Roundup: Burnout: When Everyday Irritations Ruin Your Career

Dr. Zanni is a psychologist and healthsystemsspecialist based inAlexandria, Virginia.

What comes to mind when onethinks of occupational hazards?Most think of jobsinvolving heavy physical demands orexposure to potentially life-threateningsituations. Pharmacists, however, are athigh risk for a more subtle, insidious occupationalhazard: burnout. It is psychologicallyand physically debilitating—evencareer-ending—and its warning signsshould be red flags for all pharmacists.

Defining Burnout

Burnout, a multidimensional syndrome,is generally recognized only aftersymptoms wreak havoc. Acute burnoutdoes not exist; slowly developing symptomsworsen progressively. Burnout's 3core domains to recognize are as follows:

• Cynicism—negative job and workplaceattitude, often directed at staffand clients, which leads to depersonalization(eg, a cold, distant attitude);considered by many as burnout'sdistinguishing characteristic
• Emotional exhaustion—feeling physicallyand emotionally depleted, apathetic,and indifferent
• Ineffectiveness—with time, a sense ofinadequacy, which leads to devaluingone's own work and causes anxietyand trepidation from a belief that newwork tasks are meaningless¹,²

Burnout and stress differ. Stress maycause emotional exhaustion, but burnoutalways generates cynicism and a senseof inadequacy (characteristics that areabsent from normal job-related stress).Job stress, however, generally includessomatic symptoms (eg, anxiety) that arenot necessarily present with burnout.One also is usually aware of stress reactionsbut does not always notice burnout(symptoms can take months to surface).

When workplace expectations andrealities are disparate, burnout is a given.The following 6 areas are often troublesomefor pharmacies:

• Work overload—when workloadchronically exceeds realistic levels,staff is taxed with additional job responsibilities,and work–familyboundaries become blurred, oftenexacerbated by on-call demands ande-mail communications
• Lack of control—inflexibility crampsnovel approaches, job sharing, andinnovation as staff struggles to staywithin the limits of rigid procedures
• Breakdown in community—withouta sense of belonging and job security,staff cohesiveness declines
• Unfairness—evaluations fail to recognizeoutstanding performance, ormeager rewards are given randomlyand without apparent reason
• Insufficient rewards—managementrewards staff only rarely or emphasizesnegative outcomes (ignoringsuccessful efforts)
• Value conflict—the organization'sactions differ from its public façade(eg, management emphasizes screeningfor drug interactions and safety inadvertisements but provides antiquatedtechnology), or increasinglyan employee's values might beignored (eg, an organization providesthe morning-after pill but offers noconscience clause for employees toopt out of filling these prescriptions)²

Pharmacy is fertile ground for burnoutdue to chronic staffing shortages, theheavily regulated environment, excessivedocumentation, the inability to control requests, a focus on negative outcomes (eg, prescriptionerrors), incongruence between expertise and job components (eg,certified in disease management but performing peel-and-stickbench work), lack of positive feedback (eg, drug-use reviews rarelycommented on), and few rewards for improved patient care or preventingcontraindications. Inadequate pharmacy resources seemto reach epidemic proportions. In a recent pharmacy poll, 61.5% ofrespondents indicated their employer has unrealistic expectationsregarding work that can be accomplished in an 8-hour day.³

Burnout's Warning Signs

Although >30 signs of burnout exist, the box highlights 10 classicsigns that relate to pharmacists. Not all will experience eachsymptom; most experience at least 1 in each of burnout's 3domains. Identifying with ≥1 of the signs listed in the box occasionallyor regarding specific incidents is normal. When it becomes constant,action is needed, or burnout will consume and debilitate.

Interventions

Pharmacists with burnout must self-assess, looking for workplaceconditions that fuel burnout. The following are some effectivestrategies for each workplace antecedent:

Workplace Overload. Avoid focusing on quantity or workingharder; instead, examine the process used to complete tasks withan eye to change. Explore job sharing or trading assignments withcolleagues. Overhaul daily routine and reshuffle tasks.

Lack of Control. Define and separate work and home life. Avoidworking while eating. Take breaks but avoid discussing and readingwork-related material. Learn to say "no" when asked to voluntarilytake on more assignments.

Insufficient Rewards. Seek positive feedback. Inform supervisorsthat both positive and negative feedback are important to you.

Lack of Community. Seek others suffering from burnout andform a peer support group. Initiate actions that foster interpersonalrelationships; talk to a career-seasoned mentor.

Unfairness. Work with supervisors to improve the workplace.Document personal accomplishments to help ensure fairness.

Value Conflict. Seek out value-compatible assignments. Focuson the intrinsic value of your work, not on organizational constraints.Explore potential transfers. If the value conflict is irreconcilable,seek counseling or make a career change.¹

Young Professionals Take Note

Studies demonstrate that burnout affects younger professionalsdisproportionately, especially in the first 5 years of their career.Young or struggling pharmacists may hesitate to discuss concernswith supervisors, confusing feeling overwhelmed with personalinadequacy.^1,2 Because most managers rarely discuss burnout, thestaff struggles. Some find successful interventions or a mentor tohelp; others quit the job or the profession. Adopting preventionstrategies to ward off or minimize burnout is a key component ofensuring job satisfaction.

Table

Adapted from references 1, 2, and 4.

References

• Maslach C. Burnout, The Cost of Caring. Cambridge, MA: Malor Books; 2003.
• Maslach C, Leiter M. The Truth About Burnout. San Francisco, CA: John Wiley & Sons; 1997.
• Smith M, Jaffe-Gill E, Segal R. Burnout: signs, symptoms, and prevention. www.helpguide.org/mental/burnout_signs_symptoms.htm. Accessed October 26, 2007.
• PharmacyOneSource. Poll Results: Do you feel your employer has unrealistic expectations of what you can accomplish in an 8-hour day? www.pharmacyonesource.com/members/surveys/se/poll/results.asp?survey_id=557. Accessed October 8, 2007.