Beating Behind-the-Counter Job Stress

Heavy workloads and long hours make stress management a critical skill for pharmacists. With a basic knowledge of coping strategies, pharmacists can overcome stress to achieve their personal best.

Pharmacy practice can be profoundly satisfying,¹ but it can also be stressful. What makes the pharmacy workplace stressful for you? A constantly ringing phone, the hours spent on “hold” each day, or the heavy workload? A specific coworker’s habits, or conversely, the shortage of skilled coworkers? As you think about it, is your stress at work also aggravated by problems at home or insomnia?

If you are feeling stressed at work, you probably know that other pharmacists experience stress too. A recent study of practicing pharmacists found that more that 68% experienced job stress and role overload. Almost half reported work— home conflicts. Respondents cited role ambiguity as a serious concern—they were often unable to provide ideal professional services because mundane tasks took priority. Among the functions they perceived got short shrift was patient counseling, because they lacked either time or necessary skills.^1-3

Other studies identified interpersonal interactions, level of compensation and advancement, role stress, and career commitment as stress triggers. This research found that when management improves interpersonal interactions among staff members, they become more committed to the profession. Better interactions among staff reduces nonwork conflicts— and the work environment is more manageable. ^4,5

A startling 15% of pharmacists are so stressed in their current job that they have considered finding a new job—a stressful process itself⁶—although most wish to remain in the profession.⁷ Among all pharmacy staff, uncertainty about continuing employment, heavy workload, short staffing, and inability to update and improve professional competence are significant stressors. Staff who report highest satisfaction, lowest stress, and plans to remain on their jobs cite supervisor support and managerial flexibility as key reasons.^6,8,9 Recall the adage, “People don’t quit their jobs, they quit their supervisors.”

The Nature of the Beast

Just what is stress? Acute stress is a normal response to deleterious forces—noise, uncomfortable ambient temperature, hunger, frustration, and expectations that exceed abilities. Closely related to anxiety, fear, and anger, stress causes noticeable biologic effects. We all know the feeling: the quickening pulse, patina of perspiration, tense muscles, dry mouth, and shallow, rapid breathing. Blood pressure also increases. As the stressor disappears, so does the response.¹⁰

In chronic stress, the brief, practical acute responses are inappropriate. Contemporary life’s chronic stress causes behaviors of unexpected intensity or duration, like irritability, unreasonable squabbling in the workplace or at home, frequent illness, insomnia, or appetite changes. Chronic stress also increases the likelihood of substance abuse. Often, people experiencing chronic stress selfmedicate with coffee and introduce a vicious cycle of poor stress response and coffee nerves.^10-12 It is in the best interest of the pharmacist to recognize and decrease stress, as high levels of stress compromise patient safety.¹

Handling Stress

To begin, pharmacists need to read this statement out loud as many times as necessary until they believe it: “High-volume practice, noise, and lengthy hours are not normal or acceptable.”

Many pharmacists believe that working 10- to 13-hour days under a constant barrage of prescription orders in a noisy environment is normal. They beat themselves up when errors occur. This is serious enough that boards of pharmacy in several states as well as some professional organizations are examining workload and shift lengths for pharmacists. In the immediate pharmacy setting, pharmacists themselves must speak up when they experience fatigue due to unreasonable shift lengths or workload.

Stress, like laughter, is contagious. This means that stress reduction goals that fail to include coworkers will be ineffective. Coworkers need to discuss workplace stress and resolve it. Mental health workers call this “de-escalating the situation”—and it relies on excellent communication. All employees need to be comfortable mentioning stressors, for example, and saying things such as, “Can we turn off the radio and lower the ringer on the phone during our rush period?” The Table describes frequent stressors in pharmacy settings and offers possible solutions.

Your Personal Best

Reviewing these stressors and solutions, you are probably rolling your eyes while you think, “My coworkers are never going to agree to this!” But you will never know until you approach them. Since they doubtlessly feel similar work-related stress, they may be receptive to some group solutions.

Meanwhile, you can work on your own issues. Think about the following actions:

Keep things in perspective, and remember that laughter is an antidote to stress. And it is certainly better than taking drugs! (See “Drug Abuse: A Far Reaching Reality” in the September 2010 issue of Pharmacy Times.) During a recent period of extremely high stress, a pharmacist who had never seen the sitcom “Friends” watched one episode (about 20 minutes) once a day. Joey and Phoebe, in particular, helped her laugh away the tightness in her chest. A funny book or a simple joke also helps to relieve stress.

It is important to identify successful stress-reducing strategies and use them— for example, try deep breathing, taking a short break, or doing things to silence or ameliorate environmental triggers. Avoid stress triggers when you can. Practice methods of dealing with difficult customers, and be prepared with open-ended questions such as “I’ll need to call your insurer, and from experience, I know it will be at least an hour. Would you like to wait or come back?”

Connect compassionately with people. Ditch the detached, hurried persona. Take a couple of minutes to really listen to people. Often, you’ll come away from the conversation feeling much better yourself.

Ask others for feedback on your personal stressors. Go so far as to ask coworkers to push a loud noisemaker or sing a silly song when you are getting visibly tense.

Pharmacists often set extremely high standards for themselves—this is logical, because our work demands a high level of accuracy. Remember that you are not perfect. It is hell to be human, but it is also okay to be human. It is even good.

When you feel yourself really losing patience, take a few minutes to breathe deeply, focus on the positive things in your life, and count your blessings. If a coworker frustrates you, ask yourself exactly why you feel that way. Most often, you will find that coworkers do not develop annoying habits in a malicious way.

Final Thought

Many situations will be beyond your control. You need to recognize that fact and act accordingly. Treat yourself the way you deserve to be treated. Plan your diet so you eat well, sleep 7 to 8 hours each night, and exercise.

Ms. Wick is a senior clinical research pharmacist at the National Cancer Institute, National Institutes of Health, Bethesda, Maryland. Views expressed are those of the author and not those of any government agency.

References

1. Mott DA, Doucette WR, Gaither CA, Pedersen CA, Schommer JC. Pharmacists' attitudes toward worklife: results from a national survey of pharmacists. J Am Pharm Assoc. 2004;44(3):326-336.

2. O'Neill JL, Gaither CA. Investigating the relationship between the practice of pharmaceutical care, construed external image, organizational identification, and job turnover intention of community pharmacists. Res Social Adm Pharm. 2007;3(4):438-463.

3. Nimmo CM, Holland RW. Transitions in pharmacy practice, part 4: can a leopard change its spots? Am J Health Syst Pharm. 1999;56(23):2458-2462.

4. Gaither CA, Kahaleh AA, Doucette WR, Mott DA, Pederson CA, Schommer JC. A modified model of pharmacists’ job stress: the role of organizational, extra-role, and individual factors on work-related outcomes. Res Social Adm Pharm. 2008;4(3):231-243.

5. Gaither CA. Career commitment: a mediator of the effects of job stress on pharmacists' work-related attitudes. J Am Pharm Assoc. 1999;39(3):353-361.

6. Gaither CA, Nadkarni A, Mott DA, et al. Should I stay or should I go? The influence of individual and organizational factors on pharmacists’ future work plans. J Am Pharm Assoc. 2007;47(2):165-173.

7. Seston E, Hassell K, Ferguson J, Hann M. Exploring the relationship between pharmacists’ job satisfaction, intention to quit the profession, and actual quitting. Res Social Adm Pharm. 2009;5(2):121-132.

8. Desselle SP, Holmes ER. Structural model of certified pharmacy technicians’ job satisfaction. J Am Pharm Assoc. 2007;47(1):58-72.

9. Lapane KL, Hughes CM. Job satisfaction and stress among pharmacists in the long-term care sector. Consult Pharm. 2006;21(4):287-292.

10. Anisman H, Merali Z. Understanding stress: characteristics and caveats. Alcohol Res Health. 1999;23(4):241-249.

11. Dabney DA. Onset of illegal use of mind-altering or potentially addictive prescription drugs among pharmacists. J Am Pharm Assoc. 2001;41(3):392-400.

12. McGuffey EC. Lessons from pharmacists in recovery from drug addiction. J Am Pharm Assoc . 1998;38:17.