Pharmacy Workplace Wellbeing and Resilience: Themes Identified from a Hermeneutic Phenomenological Analysis with Future Recommendations

Naloxone training programs in corporately-owned versus independently-owned Alabama community pharmacies: A pilot cross-sectional survey

Introduction

Alabama community pharmacists have the ability to furnish naloxone. The purpose of this study was to identify the differences between naloxone training, policies, procedures, and preferences in corporately-owned (chain) versus independently-owned pharmacies in Alabama.

Methods

An online cross-sectional survey was distributed to Alabama community pharmacists via email. Outcome measures included: 1) in-house versus outsourced naloxone education/training topics (13-item multiple-choice); 2) naloxone training preferences (5-item multiple-choice); and 3) perceived usefulness of naloxone education sources (14-item Likert scale from 1 =strongly disagree to 5 =strongly agree). Data were analyzed using descriptive statistics, 2-sided Fisher's Exact tests for categorical and Mann Whitney U tests for continuous/ordinal outcomes.

Results

Among the respondents (N = 64), 37 % were female, 95 % White, with an average age of 42 years. Less pharmacists received naloxone training (77 % vs 98 %, p = 0.016), naloxone education mandated by employers (7 % vs 97 %, p < 0.001), and mean[SD] in-house naloxone education topics (3.7[4.9] vs 8.5[4.2], p = 0.003) in independent versus chain pharmacies. Most independent and chain pharmacies preferred naloxone training in an online self-study format (53 % vs 45 %, p = 0.529). However, mean[SD] perceived usefulness of training sources was lower for employer-based training (2.93[0.96] vs 3.90[1.01], p = 0.003), the Alabama Department of Public Health (2.87[1.19] vs 3.66[0.90], p = 0.024), and the Veterans Affairs Administration (1.60[0.91] vs 2.41[0.98], p = 0.013) amongst independents versus chains.

Conclusions

Findings suggest that pharmacists are not all receiving the same training in independent versus chain pharmacies. Targeted training efforts, including development of educational programs tailored to preferences in pharmacy settings, may lead to more efficient and informed provision of naloxone.

Alienation and/or anomie in pharmacists: A systematic review and narrative synthesis of the international literature

BACKGROUND

Flourishing and belonging are key concepts for the wellbeing of staff and the success of a profession. Alienation and anomie are distinct types of psycho-social ills which inhibit flourishing and belonging. A better understanding of these may offer hope in preventing many negative work endpoints, including burnout and intention to leave.

OBJECTIVES

To systematically review and narratively synthesise alienation and/or anomie in pharmacists across the globe, reviewing all types of methodological designs, published in peer-reviewed journals.

METHODS

We identified published peer-reviewed research through searching eight electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, Web of Science - Core Collection, Scopus, and Google Scholar) and extensive hand/citation searching. Two independent reviewers identified and critiqued eligible studies, extracted data, and synthesised the findings. The synthesis evaluated the focuses, causes, associated factors, and/or consequences of alienation and/or anomie and aligned these to six deductive themes from alienation theory: care; values; meaning; recognition; autonomy; and shared responsibility.

RESULTS

Searches identified 886 papers, with 47 included in the final results. From the synthesis, ten key causes of alienation and/or anomie were identified; 1) Changing Professional Identity, 2) Reimbursement Models & Corporatisation, 3) Focus on Medicines Rather than People, 4) Misunderstanding & Deprofessionalisation, 5) Environments & Culture, 6) Suboptimal Societal Mandate, 7) Roles Misaligned with Aspirations, 8) Systematic Underutilisation, 9) Lack of Professional Agency, and 10) Value Conflict. From the evidence, there was high confidence that inhibitions of care, values, recognition, and/or autonomy (four of the six deductive themes) were associated with alienation and/or anomie.

CONCLUSION

Alienation and/or anomie are present across many countries and regions. This paper helps us understand the aetiology of this complex psycho-social syndrome, a necessary first step in creating an inclusive profession where all pharmacists can flourish. Future research needs to trial new interventions targeted at correcting this professional malady.

Prescription for change: Unveiling burnout perspectives among pharmacy leaders

Background

Burnout among pharmacists is increasingly pertinent, with growing demand for effective interventions. Burnout can lead to reduced productivity, increased job turnover, medical errors, poor patient satisfaction, and other negative outcomes for patients and providers. Growing attention to burnout in the pharmacy profession highlights the need for personal, organizational, and systemic solutions. However, the uptake and relative efficacy of different approaches remain unclear, particularly within community pharmacy practice. This study sought the viewpoint of community pharmacy leaders (i.e., community pharmacy managers, district managers, franchisees, owners, and executives from various pharmacy organizations) to characterize burnout from their perspectives.

Methods

This qualitative study followed a grounded theory approach. Community pharmacy leaders were interviewed using a semistructured format to gather in-depth insights into their experiences and perspectives on burnout and engagement.

Results

Sixteen people were interviewed; interviews lasted 30 to 65 minutes, averaging 51 minutes long. Six themes were identified: perceived disconnection between front-line staff and pharmacy decision-makers, overwhelming work demands, cautious optimism toward the expanding scope of pharmacy practice, the importance of employee recognition and appreciation, appropriateness and use of existing work resources, and multimodal, systemic responsibility and solutions to burnout.

Conclusion

Addressing burnout requires a multifaceted approach involving personal, organizational, and systemic interventions. Evidence from this study provides valuable insights into the feasibility and efficacy of specific interventions, informing future strategies to enhance workplace well-being and engagement. The study highlights the importance of managing job demands and maximizing resources, emphasizing that personal approaches alone are insufficient and that organizational and systemic interventions are crucial.

Accuracy and applicability of a tool designed to address pharmacy personnel stress

BACKGROUND

Many pharmacy workplaces are so stressful that pharmacy personnel are unable to meet both clinical and nonclinical duties. Adjustments to training, roles, and responsibilities are not able to be made quickly enough to adapt to change and meet expanding responsibilities.

OBJECTIVES

Misalignment between a person's unique personality type and their work dynamics can be associated with a stress reaction, what that reaction looks like, and what strategies would be most effective for reducing stress. The objectives for this study were to: (1) assess variability in the personality types of pharmacy personnel, (2) explore variation in most satisfying job activities and perceptions of stress by personality type, and (3) receive feedback regarding the accuracy, applicability, and recommendations for improving a tool for addressing stress.

METHODS

A self-administered online questionnaire was used for collecting data from 1098 pharmacy personnel licensed in Minnesota. After answering four Preferred Communication Style Questionnaire items, a personalized De-Stress Rx report was generated for each respondent's feedback by answering questions about the tool's accuracy, applicability to them for helping reduce or manage stress, and recommendations for improving its usefulness. Data were analyzed using content analysis and descriptive statistics.

RESULTS

The findings showed variability in the personality types of pharmacy personnel and that both the most satisfying job activities and stress perceptions vary by personality type. A tool that was designed to address pharmacy personnel stress was found to be both accurate and applicable. Study participants encouraged the expansion of the tool to include resources for follow-up and implementation. Also, they recommended expansion to teach groups and leaders about how to apply this tool to whole organizations, group dynamics, and evolving practice settings.

CONCLUSION

We propose that the De-Stress Rx Tool can help reduce the stress that is inherent in current pharmacy work settings.

Strategizing the removal of barriers to community pharmacist's business management capabilities

The community pharmacist may be challenged by their dual role of being both a health care provider and practice manager. This commentary proposes strategies to address the barriers to the management role of the community pharmacist in practice as perceived by stakeholders: pharmacist owners, pharmacist managers, pharmacists, and pharmacy students. Whilst some community pharmacist owners may believe managerial skills are not required for the profession, all stakeholders for the most part agree on the barriers to the management role of the community pharmacist in practice and the strategies to address these barriers. Three barriers were identified: business versus professional dichotomy, transitioning theoretical learned content into a practice setting, and professional overload. Three strategies are proposed to overcome these barriers: developing a dual thinking process, learning practice management from mentors, and the philosophy of becoming a leader and the team builder. A paradigm shift within the current culture in the profession may be required to overcome the barriers. This commentary also highlights the need to explore leadership in community pharmacy.

"We're seen as part of the supply chain of medicines rather than as the professionals that we are": The wellbeing of community pharmacists during the COVID response

INTRODUCTION

Challenges facing community pharmacists in delivering and adapting services during the COVID-19 response have been reported. However, few qualitative studies have examined the impact of these experiences on their wellbeing, and what supports the profession requires in the future.

AIM(S)

To examine the work-related experiences and psychosocial needs of community pharmacists situated in the Republic of Ireland arising from the COVID-19 response.

METHOD

11 pharmacists and 1 representative were interviewed and data analysed through inductive thematic analysis.

RESULTS

Work experiences were characterised by increased workload linked to multiple roles pharmacists played during the pandemic. Remaining open, meeting the social and medical needs of patients unable to easily access other primary services exerted its toll on pharmacists while at the same time providing a sense of professional fulfilment. Participants felt contributions made to the community during COVID-19 went largely unrecognised by the wider healthcare structure. This added to a prior sense of professional disenchantment arising from long-standing under-resourcing, lack of clinical autonomy and high administrative burden eroding their sense of purpose and meaning. Informal, peer-support networks were preferred over formal psychological support initiatives.

CONCLUSIONS

The post-pandemic environment is an opportune time for policy makers to reconsider the role of community pharmacists. Greater clinical autonomy beyond dispensing of medicines, for example, for example, would also serve to enhance the sense of purpose and meaning of pharmacists as healthcare professionals. The longer-term well-being of community pharmacists is contingent on recognition of the value that community pharmacy bring both to the healthcare system and wider society as a whole.

Moderating effect of work fatigue on the association between resilience and posttraumatic stress symptoms: a cross-sectional multi-country study among pharmacists during the COVID-19 pandemic

INTRODUCTION

In the context of the COVID-19 pandemic, pharmacists, despite their vital contributions, have faced significant challenges that have impacted their mental well-being, potentially leading to the development of Post-Traumatic Stress symptoms (PTSS). The aim of this study was to investigate the role of work-related fatigue as a potential moderator in the relationship between pharmacists' resilience and their likelihood of experiencing PTSS during the COVID-19 pandemic.

METHODS

A cross-sectional survey was conducted online in eight countries from January to December 2021, including Brazil, Lebanon, Nigeria, Pakistan, Poland, Serbia, and Tunisia. The mediation analysis was conducted using PROCESS MACRO (an SPSS add-on) v3.4 model 1, taking work fatigue as a moderator in the association between resilience and PTSS.

RESULTS

A total of 442 pharmacists were enrolled in this study (mean age = 33.91 ± 10.36 years) with 59.5% of them being females. The results were adjusted over country, gender, working in contact with COVID-19, working patients, working mandatory hours, working voluntary hours, age, household crowding index and number of months engaged in COVID-19. The interactions resilience by physical (Beta = 0.02; p = .029), mental (Beta = 0.02; p = .040) and emotional (Beta = 0.03; p = .008) work fatigue were significantly associated with PTSS; for pharmacists with low to moderate levels of physical (Beta = - 0.33; p < .001 and Beta = - 0.21; p = .001), mental (Beta = - 0.29; p < .001 and Beta = - 0.18; p = .006) and emotional (Beta = - 0.31; p < .001 and Beta = - 0.17; p = .008) work fatigue, higher resilience was significantly related to lower PTSS levels. However, for pharmacists with high levels of physical/mental/emotional work fatigue, the association between resilience and PTSS became non-significant.

CONCLUSION

This study highlights the complex relationship between work-related fatigue, resilience, and PTSS in pharmacists. It emphasizes the need to address work-related fatigue for pharmacists' psychological well-being during crises, offering insights for tailored support and interventions.

Pharmacists must take an active role as citizen scientists

Science is a process by which society advances knowledge of the physical and natural world through observation, experimentation, and testing of theories based on evidence. This process forms the foundation of the biomedical, clinical, and social sciences, which together provide an ever-changing knowledge base for health care professionals, like pharmacists, to use to provide evidence-based care to patients and communities. Yet, despite the essential and integrated application of science to improve health-related knowledge and care delivery, the utility and viability of science itself are under threat. Science as a broad discipline continues to be subject to politicization, misinformation, and persisting inequities among its beneficiaries. Science remains the subject of disparate perspectives regarding its societal benefits and expected roles. Pharmacists, given their education, training, and earned trust, can help to address these challenges by engagement as citizen scientists. Citizen scientists, through involvement with related initiatives, promote and advance all aspects of the public good, which are essential to the continued smooth functioning of our society. Pharmacists are well positioned to be engaged in various citizen scientist roles available in their communities that promote the public good economically, politically, and culturally. Involvement in citizen science activities is not without personal cost. This can be challenging, depending upon the level of involvement. It might take time away from other desired activities and generate perceived deficits of self-efficacy. Yet pharmacists who engage in the process of scientific discovery at any level as citizen scientists can experience personal and professional benefits, engage with other members of their communities, and provide an opportunity to serve as role models to others considering a career in pharmacy.

Moral Distress and Moral Injury in Pharmacy and Why the Academy Needs to Care

Pharmacists and other pharmacy personnel are experiencing job stress and burnout, and in some instances, suicidal ideation and death by suicide. However, the described lived experiences of pharmacists and other pharmacy personnel are not defined by burnout. Thus, consideration of and research about whether pharmacy personnel are possibly experiencing moral distress or moral injury is necessary and urgent. The pharmacy academy is served by considering workplace conditions and lived experiences of pharmacists because of the potential, negative impact on prospective student recruitment, quality of experiential sites and preceptors, sites for clinical faculty placement, and the well-being of alumni. Understanding phenomena occurring for pharmacy personnel and determining how they impact the pharmacy academy can lend itself to the future development of solutions.

A Call to Action to Address Well-Being Within Experiential Education

There is a significant lack of literature exploring or describing pharmacy student well-being during experiential learning even though students spend 30% of their doctor of pharmacy curricula in this environment. Drawing on inspiration from literature describing well-being challenges and solutions for pharmacy residents and other health disciplines, this commentary explores the unique challenges of supporting pharmacy student well-being during experiential education. Approaches for interventions are described along with a call to action for the academy.