Balancing Act: Dealing with Stress in the Pharmacy

For many pharmacists, there are long hours, less staff support, more reimbursement challenges, and a growing list of pharmacy services being offered to customers.

One pharmacist described it as running on a treadmill with an ever-increasing incline. Another described the “downward spiral” that may lead many pharmacists to become apathetic or disinterested in their job, or feel they have lost control.

These added demands can quickly and easily lead to burnout.

Related article: How to Cope with Residency Stress

But before pharmacists think of hanging up their lab coats, experts say there are tools and strategies that can combat burnout and help restore balance and wellbeing-at the pharmacy and at home.

“A lot of pharmacies and pharmacists in a community pharmacy setting are really getting hammered these days,” said Erin Albert, MBA, PharmD, JD, Chief Executive Officer of Pharm, LLC, in Indianapolis.

Mounting Stress and Increasing Workload

The Pharmacy Workforce Center, Inc. based in Alexandria, VA, has examined pharmacists’ work habits and satisfaction levels every five years as part of the National Pharmacist Workforce Study.

The last report, released in April 2015, focused on feedback from pharmacists. Two-thirds of those who answered categorized their workload level as high or excessively high and 64% of full-time pharmacists reported that their workload had either increased or greatly increased compared to one year earlier.

In addition, the report found that 45% of those surveyed believed their workload had negatively impacted or very negatively impacted their emotional and mental health. For 68% of chain and 63% of mass merchandiser pharmacists this also meant that there had been negative or very negative impacts on the time they were able to spend with patients.

In late 2016, Drug Topics surveyed pharmacists as part of an annual salary survey and found similar results. At the time, 72% of pharmacists surveyed said their workload had increased over the past year and 63.4% reported higher stress levels. The most common reasons named for the growing stress were increased work volume, inadequate staff support, increased paperwork, and a negative work environment.

Read more: Pharmacy Salary Survey 2016

Maria Marzella Mantione, PharmD, CGP, FAPhA, an Associate Clinical Professor at St. John’s University College of Pharmacy and Health Sciences in New York, said that the setting itself is often a source of stress for many in community pharmacy.

“There’s no organization to what’s going to come at you. There are no appointments. There’s no balancing of the workflow-of the job. You could have ten people walk in with ten prescriptions in one hour, and then nobody walk in the next,” she said.

That lack of control can create a feeling of helplessness that can often lead to burnout.

“You are always on the defense, it’s very difficult to be on the offense,” Mantione said.

Up next: What stress does to job performance

Although Mantione works in academia, she supervises students in community pharmacy settings and said she sees them struggle on a daily basis because of a lack of planned downtime in a shift. She encourages her students to take time for simple tasks like going to the restroom or taking a lunch break so they are able to think better, but said that’s often difficult to accomplish in the field.

“They say, ‘Yeah, but then if I leave for 10 minutes I come back and there’s people yelling because there was no one there to help them and there’s 40 more prescriptions in the queue,’” she said. “So it’s not even that the work stops, the work continues to build.”

Albert said today’s community pharmacists are doing more with less and many don’t have the technician help they need. They may be filling more prescriptions, while also regularly interacting with customers and diffusing any complaints or concerns.

“There’s a lot of stress in that environment,” she said.

High levels of stress over long periods of time can directly lead to burnout, or what Albert said can be a downward spiral.

Related article: Staff Burnout Rates are High at Pharmacy Schools

“Unless you can break that cycle it becomes a real challenge,” she said.

Sonia Martinez, RPh, Pharmacist-in-Charge at Marco Drugs and Compounding in Miami, FL, said although she’s never reached what she would consider burnout, she has regularly felt stressed and overworked on the job.

She points to regulation challenges, handling human resources, tighter margins, and a struggle to juggle and prioritize job responsibilities with family responsibilities as regular sources of stress in her daily life.

“It feels like you are on a treadmill and running and going nowhere, but it takes more effort because the inclination of the treadmill is going higher and higher,” she said. “That feels a little bit, to say the least, disheartening.”

Kristen Riddle, PharmD, a manager at US Compounding Pharmacy in Conway, AR, said she believes burnout can also be a factor if there is an unhealthy work environment.

“You’ve got to come to work and enjoy the atmosphere that you are in,” she said, adding that as a pharmacy manager she is regularly working to make sure staff get along to create a positive work environment.

Doing Damage on the Job

When a pharmacist begins to experience burnout, Albert said they may feel indifference or as if they are no longer engaged in their work. Depression, anger, problems sleeping, irritability, muscle tension, hopelessness, and relationship problems are often signs of work-related burnout.

Watch: Reducing stress in the pharmacy

These symptoms can have significant negative impacts on a pharmacist’s overall mood and wellbeing, but the pharmacist isn’t the
 only one who can be harmed by burnout or fatigue on the job.

Allen Vaida, PharmD, Executive Vice President of the Institute for Safe Medication Practices (ISMP), said it’s not uncommon for the ISMP to receive reports both from consumers and pharmacists themselves where fatigue played a role in a medication error.

Through ISMP, pharmacists can voluntarily report errors that are made and often detail the circumstances around the error as part of the report.

“The report basically says that, ‘two people called out sick and I had to stick around another four hours and I am not making an excuse, but I know this probably led to why I made the mistake,’” Vaida said.

Other factors that can lead to fatigue-related errors in community settings, where 12-hour shifts are common, include inadequate support staff or a lack of technical support.

“It’s a tough topic when you talk about fatigue because it intermingles a lot with staffing and workload. So it’s not just because you are working a double shift, sometimes it could be that you are on an 8-hour shift, but you never had a break,” Vaida said. “It is fatigue, but it’s not just because of hours worked, it’s because of the productivity within that period of time.”

The harms of medication errors are obvious. Patients can be given the wrong number of pills, the wrong medications, or the wrong dose, which can lead to anything from running out of a medication early to having complications that require hospitalization, or even death.

Vaida said it’s not unusual for many of the errors not to be noticed until the time of a refill, meaning patients have been on the wrong medication or dose for an entire cycle before the error is realized.

Strategies to Avoid Burnout

While burnout can have negative consequences to a pharmacist’s emotional wellbeing or to customers, experts say there are ways to combat stress and prevent or alleviate burnout.

Pharmacy chains are not unaware of the problems stress causes for their pharmacists. Walgreens offers programs to its employees and their dependents to help them maintain a healthy work-life balance, said Scott Goldberg, Senior Manager for Media Relations for the company. “We offer Work and Life Resources, an employee assistance and work/life support program to support all team members, as well as their dependents and other household members,” he said.

The program is a confidential, supportive solution for “those times in our employees’ lives when they feel overwhelmed and need some guidance,” Goldberg said. It includes assistance in areas including emotional well-being, family and relationships, childcare and elder care, financial and legal services, depression care, grief support, and work-life balance, he noted. These resources are available 24/7 online or by phone, and pharmacists and others can take advantage of face-to-face counseling as well.

Related article: What Do Checklists Say About Our Profession?

The first step in any strategy to avoid burnout, Albert said, is to take time off and use the vacation time given by an employer. Having time away from the office can give pharmacists an opportunity to recharge and can be vital to maintaining a healthy work-life balance.

“Millennials are terrible about taking their vacation,” Albert said.

But even if pharmacists aren’t able to take time off, they can still employ strategies to help reduce stress while at the pharmacy.

Mantione said it can be as simple as refocusing on why many pharmacists chose the profession: to help people. She said taking just a few minutes to have small talk with customers can help highlight the small wins pharmacists help achieve each day.

“When you build relationships with them and somebody thanks you for something, that can undo a lot of the frustrations,” she said.

Even if those small wins aren’t realized at the time, Mantione said it’s important to take a few minutes even after the work day is done to reflect on the day and what positive things were accomplished during the shift.

“It takes discipline to do that,” she said.

Time for reflection has been critical for Martinez, who has begun to practice daily meditation to reduce her frustrations.

“Personally, it has calmed my mind,” she said, adding that she had even gone on a trip to India to learn more about meditation.

Riddle also regularly builds in time for herself by trying to set aside twenty minutes each morning for prayer and Bible study before beginning her busy day on the job and caring for her three children.

“I definitely can tell a difference on the days where I’ve stopped and had twenty minutes in the morning of prayer and Bible study from a day that I just didn’t have time,” she said. “It just seems to go calmer and smoother.”

For Frances Cohenour, PharmD, owner of Chad’s Payless Pharmacy in Florence, AL, avoiding burnout has meant relying on other pharmacists for support and advice. She owns her pharmacy with her sister and said having another person to offer a fresh perspective has been invaluable whenever she is stressed or hitting a wall.

“It’s really been a blessing for us,” she said.

Pharmacy managers or owners may also have more control in creating a work environment that is positive and supportive. According to Riddle, burnout can impact one or more members of a team when there’s lots of bickering among employees or the staff isn’t able to get along with one another. Finding a common purpose or cause to unite around can rebuild a cohesive and cooperative spirit.

“If your motivation is going down because your staff members aren’t meshing like they should be, if everybody can work together and get involved in the community that, a lot of times, helps. It just helps to refocus everybody on what’s really important,” she said.

Albert said it’s also important for pharmacists to remember that their job isn’t their whole life. Finding fulfilling things to do outside of work hours-whether it’s volunteering in the community or taking up a new hobby-can also help overworked pharmacists feel restored and help re-establish balance.

If pharmacists are still unable to find the satisfaction and wellbeing they need, Albert said it could be a sign that it’s time to consider another pharmacy setting or a different job.

Today’s pharmacists are faced with increasing stress and responsibilities on the job. While some of those aspects are outside a pharmacist’s control, there are tools and strategies that are within reach for every pharmacist that help improve job satisfaction and improve mental health and wellbeing.