Job-Related Stress: Perceptions of Employee Pharmacists

Job·Related Stress: Perceptions of Employee Pharmacists by Brian G. Ortmeier, PharmD, and Alan P. Wolfgang, PhD

This study suggests that stress from heavy workloads, dealing with the public, and working conditions is affecting employee pharmacists' job satisfaction.

S

tress associated with the practice of pharmacy and its effects on pharmacists and quality of care have become an increasingly popular topic among both researchers and practitioners. Burnout, exhaustion, and job satisfaction are all subjects recently discussed in the health care literature. 1- 5 ot special concern within phannacy are employee pharmacists and the stresses they experience in fulfilling their professional duties. Evidence of this concern was exhibited at the first American Pharmaceutical Association (APhA) National Forum on the Employed Pharmacist held in March 1990. In that forum, keynote speaker Richard Schulz, PhD, noted that employees experience stress in severhl areas, ranging from employers' expectations regarding work schedules and prescription volume to a lack of

support for involvement in patient counseling and other clinical activities. 6 The pressures facing employee

pharmacists became especially evident in July 1990, when a headline in Pharmacy Today read: "Stress-

American Pharmacy, Vol. NS31, No.9 September 1991/635

27

Employee Pharmacists' Mean Stress Scores for 30 HPSI Job Situations Job Situations Mean

SD

• Being interrupted while performing job duties

3.13

0.88

• Not having enough staff to adequately provide necessary services

2.58

1.10

• Having so much work to do that everything cannot be done well

2.49

0.93

• Feeling inadequately paid as a health professional

2.31

1.17

• Feeling that opportunities for advancement on the job are poor

2.27

1.17

• Dealing with "difficult" patients

2.17

1.12

• Having non-health professionals influence your practice

2.16

1.27

• Feeling ultimately responsible for patient outcomes

2.12

0.96

• Not being able to use abilities to the fullest extent

2.09

1.00

• Not receiving respect/recognition from the general pablic

2.03'

1.08

• Not being allowed to participate in job-related decisions

2.03

0.99

• Not keeping up with new developments in the profession

2.01

1.00

• Supervising the performance of • Fearing that a mistake will be

1.06

workers

4n patient tr

• Having job duties that conflict with family responsibiltties

rienced moderate to high levels of burnout. The authors found the highest levels of burnout among women less than 40 years old, practicing in a chain setting, and working in the same job for less than 10 years.3 The primary purpose of this study was to assess sources of perceived stress among employee pharmacists. In addition, the study sought to identify differences in stress perceptions among employee pharmacists working in the three primary pharmacy practice settings (i.e., chain, hospital, and independent). Within practice settings, reported stress of employee phar-

The highest levels of burnout are among women less than 40 years old, practicing in a chain setting, and working in the same job for less than 10 years.

• Not receiving adequate feedback on job performaoce • Trying to meet society's

for high

macists in staff positions and those in management positions were compared. Finally, relationships between total perceived stress, job dissatisfaction, and demographic characteristics were explored.

• Possessing inadequate patients' conditions • Caring for the emotional needs

patients

• Not being accepted as a peer Gy Other health professionals

Methods

• Experiencing conflicts with su~rviSors and! or administrators • Not being challenged by the • Experiencing conflicts with coworkers

1.54

• Not having opportunities to share experiences with colleagues

1.46

0.95

• Being uncertain about what to tell a patient or fam~v

1.43

0.85

• Not knowing exactly what type of job performance is expected

1.42

• Disagreeing with other health profeSSionals

1.42

1.00 O. N

• Caring for terminally ill patients

1.33

0.87

• Feeling inadequately prepared to meet the needs of patients

1.31

0.87

• Allowing ~onal feelings to il'ltertere with patient care

0.98

0.70

Note: SD=

28

scale from 0 <= never stressful to 4::: very often stressful.

A cover letter and three-page questionnaire were mailed to 600 registered pharmacists (150 were selected randomly from four states: Idaho, Louisiana, Missouri, and Virginia). Two weeks after the initial mailing, a second questionnaire was mailed to increase the response rate. Overall, responses were received from 327 pharmacists' yielding a response rate of 55.2%. Of these practitioners, 215 identified themselves as employee pharmacists (43 independent, 64 hospital, and 108 chain pharmacists). The responses of these employee pharmacists are the focus of this paper. In the first section of the questionnaire, respondents completed

American Pharmacy, Vol. NS31, No.9 September 1991/636

the Health Professions Stress Inventory (HPSI), which consists of 30 job situations that health professionals might be expected to encounter in the performance of their duties. Respondents indicate how often they have found each situation to be stressful in their work environment, on a five-point Likerttype scale (from "never" to "very often"). Each item is scored from zero to four, thus the possible range of scores on the entire HPSI is zero to 120. Each job situation on the HPSI was derived from previous studies of stress in the health professions, thus maximizing content validity, and HPSI scores have shown significant correlations with scores on an index of job-related tension. 9 The Cronbach's alpha reliability coefficient was 0.87, an excellent rating. The questionnaire also contained a job dissatisfaction scale, which consisted of four Likert-type items. In addition to inquiring as to the level of overall satisfaction, these items asked respondents to indicate whether they would recommend their job to a good friend, decide again to take the same job, or try to find a new job in the next year .10 This scale is scored in a range of 4 to 13; higher scores on the scale indicate greater dissatisfaction with one's job, and lower scores indicated greater job satisfaction. In this study, the Cronbach's alpha coefficient was 0.81 for the scale. The questionnaire also collected data on several demographic characteristics of respondents, including sex, age, and practice setting. Data were analyzed using programs of the Statistical Analysis System.

Results and Discussion As the first step in data analysis, mean scores for each of the 30 job situations in the HPSI were compared to identify those situations most and least stressful for employee pharmacists; the table contains the mean stress scores for each of the job situations. By far the most stressful situation for employee pharmacists was being interrupted while performing

By far the most stressful situation for employee pharmacists was being interrupted while performing their job duties.

their job duties; other studies have also revealed interruptions to be a leading source of stress for pharmacistS. 11- 12 Those job situations with high stress scores (~ 2.00) seemed to fall into three groups. The first group of job situations was concerned with workload, including interruptions, understaffing, and excessive workload. The second group related to dealing with the public, including "difficult" patients and a perceived lack of respect from the general public. The final group of stressful job situations reflected on supervision and rewards, including such things as inadequate pay, poor advancement opportunities, and underuse of pharmacists' abilities. These job situations contrast with those on which employee pharmacists reported the least stress. There were seven situations, for example, for which the mean reported stress scores were less than 1.50. Most of these situations focused on patient contact

American Pharmacy, Vol. NS31, No.9 September 19911637

and meeting the needs of patients and their families. This may reflect the fact that many pharmacists do not have close, personal contacts with their patients, at least not to the same extent as some other health professionals (e.g., physicians and nurses). It is also interesting to note the relative lack of stress associated with "disagreeing with other health professionals." This could reflect a lack of frequent contact with other health professionals or it could be a sign that the responding pharmacists had good working relationships with other professionals in their areas. When mean stress scores for each of the 30 job situations were compared across the three major practice settings (i.e., independent, chain, and hospital pharmacies), significant differences (ANOVA; p < 0.002) were found for six of the situations. Those pharmacists practicing in independent settings perceived significantly less stress than hospital and chain pharmacists on four of the 30 job situations in the HPSI. Independent pharmacists reported being less stressed by (1) experiencing conflicts with supervisors and/or administrators, (2) experiencing conflicts with coworkers' (3) not having enough staff to adequately provide necessary services, and (4) not being allowed to participate in making decisions about their jobs. Because they work in smaller organizations, it was not surprising to find that employee pharmacists in independent settings felt less stress in dealing with other employees or staffing problems. The independent setting also appeared to provide fewer problems stemming from lack of participative decision-making. For the other two job situations where significant differences were found, hospital pharmacists perceived the least stress. Both of these situations concerned interactions with patients and probably reflect the decreased frequency of direct patient interaction typically associated with hospital pharmacy practice. Specifically, hospital pharmacists perceived less stress than independent or chain pharmacists in caring for the emotional needs of 29

80 70 60

•

Hospital

D D

Chain Independent

50 40

30 20 I-

~ 10

(.)

ffia..

o Without Hesitation

RESPONSES

80 •

70

Hospital

1·. ··· 1Chain

60 50 40

30 20 ......

~ 10

()

ffia..

o

Very Likely

Somewhat Likely

Not at AU Likely

RESPONSES Figure 2. Pharmacists' responses to the question, "Would you try to find a new , job in the. coming yearr~

30

patients and in dealing with "difficult" patients. Interestingly, there were no job situations in which chain pharmacists perceived the lowest level of stress. Within practice settings, mean stress scores were compared to determine if there were significant differences (ANOVA; p < 0.002) between employee pharmacists holding management positions versus those in staff positions. It was anticipated that management and staff pharmacists might differ in perceived stress because of potential variations in job responsibilities and authority. Overall, however, stress perception among pharmacist managers differed little from perceptions among staff pharmacists. There were no significant differences in either independent or chain settings, while only one situation exhibited a staff-management difference in the hospital setting: hospital staff pharmacists were more stressed than those in management positions by a perceived lack of participation in decision making (ANOVA; p <0.002). Since hospital pharmacies typically are larger organizations with the potential for multiple levels of authority, it is not surprising that staff pharmacists would have perceived themselves as having a diminished role in making decisions about their jobs. As has been found in previous studies,13-15 a significant relationship was found between job dissatisfaction and perceived stress (r=0.41; p <0.001), with employee pharmacists' job dissatisfaction increasing as total HPSI scores increased. This finding also is in keeping with a theoretical model of stress that predicts that as levels of stress build to unacceptable levels, job satisfaction will decline.1 6 Job stress was also analyzed by demographic characteristics of the respondents, but neither age nor sex exhibited significant relationships with HPSI scores. In addition to its relationship with stress scores, job dissatisfaction also was found to differ significantly among practice settings (F(2,211)=4.l4, p < 0.02). Pharmacists working in independent set-

American Pharmacy, Vol. NS31, No.9 September 19911638

tings expressed the least dissatisfaction (mean=6.30, SD=2.29), while chain (mean=7.42, SD=2.13) and hospital (mean=7 .27, SD=2.21) employee pharmacists did not differ significantly in terms of job dissatisfaction. The differences in dissatisfaction between practice settings can perhaps be understood better by considering the responses to two of the individual questions on job dissatisfaction. Figure 1 depicts responses to the question, "Knowing what you know now, if you had to decide all over again whether to take the job you now have, what would you decide?" While more than 50% of the employee pharmacists in independent settings indicated they would take the same job without hesita-

For the well-being of employee pharmacists and patients alike, attention needs to be focused on the reduction of job stress in pharmacy.

tion, less than 30% of the chain and hospital pharmacists concurred with that sentiment. In contrast, while approximately 60% of the chain and hospital employee pharmacists indicated they would have second thoughts about taking the same job again, less than 45% of the independent pharmacists expressed such doubts. Figure 2 represents a summation of responses to the question, "Taking everything into consideration, how likely is it that you will make a genuine effort to find a new job with another employer within the next year?" Perhaps most noteworthy is the fact that relatively few employee pharmacists in any setting felt they were "very likely" to seek a new job in the next year. This could mean that despite a certain level of dissatisfaction, working conditions were not so bad as to cause the pharmacists to look for

other employment. It also may reflect a lack of other job opportunities or perhaps a feeling that the level of satisfaction would not be improved by moving to another practice site. Nonetheless, the pattern indicates that chain and hospital pharmacists were (1) fairly similar in their feelings about seeking new jobs and (2) less satisfied with their present jobs than were independent employee pharmacists. One demographic characteristic, age, also was related significantly to job dissatisfaction (r=-0.21; p < 0.002); as age increased, dissatisfaction decreased. This finding is consistent with the results of other studies that have found younger pharmacists to be less satisfied with their jobS. 17- 19 Scores on the job dissatisfaction scale were not related significantly to the sex of responding employee pharmacists.

Conclusion Because of expressed concerns regarding stress experienced by employee pharmacists, the primary goal of this study was to document the sources of that stress. As the table shows, the most stressful job situations seemed to fall into three groups: workload, dealing with the public, and supervision and rewards. Results also indicated that as total stress scores increased, so did job dissatisfaction. Thus, perceived job stress indeed may be taking a toll on employee pharmacists in terms of its association with decreased satisfaction. A recent report indicated that heavy pharmacy workloads, a leading source of stress in this study, may be linked to medication errors being committed by pharmacists. 20 For the well-being of employee pharmacists and patients alike, attention needs to be focused on the reduction of job stress in pharmacy.

Brian Ortmeier is a doctoral candidate at the University of Georgia, Athens. Alan P. Wolfgang, PhD, is associate professor, pharmacy administration, at the university.

American Pharmacy, Vol. NS31, No.9 September 1991/639

References 1. 2.

3. 4.

5. 6.

7. 8. 9. 10.

11.

12.

13.

14.

15.

16. 17. 18.

19.

20.

Ceslowitz SB. Burnout and coping strategies among hospital staff nurses. J Adv Nurs. 1989;14:553-7. Chiriboga DA, Jenkins G, Bailey J. Stress and coping among hospice nurses: test of an analytic model. Nurs Res. 1983;32:294-9. Lahoz MR, Mason HL. Burnout among pharmacists. Am Pharm. 1990;NS30: 460-4. Nashman HW, Hoare CH, Heddesheimer JC. Stress and satisfaction among professionals who care for AIDS patients: an exploratory study. Hosp Top. 1990;68(1):22-8. Wolfgang AP. Chain pharmacy: is pharmacist turnover a function of job stress? Am Pharm. 1987;NS27:341-5. Employed pharmacists share job concerns-recommend ways to increase job satisfaction. Am Pharm. 1990;NS30: 336-7. Stressful conditions led to Walgreens strike. Pharm Today. 1990;29(14):4. Schulz RM, Baldwin HJ. Chain pharmacist turnover. J Soc Admin Pharm. 1990;7:26-33. Wolfgang AP. The health professions stress inventory. Psychol Rep. 1988;62: 220-2. Caplan RD, Cobb S, French JRP Jr, et al. Job Demands and Worker Health. Washington, DC: US Department of HEW;1975. Wolfgang AP. Job stress in the health professions: a study of physicians, nurses, and pharmacists. Behav Med. 1988; 14:43-7. Wolfgang AP, Kirk KW, Shepherd MD. Job stress in pharmacy practice: implications for managers. Am Pharm. 1985;N525:446-9. French JRP Jr, Caplan RD. Organizational stress and individual strain. In Morrow AJ, ed. The Failure of Success. New York: AMACOM;1972. Kahn RL, Wolfe DM, Quinn RP, et al. Organizational Stress: Studies in Role Conflict and Ambiguity. New York: John Wiley and Sons, 1964. Margolis BL, Kroes WH, Quinn RP. Job stress: an unlisted occupational hazard. J Occup Med. 1974;16:659-61. Ivancevich JM, Matteson MT. Stress and Work. Glenview, IL: Scott, Foresman and Company, 1980. Barnett CW, Kimberlin CL. Levels of satisfaction among Florida pharmacists. Am Pharm. 1988;2(4):23-44. Noel MW, Hammel RJ, Bootman JL. Job satisfaction among hospital pharmacy personnel. Am J Hosp Pharm. 1982; 39:600-6. Stewart JE, Smith SN. Work expectations and organizational attachment of hospital pharmacists. Am J Hosp Pharm. 1987;44:1105-10. Cardinale V. Medication errors linked to heavy pharmacy workloads. Drug Top. 1990;134(23):12-3.

31