Avoiding COVID-19 battle fatigue requires intentional efforts by employees and supervisors.
With millions of health care professionals heroically fighting COVID-19 on the front lines, battle fatigue has kicked in for many.
This battle fatigue transcends mere tiredness and is more specifically referred to as burnout.
“Burnout” as a concept was first proffered by clinical psychologist Herbert J. Freudenberger, who, in the 1970s, volunteered at a free clinic and observed that the demands of the job had left many of the workers feeling emotionally drained, resulting in cynicism, fatigue, and frustration.1
This concept was further refined by social psychologist Christina Maslach, who defined burnout as consisting of decreased feelings of personal accomplishment, as well as depersonalization and emotional exhaustion.2 The idea of burnout is particularly important to individuals who work in the pharmacy field, including pharmacy technicians, because of the impact that it can have not only on the health professional’s well-being but also on the health outcomes of the patients they serve. Burnout can also lead to lapses in judgment, resulting in medical errors.3 In the field of pharmacy, eliminating medication errors and providing efficient customer service are 2 of the highest priorities. The results of a 2017 study focusing on pharmacists showed that the rate of burnout among clinical pharmacists was 61.2%, which can surely spill over to technicians.4
Mitigating the likelihood of burnout requires a multifactorial approach. Some of the precipitating causes of burnout include an increased level of bureaucratic responsibilities, poor relationships with supervisors, and spending too many hours at work per week.1,5 As such, addressing burnout is a concern among individual employees and organizational leaders and supervisors.
On an individual level, there are several things to consider. The results of a 2018 study examining PGY1 pharmacy residents showed that participating in enjoyable activities, spending time with family and friends, and staying optimistic were some of the most effective coping strategies used to mitigate feelings of burnout throughout their residencies.6 These findings are validated by a meta-analysis conducted by Shin et al.7 Their study analyzed 2 kinds of coping strategies, emotion-focused and problem-focused, and the relationship that these strategies have with the 3 dimensions of burnout defined by Maslach.7
Problem-focused coping attempts to solve the stressful situation directly targeting the stressor to decrease or minimize it.8 Emotion-focused coping attempts to manage stress by focusing on the negative emotional reactions to the stressful situation and instead of taking actions to alter the stressor, uses tools such as meditation, positive reframing, prayer, or relaxation techniques to change perspective.8
Both strategies serve particular uses and help to mitigate feelings of burnout.
With these results in mind, pharmacy professionals can develop their own stress-reducing strategies to guard themselves against burn-out in the workplace.
On an organizational level, a progressive strategy to mitigate employee burnout was taken at Stanford Medicine in California, which several years ago created a position called chief wellness officer.9 This position takes on the responsibility
of creating initiatives to combat physician burnout within the institution.9 With this idea in mind, institutions and pharmacy practices can also consider taking a more intentional approach toward combating burnout in the workplace. Because pharmacy professions also demonstrate high rates of burnout, developing an organizational leadership approach would be in the collective best interest.
To assist health care workers, organizations can consider expanding or implementing access to mental health and self-care resources.1 Providing education about the symptoms of burnout, so that individuals can recognize it within themselves or their coworkers, can also help create a culture within practices or institutions that allows people to mitigate the negative outcomes that burnout can have on themselves, coworkers, and patients. Additionally, given that burnout often stems from stress in dealing with managers, those in supervisory positions can take heed and be more mindful of their verbal engagements with employees, making sure they understand that their contributions are valuable to the organization.
Avoiding burnout is contingent upon develop- ing effective coping strategies at the individual and organizational level. It requires intentional efforts from both employees and supervisors. Some coping strategies are more effective than others, but no one size fits all. For some individuals, this may involve leaning on the social and spiritual atmosphere of religious faith. For others, it may involve directly intervening in the stress- ors of the workplace to mitigate stress. For many, it likely involves a combination of emotion- and problem-focused approaches to deal with the everyday stresses faced at work.
Regardless of the approach, pharmacy professionals must confront the reality of burnout and the implications it has on their well-being and the health outcomes of patients. This way, they can begin to make changes in their own lives and lobby for organizational changes to create a positive workplace environment. In doing so, they can help revitalize themselves as they continue to provide efficient patient care during the COVID-19 pandemic and beyond.
Eric Flemings is a PharmD candidate at Touro University, California College of Pharmacy in Vallejo and a pharmacy intern at Walgreens Boots Alliance in Fremont, California.
Shane Desselle, PhD, RPh, FAPHA, is a professor at the Touro University California College of Pharmacy in Vallejo.
1. Reith TP. Burnout in United States healthcare professionals: a narrative review. Cureus. 2018;10(12):e3681. doi:10.7759/ cureus.3681
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3. Tawfik DS, Profit J, Morgenthaler TI, et al. Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors. Mayo Clin Proc. 2018;93(11):1571-1580. doi:10.1016/j.mayocp.2018.05.014
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6. Zinurova E, Dehart R. Perceived stress, stressors, and coping mechanisms among PGY1 pharmacy residents. Am J Pharm Educ. 2018;82(7):6574. doi:10.5688/ajpe6574
7. Shin H, Park YM, Ying JY, Kim B, Noh H, Lee SM. Relationships between coping strategies and burnout symptoms: a meta-analytic approach. Professional Psychology: Research and Practice. 2014;45(1):44-56. doi:10.1037/a0035220
8. APA Dictionary of Psychology. Accessed February 1, 2021. dictionary.apa.org/emotion-focused-coping
9. Richter R. In a first for US academic medical center, Stanford Medicine hires chief physician wellness officer. Stanford Medicine. June 22, 2017. Accessed November 11, 2021. https:// med.stanford.edu/news/all-news/2017/06/stanford-medicine-hires-chief-physician-wellness-officer.html