Andrea Beall, PharmD, BCPS, BCPP
Outpatient Mental Health Clinical Pharmacy Practitioner
VA Connecticut Healthcare System
West Haven, CT
Dr. Beall graduated from Midwestern University in Downers Grove, Illinois before completing her PGY1 pharmacy practice and PGY2 psychiatry residencies at the North Florida/South Georgia Veterans Health System. She worked at the Lee County VA Outpatient Clinic within the Bay Pines VA Healthcare System in Cape Coral, FL for 7 years as the first outpatient mental health pharmacy practitioner there. In 2025, she started at the VA Connecticut Healthcare System.
When to say no
Clinical pharmacists can expect to receive requests throughout their career that they will need to say "no" to for a variety of reasons. These may include requests that fall outside their scope and appropriate requests that cannot be completed due to time constraints. A good first step in knowing when to say "no" is to know your position well. There should be a collaborative practice agreement between pharmacy and mental health. Knowing this document and having it handy to refer back to when needed can be helpful. For example, I have been asked to see a walk-in patient new to the clinic with no diagnosis. As stated in my collaborative practice agreement, I was unable to see this patient due to lack of a diagnosis. Lastly, as with many parts of life, clinical pharmacists need to know when to say “no” because of time constraints. Day-to-day responsibilities and work projects add up. If adding another project would cause the pharmacist to work outside of work hours or take a toll on patient care, it is time to say “no.”
How to professionally say "no" while leaving opportunities open for the future.
Saying “no” to opportunities is counterintuitive to most of us, especially right out of school or residency when we are looking to make a good impression. However, learning to say “no” is important so we do not find ourselves getting burned out or taken advantage of. Learning to say "no" in a professional manner can maintain a positive image but prevent those negatives of having too much on your plate. A way to do this is to offer another solution. Offering a solution can relieve you from the task but be helpful as well. In instances where the outpatient pharmacy is better suited to assist, I will say this and provide their extension or point of contact. In instances that are out of my scope, I refer back to my collaborative practice agreement for reference and suggest another provider who may be available to help or offer ways I can help within my scope. I have found the most difficult time to say "no" is when I receive a question or request that would be appropriate for me, but I do not have the time. In these cases, I have found it best to be honest about my time limitations and again, look for other solutions including asking for more time to complete the task and referring to others for completion. For example, on a busy day I have been asked by a psychiatrist to review a patient’s medications for safety in pregnancy. I relayed my time limits but offered to put in a note in the patient’s chart by the end of the week. Another example is being asked to update a reference medication chart. If this can wait, a student may benefit from this task.
Tips for saying yes to some things and drawing boundaries to others
It can be difficult, especially when first out of school or residency, to not say “yes” to everything. Most of us want to make a good impression and show our value to the team. When we say “no,” it may feel like we are doing the opposite of this. However, in order to not become burned out, learning to say “yes” to some things and “no” to others is essential. I would recommend starting this early. If starting a new position, clearly defining your role early on can help reduce requests in the future you have to say “no” to. In order to do this, knowing your role well will help. Another way to determine what to say "yes" or "no" to is by reviewing the collaborative practice agreement, discussing with your supervisor, or referencing other sources like those found on the AAPP website. If requests fall under this role, consider adding it to the “to do” list. Considering time constraints and prioritization may also help with saying yes to some things and drawing boundaries to others. If you are swamped, you can say "yes, but not at this time." Offering a later deadline would be feasible. Finally, prioritizing your tasks by patient care, supervisor designated tasks, and then other tasks in the remaining time can help with this.
Communicating your availability and bandwidth
One of the best ways we can set limits and draw appropriate boundaries is by communicating these with our co-workers, teams, and volunteer professional organizations. When an ask is made, also discussing and communicating appropriate and reasonable timelines is important. I found a good way to do this is speaking up at meetings, sending emails, and reaching out when opportunities present themselves.