- Email: [email protected]
A pilot assessment on perceived stress among working pharmacist moms
SCIENCE AND PRACTICE Journal of the American Pharmacists Association xxx (2019) 1e5
Contents lists available at ScienceDirect
Journal of the American Pharmacists Association journal homepage: www.japha.org
RESEARCH NOTES
A pilot assessment on perceived stress among working pharmacist moms Evangelina Berrios-Colon, Charnicia Huggins, Suzanne Soliman, Batoul Senhaji-Tomza, Levita Hidayat* a r t i c l e i n f o
a b s t r a c t
Article history: Received 27 September 2019 Accepted 1 October 2019
Objective: To assess perceptions of stress among working pharmacist moms. Methods: Members of the then 1000-member Facebook Pharmacist Moms group were invited to complete an 18-question online survey. The survey included questions related to stress and demographics. Results: Ninety-three pharmacist moms responded to the survey. The majority (82%) of respondents graduated more than 5 years ago. Most (81%) had at least 2 children; 44% had at least 1 child younger than 5 years. The largest proportion (58%) of respondents practiced in a community pharmacy, whereas nonretail respondents included those working in a hospital (25%) or in academia (12%). Retail pharmacist moms felt more nervous or stressed about work than nonretail pharmacist mothers (70% vs. 49%; P < 0.01) and were more likely to feel difficulties were piling up so high they could not overcome them (48% vs. 15%; P < 0.01). Moms who worked in retail also felt more upset because of something that happened at work compared with nonretail pharmacist moms (63% vs 28%; P < 0.01). Conclusion: Women have become a major force in pharmacy and will continue to play a considerable role in the future of the profession. Pharmacist moms working in retail report higher stress levels compared with their nonretail counterparts. These results indicate a need to educate future female pharmacists on coping skills and life management techniques that foster healthy work-life balances. Employers should be aware of the underlying stressors that pharmacist moms are coping with in the workplace. These findings suggest the need for a more comprehensive survey to determine whether the stress perceived by pharmacist moms is warranted. © 2019 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
Background Women have been attracted to the field of pharmacy because it is widely perceived as a profession that offers them an opportunity to combine a professional career with a family.1,2 In 2016, the American Association of Colleges of Pharmacy reported that of 14,502 first-professional degrees in pharmacy, 61.9% were awarded to women, and 38.1% were awarded to men.3 The 2014 National Pharmacist Workforce
Disclosure: The authors declare no relevant conflicts of interest or financial relationships. Previous presentation: The results of this study have been reported at a poster presentation at the American Society of Health-System Pharmacists Midyear Clinical Meeting and Exhibition in Anaheim, CA, December 3, 2018. * Correspondence: Levita Hidayat, PharmD, Medical Science Director, Melinta Therapeutics, 44 Whippany Rd., Ste. 280, Morristown, NJ 07960. E-mail address: [email protected] (L. Hidayat).
Survey released by the Pharmacy Workforce Center also found that more women than men were practicing pharmacy or working in a pharmacy-related career (83.9% vs. 65.2%, respectively).4 Many of these women are also mothers. To date, there is a lack of data on job satisfaction of working pharmacist mothers. However, Heuser et al.5 found that job satisfaction among female physician mothers was high concerning professional morale but low concerning time for extraprofessional activities. They also found that long work hours (> 50 h/wk) correlated with increased job dissatisfaction among working physician mothers.5 The extent and determinants of job satisfaction have been topics of considerable interest to the pharmacy profession over the last decades.5-7 Pharmacist work attitudes and the role of stress have been an international source of curiosity for more than 50 years, with widely varying assessment methodologies and data.2,6-8 Pharmacists’ job-related perceptions and opinions are shaped by their experiences in the workforce. These
https://doi.org/10.1016/j.japh.2019.10.001 1544-3191/© 2019 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
SCIENCE AND PRACTICE E. Berrios-Colon et al. / Journal of the American Pharmacists Association xxx (2019) 1e5
experiences vary systematically and are interpreted differently by both sex and diverse age groups.8,9 Munger et al.9 reported substantial levels of occupation dissatisfaction and stress among community pharmacists across the country. Higher stress levels and lower work-life balance have been suggested as negatively affecting career satisfaction among pharmacy faculty.10 Ip et al.11 noted that more female pharmacy faculty in the United States hold a lower academic ranking and are less satisfied with their academic position relative to men.11 In addition, women faculty members were significantly less satisfied with their current work-life balance and reported higher stress levels compared with men.10 These findings suggest that career satisfaction, work-life balance, and stress are interrelated, and that gender may play a role. Work and family life are the 2 most common life domains, and balancing these domains has been a part of everyday life for millions of adults.12 More than half (61%) of female pharmacists are reported to have children, including nearly 8 of 10 women aged 40-44 years.13 Goodwin et al.14 found that U.S. pharmacists believe that work-life balance is a critical aspect of career success. However, workplace pressures can produce job stress that negatively affects pharmacy professionals’ health, their workplace, and indirectly, their patients.5,12,14 As women will play a considerable role in shaping the future of pharmacy, determining their stress level and how it coincides with their work-life balance is increasingly important. The influence of women within the profession and responsibilities at home should be addressed in ways that prevent hindering their professional careers. National surveys of U.S. pharmacists’ work attitudes also indicate high levels of work-family conflict in nearly all practice settings, suggesting that workplace pressures also negatively affect their family domain.12 Women have been found to have a disproportionate involvement with childcare and household responsibilities, which leads them to develop different sets of tastes and preferences for job characteristics than those exhibited by men.15,16 The relationship between job stress and work-related attitudes or its impact on work-life balance has been widely explored in the pharmacy field; however, data specific to working pharmacist moms have not been previously studied. Our study aimed to conduct a pilot assessment to evaluate perceived stress in working pharmacist moms.
Objectives The objective of this study was to assess perceptions of stress among working pharmacist moms.
Methods Study design and participants The Pharmacist Moms Facebook group was founded in 2017. The group members were screened through a series of questions to verify their authenticity of membership. At the time of this study, the Pharmacist Moms Facebook group had 1000 members worldwide. As of August 2019, the group had approximately 30,000 members. Facebook is a useful recruitment tool for health care research.17 Facebook is particularly 2
useful when recruiting from a wide range of participants of all ages and demographics.17 An online pilot survey was developed to evaluate perceived stress and discrimination among working pharmacist moms. SurveyMonkey, an online survey response system, was used to allow research respondents to participate in the online survey by clicking on a provided hyperlink to access a survey. The survey was open for 60 days, with several reminders sent intermittently during the study period. The pilot survey was conducted to assess question appropriateness. Meaningful results will be used to design future surveys on a larger scale. Our research team aimed to have roughly 100 participants during the study period. The study respondents were categorized into retail and nonretail pharmacist mom groups. The retail group included pharmacists practicing in chain, big-box, and independent pharmacies. The nonretail group included pharmacists practicing in all the other settings. Survey instrument The Pharmacist Moms Facebook group members were invited to complete the voluntary, anonymous Web-based survey. The Perceived Stress Scale-10 (PSS-10) questionnaire was used to measure stress among survey respondents. The PSS-10 is one of the most commonly used and validated psychological instruments to measure the perception of stress.18 The PSS-10 used in this study is a modification of the early inventory of items developed by Cohen and Williamson in 1988 and consists of 10 items about job stress.19 The participants were asked to rate stress on a 5-point Likert scale (4 ¼ always, 3 ¼ often, 2 ¼ sometimes, 1 ¼ almost never, and 0 ¼ never). Respondents’ response agreement was categorized based on the 2 responses of often (3) and always (4), whereas disagreement was categorized based on the 3 responses of sometimes (2), almost never (1), and never (0). A total score ranging from 0 to 40 was calculated through reverse scoring of the 4 positively worded survey items and then summing all the scale items in the survey.14 Higher scores indicated greater levels of perceived stress. Scores ranging from 0 to 13 were considered low stress. Scores ranging from 14 to 26 were considered moderate stress. Scores ranging from 27 to 40 were considered high perceived stress. Questions related to demographics and discrimination were also asked and developed by the researchers. Work-related demographic questions consisted of the number of years since graduation, area of pharmacy practice, geographical region, and number of children. Data analysis Descriptive and inferential statistics were used for data analysis. The study objective was analyzed using univariate and bivariate analyses. Stress levels were analyzed with a chisquare test. Fisher exact test was used for categorical variables. A t test was performed for continuous variables. Tests were determined based on data level of measurement. A P value of 0.05 denoted statistical significance. Statistical analyses were performed using GraphPad Prism software version 6.0 (GraphPad Software Inc., San Diego, CA). As most respondents indicated they worked in retail settings, the authors compiled survey results into 2 categories: retail versus nonretail. Previous studies have demonstrated reliability statistics
SCIENCE AND PRACTICE Perceived stress among working pharmacist moms
Table 1 Respondent characteristics based on practice settinga Characteristics Postpharmacy degree <5y 5-10 y 11-15 y 16-20 y > 20 y No. children 1 2 3 4 5 Median (IQR) Age of children <5y 5-12 y 13-18 y > 18 y PSS-10 high perceived stressd
Overall respondents (N ¼ 93)
Retailb (n ¼ 54)
Nonretailc (n ¼ 39)
17 36 25 8 7
(18) (39) (27) (9) (8)
13 23 13 4 2
(24) (42) (24) (7) (4)
5 13 12 4 5
(13) (33) (31) (10) (13)
0.29 0.49 0.92 0.92 0.21
2 38 37 15 2 1
(1-2) (41) (40) (16) (2) (1)
2 22 20 10 1 1
(1-2) (41) (37) (19) (2) (2)
2 16 17 5 1
(1-2) (41) (44) (13) (3) d
0.89 0.55 0.99 0.65 0.62 d
92 55 18 5 27
(99) (59) (19) (5) (29)
60 32 9 4 23 (43)
32 23 9 1 4 (11)
P value
<0.01 0.53 0.74 0.21 0.02
Abbreviations used: IQR, interquartile range; PSS-10, Perceived Stress Scale-10. Note: Values are n (%) unless otherwise specified. a Other practice settings: managed care (n ¼ 1), industry (n ¼ 1), retail and hospital staff (n ¼ 1), consulting (n ¼ 2), and home infusion (n ¼ 1). b Fifteen of 60 respondents in the retail group have more than 1 child younger than 5 years. c Eight of 32 respondents in the nonretail group have more than 1 child younger than 5 years. d PSS-10 score of > 26 is considered to be high perceived stress.
associated with the PSS-10. These studies have shown strong psychometric evidence associated with its use.20 The PSS-10 has also shown to have Cronbach alpha values ranging between 0.7 and 0.9. These measures establish the internal consistency of the PSS-10.20
they were asked if they felt more highly scrutinized than their childless counterparts. There were also no significant findings regarding workplace discrimination (data not shown) and no differences in perceived stress when we compared pharmacist moms who graduated within the last 5 years with those who had graduated 5 years ago or before (data not shown).
Results Discussion A total of 93 pharmacist moms responded to the survey; respondent characteristics are given in Table 1. The majority (82%) of respondents graduated more than 5 years ago. Most (81%) had at least 2 children; 44% had at least 1 child younger than 5 years. The retail pharmacist mom group reported having more statistically significant more children younger than 5 years than the nonretail pharmacist mom group (65% vs. 35%; P < 0.01) did. In addition, 44% of the respondents were from the South, 27% from the Midwest, 19% from the Northeast, and 10% from the West (data not shown). More than half of the respondents (58%) practiced in community pharmacy, 25% in a hospital setting, and 12% in academia (data not shown). The high perceived stress score for retail pharmacist moms was statistically significant higher than that of nonretail pharmacist moms (43% vs. 11%; P ¼ 0.02). The respondents’ response agreement based on work setting is summarized in Table 2. Moms who worked in retail felt more upset because of something that happened at work compared with nonretail pharmacist moms (63% vs. 28%; P < 0.01). Retail pharmacist moms also felt more nervous or stressed about work (70% vs. 49%; P < 0.01) and were more likely than nonretail pharmacist mothers to feel difficulties were piling up so high they could not overcome them (48% vs. 15%; P < 0.01). Retail pharmacist moms also significantly felt angered owing to things that were outside of their control at work (59% vs. 33%; P ¼ 0.02). However, no difference was found between retail and nonretail pharmacist moms when
Over the past 4 decades, more than half of pharmacy graduates in the United States have been women. Thus, women will play a considerable role in shaping the future of the pharmacy profession. Our study provides insights on working pharmacist moms, their stress level, and how it coincides with their work-life balance. In our pilot survey, we did not consider several stress-inducing factors such as relationship status, underlying reasons for each of the negative findings, personal and professional priorities, and external factors such as workload and environment. One of the limitations of this study was that the respondents were recruited based on convenience sampling; thus, some of the pharmacist mom group (i.e., retail vs. nonretail) may be overrepresented or underrepresented. However, we were able to target the population of interest effectively during this exploration stage of research. This pilot study targeted data collection to identify and address shortcomings associated with questionnaire design. Our study found that retail pharmacist moms frequently described themselves as feeling overwhelmed (i.e., feeling that difficulties at work were piling up too high for them to overcome) compared with nonretail pharmacist moms. Indeed, one of the most stressful things for pharmacists, as identified by Munger et al.,9 is having more things to take care of than having time to do them. This piling up of work, particularly if coupled with unpleasant interactions with difficult patients, 3
SCIENCE AND PRACTICE E. Berrios-Colon et al. / Journal of the American Pharmacists Association xxx (2019) 1e5
Table 2 Respondent response agreement based on work setting (only “often” or “always”) Questions In the last month, how often have you been upset because of something that happened at work unexpectedly? In the last month, how often have you felt that you were unable to control the important things in your life? In the last month, how often have you felt nervous and “stressed” about work? In the last month, how often have you felt confident about your ability to handle your work-related problems? In the last month, how often have you felt that things were going your way at work? In the last month, how often have you found that you could not cope with all the things that you had to do at work? In the last month, how often have you been able to control irritations at work? In the last month, how often have you felt that you were on top of things at work? In the last month, how often have you been angered because of things that were outside your control at work? In the last month, how often at work have you felt difficulties were piling up so high that you could not overcome? In the last month, how often at work have you felt more highly scrutinized as compared to your childless counterparts? In the last month, have you felt discriminated against at work because you are a Mom?
Retail (n ¼ 54)
Nonretail (n ¼ 39)
P value
34 (63)
11 (28)
< 0.01
25 (46)
10 (26)
0.05
38 (70)
19 (49)
< 0.01
26 (48)
25 (64)
0.82
13 (24)
17 (44)
< 0.01
19 (35)
11 (28)
0.44
25 (46)
23 (59)
0.77
19 (35)
17 (44)
0.69
32 (59)
13 (33)
0.02
26 (48)
6 (15)
< 0.01
5 (9)
5 (13)
0.72
3 (6)
4 (10)
0.43
Note: Values are n (%) unless otherwise specified.
frequent live or telephone interruptions, and other potential stress-inducing factors, may be contributing factors to increased feelings of nervousness and stress reported by our retail pharmacist moms. Our study did not differentiate between single pharmacist moms and those in relationships. This factor may also affect stress levels among moms, potentially compounding the stress experienced by those in retail. Research shows that single moms may experience a higher burden of stress owing to being less likely to seek support than those in relationships.21 We did not investigate the underlying reasons for each of the negative findings among our retail pharmacist moms, but 1 plausible explanation may be related to the additional stressors inherent upon women tasked with balancing care for children with demanding work responsibilities. More than 80% of our total population of pharmacist moms had 2 or more children, and more than 4 of 10 had at least 1 child younger than 5 years. In addition, incompatibility between the pressures of home and work roles is typically experienced by half of all pharmacists. It is more prevalent among retail pharmacists (independent or chain) than among pharmacists practicing in other settings, according to findings from the recent National Pharmacist Workforce Survey.4 Our survey findings also indicate that retail pharmacist moms more commonly reported feeling “unable to control the important things” in life and were more frequently angered about things at work beyond their control than their counterparts. We did not inquire with these moms about what they consider to be the most important things, but previous research has identified family as one of the most important priorities in life.22 The perceived lack of control and increased work-home conflict among our survey respondents may also make them more susceptible to feeling upset when unexpected happenings occur at work, the other crucial life domain that, arguably, demands an amount of time, attention, and focus secondary only to that given to their primary responsibility as moms. 4
We found that significantly more moms in the retail setting had a high perceived stress level score (PSS-10 score of > 26) when compared with nonretail pharmacist moms. Workload and work environment could be another plausible explanation that contributes to this high stress level. Specifically, 45% of U.S. pharmacists believe their current workload has adverse or very negative effects on their mental and emotional health.4 Lea et al.23 identified 13 studies in the United Kingdom that focused on workload in community pharmacy alone or along with job satisfaction and stress.23 They found that increased workload contributed to increasing job-related stress and decreasing job satisfaction in a retail setting. Community pharmacy is still primarily a transaction-based business, and its standard metrics include the number of prescriptions versus wait time, the number of influenza injections, and customer satisfaction surveys. Metrics are typically tied to performance and compensation. The demand to fill more prescriptions in less time diminishes the direct patient care relationship and opportunities to use their education and skills. These influences may cause a decrease in job satisfaction and higher stress level among retail pharmacist moms. Finally, we explored whether the number of years after graduation may influence the stress level in pharmacist moms. Nearly half of our survey respondents reported graduating more than 10 years ago, but those in retail tended to be more recent graduates. We explored if stress level changes with number of years of experience (graduated < 5 years vs. 5 years) in the retail setting and found no difference in perceived stress among retail pharmacist moms. These findings are also consistent with the results of the National Pharmacist Workforce Survey.4 Another study limitation is that participants were based on convenience sampling; thus, respondents may not be representative of the whole female pharmacist mom population. The U.S. Department of Health and Human Services, Bureau of Health Professions, noted that 60% of pharmacist positions
SCIENCE AND PRACTICE Perceived stress among working pharmacist moms
were in retail and about 29% in health care institutes.24 This demographic proportion is comparable to 58% of our study respondents who practiced in a retail setting. The 2014 Pharmacy Workforce Survey noted that 52% of survey respondents were female and 44% practiced in the retail setting. In addition, Goodwin et al.14 noted that more than half of female pharmacists (61%) have children, including nearly 8 of 10 women aged 40 to 44 years. Of note, our sampling method is fitting during the first phase of this study. This study was conducted to explore and assess survey question appropriateness for this group and apply meaningful results to design a future survey on a larger scale. Our study found that pharmacist moms working in retail report higher stress levels compared with their nonretail counterparts. A more comprehensive survey should include in-depth interviews and focus groups (a qualitative study) to determine stressors and stress level perceptions by pharmacist moms particularly in the retail setting. Conclusion Women have become a major force in pharmacy and will play a considerable role in the future of the profession. Our study found that pharmacist moms working in retail report higher stress levels compared with their nonretail counterparts. These findings suggest that a more comprehensive survey is warranted to determine the stressors and stress level perceptions by pharmacist moms particularly in the retail setting. References 1. D'Angelo A. Special strengths of the woman practitioner. 1976. Ann Pharmacother. 2006;40(5):970e971. 2. Janzen D, Fitzpatrick K, Jensen K, Suveges L. Women in pharmacy: a preliminary study of the attitudes and beliefs of pharmacy students. Can Pharm J (Ott). 2013;146(2):109e116. 3. American Association of Colleges of Pharmacy. Academic pharmacy’s vital statistics. Available at: https://www.aacp.org/article/academicpharmacys-vital-statistics. Accessed March 12, 2019. 4. American Association of Colleges of Pharmacy. National pharmacist workforce studies. Available at: https://www.aacp.org/article/nationalpharmacist-workforce-studies. Accessed March 11, 2019. 5. Heuser CC, Gibbins KJ, Herrera CA, Theilen LH, Holmgren CM. Moms in medicine: job satisfaction among physician-mothers in obstetrics and gynecology. Work. 2018;60(2):201e207. 6. Dowell AC, Westcott T, McLeod DK, Hamilton S. A survey of job satisfaction, sources of stress and psychological symptoms among New Zealand health professionals. N Z Med J. 2001;114(1145):540e543. 7. 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 (2003). 2004;44(3):326e336.
8. Gaither CA. An investigation of pharmacists’ role stress and the work/ non-work interface. J Soc Admin Pharm. 1998;15(2):92e102. 9. Munger MA, Gordon E, Hartman J, Vincent K, Feehan M. Community pharmacists' occupational satisfaction and stress: a profession in jeopardy? J Am Pharm Assoc (2003). 2013;53(3):282e296. 10. Latif DA, Grillo JA. Satisfaction of junior faculty with academic role functions. Am J Pharm Educ. 2001;65(2):137e143. 11. Ip EJ, Lindfelt TA, Tran AL, Do AP, Barnett MJ. Differences in career satisfaction, work-life balance, and stress by gender in a national survey of pharmacy faculty. J Pharm Pract. 2018, 897190018815042. 12. Gubbins PO, Ragland D, Castleberry AN, Payakachat N. Family commitment and work characteristics among pharmacists. Pharmacol (Basel). 2015;3(4):386e398. 13. Goldin C, Katz LF. A most egalitarian profession: pharmacy and the evolution of a family-friendly occupation. J Lab Econ. 2016;34(3): 705e746. 14. Goodwin SD, Kane-Gill SL, Ng TM, et al. Rewards and advancements for clinical pharmacists. Pharmacotherapy. 2010;30(1):114. 15. Carvajal MJ, Armayor GM, Deziel L. The gender earnings gap among pharmacists. Res Social Adm Pharm. 2012;8(4):285e297. 16. Carvajal MJ, Deziel L, Armayor GM. Labor supply functions of working male and female pharmacists: in search of the backward bend. Res Social Adm Pharm. 2012;8(6):552e566. 17. Whitaker C, Stevelink S, Fear N. The use of Facebook in recruiting participants for health research purposes: a systematic review. J Med Internet Res. 2017;19(8):e290. 18. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385e396. 19. Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: Spacapam S, Oskamp S, eds. The Social Psychology of Health. Newbury Park, CA: Sage; 1988:31e67. 20. Lee EH. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res (Korean Soc Nurs Sci). 2012;6(4):121e127. ska MA. Types of work-related 21. Napora E, Andruszkiewicz A, Basin behavior and experiences and stress coping strategies among single mothers and mothers in relationships differentiating role of work satisfaction. Int J Occup Med Environ Health. 2018;31(1):55e69. 22. Bowling A. What things are important in people’s lives? A survey of the public’s judgements to inform scales of health related quality of life. Soc Sci Med. 1995;41(10):1447e1462. 23. Lea VM, Corlett SA, Rodgers RM. Workload and its impact on community pharmacists’ job satisfaction and stress: a review of the literature. Int J Pharm Pract. 2012;20(4):259e271. 24. Health Resources & Services Administration. Bureau of Health Workforce. Available at: https://www.hrsa.gov/about/organization/bureaus/ bhw/index.html. Accessed September 9, 2019. Evangelina Berrios-Colon, PharmD, MPH, BCPS, CACP, Director of Community & Co-curricular Affairs and Associate Professor of Pharmacy Practice, Arnold & Marie Schwartz College of Pharmacy and Health Sciences, LIU Pharmacy, Brooklyn, NY Charnicia Huggins, PharmD, MS, BCACP, AE-C, Clinical Pharmacy Specialist, BronxCare Health System, Bronx, NY Suzanne Soliman, PharmD, BCMAS, Chief Academic Officer, Accreditation Council for Medical Affairs, Norwood, NJ Batoul Senhaji-Tomza, PharmD, MPH, Assistant Dean of Curriculum, Touro College of Pharmacy, New York, NY Levita Hidayat, PharmD, Medical Science Director, Melinta Therapeutics, Morristown, NJ
5
Contents lists available at ScienceDirect
Journal of the American Pharmacists Association journal homepage: www.japha.org
RESEARCH NOTES
A pilot assessment on perceived stress among working pharmacist moms Evangelina Berrios-Colon, Charnicia Huggins, Suzanne Soliman, Batoul Senhaji-Tomza, Levita Hidayat* a r t i c l e i n f o
a b s t r a c t
Article history: Received 27 September 2019 Accepted 1 October 2019
Objective: To assess perceptions of stress among working pharmacist moms. Methods: Members of the then 1000-member Facebook Pharmacist Moms group were invited to complete an 18-question online survey. The survey included questions related to stress and demographics. Results: Ninety-three pharmacist moms responded to the survey. The majority (82%) of respondents graduated more than 5 years ago. Most (81%) had at least 2 children; 44% had at least 1 child younger than 5 years. The largest proportion (58%) of respondents practiced in a community pharmacy, whereas nonretail respondents included those working in a hospital (25%) or in academia (12%). Retail pharmacist moms felt more nervous or stressed about work than nonretail pharmacist mothers (70% vs. 49%; P < 0.01) and were more likely to feel difficulties were piling up so high they could not overcome them (48% vs. 15%; P < 0.01). Moms who worked in retail also felt more upset because of something that happened at work compared with nonretail pharmacist moms (63% vs 28%; P < 0.01). Conclusion: Women have become a major force in pharmacy and will continue to play a considerable role in the future of the profession. Pharmacist moms working in retail report higher stress levels compared with their nonretail counterparts. These results indicate a need to educate future female pharmacists on coping skills and life management techniques that foster healthy work-life balances. Employers should be aware of the underlying stressors that pharmacist moms are coping with in the workplace. These findings suggest the need for a more comprehensive survey to determine whether the stress perceived by pharmacist moms is warranted. © 2019 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
Background Women have been attracted to the field of pharmacy because it is widely perceived as a profession that offers them an opportunity to combine a professional career with a family.1,2 In 2016, the American Association of Colleges of Pharmacy reported that of 14,502 first-professional degrees in pharmacy, 61.9% were awarded to women, and 38.1% were awarded to men.3 The 2014 National Pharmacist Workforce
Disclosure: The authors declare no relevant conflicts of interest or financial relationships. Previous presentation: The results of this study have been reported at a poster presentation at the American Society of Health-System Pharmacists Midyear Clinical Meeting and Exhibition in Anaheim, CA, December 3, 2018. * Correspondence: Levita Hidayat, PharmD, Medical Science Director, Melinta Therapeutics, 44 Whippany Rd., Ste. 280, Morristown, NJ 07960. E-mail address: [email protected] (L. Hidayat).
Survey released by the Pharmacy Workforce Center also found that more women than men were practicing pharmacy or working in a pharmacy-related career (83.9% vs. 65.2%, respectively).4 Many of these women are also mothers. To date, there is a lack of data on job satisfaction of working pharmacist mothers. However, Heuser et al.5 found that job satisfaction among female physician mothers was high concerning professional morale but low concerning time for extraprofessional activities. They also found that long work hours (> 50 h/wk) correlated with increased job dissatisfaction among working physician mothers.5 The extent and determinants of job satisfaction have been topics of considerable interest to the pharmacy profession over the last decades.5-7 Pharmacist work attitudes and the role of stress have been an international source of curiosity for more than 50 years, with widely varying assessment methodologies and data.2,6-8 Pharmacists’ job-related perceptions and opinions are shaped by their experiences in the workforce. These
https://doi.org/10.1016/j.japh.2019.10.001 1544-3191/© 2019 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
SCIENCE AND PRACTICE E. Berrios-Colon et al. / Journal of the American Pharmacists Association xxx (2019) 1e5
experiences vary systematically and are interpreted differently by both sex and diverse age groups.8,9 Munger et al.9 reported substantial levels of occupation dissatisfaction and stress among community pharmacists across the country. Higher stress levels and lower work-life balance have been suggested as negatively affecting career satisfaction among pharmacy faculty.10 Ip et al.11 noted that more female pharmacy faculty in the United States hold a lower academic ranking and are less satisfied with their academic position relative to men.11 In addition, women faculty members were significantly less satisfied with their current work-life balance and reported higher stress levels compared with men.10 These findings suggest that career satisfaction, work-life balance, and stress are interrelated, and that gender may play a role. Work and family life are the 2 most common life domains, and balancing these domains has been a part of everyday life for millions of adults.12 More than half (61%) of female pharmacists are reported to have children, including nearly 8 of 10 women aged 40-44 years.13 Goodwin et al.14 found that U.S. pharmacists believe that work-life balance is a critical aspect of career success. However, workplace pressures can produce job stress that negatively affects pharmacy professionals’ health, their workplace, and indirectly, their patients.5,12,14 As women will play a considerable role in shaping the future of pharmacy, determining their stress level and how it coincides with their work-life balance is increasingly important. The influence of women within the profession and responsibilities at home should be addressed in ways that prevent hindering their professional careers. National surveys of U.S. pharmacists’ work attitudes also indicate high levels of work-family conflict in nearly all practice settings, suggesting that workplace pressures also negatively affect their family domain.12 Women have been found to have a disproportionate involvement with childcare and household responsibilities, which leads them to develop different sets of tastes and preferences for job characteristics than those exhibited by men.15,16 The relationship between job stress and work-related attitudes or its impact on work-life balance has been widely explored in the pharmacy field; however, data specific to working pharmacist moms have not been previously studied. Our study aimed to conduct a pilot assessment to evaluate perceived stress in working pharmacist moms.
Objectives The objective of this study was to assess perceptions of stress among working pharmacist moms.
Methods Study design and participants The Pharmacist Moms Facebook group was founded in 2017. The group members were screened through a series of questions to verify their authenticity of membership. At the time of this study, the Pharmacist Moms Facebook group had 1000 members worldwide. As of August 2019, the group had approximately 30,000 members. Facebook is a useful recruitment tool for health care research.17 Facebook is particularly 2
useful when recruiting from a wide range of participants of all ages and demographics.17 An online pilot survey was developed to evaluate perceived stress and discrimination among working pharmacist moms. SurveyMonkey, an online survey response system, was used to allow research respondents to participate in the online survey by clicking on a provided hyperlink to access a survey. The survey was open for 60 days, with several reminders sent intermittently during the study period. The pilot survey was conducted to assess question appropriateness. Meaningful results will be used to design future surveys on a larger scale. Our research team aimed to have roughly 100 participants during the study period. The study respondents were categorized into retail and nonretail pharmacist mom groups. The retail group included pharmacists practicing in chain, big-box, and independent pharmacies. The nonretail group included pharmacists practicing in all the other settings. Survey instrument The Pharmacist Moms Facebook group members were invited to complete the voluntary, anonymous Web-based survey. The Perceived Stress Scale-10 (PSS-10) questionnaire was used to measure stress among survey respondents. The PSS-10 is one of the most commonly used and validated psychological instruments to measure the perception of stress.18 The PSS-10 used in this study is a modification of the early inventory of items developed by Cohen and Williamson in 1988 and consists of 10 items about job stress.19 The participants were asked to rate stress on a 5-point Likert scale (4 ¼ always, 3 ¼ often, 2 ¼ sometimes, 1 ¼ almost never, and 0 ¼ never). Respondents’ response agreement was categorized based on the 2 responses of often (3) and always (4), whereas disagreement was categorized based on the 3 responses of sometimes (2), almost never (1), and never (0). A total score ranging from 0 to 40 was calculated through reverse scoring of the 4 positively worded survey items and then summing all the scale items in the survey.14 Higher scores indicated greater levels of perceived stress. Scores ranging from 0 to 13 were considered low stress. Scores ranging from 14 to 26 were considered moderate stress. Scores ranging from 27 to 40 were considered high perceived stress. Questions related to demographics and discrimination were also asked and developed by the researchers. Work-related demographic questions consisted of the number of years since graduation, area of pharmacy practice, geographical region, and number of children. Data analysis Descriptive and inferential statistics were used for data analysis. The study objective was analyzed using univariate and bivariate analyses. Stress levels were analyzed with a chisquare test. Fisher exact test was used for categorical variables. A t test was performed for continuous variables. Tests were determined based on data level of measurement. A P value of 0.05 denoted statistical significance. Statistical analyses were performed using GraphPad Prism software version 6.0 (GraphPad Software Inc., San Diego, CA). As most respondents indicated they worked in retail settings, the authors compiled survey results into 2 categories: retail versus nonretail. Previous studies have demonstrated reliability statistics
SCIENCE AND PRACTICE Perceived stress among working pharmacist moms
Table 1 Respondent characteristics based on practice settinga Characteristics Postpharmacy degree <5y 5-10 y 11-15 y 16-20 y > 20 y No. children 1 2 3 4 5 Median (IQR) Age of children <5y 5-12 y 13-18 y > 18 y PSS-10 high perceived stressd
Overall respondents (N ¼ 93)
Retailb (n ¼ 54)
Nonretailc (n ¼ 39)
17 36 25 8 7
(18) (39) (27) (9) (8)
13 23 13 4 2
(24) (42) (24) (7) (4)
5 13 12 4 5
(13) (33) (31) (10) (13)
0.29 0.49 0.92 0.92 0.21
2 38 37 15 2 1
(1-2) (41) (40) (16) (2) (1)
2 22 20 10 1 1
(1-2) (41) (37) (19) (2) (2)
2 16 17 5 1
(1-2) (41) (44) (13) (3) d
0.89 0.55 0.99 0.65 0.62 d
92 55 18 5 27
(99) (59) (19) (5) (29)
60 32 9 4 23 (43)
32 23 9 1 4 (11)
P value
<0.01 0.53 0.74 0.21 0.02
Abbreviations used: IQR, interquartile range; PSS-10, Perceived Stress Scale-10. Note: Values are n (%) unless otherwise specified. a Other practice settings: managed care (n ¼ 1), industry (n ¼ 1), retail and hospital staff (n ¼ 1), consulting (n ¼ 2), and home infusion (n ¼ 1). b Fifteen of 60 respondents in the retail group have more than 1 child younger than 5 years. c Eight of 32 respondents in the nonretail group have more than 1 child younger than 5 years. d PSS-10 score of > 26 is considered to be high perceived stress.
associated with the PSS-10. These studies have shown strong psychometric evidence associated with its use.20 The PSS-10 has also shown to have Cronbach alpha values ranging between 0.7 and 0.9. These measures establish the internal consistency of the PSS-10.20
they were asked if they felt more highly scrutinized than their childless counterparts. There were also no significant findings regarding workplace discrimination (data not shown) and no differences in perceived stress when we compared pharmacist moms who graduated within the last 5 years with those who had graduated 5 years ago or before (data not shown).
Results Discussion A total of 93 pharmacist moms responded to the survey; respondent characteristics are given in Table 1. The majority (82%) of respondents graduated more than 5 years ago. Most (81%) had at least 2 children; 44% had at least 1 child younger than 5 years. The retail pharmacist mom group reported having more statistically significant more children younger than 5 years than the nonretail pharmacist mom group (65% vs. 35%; P < 0.01) did. In addition, 44% of the respondents were from the South, 27% from the Midwest, 19% from the Northeast, and 10% from the West (data not shown). More than half of the respondents (58%) practiced in community pharmacy, 25% in a hospital setting, and 12% in academia (data not shown). The high perceived stress score for retail pharmacist moms was statistically significant higher than that of nonretail pharmacist moms (43% vs. 11%; P ¼ 0.02). The respondents’ response agreement based on work setting is summarized in Table 2. Moms who worked in retail felt more upset because of something that happened at work compared with nonretail pharmacist moms (63% vs. 28%; P < 0.01). Retail pharmacist moms also felt more nervous or stressed about work (70% vs. 49%; P < 0.01) and were more likely than nonretail pharmacist mothers to feel difficulties were piling up so high they could not overcome them (48% vs. 15%; P < 0.01). Retail pharmacist moms also significantly felt angered owing to things that were outside of their control at work (59% vs. 33%; P ¼ 0.02). However, no difference was found between retail and nonretail pharmacist moms when
Over the past 4 decades, more than half of pharmacy graduates in the United States have been women. Thus, women will play a considerable role in shaping the future of the pharmacy profession. Our study provides insights on working pharmacist moms, their stress level, and how it coincides with their work-life balance. In our pilot survey, we did not consider several stress-inducing factors such as relationship status, underlying reasons for each of the negative findings, personal and professional priorities, and external factors such as workload and environment. One of the limitations of this study was that the respondents were recruited based on convenience sampling; thus, some of the pharmacist mom group (i.e., retail vs. nonretail) may be overrepresented or underrepresented. However, we were able to target the population of interest effectively during this exploration stage of research. This pilot study targeted data collection to identify and address shortcomings associated with questionnaire design. Our study found that retail pharmacist moms frequently described themselves as feeling overwhelmed (i.e., feeling that difficulties at work were piling up too high for them to overcome) compared with nonretail pharmacist moms. Indeed, one of the most stressful things for pharmacists, as identified by Munger et al.,9 is having more things to take care of than having time to do them. This piling up of work, particularly if coupled with unpleasant interactions with difficult patients, 3
SCIENCE AND PRACTICE E. Berrios-Colon et al. / Journal of the American Pharmacists Association xxx (2019) 1e5
Table 2 Respondent response agreement based on work setting (only “often” or “always”) Questions In the last month, how often have you been upset because of something that happened at work unexpectedly? In the last month, how often have you felt that you were unable to control the important things in your life? In the last month, how often have you felt nervous and “stressed” about work? In the last month, how often have you felt confident about your ability to handle your work-related problems? In the last month, how often have you felt that things were going your way at work? In the last month, how often have you found that you could not cope with all the things that you had to do at work? In the last month, how often have you been able to control irritations at work? In the last month, how often have you felt that you were on top of things at work? In the last month, how often have you been angered because of things that were outside your control at work? In the last month, how often at work have you felt difficulties were piling up so high that you could not overcome? In the last month, how often at work have you felt more highly scrutinized as compared to your childless counterparts? In the last month, have you felt discriminated against at work because you are a Mom?
Retail (n ¼ 54)
Nonretail (n ¼ 39)
P value
34 (63)
11 (28)
< 0.01
25 (46)
10 (26)
0.05
38 (70)
19 (49)
< 0.01
26 (48)
25 (64)
0.82
13 (24)
17 (44)
< 0.01
19 (35)
11 (28)
0.44
25 (46)
23 (59)
0.77
19 (35)
17 (44)
0.69
32 (59)
13 (33)
0.02
26 (48)
6 (15)
< 0.01
5 (9)
5 (13)
0.72
3 (6)
4 (10)
0.43
Note: Values are n (%) unless otherwise specified.
frequent live or telephone interruptions, and other potential stress-inducing factors, may be contributing factors to increased feelings of nervousness and stress reported by our retail pharmacist moms. Our study did not differentiate between single pharmacist moms and those in relationships. This factor may also affect stress levels among moms, potentially compounding the stress experienced by those in retail. Research shows that single moms may experience a higher burden of stress owing to being less likely to seek support than those in relationships.21 We did not investigate the underlying reasons for each of the negative findings among our retail pharmacist moms, but 1 plausible explanation may be related to the additional stressors inherent upon women tasked with balancing care for children with demanding work responsibilities. More than 80% of our total population of pharmacist moms had 2 or more children, and more than 4 of 10 had at least 1 child younger than 5 years. In addition, incompatibility between the pressures of home and work roles is typically experienced by half of all pharmacists. It is more prevalent among retail pharmacists (independent or chain) than among pharmacists practicing in other settings, according to findings from the recent National Pharmacist Workforce Survey.4 Our survey findings also indicate that retail pharmacist moms more commonly reported feeling “unable to control the important things” in life and were more frequently angered about things at work beyond their control than their counterparts. We did not inquire with these moms about what they consider to be the most important things, but previous research has identified family as one of the most important priorities in life.22 The perceived lack of control and increased work-home conflict among our survey respondents may also make them more susceptible to feeling upset when unexpected happenings occur at work, the other crucial life domain that, arguably, demands an amount of time, attention, and focus secondary only to that given to their primary responsibility as moms. 4
We found that significantly more moms in the retail setting had a high perceived stress level score (PSS-10 score of > 26) when compared with nonretail pharmacist moms. Workload and work environment could be another plausible explanation that contributes to this high stress level. Specifically, 45% of U.S. pharmacists believe their current workload has adverse or very negative effects on their mental and emotional health.4 Lea et al.23 identified 13 studies in the United Kingdom that focused on workload in community pharmacy alone or along with job satisfaction and stress.23 They found that increased workload contributed to increasing job-related stress and decreasing job satisfaction in a retail setting. Community pharmacy is still primarily a transaction-based business, and its standard metrics include the number of prescriptions versus wait time, the number of influenza injections, and customer satisfaction surveys. Metrics are typically tied to performance and compensation. The demand to fill more prescriptions in less time diminishes the direct patient care relationship and opportunities to use their education and skills. These influences may cause a decrease in job satisfaction and higher stress level among retail pharmacist moms. Finally, we explored whether the number of years after graduation may influence the stress level in pharmacist moms. Nearly half of our survey respondents reported graduating more than 10 years ago, but those in retail tended to be more recent graduates. We explored if stress level changes with number of years of experience (graduated < 5 years vs. 5 years) in the retail setting and found no difference in perceived stress among retail pharmacist moms. These findings are also consistent with the results of the National Pharmacist Workforce Survey.4 Another study limitation is that participants were based on convenience sampling; thus, respondents may not be representative of the whole female pharmacist mom population. The U.S. Department of Health and Human Services, Bureau of Health Professions, noted that 60% of pharmacist positions
SCIENCE AND PRACTICE Perceived stress among working pharmacist moms
were in retail and about 29% in health care institutes.24 This demographic proportion is comparable to 58% of our study respondents who practiced in a retail setting. The 2014 Pharmacy Workforce Survey noted that 52% of survey respondents were female and 44% practiced in the retail setting. In addition, Goodwin et al.14 noted that more than half of female pharmacists (61%) have children, including nearly 8 of 10 women aged 40 to 44 years. Of note, our sampling method is fitting during the first phase of this study. This study was conducted to explore and assess survey question appropriateness for this group and apply meaningful results to design a future survey on a larger scale. Our study found that pharmacist moms working in retail report higher stress levels compared with their nonretail counterparts. A more comprehensive survey should include in-depth interviews and focus groups (a qualitative study) to determine stressors and stress level perceptions by pharmacist moms particularly in the retail setting. Conclusion Women have become a major force in pharmacy and will play a considerable role in the future of the profession. Our study found that pharmacist moms working in retail report higher stress levels compared with their nonretail counterparts. These findings suggest that a more comprehensive survey is warranted to determine the stressors and stress level perceptions by pharmacist moms particularly in the retail setting. References 1. D'Angelo A. Special strengths of the woman practitioner. 1976. Ann Pharmacother. 2006;40(5):970e971. 2. Janzen D, Fitzpatrick K, Jensen K, Suveges L. Women in pharmacy: a preliminary study of the attitudes and beliefs of pharmacy students. Can Pharm J (Ott). 2013;146(2):109e116. 3. American Association of Colleges of Pharmacy. Academic pharmacy’s vital statistics. Available at: https://www.aacp.org/article/academicpharmacys-vital-statistics. Accessed March 12, 2019. 4. American Association of Colleges of Pharmacy. National pharmacist workforce studies. Available at: https://www.aacp.org/article/nationalpharmacist-workforce-studies. Accessed March 11, 2019. 5. Heuser CC, Gibbins KJ, Herrera CA, Theilen LH, Holmgren CM. Moms in medicine: job satisfaction among physician-mothers in obstetrics and gynecology. Work. 2018;60(2):201e207. 6. Dowell AC, Westcott T, McLeod DK, Hamilton S. A survey of job satisfaction, sources of stress and psychological symptoms among New Zealand health professionals. N Z Med J. 2001;114(1145):540e543. 7. 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 (2003). 2004;44(3):326e336.
8. Gaither CA. An investigation of pharmacists’ role stress and the work/ non-work interface. J Soc Admin Pharm. 1998;15(2):92e102. 9. Munger MA, Gordon E, Hartman J, Vincent K, Feehan M. Community pharmacists' occupational satisfaction and stress: a profession in jeopardy? J Am Pharm Assoc (2003). 2013;53(3):282e296. 10. Latif DA, Grillo JA. Satisfaction of junior faculty with academic role functions. Am J Pharm Educ. 2001;65(2):137e143. 11. Ip EJ, Lindfelt TA, Tran AL, Do AP, Barnett MJ. Differences in career satisfaction, work-life balance, and stress by gender in a national survey of pharmacy faculty. J Pharm Pract. 2018, 897190018815042. 12. Gubbins PO, Ragland D, Castleberry AN, Payakachat N. Family commitment and work characteristics among pharmacists. Pharmacol (Basel). 2015;3(4):386e398. 13. Goldin C, Katz LF. A most egalitarian profession: pharmacy and the evolution of a family-friendly occupation. J Lab Econ. 2016;34(3): 705e746. 14. Goodwin SD, Kane-Gill SL, Ng TM, et al. Rewards and advancements for clinical pharmacists. Pharmacotherapy. 2010;30(1):114. 15. Carvajal MJ, Armayor GM, Deziel L. The gender earnings gap among pharmacists. Res Social Adm Pharm. 2012;8(4):285e297. 16. Carvajal MJ, Deziel L, Armayor GM. Labor supply functions of working male and female pharmacists: in search of the backward bend. Res Social Adm Pharm. 2012;8(6):552e566. 17. Whitaker C, Stevelink S, Fear N. The use of Facebook in recruiting participants for health research purposes: a systematic review. J Med Internet Res. 2017;19(8):e290. 18. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385e396. 19. Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: Spacapam S, Oskamp S, eds. The Social Psychology of Health. Newbury Park, CA: Sage; 1988:31e67. 20. Lee EH. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res (Korean Soc Nurs Sci). 2012;6(4):121e127. ska MA. Types of work-related 21. Napora E, Andruszkiewicz A, Basin behavior and experiences and stress coping strategies among single mothers and mothers in relationships differentiating role of work satisfaction. Int J Occup Med Environ Health. 2018;31(1):55e69. 22. Bowling A. What things are important in people’s lives? A survey of the public’s judgements to inform scales of health related quality of life. Soc Sci Med. 1995;41(10):1447e1462. 23. Lea VM, Corlett SA, Rodgers RM. Workload and its impact on community pharmacists’ job satisfaction and stress: a review of the literature. Int J Pharm Pract. 2012;20(4):259e271. 24. Health Resources & Services Administration. Bureau of Health Workforce. Available at: https://www.hrsa.gov/about/organization/bureaus/ bhw/index.html. Accessed September 9, 2019. Evangelina Berrios-Colon, PharmD, MPH, BCPS, CACP, Director of Community & Co-curricular Affairs and Associate Professor of Pharmacy Practice, Arnold & Marie Schwartz College of Pharmacy and Health Sciences, LIU Pharmacy, Brooklyn, NY Charnicia Huggins, PharmD, MS, BCACP, AE-C, Clinical Pharmacy Specialist, BronxCare Health System, Bronx, NY Suzanne Soliman, PharmD, BCMAS, Chief Academic Officer, Accreditation Council for Medical Affairs, Norwood, NJ Batoul Senhaji-Tomza, PharmD, MPH, Assistant Dean of Curriculum, Touro College of Pharmacy, New York, NY Levita Hidayat, PharmD, Medical Science Director, Melinta Therapeutics, Morristown, NJ
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