Kay Yamamoto, PharmD

Two years after the start of the COVID-19 pandemic, health care workers continue to face challenges.

Many health systems and pharmacies have grappled with drug shortages, patient care issues, rolling out new COVID-19 therapies, staffing constraints, and vaccination demands during the past few months. Along with the rest of the world, health systems have had to implement strategies to cope with this complex and often tiresome “new normal.”

In addition to clinical and operational challenges, many work settings have changed drastically. Starting out as necessities because of quarantine restrictions, remote work models and telehealth have become permanent fixtures in many organizations. These may be beneficial in terms of health care worker and patient safety, but they can limit feelings of workplace support and social interaction. The addition of these stressors on top of the already demanding responsibilities of health care workers means burnout remains a huge concern in the face of an uncertain future.

Burnout is a term often thought to mean feeling tired, but its presentation can be much more than exhaustion. Burnout is a phenomenon defined by the International Classification of Diseases 11th Revision as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”

The syndrome presents with symptoms of blunted emotions, cynicism and negativity related to one’s job, detachment or disengagement from work, energy depletion or exhaustion while at work, loss of enthusiasm or motivation, and reduced professional efficacy.

Burnout can result in job dissatisfaction, leading to decreases in productivity and teamwork. Although burnout itself is not considered a disease, findings from cross-sectional studies have shown it to be associated with mental illnesses, such as alcohol dependence, depression, and even suicidal ideation.

Burnout not only affects those who experience it, but it can also have a downstream effect on patients and their care experiences. Health care–associated infections, increases in medical errors, and patient mortality ratios are associated with burnout. It also negatively affects adherence to medical advice, patient-provider relationships, and patient satisfaction.

Many tools can be used to measure burnout, but the 2 standout tests with national benchmark data for health care professionals are the Maslach Burnout Inventory - Human Services Survey for Medical Personnel (MBI-HSS MP) and the Well-Being Index. Both have strong data that show correlation with outcomes of interest, such as medical errors and turnover.

 The MBI-HSS MP tests for occupational burnout across 22 items and takes 10 to 15 minutes to complete. The survey is used frequently in research and has 3 dimensions: depersonalization (possessing an impersonal and unfeeling response toward patients), emotional exhaustion (feeling emotionally overextended and exhausted because of work), and personal accomplishment (feeling competent and a sense of achievement at work).

 Broader than the MBI-HHS MP, the Well-Being Index analyzes dimensions, such as the dropout risk, likelihood of burnout, meaning in work, overall well-being, quality of life, risk of medical error, severe fatigue, suicidal ideation, and work-life integration.

Burnout is a growing topic of research in pharmacy, and the evidence suggests it is prevalent across all practice settings. In a 2017 survey of 974 inpatient clinical pharmacists, 61.2% were determined to have burnout, and in a 2018 survey of 328 health system pharmacists, 53.2% similarly reported experiencing a high degree of burnout.

 Prior to the pandemic, a 2020 survey of community pharmacists showed that 74.9% reported burnout in at least 1 of the 3 MBI-HSS MP subscales; 68.9% experienced emotional exhaustion, 50.4% experienced depersonalization, and 30.7% experienced reduced personal accomplishment.

 Pharmacy technicians are not exempt from the effects of burnout, either. In a 2020 study of 253 technicians in North Carolina, 69.1% reported experiencing burnout within the past year, with 67.8% scoring high on emotional exhaustion and 36.4% scoring high on depersonalization.

 Pharmacy residents are also susceptible to burnout, undergoing intense training with continual pressure to balance several responsibilities simultaneously. A 2019 survey of 43 residents showed a burnout rate of 74.4%, and in a 2017 study of 524 pharmacy residents, those working more than 60 hours per week reported high levels of depression, hostility, and stress.

Some potential risk factors that can contribute to burnout include the following

Being female, a nonmodifiable risk factor associated with burnout in research

Having caretaking responsibilities, such as dependent children or family members

Lacking resources or time to meet deadlines or demands

Having a poor work environment, such as frequent interruptions, lack of human interaction, and too many duties unrelated to areas of interest

Feeling one's work culture lacks collaboration and/or safety

Many of these risk factors relate to organizational culture and workplace conditions, which have been put under extra stress with the pandemic. Remote work, although necessary to reduce the spread of infection, can make it harder to communicate with coworkers and maintain the feeling of support gained from face-to-face interactions. Drug and staffing shortages and the introduction of new therapies and vaccines mean juggling limited resources to build processes that need support, while still upholding the same care standards.

In a study of 267 health care workers in Italy during the pandemic, results from a cluster analysis showed that the difference between workers with low burnout risk (high personal accomplishment, low depersonalization and emotional exhaustion) vs high burnout risk (high depersonalization and emotional exhaustion, low personal accomplishment) was the ability to maintain resilience and tolerate uncertainty.

 How can health systems build resilience to reduce the risk of burnout?

Resilience is the ability to adapt to or recover from change or misfortune, and to maximize it, health systems should try to anticipate and target the risk factors at their organizations that may cause burnout. Organizations can take many initiatives to improve wellbeing and reduce workplace stressors, such as

Adjusting schedules and acquiring sufficient staff to support the pharmacy services provided

Celebrating wins, commending others, and letting employees know they are appreciated

Developing clear, standardized, and up-to-date guidelines, policies, and procedures

Ensuring honest and open communication and hosting team meetings often to ensure that staff members feel heard, prepared, and protected

Maintaining engagement by implementing career progression planning that encourages individuals to practice at the top of their abilities and licenses

Optimizing workflows wherever possible to reduce workload while maintaining efficiency and safety

Reviewing and editing the goals, mission, and values of the organization and ensuring its ongoing alignment with the interests and needs of the institution, patients, and staff members, especially during times of momentous change

Strengthening workplace relationships by fostering collaboration on team-based projects and learning, creating after-work in-person or virtual social events, and developing a system of mentorship

Supporting the emotional, mental, and physical health of staff members by providing counseling and other employee assistance and support resources

The COVID-19 pandemic has increased concerns about burnout, which has prompted health systems to address and support employee well-being through institutional interventions and programs. Burnout is not a new occurrence in health systems and pharmacies, and it will likely remain a challenge as the profession progresses, navigates uncertainties, and moves forward into the future of health care.

is the medication safety and quality coordinator of hospital pharmacy services at the University of Illinois Hospital & Health Sciences System and a clinical assistant professor in the UIC College of Pharmacy Department of Pharmacy Practice in Chicago, Illinois.

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