Learn to Mitigate Feelings of Burnout and Stress

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Supplements, April 2022 Technician Supplement, Volume 4,

Lack of acknowledgement or rewards in high-pressure pharmacy environments can lead to mental health issues.

As stress rises for workers and as more individuals quit their jobs or retire, the concept of burnout has gained attention. As described by the World Health Organization (WHO) in its International Classification of Diseases, “burnout is a syndrome conceptualized as resulting from workplace stress that has not been successfully managed” and is categorized by exhaustion, a low sense of accomplishment and personal impact, and negative feelings toward a job.1

In addition to WHO’s definition, there is a common conceptualization of burnout as per the Maslach inventory.

It consists of depersonalization, emotional exhaustion, and lack of personal accomplishment.2 The culmination of these feelings can cause individuals to lose motivation and decrease quality of their work, which can become dangerous in industries as critical as health care.

Although burnout can happen to anyone in any profession, health care workers are especially vulnerable because of the potential consequences of their actions and the high performance standards and high-stress environments in which they work.3 Health care workers are more likely to experience higher levels of burnout and stress if they are female, unmarried, younger than 30 years, or have low self-esteem, among other risk factors.3 They are also frequently subject to chronic understaffing and an immense workload, especially in the pharmacy profession.4

Although there are numerous studies exploring burnout among nurses and physicians, few have focused on pharmacy staff members and even fewer have examined pharmacy technicians.5 This is unfortunate, because technicians may have some of the highest burnout rates in health care. Compared with nurses and physicians—who reported 43% and 50% of professionals experiencing burnout, respectively—the results of 1 survey of health system pharmacy departments reported a burnout rate of 70% among participants.5

Results of another study of technicians in Singapore showed that 52% of respondents were clinically categorized with moderate or greater levels of burnout via evaluation of their survey responses, although 81.7% reported feelings of burnout on a subjective level.6 Pharmacy teams receive little attention to their mental health, despite being among groups most vulnerable to burnout.

Results of a study of health care professionals showed that those with postgraduate degrees are less likely to experience burnout, possibly because there is a greater sense of achievement associated with earning such a degree.3 Technicians might not be rewarded properly or shown acknowledgement for their important work, contributing to depersonalization and feelings of a lack of accomplishment, even while laboring in high-pressure environments under intense scrutiny.

Technicians participate in myriad tasks, all of which are vital to effective pharmacy practice. In a survey of certified technicians, those in community settings reported that their most important roles are collecting and communicating patient information and filling and verifying prescriptions.4

In the hospital, technicians reported being most involved in packaging and repackaging activities, quality assurance and unit inspections, and restocking automated dispensing cabinets.4 This is not an exhaustive list of responsibilities for technicians, but it does highlight their essential contribution to effective pharmacy services delivery.

Recognizing the efforts of technicians and conveying proper appreciation for their work are important steps in mitigating their burnout, which helps them want to stay with the organization and in the profession. Although technicians report amicable relationships with pharmacists and fellow technicians, many report dissatisfaction with their employers, citing being treated as replaceable, poor pay, and understaffing as major sources of their work stress.4 Technicians who experienced burnout reported decreased sleep quality, higher rates of mental health conditions, lower job satisfaction rates, and more frequent thoughts about changing jobs or careers compared with those not experiencing burnout.6 With such high burnout rates and the potential consequences for personal well-being and work effectiveness, it is important that employers, pharmacists, and other leaders in the profession act to improve the situation.

Work-related burnout and stress were exacerbated by the COVID-19 pandemic.

It resulted in many health care workers getting sick or becoming anxious about the possibility. This created more staffing shortages even as demand rose at pharmacies because of the roles they play in vaccinations, testing, and treatment. Technicians have, at least temporarily and in some cases permanently, seen an expansion in job responsibilities and scope, due to the pandemic. Under guidance from the US Department of Health & Human Services, certified or state-licensed technicians who received vaccine training have been temporarily authorized to administer COVID-19 vaccines in all states, under the supervision of pharmacists.7 Implementation has been effective and safe, allowing pharmacists to delegate tasks to improve workflow and expanding the role of technicians in serving communities.8 This is a silver lining for the advancement of pharmacy services, yet it remains problematic in regard to technicians’ workloads given their still relatively low pay.

As such, there has been an increase in burnout among technicians, especially in community pharmacies.9 Challenges have included extra work related to COVID-19 involving patients’ questions, access to testing, and new vaccination mandates.

COVID-19 has also exacerbated staff shortages, leading to sick leave, placing more pressure on pharmacists and technicians.9 As a result, there is a larger workload causing more burnout, increased mental and physical fatigue, and weakened immune responses, which can lead to susceptibility to other diseases.

Burnout within community and retail pharmacies has become a phenomenon.

Some states’ required ratios of pharmacists to technicians do not help matters. Although 22 states do not have a required pharmacist-technician ratio, as of 2020 7 required a ratio of 1:2, and 18 required a ratio of 1:3 or 1:4.10 In view of the pandemic, several states have opted to either relax or suspend these requirements to accommodate the increased workload on pharmacy personnel, which has increased productivity without compromising patient safety.10 As the pharmacy industry continues to expand its role in providing health services, permanently implementing such relaxations may be a crucial step forward in maintaining wellness for pharmacists and technicians.

Evidence-based mitigation strategies include the incorporation of exercise programs, regularly scheduled breaks, and wellness teams to focus on preventing burnout. One example of a wellness team at Rush University in Chicago, Illinois, was created and integrated as part of daily routine. The institution decided to implement organizational strategies to address mental health concerns, but initially there was resistance because of factors such as reluctance to engage with services and stigma regarding mental health concerns.11

Health system work environments are not immune to burnout and stressful environments, either. Rush University System for Health created wellness response teams, each of which consists of a licensed social worker, nurse, psychologist, and physician. The leaders of each team conduct quality analyses to ensure that mental health resources, tool kits, and triage are viable. All team members were volunteers from different departments within the institution. Rush University System for Health also appointed a chief wellness officer to coordinate teams and keep track of all services.11 The 4 teams established were engaged in mental health emergency response, mental health intervention programs, wellness consulting services, and wellness rounds.11 After implementing this program, the health system saw an increase in the number of staff members who registered for these services, indicative of the program’s success. Addressing burnout and any associated symptoms such as emotional exhaustion, feelings of depersonalization, and stress can minimize lack of initiative and lost productivity while promoting a positive, safe environment for technicians to grow within their scopes of practice.

There are many evidence-based recommendations and strategies presented in literature that address burnout among health care workers, as well as potential solutions that can be incorporated. However, very few specifically address burnout among technicians. In general, pharmacy managers and owners must recognize burnout as a phenomenon that has short-term and long-term effects. The first step in addressing burnout among technicians is acknowledging that it exists.

Managers should see this as a human condition but also must recognize it from an economic perspective: Employee burnout costs money. Compromised patient safety, customer service mistakes, diminished productivity, errors in dispensing, employee replacement, and heightened legal vulnerability are substantial economic burdens. To avoid these outcomes, managers can balance workload while allowing greater employee buy-in, engagement, and trust in a way that leverages environmental, personal, and situational factors.11 Fostering camaraderie, collegiality, and interpersonal relationships is important in creating a positive workplace culture where burnout is less prevalent. Additionally, managers can help employees further their development in terms of effective coping strategies and emotional intelligence. A public health framework is crucial for implementing burnout prevention strategies.12 Many evidence-based principles have suggested incorporating a prophylactic method of preventing burnout.12

Finding and incorporating ways to diminish burnout in pharmacies is challenging but necessary to preserve vitality in the profession. It is incumbent upon managers to create positive, safe environments for technicians, but it is also the responsibility of technicians to maintain their own wellness and seek development opportunities to help them cope in increasingly challenging, complex work environments.

Madison Kim and Anu Tirupasur are PharmD candidates at Touro University California College of Pharmacy in Vallejo.

Shane P. Desselle, PhD, RPh, FAPhA, is a professor of social, behavioral pharmacy, and administrative sciences at Touro University California College of Pharmacy in Vallejo.

References

1. QD85 burnout. ICD-11 for Mortality and Morbidity Statistics. February 2022. Accessed February 24, 2022. https://icd.who.int/browse11/l-m/en#/http:// id.who.int/icd/entity/129180281

2. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory: third edition. In: Zalaquett CP, Wood RJ. Evaluating Stress: A Book of Resources. Scarecrow Education; 1997:191-218.

3. Johnson AR, Jayappa R, James M, Kulnu A, Kovayil R, Joseph B. Do low self-esteem and high stress lead to burnout among health-care workers? Evidence from a tertiary hospital in Bangalore, India. Saf Health Work. 2020;11(3):347-352. doi:10.1016/j.shaw.2020.05.009

4. Desselle SP, Holmes ER. Results of the 2015 National Certified Pharmacy Technician Workforce Survey. Am J Health Syst Pharm. 2017;74(13):981-991. doi:10.2146/ajhp160666

5. Kraus S, Gardner N, Jarosi N, McMath T, Gupta A, Mehta B. Assessment of burnout within a health-system pharmacy department. Am J Health Syst Pharm. 2020;77(10):781-789. doi:10.1093/ajhp/zxaa042

6. Chong JJ, Tan YZ, Chew LST, Tan KH, Wang A. Burnout and resilience among pharmacy technicians: a Singapore study. J Am Pharm Assoc (2003). 2022;62(1):86-94.e4. doi:10.1016/j.japh.2021.09.013

7. Guidance for PREP act coverage for qualified pharmacy technicians and state-authorized pharmacy interns for childhood vaccines, COVID-19 vaccines, and COVID-19 testing. US Department of Health & Human Services. October 20, 2020. Accessed February 25, 2022. https://www.hhs.gov/sites/ default/files/prep-act-guidance.pdf

8. Adams AJ, Bright D, Adams J. Pharmacy technician-administered immunizations: a five-year review. J Am Pharm Assoc (2003). 2022;62(2):419-423. doi:10.1016/j.japh.2021.11.011

9. Hayden JC, Parkin R. The challenges of COVID-19 for community pharmacists and opportunities for the future. Ir J Psychol Med. 2020;37(3):198-203. doi:10.1017/ipm.2020.52

10. Broughel J, Yatsyshina Y. Pharmacy technician ratio requirements. SSSN. March 22, 2021. Accessed March 29, 2022. https://ssrn.com/abstract=3809876

11. Adibe B, Hebert C, Perticone K, Dowd SM. Creating wellness in a pandemic: a practical framework for health systems responding to Covid-19. NEJM Catalyst. March 24, 2021. March 29, 2022. https://catalyst.nejm.org/doi/ full/10.1056/CAT.20.0218

12. Maslach C. Finding solutions to the problem of burnout. Consult Psychol J. 2017;69(2):143-152. doi:10.1037/cpb0000090