The latest Pharmacy Workplace and Well-Being Reporting (PWWR) from the American Pharmacists Association (APhA) highlights the continued strain on pharmacy personnel under pressure due to working conditions, staffing concerns, and aggressive behavior from patients and their caregivers.
The PWWR is not a survey, but rather “a safe space to submit both positive and negative pharmacy workplace experiences in a confidential and anonymous manner,” the APhA said in a mid-March news announcement. “The goal of PWWR is to tell the stories of those who submit their experiences so that the profession may begin to act on the findings and learnings. This cycle’s report includes summaries of 2023 report findings.”
Problems for pharmacists persist
The PWWR launched in October 2021 and has so far collected nearly 2,000 submissions from pharmacists, certified pharmacy technicians, pharmacist managers and supervisors, pharmacy technicians, and student pharmacists/interns.
For the latest reporting period — October through December 2023 — the PWWR system received 174 submissions. During the previous reporting period (July through September 2023), the PWWR received 378 submissions.
Pharmacy personnel who submitted information work in supermarket pharmacies; mass-merchant pharmacies; independent pharmacies with one to three locations; hospital/institutional in-patient pharmacies; or chain pharmacies with four or more locations. For this latest cycle, 78% of submissions came from pharmacy personnel from “large community pharmacy employers,” the report said.
Negative reports outnumber positive ones
The latest PWWR report tallied 46 positive experiences and 128 negative ones.
Positive experiences were sorted into four categories: Communication, feedback or psychological safety (25 responses); safety and quality by design (6 responses); preventing errors and improving quality (13 responses); and other (2 responses).
Those experiences were further sorted by sub-categories, including “I received positive feedback from a patient about an action I took related to their medication and/or its use.” One example in that sub-category, submitted by a pharmacist manager/supervisor of an independent pharmacy, said, “A husband and wife had questions regarding their choices of vaccines and the timing of those vaccines. We talked for a few minutes about the options they had, their health conditions, previous experiences with vaccines, and what they had planned in their lives in the next few months. We made a plan for which vaccines they would need that would protect their health and impact holiday plans with family the least amount possible.”
Noting that the interaction had “a lasting positive effect on my overall well-being,” the pharmacist manager added, “They also commented on the vaccine being the most pain free they’ve ever had!”
“As has been the case in previous reports, positive experiences do not have to be a big undertaking – respect of clinical knowledge, time to help patients, freedom to use clinical judgement – to have positive effects,” the PWWR report said. “Like last quarter, the majority of positive reports indicated that their positive experiences would have a lasting positive effect on their well-being.”
Pharmacies still understaffed considering workload expectations
The report noted that negative experience submissions “focused primarily on staffing/scheduling, followed closely by volume/workload expectation mismatched to hours available.”
And pharmacy personnel participating in the PWWR noted that nearly all the negative experiences are ongoing: “Of those submitting negative experiences in this cycle, 94% indicated that they were recurring problems compared to 95%, 96%, and 98% in the other 2023 PWWR Reports,” APhA said. “The recurring problems were across all practice settings, but the majority were from reporters in chain pharmacy practice.”
Another section of the report — titled “Harassment of Pharmacy Staff Is Real” — said, “Negative experience submissions related to harassment from patients/customers and co-workers continues again this analysis cycle.” Nearly 75% of the verbal or emotional harassment incidents involved patients/customers or pharmacy managers. Nine participants reported threats of physical harm or actual physical harm; eight of those experiences involved patients and customers.
Inadequate staffing — mentioned in 90 of 174 negative reports — was the most common response from participants asked to specify the root cause of their experiences. Tied as the second-most common root causes were metrics and workflow design/policies (69 responses each). Those were followed by corporate/organization policies or requirements beyond the pharmacy department’s control (58 responses); inadequate pharmacist to pharmacy technician staffing (56 responses); patient/caregiver expectations or demands (47 responses); and unexpected influx of patients (45 responses).
Other root causes of negative experiences included issues with training and education; medication shortages; break policies and practices; drive-through and hospital staff windows; insurance/prior authorization issues; technology and automation; floater/per diem staffing; and state/federal laws and regulations. Participants were allowed to choose more than one root cause per negative experience.
What PWWR reports can teach us
“The negative reported experiences in this cycle included many of the same threatening and abusive stories described in detail in the previous analysis,” the latest report said. As noted in Report VII, these stories speak loudly and boldly about the difficulties in working in community-chain pharmacy. As seen in the table of root causes, reporters identified multiple reasons for a given negative experience.”
The report called out harassing and threatening situations from “individuals in positions of authority (both the pharmacy proper and non-pharmacy),” as well as from patients and their caregivers. “It continues to be critical that organizations review and update policies and training on the types of harassment and microaggressions within the pharmacy and how to report. In addition, training continues to be needed for pharmacy staff members on how to deescalate or walk away from these situations when they occur. … Simply put — the patient is not always right.”
Pharmacy personnel on the front lines also mentioned being told that staffing shortages are being caused by a lack of candidates to hire, despite personally knowing that qualified candidates are available.
“One theme that stands out in this period is that ‘corporate’ is stating that there is a shortage of health-care providers including pharmacists, yet the reporter notes that pharmacy graduates and experienced pharmacist can’t get jobs or even interviews from the company because they don’t have the money to train them,” the report said. “The reporter believes the real intention is to cover up the real truth, which is the corporate bottom line.”
Pharmacy personnel are feeling additional frustration over how long problems have persisted without being meaningfully addressed.
“While many of the reasons for negative reports are the same as in previous reports, the troubling learning is the lack of response, inaction taken, or flippant replies by supervisors/management when offered recommendations,” the latest PWWR said. “It has been well documented that feeling valued and heard are key factors to preventing occupational burn-out. A ‘take it or leave it’ response is a quick way to lose staff. Maybe nothing can be done, but a serious response or an indication why a recommendation can’t be implemented would be beneficial to addressing these key factors.”
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