacist license and doctor of pharmacy degree outweighs the financial burden of student loan debt.
In your position now, knowing what you do – what would you say to yourself back when you started your pharmacy career?
When I first started working in an inpatient setting, I did not know I would love acute care as much as I do! Looking back, I would have done a PGY1 and possibly PGY2 residency specializing in acute care.
What information/advice do you wish you had known prior to the pharmacy program you attended?
The cost! I wish the tuition information for all semesters was transparent and easily accessible. I would have liked to meet with a financial counselor on a regular basis throughout the pharmacy program. I also wish I had an older pharmacy student as a mentor throughout the years.
From your perspective, what is the biggest problem in health care today?  Explain.
The biggest problem is the lack of health literacy and personal responsibility. Too many of my patients do not know what medications they take or why. I also cannot leave out the issue of pharmacist reimbursement for clinical activities and services and legal recognition as providers.
Where do you see clinical pharmacy in  five  years?
I hope that pharmacists will gain recognition as health care providers and get reimbursement for clinical services. The increased access to health care brought on by the Affordable Care Act and an increase in patients is an opportunity for pharmacists to show that we can and should be considered providers.
What types of outreach/volunteer work do you do, if any?
My volunteer work is focused around my two boys and their activities.
Do you have any final piece of advice for students interested in pursuing your specialty as a career?
Pursue a career as a pharmacist for the right reasons. It is easy to see a big salary and great working environment, but what’s really important is caring for patients. I would also recommend earning a bachelor’s degree first. Pharmacists have great responsibility and must be detail-oriented. It is a rewarding profession with lots of opportunities.

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