Easing the burden—how pharmacists are supporting a depleted healthcare system at the cost of their own wellness

INTRODUCTION

The recovery of the greatest global health pandemic of our time has been made possible by countless professionals. We celebrate and honour each and every person who has contributed to solutions. Front line medical professionals have been rightfully lauded. And in this most deserved recognition, there is one group that seems to be overlooked, the pharmacist.

Mallhi et al. (2020) describe how pharmacists are a critical mainstay in public health. The pharmacist can directly or indirectly support patient care in a multitude of ways including but not limited to education, counselling, guidance, medication regulation, minor symptoms management, infection prevention, and preparation and administrating vaccines. The role of the pharmacist is easing the extraordinary burden on healthcare facilities, yet it is coming at a cost. Prior to the COVID-19 outbreak, some pharmacists reportedly were already in a depleted state as a result of their profession.

Read: Alberta pharmacists helped divert more than 100 tonnes of 'dead drugs,' used needles from landfill in 2020

According to a study conducted by Durham et al., in 2018, over 53% of pharmacist were reporting high scores of burnout using the Maslach Burnout Inventory Health Services Survey. The assessment measures burnout in three key areas: emotional exhaustion, depersonalization, and lack of personal accomplishment. In this study, emotional exhaustion was the most reported symptom. Ball et al. (2020) used the same assessment with a different group of pharmacists since COVID-19 was discovered, and over 64% of pharmacists were reporting high levels of burnout. The rise of burnout and compassion fatigue within this population of health care providers needs to be addressed if they are to continue to ease the burden of an overwhelmed healthcare system.

The pharmacist is a vital collaborator and champion for public health.

This open resource aims to serve as an invitation with a tool for pharmacists to start the self-awareness practice and reflection required to acknowledge and validate the unique challenges of their roles and explore individualized solutions. The secondary aim is to highlight a recent capstone project completed by PharmD candidate Nicole Gwiazdowicz. The open resource serves as an example of a collaborative approach to knowledge mobilization.

Read: New frontiers—The emerging role of the pharmacist in remission of Type 2 diabetes and other chronic diseases

CASE STUDY: PHARMACY STAFF BURNOUT

Anna is a community pharmacist working at a busy pharmacy. She has always enjoyed the patient care aspect of the being pharmacist, but has often struggled with stress at work due to time constraints and competing demands without adequate support. Anna was already feeling drained at work, and when she got home she was unable to enjoy herself and spend time with her family and friends due to the mental and physical exhaustion she was experiencing. Despite her struggles, Anna showed up to work every day trying to provide the best patient care possible, because she knew how much her patients and the healthcare system relied on her.

Read: New pharmacists drawn to niche practice options

The COVID-19 pandemic was no exception to this reliance, and in fact amplified the multitude of responsibilities Anna had. Despite the unknowns and concerns of the pandemic, pharmacists continued to provide direct patient care on the frontline. Already feeling overwhelmed by her daily demands, Anna took on the additional workload including increased patient consultations, information dissemination, solving drug shortages, screening/ testing for COVID-19, and vaccinating.

The additional pressure of COVID-19 in relation to burnout was analyzed in a recent study completed on pharmacists and registered pharmacy technicians in Ontario (N = 249). The results are as follows:

• 88% of respondents are burned out from their work due to COVID-19
• 83.9% of respondents report a decline in their mental health since the beginning of COVID-19 due to stress at their workplace
• Over 79% of respondents with pre-existing mental health issues or illness report a worsening of their illness/issue
• Largest contributors of stress include:
  1. Vaccine roll out (72%)
  2. Staff shortages (69%)
  3. Staying up to date with information (65%)
  4. Managing drug shortages (55%)
  5. Increased patient encounters/ interactions (51%)
• On a scale to assess support from leadership, only 36% of respondents felt supported while 40% felt unsupported (24% felt neutral or not applicable)
• 46.4% of respondents have no additional resources to reduce stress caused by COVID-19 available to them
• 74.5% of respondents who did have additional resources provided to them did not find that they significantly reduced COVID-19 related stress

The results from this survey have highlighted the immense mental health toll that COVID-19 has brought to pharmacists and registered pharmacy technicians due to their expanded roles and work environment. The alarmingly high percentage of burned-out pharmacy staff is a concerning matter that requires recognition and more importantly, mitigation.

WHERE DO WE GO FROM HERE?

Over the past six months, I have worked with pharmacists coast-to-coast-to-coast. I have heard about the joys of being of services to their fellow Canadians, and the challenges that come along with being on the frontlines. How many times can a pharmacist be asked the same questions? Well over a 100 times, reportedly. Imagine trying to do complex cognitive work while being interrupted over 100 times to answer the same question! Time on-task is fleeting. The demands are real. And the stakes are as high as they can get!

Self-inquiry and discovery can be the first step in addressing burnout. This practice involves acknowledging and validating the stressors to then execute a tailored approach of recovery. Identifying the key areas of burnout can be established using the key areas of the Maslach Burnout Inventory Health Services Survey (Workload, Control, Reward, Community, Fairness & Values), and a behavioural perspective to address life-with-work integration.

Key Questions for Reflection

Take time to reflect on your responses

+ What areas need attention immediately?

+ What is the cost of inaction if you don’t address these areas?

+ Imagine what it would look like and feel like if this area were addressed. What is the first step in taking committed action to address this area?

Identity your top three daily priorities. Schedule time on-task to complete the task with a deadline. For example: by the halfway point in my shift I will have completed 2 of the 3 tasks. Use your boundaries to ensure that you can meet this goal. We often overestimate what we can do in a day and underestimate what we can do in an hour when we spend time on-task. Ultimately, your workload needs to be within the scope human limits.

VALUES

At the heart of burnout is a deep experience with depletion. We feel disconnected from our values. Time spent outside of our values hurts us both physically and psychologically. We need to make what matters most, matter most. Ensure we are building a professional practice that is not at the cost of our relationships, including the relationship you have with yourself. Living wholeheartedly in every domain of your life is the most powerful defence to combat the celebrated norm of hustling, the praise of exhaustion, and the disease to please others.

REWARD

From a behavioural perspective, if we are not reinforced often enough it is extremely challenging to continue. And if we receive punishment (angry customer, negative feedback, or lack of acknowledgement), it is even more likely we will not be able to continue. Your rewards do not require money or food. It is the perspective that matters. Giving yourself time off task, being unproductive without feeling guilty or enjoying your favourite shows or books counts. Be sure to label your behaviour as a reward to deepen the benefits. ‘I am having this 10-minute stillness break to enjoy my coffee in peace, because I am working hard, and I deserve to take time to recharge and replenish.” It is important to have daily rewards and long-term rewards.

COMMUNITY

Collaboration and being part of a team is critical for preventing burnout. You cannot carry the weight of your profession alone. Seek connection. Build the social capital within your team. Build trust, mutual respect, foster cooperation, and acknowledge effort. When people feel connected and share the vision of what the work culture can be, work becomes more sustainable and enjoyable.

CONTROL

Identify the locus of control – decipher your controllables. You may not be able to control how many times your patients ask you the same question in a day. Pharmacists have shared with me that some days they answer the same question over 75 times! You can control how you respond. Coach yourself – I will respond in a kind and professional manner because this is who I am and how I want to show up for the people who are counting on me.

FAIRNESS

Ensuring that equity, inclusion, and diversity are authentically practised in all areas of a workplace is crucial for fostering a sense of fairness and respect. We need to create spaces where all people are seen and heard. It is not just having a seat at the table. It is having a voice too.

FINAL THOUGHT

Managing the risks of burnout comes down to extreme ownership. You need to protect your peace. It would be ideal if the systems adjust and change, but this can only happen when a collective advocates for change. And to be part of that needed change movement, you need to take care of yourself. If we look at each area of intervention the common thread is living within your values. Value-based living frees us from the scarcity mindset. So many people start their day with this feeling of scarcity; not enough sleep, too little time, a lack of support, or a lack of feeling of lack of motivation or discipline to change. My invitation is to prioritize what matters most. Shift your perspective to a mindset of sufficiency. You already have everything you need to do this work. Awaken a rich sense of sufficiency and know that you deserve to be well. It is not selfish to practise self-care. It is science. Take the time you need to be well and stay well. Our country needs you. And for that, WE thank YOU for your service.