Roundup: Burnout: When Everyday

Irritations Ruin Your Career

Guido R. Zanni, PhD
Published Online: Saturday, March 1, 2008
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Dr. Zanni is a psychologist and healthsystems specialist based in Alexandria, Virginia.

What comes to mind when one thinks of occupational hazards? Most think of jobs involving
heavy physical demands or exposure to potentially life-threatening situations. Pharmacists,
however, are at high risk for a more subtle, insidious occupational hazard: burnout. It is
psychologically and physically debilitatingeven career-endingand its warning signs
should be red flags for all pharmacists.

Defining Burnout
Burnout, a multidimensional syndrome, is generally recognized only after symptoms wreak
havoc. Acute burnout does not exist; slowly developing symptoms worsen progressively.
Burnout's 3 core domains to recognize are as follows:

Cynicismnegative job and workplace attitude, often directed at staff and clients,
which leads to depersonalization (eg, a cold, distant attitude); considered by many as
burnout's distinguishing characteristic

Emotional exhaustionfeeling physically and emotionally depleted, apathetic, and

indifferent

Ineffectivenesswith time, a sense of inadequacy, which leads to devaluing one's own

work and causes anxiety and trepidation from a belief that new work tasks are
meaningless1,2

Burnout and stress differ. Stress may cause emotional exhaustion, but burnout always
generates cynicism and a sense of inadequacy (characteristics that are absent from normal
job-related stress). Job stress, however, generally includes somatic symptoms (eg, anxiety)
that are not necessarily present with burnout. One also is usually aware of stress reactions but
does not always notice burnout (symptoms can take months to surface).
When workplace expectations and realities are disparate, burnout is a given. The following 6
areas are often troublesome for pharmacies:

Work overloadwhen workload chronically exceeds realistic levels, staff is taxed

with additional job responsibilities, and workfamily boundaries become blurred,
often exacerbated by on-call demands and e-mail communications

Lack of controlinflexibility cramps novel approaches, job sharing, and innovation

as staff struggles to stay within the limits of rigid procedures

Breakdown in communitywithout a sense of belonging and job security, staff

cohesiveness declines

Unfairnessevaluations fail to recognize outstanding performance, or meager

rewards are given randomly and without apparent reason

Insufficient rewardsmanagement rewards staff only rarely or emphasizes negative

outcomes (ignoring successful efforts)

Value conflictthe organization's actions differ from its public faade (eg,
management emphasizes screening for drug interactions and safety in advertisements
but provides antiquated technology), or increasingly an employee's values might be
ignored (eg, an organization provides the morning-after pill but offers no conscience
clause for employees to opt out of filling these prescriptions)2

Pharmacy is fertile ground for burnout due to chronic staffing shortages, the heavily regulated
environment, excessive documentation, the inability to control requests, a focus on negative
outcomes (eg, prescription errors), incongruence between expertise and job components (eg,
certified in disease management but performing peel-and-stick bench work), lack of positive
feedback (eg, drug-use reviews rarely commented on), and few rewards for improved patient
care or preventing contraindications. Inadequate pharmacy resources seem to reach epidemic
proportions. In a recent pharmacy poll, 61.5% of respondents indicated their employer has
unrealistic expectations regarding 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 classic signs that relate to
pharmacists. Not all will experience each symptom; most experience at least 1 in each of
burnout's 3 domains. Identifying with 1 of the signs listed in the box occasionally or
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 workplace conditions that fuel
burnout. The following are some effective strategies for each workplace antecedent:
Workplace Overload. Avoid focusing on quantity or working harder; instead, examine the
process used to complete tasks with an eye to change. Explore job sharing or trading
assignments with colleagues. Overhaul daily routine and reshuffle tasks.

Lack of Control. Define and separate work and home life. Avoid working while eating. Take
breaks but avoid discussing and reading work-related material. Learn to say "no" when asked
to voluntarily take on more assignments.
Insufficient Rewards. Seek positive feedback. Inform supervisors that both positive and
negative feedback are important to you.
Lack of Community. Seek others suffering from burnout and form a peer support group.
Initiate actions that foster interpersonal relationships; 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. Focus on 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 professionals disproportionately, especially
in the first 5 years of their career. Young or struggling pharmacists may hesitate to discuss
concerns with supervisors, confusing feeling overwhelmed with personal inadequacy.1,2
Because most managers rarely discuss burnout, the staff struggles. Some find successful
interventions or a mentor to help; others quit the job or the profession. Adopting prevention
strategies to ward off or minimize burnout is a key component of ensuring job satisfaction.
Table

Adapted from references 1, 2, and 4.

References
1. Maslach C. Burnout, The Cost of Caring. Cambridge, MA: Malor Books; 2003.
2. Maslach C, Leiter M. The Truth About Burnout. San Francisco, CA: John Wiley &
Sons; 1997.
3. Smith M, Jaffe-Gill E, Segal R. Burnout: signs, symptoms, and prevention.
www.helpguide.org/mental/burnout_signs_symptoms.htm. Accessed October 26,
2007.
4. 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.
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