MANAGING STRESS IN A WORKPLACE OF RISKS THE PHARMACY PERSPECTIVE

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1 MANAGING STRESS IN A WORKPLACE OF RISKS THE PHARMACY PERSPECTIVE PHARM CHARLES ANANE Clinical Pharmacy Unit, Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana. <chaanane2005@yahoo.com; Tel: +233 (0) ABSTRACT AND INTRODUCTION ABSTRACT It is imperative that pharmacists recognise ways to reduce stressful situations in the pharmacy workplace that can contribute to medication errors. Pharmacy work can be highly stressful, and pharmacists who are under extreme stress are at risk for more errors. Pharmacists need to identify their own personal stress triggers and anticipate their responses to stress. Given the relatively high incidence of medication use among patients/clients and the high potential for adverse outcomes of medicationrelated errors, tracking of such errors and subsequent identification of factors that lead to medication errors is an essential component of the performance improvement process in institutions such as pharmacy providing healthcare. It is, therefore, important that as pharmacists, we become aware that our emotions are contagious, and stress has an impact on the quality of our interactions with our patients, colleagues and other health care professionals. The better we are at managing our own stress, the more we will positively affect those around us and the less other colleagues stress will negatively affect us. As with all health and safety issues, managing stress in the pharmacy workplace is a joint responsibility of pharmacists and pharmacy managers. Neither party can assume these issues can be left to the other. Both must cooperate to prevent the problems or resolve them if they do arise. We need, as matter of urgency, to do everything possible to reduce tension, acrimony and stress in the pharmacy workplace that can affect the provision of quality pharmaceutical care which is patients oriented. INTRODUCTION If we are to deal with stress and manage it effectively in the pharmacy workplace, it is important for us to understand what stress is. Stress has been defined as a natural response to the challenges, changes and pressures of life. Others have defined it as the awareness of a person not being able to cope with the demands of their work environment, with an associated negative emotional response. Stressors are events or circumstances that lead someone feeling that physical or psychological demands are about to exceed his or her ability to cope. In the pharmacy, stressors can arise out of, Excessive work demands such as dealing with a large number of patients/clients Poor condition of service and remunerations Lack of incentives Poor working relationship between management and staff Generally a healthy and safe workplace requires pharmacy managers and pharmacists working together systematically to identify stress and manage them. It also requires a workplace with ongoing and effective communications between managers and staff. Stress is a complex issue and no two individual pharmacists will be affected in the same way by either work requirements or the work environment. Pharmacy managers should be alert to signs of stress at

2 their facilities. There should be systems in place that give pharmacists the confidence that if they report their situation to their managers or directors everything possible will be done to deal with them. In practice, it can be helpful to think of stress in terms of a simple bucket model. The bucket model suggests that stress and fatigue result when a person s reservoir of personal resilience is drained faster than it is replenished. Things like good working atmosphere, job satisfaction, supportive management, good health, and good communication fill the bucket. Deficient working conditions, acrimony and conflict at work, backbiting, emotionally draining work, excess or not enough work and poor professional interactions drain the bucket. You are coping when you maintain the balance between these factors. CAUSES OF STRESS IN THE PHARMACY WORKPLACE Whether we like it or not a life with no challenges would be very dull. In that sense, some stress is good for us. There is evidence that a lack of challenge at work can be just as stressful as work that is reasonably demanding physical or mentally. Even so, a balance between stimulation and rest is required. Whether stress is good or bad depends on personal tolerance levels and adequate recovery time. This common-sense approach tells us that prolonged or profound stress or prolonged and profound exposure to stressors can be bad for a pharmacist and an institution or organisation. There are a number of factors that can make a pharmacist feel stressed at work, and these include Poor working conditions Long working hours Relationships with management/supervisors/colleagues Lack of job incentives Lack of career progression Lack of job security Difficult journeys to and from work The way the pharmacy workplace is managed Lack of support Lack of cohesiveness Work-group conflict Inflexible working hours No opportunity for promotion Punitive appraisal systems Too much or too little responsibility Bickering and backbiting at the workplace Cronyism and favouritism Pull-him-down syndrome Negative criticism However, often there is no single cause of work-related stress. Although it can be triggered by sudden, unexpected pressures, it is often the result of a combination of stressful factors that build up overtime. Factors outside the workplace family problems, a second job i.e. locum, or poor mental or physical health can cause stress. These factors can be more significant when they operate in combination with workplace factors and adversely affect a pharmacist s ability to cope at work.

3 EFFECTS OF STRESS Workplace stress can lead to poor communication among colleague pharmacists, management and other health professionals which can hinder the discovery of medication errors. Medication errors in the pharmacy occurs when a patient/client receives an incorrect drug, drug dose, dosage forms, quantity, route, concentration, or rate of administration. Therefore, both the failure to administer or dispense the correct medication or the administration of a drug on a schedule other than intended constitutes medication errors. Often it is difficult to identify one or more distinct factors when considering the circumstances leading to such errors. In most cases, when pharmacists feel overwhelmed loose confidence and become irritable or withdrawn and loose concentration that lead to such errors occurring. Beyond interfering with job performance and satisfaction and providing quality pharmaceutical care, chronic or prolonged intense stress can also lead to physical and emotional health problems such headaches, muscular tension and tiredness. The pharmacist may also be prone to psychological symptoms such as irritability and mood swings, disturbed eating patterns, finding it hard to concentrate and feeling less motivated. A stressed pharmacist may have deteriorating relationships with colleagues and indecisive leading to poor performance and be more error-prone. A pharmacy institution where workplace stress is prevalent may demonstrate the following; High number of staff with low morale High absenteeism and staff turnover Poor employment relations Low quality work and low productivity High accident and illness rates High numbers of patients/clients complaints Increasing number of pharmacists saying they are under stress. SOME FEATURES OF POORLY ORGANIZED WORK RESULTING IN UNNECESSARY STRESS IN THE PHARMACY WORKPLACE WORK CHARACTERISTIC ORGANIZATIONAL FUNCTION AND CULTURE CONDITIONS POSSIBLY STRESSFUL TO THE PHARMACIST Rigid work practices pharmacists unable to work out their own solutions to the day-to-day problems they encounter in the workplace Poor communication within the pharmacy workplace A non-supportive work culture concerns and requests are dismissed without consideration ROLE IN ORGANIZATION Role or task ambiguity/uncertainty (for example, pharmacist unsure about what they should be doing) Role conflict from imprecise or conflicting job demands

4 Responsibility for pharmacists beyond the individual s capacity CAREER DEVELOPMENT Career uncertainty or stagnation (where the institution has no jobs with greater responsibility or content to offer) Poor status or status incongruity (a mismatch between qualifications/ability and job demands) Lack of rewards (status, self-esteem, recognition) DECISION LATITUDE/CONTROL Little opportunity to participate in decisionmaking Lack of control over the speed and scheduling of work RELATIONSHIPS AT WORK Physical isolation No formal pharmacist participation system Poor relationships with managers/supervisors and colleague pharmacists. Interpersonal conflict and acrimony at work LIFE/RELATIONSHIPS OUTSIDE WORK Conflicting demands of work and home life Dual career problems (for example, having two locums or juggling schedules with a working partner) MANAGING STRESS IN THE PHARMACY The ability to manage stress in the workplace can make the difference between success and failure on the job as a pharmacist. Even if the pharmacy workplace has grown increasingly stressful, the pharmacist can retain a large measure of self-control and self-confidence by understanding and practicing emotional intelligence. What do I mean by emotional intelligence? Emotional intelligence is the ability to manage and use your emotions in positive and constructive ways. It is about communicating with other pharmacists in ways that draw them to you, overcome differences, repair wounded feelings and diffuse tension and stress. Emotional intelligence in the pharmacy workplace has four major components; Self-awareness the ability to recognize your emotions and their impact while using gut feelings to guide your decisions

5 Self-management the ability to control your emotions and behaviour and adapt to changing circumstances Social awareness the ability to sense, understand and react to other s emotions and feel comfortable socially Relationship management the ability to inspire, influence and connect to others and manage conflict. The more emotional intelligence a pharmacist has the more stress he can avoid in the workplace. Fortunately, emotional intelligence is not something we are born with; it is something we can learn and develop. The skill set that enables a pharmacist to acquire these capabilities can be learned but requires the development of emotional and non-verbal ways of communicating that include; Learning to recognize the particular stress response and becoming familiar with sensual cues that can rapidly calm and energize you Staying connected to your internal emotional experience so you can appropriately manage your own emotions. Knowing what you are feeling will not only add to your confidence and improve your self control but enhance your understanding of others and help you build more satisfying relationships Learning to recognize and effectively use the non-verbal cues that make up 95-98% of your communication process including eye contact, facial expression, tone of voice, posture, gesture and touch. It is not what you say but how you say it that impacts others for better or worse. Developing the capacity to meet challenges with humour. There is no better stress buster than a laugh and nothing reduces stress quicker in the workplace than mutually shared humour. But, if the laughter is at someone else s expense, you may end up with more rather than less stress. Learning to navigate conflict by becoming a good listener and someone who can face conflict fearlessly with the expectation that differences resolved will strengthen the relationship. BENEFITS OF REDUCING PHARMACY WORKPLACE STRESS Given the relatively high incidence of medication use among patients/clients and the high potential for adverse outcomes of medication-related errors, track of such errors and subsequent identification of casual factors is an essential component of the performance improvement process in organizations providing health care. As the pharmacist learn to manage workplace stress and improve on his work relationships, he will have more control over his ability to think clearly and act appropriately to provide quality pharmaceutical services to his patients/clients avoiding common medication errors and medication discrepancies. If pharmacists are to achieve this goal, we shall need to be able to break habits that add to stress at work. If we can turn around these self-defeating habits, we will find workplace stress easier to handle. If you are the kind of pharmacist who sees the downside of every situation and interaction, you will find yourself drained of energy and motivation. Pharmacists must think positively about their work, avoid negative thinking and pat themselves on the back about small accomplishments, even if no one else does. THE ROLE OF PHARMACY MANAGERS It is in a manager s best interest to keep stress levels in the pharmacy workplace to a minimum. Pharmacy managers or heads must act as positive role models, especially in times of high stress. All the tips mentioned in this article are twice as important for managers to follow. There are also organizational changes that pharmacy managers can make to reduce workplace stress i.e. Improve communication Share information with your pharmacists to reduce uncertainty about their jobs and future

6 Clearly define each pharmacist s roles and responsibilities Make communication friendly and efficient, not mean-spirited or petty Consult your pharmacists Give your pharmacists opportunities to participate in decisions that affect their jobs Consult your pharmacists about work scheduling and rules Be sure that the workload is suitable and equitable to each pharmacist s abilities and resources, avoiding unrealistic expectations Show that individual pharmacists are valued Offer rewards and incentives Praise good work performance verbally and institutionally Provide opportunities for career development Promote an entrepreneurial work climate that gives pharmacists more control over their work Cultivate a friendly social climate Provide opportunities for social interaction among pharmacists Establish a zero-tolerance policy for gossiping, backbiting, pull-him-down syndrome, harassment and cronyism Make management actions consistent with organizational values. CONCLUSION It is in everyone s interest, both the pharmacist and the manager, to keep the workplace as stress-free as possible. Sometimes the best stress-reducer is simply sharing your stress with someone close to you. The act of talking it out and getting support and empathy from someone else is often an excellent way of blowing off steam and reducing stress. If you are a pharmacist and you feel you are suffering from work-related stress, it is important to talk directly to your pharmacy manager or head about it. Your manager or head has a duty to take reasonable steps to try to resolve that stressor. It is imperative that a congenial atmosphere is created in the pharmacy workplace for pharmacists to impact positively on patients/clients and other health professionals.