Community pharmacists at transition to independent practice: Isolated, unsupported, and stressed.

While there is evidence from nursing and medicine that transition to independent practitioner is challenging and has implications for patient care, there is little research exploring novice community pharmacists' (NCPs) transition. This study aimed to identify the challenges faced by NCPs at transition to independent practitioner and perceptions of the relative importance of these challenges. Nominal group discussions were held between November 2015 and April 2016, in North West England, with purposively sampled NCPs, early career pharmacists, work-based preregistration tutors, and pharmacy support staff. In response to the question "What are the challenges faced by NCPs at transition?" participants individually wrote down and subsequently called out, in round-robin fashion, then discussed, and broadly categorised challenges before ranking them in order of importance. Discussions were audio-recorded with consent, transcribed, and analysed thematically. Twenty-five participants from independent, supermarket, and small and large multiple pharmacies took part in five nominal group discussions. Challenges experienced through interacting with the workplace environment were identified as: (in order of importance) relationship management; confidence; decision-making; being in charge and accountable; and adapting to the workplace. With the exception of disagreement between pharmacists and pharmacy support staff regarding whether adapting to the team was challenging for NCPs, all participants reported challenges experienced through interacting with the workplace environment. Challenges were described as inducing psychosocial stress, particularly because NCPs acquired immediate professional accountability, worked in isolation from experienced peers, and faced job-related pressures. Interpretation of the findings suggests that the Karasek job-demand-control-support (JDCS) model of occupational stress provides valuable insight about transition for NCPs. NCPs' jobs are classified as high strain, where high workplace demands coupled with NCPs' lack of control in being able to meet demands, together with isolation and lack of support, result in transition being characterised as causing isostrain, where the workplace becomes a "noxious" environment.