Who Is Taking Care of Pharmacists?
“Every pharmacist raises their hand and takes an oath before they graduate to put patients first,” said Bruce Berger, PhD, FAPhA. “But what happens when you exist in an environment every single day where that’s impossible?”
Once considered a celebratory perk, pizza parties have become a symbol for corporate disconnect.1 The issue isn’t the food itself—it is the way in which pizza parties have been used to assuage feelings about unfair treatment, low pay, heavy workloads, and other organizational shortcomings.
Pharmacist in distress / SHUTTER DIN - stock.adobe.com
The same can be said for other flimsy solutions offered by corporate higher-ups. In a session presented at the American Pharmacists Association 2024 Annual Meeting,2 Bruce Berger, PhD, FAPhA, didn’t discuss pizza parties, but he did note that although taking a yoga class or receiving deep muscular relaxation can be a nice way to spend a workday, the activities don’t address the deeper issues driving burnout, stress, and moral injury in the workplace.
“If you work with a direct report and tell them how stressed you are, and the response is, ‘You just need to get over it. You need to go get some deep muscular relaxation or yoga,’ it makes the person the problem,” said Berger, professor emeritus at Auburn University Harrison College of Pharmacy and president of Berger Consulting LLC. “Asking them to do this is analogous to me asking a person to walk into a room 8 hours a day, at least 5 days a week, where there’s toxic gas leaking, and then go home and put the gas mask on.”
It has become abundantly clear that the health care system is under a lot of stress. Some point to the COVID-19 pandemic, rising health care costs, or staff shortages for exacerbating the issue, but Berger says the reasons may be more foundational.
“Humans are relational,” said Berger. “And one of the major problems we have in health care today is that we have become far more transactional than relational.”
Connection is one of humans’ fundamental needs for emotional and psychological health. Other needs include a sense of purpose, self-worth, physical and psychological safety, and self-determination; in a healthy work environment, these needs are translated and addressed. Employees know that they’re making a difference because they are told so, they can safely express their concerns to corporate leaders, and they are given clear opportunities for growth and advancement.
READ MORE: Assessing How COVID-19 Impacted Pharmacists’ Work Activities, Job Satisfaction
Burnout, stress, and moral injury arise when these needs are not met. In an unhealthy workplace, opinions may not be asked or valued, there may be a lack of transparency among corporate ranks, and personal development may not be encouraged. And where this results in a disconnect between the moral compass of the individuals and the moral compass of the organization, employees may feel trapped.
“Every pharmacist, every health care professional, raises their hand and takes an oath before they graduate to put patients first,” said Berger. “But what happens when you exist in an environment every single day where that’s impossible?”
Despite touting patient care as their core mission, many health care corporations fail to equip their providers with the necessary support to achieve that mission. Organizations that neglect staffing, for instance, leave health care providers chronically stressed and burnt out, fostering an unsafe work environment where providers are stretched thin. Last year, the estimated cost of medication nonadherence was $500 billion, said Berger, who posited that this high cost may be a result of pharmacists who don’t have the bandwidth to talk to patients—let alone provide optimal care.
“When you ask health care corporations what their goal is, they will say, ‘Our goal is to do the best job of taking care of our patients,’” said Berger. “To that, Simon Sinek, an organizational consultant, said, ‘Your job is not to provide the best patient care. Your job is to take care of the people who know how to take care of patients.’ That’s a big difference.”
While feelings of burnout, stress, and moral injury caused by organizational shortcomings are harmful enough on their own, they can lead to a further spiral of negativity. Pharmacists may begin to blame themselves for not keeping pace with their work environment. They may also begin to feel like a pawn in a corporation’s pursuit of profit rather than a valuable member of the health care team.
“Oftentimes when people work in unhealthy organizations, they feel like objects,” said Berger. “The problem with objectification is that objectification begets objectification. When I first started working in pharmacy, we were so unbelievably busy, and I would feel so stressed that I could not see the next patient as a person. And that’s a dangerous place to be in health care.”
What’s more, pharmacists may feel shame. “We, as human beings—because we’re relational—expect our relationships not to harm us,” said Berger. “We expect people that hire us to take care of us in some healthy ways. And when that doesn’t happen, the interpersonal bridge between a human and another human or human and an organization gets shattered. Shame is the result.”
And at the end of this spiral, pharmacists may experience powerlessness, and surplus powerlessness, which is felt when people get to the point where they feel like there’s nothing they can do to improve their situation, Berger said.
There may be something to learn from these feelings as they apply to communicating with patients.
“We often convert other emotions into anger because it feels more powerful,” said Berger. “Keep that in mind when thinking about patients who are angry.”
Just as toxic work environments can cause negative feelings such as anger, objectification, and powerlessness from pharmacists, they can also cause them for patients. A pharmacist who feels powerlessness at being short-staffed is just as valid as a patient who feels powerlessness at waiting in a long line to be seen. In moments where patients show anger, Berger advises pharmacists to listen, show empathy, and reflect understanding.
“Anger is borne in powerlessness,” said Berger. “Pay attention to the patient’s powerlessness.”
Pharmacist well-being is the cornerstone of excellent patient care. Health care corporations must prioritize it. It’s clear that superficial solutions are not working; organizations must address the fundamental needs of pharmacists by fostering a culture of connection, purpose, and growth. This means promoting open communication, valuing employee input, and providing opportunities for development.
By investing in their employees, health care organizations can create a landscape of care where both providers and patients thrive.
Read more of our coverage from the 2024 APhA Annual Meeting & Exposition here.
