Promoting resiliency: Recognizing and preventing burnout

Cover Story

Chances are the term “burnout” resonates with you due to the rigors of school combined with any or all of your other professional and personal commitments. Maybe you are realizing that pursuing a PharmD degree is far more challenging than you anticipated, or you might even be second-guessing your decision. Understand that relating to any of these statements is completely normal. These feelings don’t mean that you chose the wrong profession or that you aren’t meant to be a pharmacist. It simply means you have chosen to join a profession with stressors, and as you develop resilience, you can avoid burnout and continually provide the best care possible for your patients and community.
To learn how to avoid burnout, it is important to understand the relationship between stress and burnout and the difference between them. Burnout is a process that begins with high and persistent levels of stress that can eventually lead you to feel irritable, cynical, and disengaged.1 Three hallmarks of burnout are emotional exhaustion, depersonalization, and a lowered sense of self-worth, which ultimately lead to decreased productivity and effectiveness.1 In other words, once someone transitions from prolonged stress to burnout, he or she transitions from feeling overengaged and overreactive to feeling disengaged and emotionally numb. One loses motivation to work and do one’s best. Ultimately, burnout can produce hopelessness, feelings of failure, and resentment.  
Prevalence of burnout
Considering that prolonged stress serves as a major precursor to burnout, what is the risk of pharmacists experiencing burnout during their career? According to a 2004 survey by Mott et al., almost 70% of pharmacists surveyed experienced job stress and role overload.2 In my experience, the health care environment has become even more stressful over the last 10 years. Increased patient volume due to an aging population, among other factors, now enhances the risk for pharmacist burnout.  
This issue is not limited to pharmacy or health professionals. Burnout is highly prevalent across many professions. The National Institute for Occupational Safety and Health (NIOSH) estimates that 25% to 40% of U.S. workers suffer from stress-related job burnout.3 More than $300 billion is spent annually on stress-related job compensation claims, reduced productivity, absenteeism, and medical expenses in the United States alone.4
While the impact of burnout can be clearly seen from a prevalence and financial perspective, the consequences of burnout among pharmacists and other health professionals can adversely affect patient care. 
In the patient care work environment, multiple stress factors may cause health professionals to succumb to burnout. These stress factors include frequent interactions with patients and other health professionals, exponential growth in and subsequent dependence on technology, shortages in resources such as medications and labor, and extremely high demands for quality patient care given that these decisions involve human life. The last stressor is the most important reason burnout in health care can endanger the patients we serve. Burnout has been associated with multiple negative patient outcomes, including lower patient satisfaction, reduced patient safety, and ultimately, inferior quality of care.5
For example, a study conducted at the University of Washington Hospitals observed medical resident burnout and the unfortunate consequences on patient care. The Maslach Burnout Inventory, a widely accepted instrument that assesses levels of burnout, was used to identify residents who were actively experiencing burnout. The differences between the burnout and no-burnout groups were frightening. The group experiencing burnout related more closely to the following statements regarding their patient care efforts compared with the residents not experiencing burnout:    
  • “I found myself discharging patients to make the service ‘manageable’ because the team was too busy.” 
  • “I did not fully discuss treatment options or answer a patient’s questions.” 
  • “I made treatment or medication errors that were not due to a lack of knowledge or inexperience.” 
  • “I paid little attention to the social or personal impact of an illness on a patient.” 
  • “I had little emotional reaction to the death of one of my patients.” 
  • “I felt guilty about how I treated one of my patients from a humanitarian standpoint.”
In short, you not only owe it to yourself to develop resilience and prevent burn out. You owe it to your patients.
Resilience refers to a person’s ability to rebound from adversity and overcome difficult circumstances.7 Specific characteristics equip people to cope well with adversity. Generally, if we make concerted efforts to be socially active, maintain strong relationships with our family, maintain a positive self-image and mindset, and take care of our bodies, we will ultimately build our inner sense of resilience.8 This makes sense because burnout is the exact opposite of the characteristics of resiliency.    
One of the most intriguing studies I reviewed involved a series of interviews with Vietnam Prisoners of War (POW) conducted by a physician in New York. He found that among all the POWs he interviewed who never developed depression or posttraumatic stress disorder, all shared the same 10 qualities and resources.9 These include optimism, altruism, moral compass, faith/spirituality, humor, role model, social supports, facing fear, have a mission, and training.
Many of these are self-explanatory and don’t require further explanation. However, if you take anything away from this article, understand the importance of developing your own personal mission statement.
Focal point preserves resilience
When presenting this topic, I often use the analogy of a figure skater or ballet dancer who executes dozens of spins in a single performance. Spinning several times in place can cause you to become dizzy and fall over. Athletes and performers maintain their balance by focusing their eyes on a single point during each spin. Similarly, student pharmacists and pharmacists are constantly spun around by their professional and personal expectations. The best way to maintain balance and prevent yourself from stumbling is to have a focal point. That focal point is your own personal mission.  
Developing your mission statement should be easy. It should encompass what makes you tick—why you do what you do every day. For instance, name the top three reasons you got out of bed this morning that did not begin with “I had to” but with “I want to.” As far as pharmacy goes: why did you want to become a pharmacist? To help others? To make a good living? Whatever the reasons may be, incorporate them in your mission statement.  
Once you have developed your mission statement, revisit it often, especially during the times when you are feeling especially stressed. Use it to remind yourself why you chose pharmacy. Most importantly, understand that it is okay for your mission to change. It should be considered a living document, one that will evolve as you progress through your career and life.
My mission is somewhat different now compared with when I had the privilege of serving as APhA–ASP National President 10 years ago. At that time, I was committed to advancing the role of student pharmacists. In addition, I was single and had not yet met my wife. Today, I still commit myself to advancing the role of pharmacy learners, but now I include pharmacy residents in addition to student pharmacists. However, the crux of my mission has become my family. They are the reason I continue to be resilient in both my personal and professional lives.
Take the time to commit to a greater understanding of why you chose to be a part of this profession, and write it down. Use this focal point to maintain your resolve and prevent yourself from succumbing to the stress and burning out. Also, find ways to develop the tools and qualities that have been observed in highly resilient individuals. Your well-being means everything to your loved ones, your patients, and your community.
1. Gopal R, Glasheen, JJ, Miyoshi TJ, Prochazka AV.  Burnout and internal medicine resident work-hour restrictions. Arch Intern Med. 2005;165(22):2595–600.  
2. Mott DA, Doucette WR, Gaither CA, Pederson CA, Schommer JC. Pharmacists’ attitudes toward worklife: Results from a national survey of pharmacists. J Am Pharm Assoc. 2004;44(3):326–36.  
3. Boisaubin E. The epidemic within: addressing stress, burnout and well-being with medical oncologists. Fifth Annual Elihu N. Root, M.D. Distinguished Lectureship; Keynote; October 28, 2013; Kelsey Research Foundation; Houston, TX. 
4. Rosch PJ, ed. The quandary of job stress compensation. Health Stress. 2001;(3):1–4.
5. Halbesleben JR, Rathert C. Linking physician burnout and patient outcomes: Exploring the dyadic relationship between physicians and patients. Health Care Manage Rev. 2008;33(1):29–39.
6. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Resident burnout and self-reported patient care. Ann Intern Med. 2002;(136):358–67.
7. McCallister M, Lowe, JB. The Resilient Nurse: Empowering Your Practice. New York: Springer Publishing Co; 2011. eBook. Accessed February 4, 2014.
8. Denz-Penhey H, Murdoch C. Personal resiliency: serious diagnosis and prognosis with unexpected quality outcomes. Qual Health Res. 2008;18(3):391–404.
9. Charney DS. Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. Am J Psychiatry. 2004;161(2):195–216.