Pharmacy Times spoke with Meagen Rosenthal, PhD, about her session at the APhA 2022 Annual Meeting and Exposition, titled "Heal Thyself: Burnout Recovery for Front-Line Heroes."
Meagen Rosenthal: According to the WHO, burnout is a syndrome that is really resulting from chronic workplace stress, right? So we talk about burnout and being like burned out in lots of different spaces in our lives. But the clinical kind of particular definition from the WHO pertains specifically to workplace stress, and this is characterized by feelings of energy depletion, exhaustion, negativism towards your work, feeling cynical, but like extra cynical, like it's not just “I had a bad day and I'm feeling kind of crummy,” it's just feeling of that dissatisfaction pervasively in your work. And then also, it can ultimately impact your professional efficacy, so how well you do your job, if it's allowed to kind of continue on unaddressed.
Rosenthal: In terms of symptoms, we're talking about things like exhaustion, lack of motivation, frustration, you know, slipping in your job performance, forgetting things, you know, that you would normally not have to be worried about, or, you know, having to spend more time on something that you had to do previously, just to make sure that you did it correctly. And then, of course, that kind of general malaise and dissatisfaction with your work. And this also has like some really specific health implications, so things like neck pain, eye fatigue, difficulty sleeping; it has been linked to cardiovascular disease, obesity and depression. And so you know, it is a big, important, you know, impact on your health. In terms of the causes of burnout, we're talking about things like working long hours, juggling too many tasks, on a regular and ongoing basis, right, like this is chronic overwork. It also, and this is something that's particularly interesting to me or of interest to me is like that, the idea of lack of control over how you do your work, which I think is particularly important in the pharmacy world, where often a lot of how pharmacists perform their tasks is dictated by other people. And so feeling like you don't get to have a say in how you deliver care to your patients over a long period of time is a major contributing factor to burnout. We're also talking about a lack of support from your direct reports and your managers, and then also this idea of a misalignment between what you thought you would be doing and what you are doing, and that's, again, on an ongoing chronic kind of basis, and this is what leads to burnout for our for our pharmacy friends.
Rosenthal: I think I always like to start the conversation with the individual, because when we're in the midst of burnout, it feels more oftentimes, like we don't have any control, when in fact, we do have a little bit of control still. And I'm in particular thinking through that alignment between what we think we're doing and what we want to be doing kind of that idea of the true calling of our work. And so sitting down and asking yourself some really hard questions about, you know, how you want to practice your work, how you want to feel at the end of the day. And there's a number of questions that kind of guide you through to talk about this. In terms of the professional level, I think the other thing to be thinking about from a managerial perspective is, you know, asking the hard question: is the work I'm asking from my staff, reasonable, right? Is this too much work, is this something that can reasonably be accomplished in in our day-to-day life? And I think that it's important here to step outside of what's been expected, or what's been done, because I don't know that expectation. And this is a stereotype, but something I've heard so often in the time that I've been in pharmacy, that pharmacists don't get to go to the bathroom during the day or don't get to have lunch. And that might be true, but that's wrong, right? That’s just a terrible way to function. And so, is the workload reasonable? Do the people who are doing the work every day have adequate amount of control over how that work is conducted to feel that level of autonomy and kind of management of their of their day to day lives?Are there sufficient rewards being provided to the people in the space? Right, and this is not just, you know, simply talking about monetary rewards? There's a lot of different reward structures out there that have very little to do with financial benefit, but are they being acknowledged and for their contributions to the organization? Do people in the company or the pharmacy feel like they have a sense of community, right? Do they feel like they're all part of the same team that are working towards the same goal? Are the decisions you know, being made within the organization perceived as being fair? And these are the kinds of questions that really do need to come to the staff themselves. And I know this would be a hard thing to have to ask and to be able to get true and honest answers from, but this is a really important process to go through. And are there finally, and potentially most importantly, are the values of the of the job consistent with the values of the workers, right? It’s that talking again, about that alignment between our true calling of our work and what we get to do on a day to day basis. And then finally, from a professional level, and this is where it gets, you know, even more tricky, right? The individual stuff we have control over as individuals, right? Our managerial or supervisory capacity, you know, that's a slightly smaller piece of the elephant to chew. But when we're talking about those professional values, and that professional alignment, thinking through really carefully as pharmacists scope of practice continues to expand, which I feel is an amazing thing. And this is part of the reason why I've been in pharmacy as a non-pharmacist and working really, you know, to help pharmacists be more successful at their work, their capacity to provide amazing patient care and help patients take their medications better, and over time, and in the way that is, you know, really moving the needle on patient outcomes. You know, thinking about what, as we continue to expand that scope of practice what has to give, right, like we just keep adding, oh, one more thing- now you're going to do immunizations. Now, you're going to do MTM. Now, you know, in certain places, we're talking about prescribing authorization, oh, and comprehensive medication management and all these things. Is that too much? And what are we as a profession thinking through of like maybe that we divest pharmacists from that other members of our healthcare team could be taking on in a different kind of way? I think it's unreasonable and unfair for frontline pharmacists to be burdened with here. Not only do you do all your insurance, phone calls and you're doing MTM, and oh, by the way, you're going to give 600 flu shots this month, and all these kinds of things without thinking carefully about what's going to give. And then from an academic, you know, researcher side, how do we not only help push the envelope on those new scopes of practice that we know pharmacists would be amazing at, but help create those scopes of practice in a way that they can be easily integrated into practice? And without leaving the expectation that pharmacists just figure it out. Like we know you can do NPM, so just go figure out how to do it on your own. Like that's not a reasonable expectation to have. Because, you know, researchers, we're the experts in that space, right, of how to do that. So let's work harder on figuring out how to do that in an effective way that helps give them the tools that they need to be successful and in all of those different endeavors.
Rosenthal: If there could be a bright spot for a pandemic, and I noticed that that's a huge ask, right, is that these conversations are happening in a way now that I've never had heard them happen before, like burnout has been a function of pharmacy practice for as long as I can remember, but having really direct and specific conversations about this, and the impact it has on people's capacity to do their work. And at this point, more importantly, about, you know, access to these amazing resources as healthcare providers, as they, you know, there's been a kind of leaving of the profession in a not insignificant numbers. I hope we continue to have these frank and open conversations about the impact of these things and that they not only happen, but they lead to action, right, and I think that's a really key part of these conversations is that not only do we acknowledge that burnout is a significant problem, but let's start implementing some of the best practices that we have in that area around how to mitigate burnout at the individual, at the kind of store, and at the professional level, so that we don't have to kind of come back and have this conversation and find barriers being like “well burnout’s still a thing,” because that's not useful either. So that's my hope for this, is that we continue these conversations, but that we continue them towards action.