What's the Buzz with Burnout?
Steph’s Note: After a couple hard-hitting, clinically minded-posts, we’re taking a mid-year break this week for an important reminder since it’s been a hot minute since our last one. Whether you’re a student starting clinical rotations, a new resident diving in after your orientation period, or a practitioner juggling all of these new learners, we’re all on the go so much every day, and it’s imperative to take a step back. Smell the roses. For this, we have the help of 2 recent residency graduates (honestly, who better understands the need for balance??)
Shannon Kraus, PharmD, MS, BCPS, graduated from Ohio Northern University in 2017 and recently completed her PGY1/PGY2 Health-System Pharmacy Administration residency at OhioHealth Riverside Methodist Hospital. During residency, her research was focused on burnout within a health-system pharmacy setting. Shannon is excited to launch into the next stage in her career as the Medication Strategy Specialist at Wake Forest Baptist Health.
Shannon is joined on this piece by Kristine Mason, PharmD, MS. Kristine graduated from The Ohio State University College of Pharmacy in 2017 and completed a PGY1/PGY2 Community Pharmacy Leadership & Administration residency with The Ohio State University College of Pharmacy. After many years in the fast-paced world of community-based practice, and years of researching workforce engagement, Kristine pursued research on burnout in Community-Based Pharmacist Practitioners in the State of Ohio. In addition to her passion for pharmacist well-being and resilience, Kristine loves to bike, kayak, and spend time with family. Kristine is excited to begin her post-residency career as the Director for Practice Advancement with The Ohio Pharmacists Association and as an Assistant Professor at The Ohio State University College of Pharmacy.
These two have a serious passion for recognizing and fighting pharmacist burnout. Not only have they composed this post for tl;dr, but you should also check out their podcast on this topic, which can be found here.
Now grab your roses, and SIT. READ. Get ready to smell them!
Imagine you are at work - a patient is there to see you with questions, the phone is ringing off the hook, a physician has a question about a drug interaction, you haven’t used the restroom all day. Now it’s 3pm and you still didn’t finish the granola bar you brought for breakfast… Finally you get home 12 hours later, kick off your shoes and think “I feel so burnt out”.
(Sound familiar to anyone?)
In Community-Based Practice
Common healthcare worker stressors have been described as patient load, high expectations of patients and supervisors/management, and work-home conflict. For those who have practiced in community-based practice you probably have multiple scenarios running through your head of days when you felt overwhelmed by patient load or when you had conflict with a patient or co-worker due to mismatched expectations. And all of this is happening while juggling the many roles that community-based pharmacist practitioners play to help serve their patients. This along with the fast-paced, often high-stress, environment can lead to increased workplace stress and decreased congruence between individuals and their work environment. When practicing in this setting consistently, many may not have the opportunity to mentally digest their days to be able to bounce back the next day. This can lead to higher risk of emotional exhaustion and depersonalization in community-based settings.
In Health-System Practice
Similar to the work stressors experienced in community practice, inpatient pharmacy teams are likewise overwhelmed by workload, lack of control, and conflicts within their work communities. While it would be ideal to eliminate drug shortages as a “quick fix”, the impact of burnout runs deeper and, if ongoing, can lead to medical errors, healthcare associated infections, and increased patient mortality. One study showed that pharmacists in a health-system setting are at higher risk for experiencing decreased feelings of personal accomplishment.
“Burnout” - the new buzzword for healthcare workers. But what does it really mean?
You commonly hear people say they feel burnt out, but are they experiencing this “burnout” that is taking over medical literature and media by storm?
Burnout syndrome is characterized by 3 indicators:
1) emotional exhaustion,
2) depersonalization, and
3) lack of personal accomplishment.
Burnout can manifest as forgetfulness, fatigue/insomnia, GI pain and discomfort, headaches, loss of appetite, feelings of isolation, irritability, feelings of hopelessness, anxiety, and depression.
According to the National Academy of Medicine, causes for burnout include organizational factors, learning environment, practice environment, society and culture, personal factors, and rules and regulations. The overwhelming response to practitioner burnout has been focused on personal resilience. If we could only get pharmacists to eat healthy, exercise, and get a full night’s sleep, we would cure burnout, right? (Spoiler alert!: There’s more to the story!)
But why do we care?
The National Academy of Medicine has shown that clinician burnout can lead to safety concerns, less than optimal patient outcomes, increased employee turnover, decreased productivity, increased health care costs, and a decline in the clinican’s health and well-being. Moral of the story, burnout isn’t associated with great patient outcomes and practitioner quality of life. Clinicians experiencing burnout are:
Less engaged and/or friendly with patients
Less likely to report medical errors
Less productive with their work
More likely to leave their current position, or the profession as a whole
More likely to experience depression or depressive symptoms
More likely to experience alcohol abuse or dependence
More likely to commit suicide
For a profession of people that dedicated many years (and a lot of money!) in training to help improve patient care, these are some pretty powerful statements. I’ve yet to hear a pharmacist tell me they decided to enter this profession with hopes of feeling detached from their work, not empathetic to patient concerns, or to want to turn around and leave pharmacy a few short years after becoming licensed.
So what do we do about this?
As burnout syndrome is gaining visibility in healthcare media, one of the most common “cures to burnout” is improved personal resiliency and mindfulness.
While personal resiliency and the ability to bounce back from stressful situations are ever important as healthcare providers, it is also important that we as a profession are addressing the systemic causes of burnout. Some systemic/organizational tactics include:
Aligning organizational mission, vision, values, and culture
Developing high-functioning and diverse teams at all levels of an organization
Ensure personal career “fit” to improve work-life integration
Simplification of documentation requirements
Breaking through the stigma of mental health
Decreasing administrative burden on practitioners
Simultaneous organizational “top-down” approaches mixed with individual “bottom-up” resilience training will allow us to meet in the middle of this complex issue to prevent burnout in pharmacist practitioners.
… But what can I do?
This is indubitably the most challenging part of the conversation, where the rubber hits the road, the million dollar question!
The first step is recognizing that you are burnt out! There are a variety of tools that can you can use for a small charge, or for free. Some free options include Stanford Medicine and Mind Tools. Once you know if you are experiencing, or at risk of experiencing, burnout you might be thinking, “Now I KNOW I’m burnt out (or at risk for) – but what can I DO?”
(If you aren’t burnt out or at risk of burnout, share your positivity and resilience skills with your peers!!)
Now back to burnout. Unfortunately, there’s no one-size-fits-all fix for burnout. To address your personal contributors to burnout, you must understand how you personally express stress. In other words, what are your stress symptoms?
If you experience physical stress such as insomnia and muscle tenseness, use physical coping strategies such as running, yoga, or HIIT. Likewise if you experience “thought”-based stress, utilize cognitive coping strategies such as journaling and positive self-talk. Just as the causes for burnout are very individualized, so are the prevention and coping strategies. Some various strategies can include:
Physical activity (everything from running marathons, to yoga, to taking the stairs and parking at the back of the parking lot)
A healthy and well-balanced diet
Mini-breaks/vacations (Who’s up for a weekend road trip?)
Sharing stories and talking with friends, family, and those close to you
Finding your purpose through spirituality
AND SO MANY MORE!!!
Try a strategy and see how it feels! We know that as pharmacists, we like to live in a “black and white world”, but this is an opportunity to use a “gut check”. Keep trying different strategies until you find what works for you. Just like you would counsel a patient on warfarin to be consistent with the amount of leafy greens in their diet or a patient on insulin to be consistent with their diet and exercise… THIS IS NO DIFFERENT! Find a way to incorporate these activities into your day-to-day to maintain well-being.
“You cannot merely expect culture to be a natural occurrence; it has to be taught and made a part of your everyday routine.”
- Mike Krzyzewski
We pharmacists (or soon-to-be pharmacists!) must invest in our own well-being through resilience training, but we also should expect the organizations and associations that represent our profession to be advocating for alignment in our practice and day-to-day expectations.