The compound effect: Tackling stress stacking in pharmacy

Pharmacies are high-stress environments. Being the masters of multi-tasking that we are, most of us can deal with an individual stressful event. We can handle a staff member calling in sick, a customer complaint, or fax lines going down (are we still the only professionals using this archaic form of communication?). However, when faced with combinations of these events simultaneously, the compounding effect can have a significant impact on our teams. "Stress stacking," also known as "trigger stacking," refers to the accumulation of stressful events or triggers that occur quickly, leading to an extreme reaction to a minor stimulus. This concept is often discussed in the context of dog behaviour, where a series of stressful situations can cause an increase in cortisol levels.1As pharmacists, we are well aware of the role cortisol plays in our stress response. The half-life of cortisol shows considerable variation ranging from 40 to 225 minutes depending on the level of the stressor, other hormones in the body and an individual’s rate of absorption and metabolism.2 This means it can take up to 18 hours for the cortisol released during a single stressful event to be cleared from the body. In that time, it is common to deal with overlapping challenging situations.We have all seen the effects of stress stacking in our patients. It is not uncommon to overhear a disgruntled patient voicing their displeasure about a service or coverage-related issue when picking up their prescription. Sometimes, this takes us by surprise and we think they are overreacting to the situation. The truth is, we have no idea what the patient experienced before approaching the counter. Perhaps they’ve just come from six hours at the ER and had to take the day off work without pay. As healthcare professionals, we must understand a person’s response to any situation comes from the sum of their experiences up to that point. Understanding this can help us be more present and empathetic during these situations. As pharmacists, we are communicators. We communicate to our patients, team members, colleagues, stakeholders and other HCPs. Because we are spending so much of our time communicating, it is natural for much of our stress to come from our relationships. What tools can we use to improve our communication and mitigate stress stacking in our lives?Expectations vs. agreementsExpectations and agreements play crucial roles in shaping our interactions and relationships, both personally and professionally. Understanding their differences and replacing expectations with agreements can improve the quality of our relationships and minimize the frequency and severity of stressful situations in our lives.Expectations are generally internal, unspoken and one-sided. They are based on our personal beliefs, past experiences and perceptions of how things should be. Much of the time, they stay within us and are not communicated to others. Some expectations can be set too high often leading to disappointment. This has a profound impact on the relationship and can increase stress levels.Conversely, agreements are clear and specific commitments made between individuals. They require open dialogue and a mutual understanding of what is required from each party. As a result, they prevent misunderstandings by dissolving assumptions. Doing a self-audit, I think you will be surprised by how many expectations you have of others. By opening up the lines of communication and showing a willingness to compromise you can shift these towards mutual agreements. All this decreases stressful situations that can impact our physical, emotional and psychological health. Responding vs. reactingWhen we react, we are letting our sympathetic nervous system take control. Most of the time this contributes to stress stacking and further exacerbates an already challenging situation. Shifting ourselves into a more balanced, parasympathetic nervous system is what is necessary. One of the most effective ways to do this is to use our breath. Breathwork slows down our breathing rate and increases vasodilatory substances like carbon dioxide and nitric oxide. Although we can all breathe in this way, the key is practicing these techniques so they stay top of mind when you need them most. Click HERE for some effective downregulating techniques.ACTION ITEMConsider a challenging personal or professional relationship you currently have. Take a step back and ask yourself about your expectations of the other person. By shifting towards agreements, you will have more clarity between the roles and responsibilities. This fosters a sense of shared ownership and commitment towards agreed-upon outcomes ultimately improving the trust between parties.Manjit Hansra is the founder of Rx for Renewal (www.rx-renewal.ca). Through keynote speaking, 1:1 coaching, corporate wellness programs and curated retreats, he shares evidence-based and practical tools to help pharmacy organizations and pharmacists prevent and manage burnout. Subscribe to his weekly newsletter HERE.References:[1] https://k9turbotraining.com/what-is-trigger-stacking/[2]Clin Endocrinol (Oxf). 2015 Apr;82(4):557-61. doi: 10.1111/cen.12653. Epub 2014 Dec 19

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The compound effect: Tackling stress stacking in pharmacy

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Manjit Hansra

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