The State of Health, Burnout, Healthy Behaviors, Workplace Wellness Support, and Concerns of Medication Errors in Pharmacists During the COVID-19 Pandemic

Burnout affects a substantial percentage of pharmacists and is associated with concern of making a medication error. When workplaces support pharmacists’ well-being, there is less burnout. Health care systems must fix system problems that cause burnout as well as build wellness cultures and offer evidence-based programming to support pharmacist well-being.

Objectives

The aims of the study were to describe the well-being and lifestyle behaviors of health-system pharmacists during the COVID-19 pandemic and to determine the relationships among well-being, perceptions of workplace wellness support, and self-reported concern of having made a medication error.

Methods

Pharmacist (N = 10,445) were randomly sampled for a health and well-being survey. Multiple logistic regression assessed associations with wellness support and concerns of medication error.

Results

The response rate was 6.4% (N = 665). Pharmacists whose workplaces very much supported wellness were 3× more likely to have no depression, anxiety, and stress; 10× more likely to have no burnout; and 15× more likely to have a higher professional quality of life. Those with burnout had double the concern of having made a medication error in the last 3 months.

Conclusions

Healthcare leadership must fix system issues that cause burnout and actualize wellness cultures to improve pharmacist well-being.

LEARNING OUTCOMES

• Outline health and well-being outcome differences between pharmacists with workplaces that very much supported their wellness and pharmacists who perceived little to no wellness support.

• Describe the type of work environments that result in burnout.

The pharmacy profession is experiencing alarming proportions of occupational burnout. In hospital and health-system settings, up to 70% of pharmacists report experiencing moderate to high levels of burnout. ^1–3 Workflow inefficiencies, workload volume, lack of autonomy, regulatory burdens, and staffing and medication shortages are cited as threats to well-being at work. ^1–4 Burnout is a unique construct that can occur with depression and anxiety. ⁵ In community pharmacists, burnout has been associated with depression, anxiety, and alcohol misuse. ⁶

Together with fixing system level factors for burnout, engaging in healthy lifestyle behaviors like obtaining appropriate sleep, exercise, and servings of fruit and vegetables daily can also support mental/physical health improvements. ⁷ However, most clinicians do not meet the evidence-based recommendations. ⁸ Clinician turnover and a lack of high-value care are associated with poor clinician well-being. ^9,10

A pre–COVID-19 study of 2231 pharmacists indicated professional consequences to not being physically and mentally well. ¹¹ Pharmacists in greater emotional distress had higher odds of being concerned that they made a medication error, raising the alarm that pharmacist distress may adversely impact patient safety.

To address mounting workforce and patient safety issues, the 2022 American Society of Health-System Pharmacists (ASHP) Pharmacy Forecast included establishing “strategies and resources for employee resilience and well-being specifically targeted on mitigation of burnout and feelings of isolation for pharmacists and pharmacy technicians” as one of six strategic recommendations for practice leaders. ¹² While there has been work establishing the prevalence of burnout in pharmacists, ^1–4,11 there has been no research concerning pharmacists’ perceived level of workplace wellness support and its impact on their mental/physical health. Thus, this study’s aims were to (1) describe the health/healthy lifestyle behaviors of pharmacists along with changes during the COVID-19 pandemic, (2) compare the health/healthy lifestyle behaviors of pharmacists based on perceived level of workplace wellness support, and (3) examine the self-reported concern of having made a medication error compared with mental/physical well-being and health/healthy lifestyle behaviors.

MATERIALS AND METHODS

A cross-sectional, descriptive correlational design was used. Data were obtained between April and May 2022. An institutional review board deemed the study exempt because it was minimal risk with adequate privacy measures.

A wellness survey invitation was emailed from ASHP’s Chief Executive Officer to a random sample of 10,445 ASHP pharmacist members. Fifty percent of the total membership was randomly selected using the randomization function in Excel. Two reminder emails were sent after the initial email. Only the pharmacist outcomes are reported in this article; however, survey responses were also obtained from pharmacy residents, technicians, and students. Those surveys results will be disseminated later. Invitations sent through email specified the voluntary nature of the study, the anonymity of responses, and that completing the survey was not obligatory. A link to the consent form and survey was also included in the email. A giveaway incentive, 10 $100.00 gift cards, was offered to participants who completed the survey. The survey was hosted on Qualtrics XM Management Software.

Measures

Demographic information included age, sex, race/ethnicity, relationship status, having children, education level, hours worked per day, and primary employer. Remaining survey questions assessed participant mental/physical well-being, COVID-19’s impact on mental/physical well-being, level of workplace wellness support, and self-reported concern of having made a medication error.

Healthy Lifestyle Behaviors

Healthy behavior guidelines from the Centers for Disease Control and Prevention ¹³ informed the healthy lifestyle behavior questions, which inquired about the quantity of fruits and vegetables eaten/day, minutes of physical activity obtained/week, hours of sleep obtained/night, and degree of alcohol and tobacco use.

COVID-19 Impact on Overall Health and Well-being

Using multiple choice, participants self-reported if COVID-19 had impacted their healthy lifestyle behaviors, mental health, and physical health. For example, the question “Since the start of COVID-19, has your frequency of alcohol use increased?” had the response options of no or yes, I am consuming more alcohol than I usually do. The mental health question asked, “Has your mental health been impacted by COVID-19?” with the response options of no; yes, I am in better mental health as a result of COVID-19; or yes, I am not as mentally healthy as a result of COVID-19. The physical health question was formatted like the mental health question, but mental health was replaced with physical health.

Patient Health Questionnaire 2

The Patient Health Questionnaire 2 (PHQ-2) is a valid, reliable, and widely used scale that screens for clinically relevant depressive symptoms. ¹⁴ Using two items, the instrument asks how frequently participants have had little interest in doing things and felt down, depressed, or hopeless over the past 2 weeks. Responses use a four-point Likert-type scale: 0 = not at all, 1 = several days, 2 = more than half the days, and 3 = nearly every day. A score ≥3 is considered a positive screening for depression.

Generalized Anxiety Disorder 2

The Generalized Anxiety Disorder 2 (GAD-2) also is a widely used valid and reliable scale that screens for clinically relevant anxiety symptoms. ¹⁵ Using two items, the instrument asks how frequently participants feel nervous, anxious, or on edge and cannot control worrying over the past 2 weeks. Responses use a four-point Likert-type scale: 0 = not at all, 1 = several days, 2 = more than half the days, and 3 = nearly every day. A score of 3 or higher is considered a positive screening for anxiety.

Perceived Stress Scale 4

The Perceived Stress Scale 4 (PSS-4) is a valid and reliable scale used to measure stress perception during the last month. ^16,17 The PSS-4 uses the following four items to assess stress perceptions: (1) “How often have you felt that you were unable to control the important things in your life”; (2) “How often have you felt confident about your ability to handle personal problems”; (3) “How often have you felt that things were going your way”; and (4) “How often have you felt difficulties were piling up so high that you could not overcome them?” Responses uses a five-point Likert-scale: never = 0, almost never = 1, sometimes = 2, fairly often = 3, and very often = 4. A score of less than 4 is considered no/little stress.

Professional Quality of Life

Professional Quality of Life (ProQOL) was assessed the following using four ProQOL Scale ¹⁸ statements: “I feel worn out because of my work;” “I feel trapped by my job;” “I am not as engaged with my patients today as I used to be;” and “I believe I can make a difference through my work.” Responses use a five-point Likert scale: never = 1, rarely = 2, sometimes = 3, often = 4, and very often = 5. A score of 12 or higher is considered high ProQOL.

Burnout

The nonproprietary burnout measure assessed burnout and is a viable stand-in for the proprietary Maslach Burnout Inventory. ¹⁹ The measure uses a single item to assess for burnout, “Overall, based on your definition of burnout, how would you rate your level of burnout?” Responses use a five-category ordinal scale: no symptoms = 1; occasional stress, but don’t feel burned out = 2; definitely burning out and am experiencing physical or emotion exhaustion = 3; symptoms of burnout won’t go away = 4; and I feel completely burned out and often wonder if I can go on = 5.

Self-reported Mental/Physical Health

Participants self-reported their mental/physical health using a scale of 0 (very unhealthy) to 10 (extremely healthy): “On a scale of 0–10, how would you rate your current mental health?” and “On a scale of 0–10, how would you rate your current physical health?”

Workplace Wellness Support

A question adapted from the valid and reliable Perceived Wellness Culture and Environment Support Scale assessed self-reported perception of workplace wellness: “How supportive is your work environment of personal wellness?”¹⁹ Responses used a five-point Likert-type scale: 0 = not at all, 1 = a little, 2 = somewhat, 3 = moderately so, and 4 = very much. ²⁰

Medication Errors

The survey included a binary question about medication errors, “In the last 3 months, are you concerned you may have made a major medication error?” adapted from Skrupky and colleagues. ¹¹ This is a self-report measure.

Statistical Analysis

Sample characteristics, healthy lifestyle behaviors, mental/physical health, and changes during COVID-19 pandemic were summarized using descriptive statistics. In the multiple logistic regression, each healthy lifestyle behavior and health measure was analyzed separately and dichotomized as better or worse categories. Better categories were composed of sufficient sleep (≥7 hr/night), adequate physical activities (≥150 minutes of moderate physical activities/week), healthy eating (≥5 servings of fruits and veggies/day), not a current smoker, no/light alcohol use (≤3 times/week), better physical health (self-rated physical health score of 6–10), better mental health (self-rated mental health score of 6–10), no symptoms of depression (PHQ-2 score of 0), no symptoms of anxiety (GAD-2 score of 0), no/little stress (PSS-4 score of ≤4), and high ProQOL (ProQOL-4 score of ≥12). Similarly, the negative impact indicators were analyzed separately in the multiple logistic regression model and dichotomized as having a negative impact (yes vs. no). The “yes” category contained the following: (1) negative impact on sleep (ie, sleeping more or less); (2) less physical activity; (3) less healthy eating; (4) more smoking; (5) more consumption of alcohol; (7) worse physical health; and (8) worse mental health. Characteristics of the sample (ie, age, sex, race/ethnicity, marital/relationship status, number of children at home, degree of education, hours of workday/shift) were adjusted as covariates in all the previously described logistic regression models.

Multiple logistic regression models examined to what extent the concern of having made a medication error (dependent variable) were affected by each independent variable of healthy lifestyle behaviors, health status, and impact of COVID-19 on behavior/health, adjusting for covariates (pharmacists’ age, sex, race/ethnicity, marital status, number of children, education degree, primary employer setting, hours of workday/shift, and workplace wellness support). SAS 9.4 (SAS® Institute, Cary, NC) was used for all the analyses.

RESULTS

Sample Characteristics

A response rate of 6.4% (n = 665) was obtained. Most pharmacists who completed the survey had a doctoral degree (89.5%), were between ages of 30 to 49 years (65.4%), female (72.0%), non-Hispanic white (76.4%), married or in a relationship (77.3%), and had no child 21 years or younger living at home (54.6%). Most (59.1%) worked 8 to 10 hours per day. About a third (34.7%) worked at an academic medical center/health system, 18.3% at a large nonacademic medical center/health system, and 14.3% at a small community/rural hospital (Table 1).

TABLE 1.

Pharmacist Demographics (N = 665)

	n	%
Age
Not reported	16	2.4
<30	48	7.2
30–39	246	37.0
40–49	189	28.4
50–59	93	14.0
≥60	73	11.0
Sex
Missing	21	3.2
Female	479	72.0
Male	165	24.8
Race/ethnicity
Not reported	37	5.6
Non-Hispanic White	508	76.4
Non-Hispanic Black	24	3.6
Hispanic	20	3.0
Other	76	11.4
Currently married/in a relationship
Not reported	22	3.3
No	129	19.4
Yes	514	77.3
Having children (age <21 yr) living at home
Not reported	5	0.8
No	363	54.6
Yes	297	44.7
Education (all that apply)
Not reported	3	0.5
Associate	21	3.2
CPhT	25	3.8
ASHP/ACPE training program	57	8.6
Bachelor	306	46.0
Master	131	19.7
Doctorate	595	89.5
Residency	377	56.7
Board certification	381	57.3
Hours of work per day
<8	188	28.3
8–10	393	59.1
>10	83	12.5
Primary employer setting
Not reported	0	0.0
Academic medical center/health system	231	34.7
Large nonacademic medical center/health system	122	18.3
Government hospital/health system	45	6.8
Small community/rural hospital	95	14.3
Ambulatory clinic	23	3.5
Home health/infusion	5	0.8
Hospital outpatient pharmacy/clinic-based pharmacy/specialty pharmacy	25	3.8
College of pharmacy	58	8.7
Other	61	9.2

ACPE, Accreditation Council for Pharmacy Education; ASHP, American Society of Health-System Pharmacists; CPhT, Certified Pharmacy Technician.

Healthy Lifestyle Behaviors, Health Measures, and Related Changes During COVID-19 Pandemic

A small proportion met the Centers for Disease Control and Prevention guidelines in all three aspects of sleep, physical activity, and fruit/vegetable consumption. Approximately half (48.0%) slept ≥7 hours/night. Twenty-six percent reported ≥150 minutes of moderate physical activity/week. Only 7.1% of the pharmacists consumed ≥5 servings of fruits/vegetables/day. Most were not current smokers (97.9%) and light drinkers (72.5%); 14.0% never drank alcohol, and 13.5% reported moderate/heavy drinking (Table 2).

TABLE 2.

Healthy Lifestyle Behaviors, Physical/Mental Health, and Change Since COVID-19 Pandemic

Healthy Lifestyle Behaviors	n	%
Hours of sleep per night
<7 hr	346	52.0
≥7 hr	319	48.0
Minutes of moderate physical exercise per week
<150 min	492	74.0
≥150 min	173	26.0
Servings of fruits/vegetables per day
<5 servings	618	92.9
≥5 servings	47	7.1
Current smoker
No	651	97.9
Yes	13	2.0
Alcohol use
Never	93	14.0
Light drinker (3 times per week or less)	482	72.5
Heavy drinker (≥4 times per week)	90	13.5
Impact of COVID-19 Pandemic on Health Behaviors	n	%
Sleep
No change	310	46.6
More sleep	39	5.9
Less sleep	312	46.9
Physical exercise
No change	318	47.8
Exercise less	302	45.4
Exercise more	40	6.0
Diet
No change	297	44.7
Eat less healthy	270	40.6
Eat healthier	97	14.6
Increased smoking since COVID-19 pandemic
No	660	99.2
Yes	5	0.8
Increased alcohol intake since COVID-19 pandemic
No	474	71.3
Yes	191	28.7
Physical and Mental Health	n	%
Physical health
0–5	187	28.1
6–10 (good)	478	71.9
Mental health
0–5	257	38.6
6–10 (good)	408	61.4
PHQ-2
<3 (no depression)	563	84.7
≥3	100	15.0
GAD-2
<3 (no anxiety)	482	72.5
≥3	181	27.2
PSS-4
0–4 (no/little stress)	186	28.0
5–12	477	71.7
ProQOL-4
0–11	552	83.0
12–16 (high professional QOL)	112	16.8
Having burnout
No	241	36.2
Yes	423	63.6
COVID impact on physical health
No change	295	44.4
Better	58	8.7
Worse	312	46.9
COVID impact on mental health
No change	173	26.0
Better	21	3.2
Worse	471	70.8

GAD-2, Generalized Anxiety Disorder 2; PHQ-2, Patient Health Questionnaire 2; PROQOL-4, Professional Quality of Life 4; PSS-4, Perceived Stress Scale 4; QOL, quality of life.

Table 2 also shows the pandemic impact on healthy lifestyle behaviors. More than half of the pharmacists indicated that the pandemic negatively impacted their sleep, with 46.9% obtaining less sleep and 5.9% obtaining more sleep. In relation to the pandemic, more than 40% related that they were less physically active (45.4%) and ate less healthy (40.6%). The pandemic marginally impacted smoking, as only 0.8% increase was observed. However, a substantial proportion of respondents (28.7%) reported an increase in their alcohol consumption in relation to the pandemic.

A substantial percentage of pharmacists reported suboptimal health with 28.1% reporting a physical health score of ≤5 and 38.6% reporting a low mental health score of ≤5. Based on the validated screening tools, a considerable proportion screened positive for depression (15.0%), anxiety (27.2%), stress (71.7%), and burnout (63.6%). A small proportion (16.8%) reported high ProQOL. More than half reported worse physical (46.9%) and mental health (70.8%) due to the pandemic (Table 2).

Associations of Workplace Wellness Support With Healthy Lifestyle Behaviors, Health Measures, and the Related Changes During COVID-19 Pandemic

The percentage of pharmacists who had ≥7 hours of sleep/night were highest among those who reported very much support in perceived workplace wellness support (47.0%, 45.9%, and 54.76%, respectively, for not at all/a little, somewhat, and very much support (Table 3). Similar trends were observed for fruit/vegetable consumption and physical activity. The significant relationships between greater perceived support of wellness and physical activity held after adjusting for age, sex, race/ethnicity, marital status, number of children living at home, education, hours of workday/shift, and primary employee setting in the multiple logistic regression models. Compared with pharmacists whose workplaces provided little/no support, those whose workplaces supported higher wellness were almost twice as likely to have more than 150 minutes of moderate physical activity per week (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.11–3.35; Table 3).

TABLE 3.

Associations of Perceived Workplace Wellness Support With Healthy Lifestyle Behaviors, Physical/Mental Health, and Their Changes since COVID-10 Pandemic

	Perceived Support of Wellness at the Place of Employment
	Not at All/a Little (n = 215)	Somewhat (n = 351)	Very Much (n = 97)	Somewhat vs Not at All/a Little	Very Much vs Not at All/a Little
		%		Adjusted OR (95% CI)a		P
Good healthy lifestyle behaviors
≥7-hr sleep per night	47.0	45.9	57.7	0.89 (0.61–1.31)	1.41 (0.82–2.43)	0.210
≥150 mins moderate physical activity per week	24.2	23.1	41.2	0.91 (0.59–1.41)	1.93 (1.11–3.35)	0.014*
≥5 servings of fruits/vegies per day	6.5	6.6	10.3	0.87 (0.42–1.79)	1.69 (0.68–4.18)	0.308
No smoking	97.2	98.9	95.9	1.45 (0.27–7.72)	0.75 (0.12–4.79)	0.721
No/light alcohol drinking	87.0	88.9	76.3	1.46 (0.83–2.57)	0.71 (0.36–1.41)	0.073
Negative impact of COVID on healthy lifestyle behaviors
Less/more sleep	61.4	52.7	35.1	0.73 (0.49–1.07)	0.39 (0.22–0.68)	0.004*
Less physical activities	51.2	46.4	29.9	1.24 (0.54–2.87)	0.26 (0.09–0.71)	0.006*
Less healthy eating	48.8	39.6	26.8	0.69 (0.47–1.01)	0.38 (0.22–0.68)	0.003*
Increased smokingb	1.4	0.6	0.0	0.51 (0.14–1.83)	0.34 (0.04–2.98)	0.453
Increased alcohol use	31.6	26.8	29.9	0.69 (0.46–1.04)	0.89 (0.51–1.56)	0.197
Good health
Good physical health	62.8	74.4	82.5	1.55 (1.03–2.32)	2.40 (1.27–4.53)	0.013*
Good mental health	47.0	65.8	76.3	2.10 (1.43–3.10)	2.96 (1.65–5.32)	<0.001*
No depression	77.2	87.7	90.7	1.92 (1.14–3.22)	3.02 (1.29–7.05)	0.008*
No anxiety	62.3	75.5	85.6	1.95 (1.29–2.95)	3.36 (1.69–6.66)	<0.001*
No/little stress	19.1	28.5	46.4	1.87 (1.20–2.92)	3.60 (2.03–6.39)	<0.001*
High professional QOL	5.1	16.2	45.4	4.24 (2.00–8.97)	15.44 (6.77–35.19)	<0.001*
No burnout	18.1	37.9	71.1	3.24 (2.05–5.10)	10.32 (5.56–19.17)	<0.001*
Negative impact of COVID on health
Worsen physical health	58.6	44.2	32.0	0.53 (0.36–0.77)	0.30 (0.17–0.53)	<0.001*
Worsen mental health	81.9	70.1	49.5	0.47 (0.30–0.74)	0.21 (0.12–0.38)	<0.001*

^aOdds ratio and 95% CI were derived from logistic regression models. Dependent variable—each behavior/health measure; primary independent variable—perceived support of wellness at the place of employment; covariates—age, sex, race/ethnicity, marital/relationship status, highest degree, number of children (<21 yr of age) at home, primary employer setting, and hours of workday/shift. *P < 0.05.

^bExact logistic regression was used because of sparse data.

*P < 0.05.

CI, confidence interval; OR, odds ratio.

Table 3 also shows that higher workplace wellness support was significantly associated with less likelihood of having a negative impact of COVID-19 pandemic on their sleep (P = 0.004), physical activity (P = 0.006), and fruit/vegetable intake (P = 0.003), after adjusting for covariates (pharmacists’ age, sex, race/ethnicity, marital status, number of children living at home, education, hours of workday/shift, and primary employee setting). Compared with pharmacists whose workplaces provided little/no support, the likelihoods of experiencing negative impact of COVID-19 pandemic were reduced by a third on sleep (OR = 0.39, 95% CI = 0.22–0.68), physical activity (OR = 0.26, 95% CI = 0.09–0.71), and fruit/vegetable intake (OR = 0.38, 95% CI = 0.22–0.68) among those whose workplaces very much supported their wellness.

The percentage of pharmacists with good physical health increased with higher perceived workplace wellness support (62.8%, 74.4%, and 82.5%, respectively, for not at all/a little, somewhat, and very much support; Table 3). The same trend was observed for other health indicators, including mental health, depression, stress, ProQOL, and burnout. The significant relationship between greater perceived support of wellness and better health held after adjusting for age, sex, race/ethnicity, marital status, number of children living at home, education, hours of workday/shift, and primary employee setting in the multiple logistic regression models. Compared with pharmacists whose workplaces provided little/no support, those whose workplaces supported wellness very much were 2 to 15 times as likely to have good physical health (OR = 2.40, 95% CI = 1.27–4.53), good mental health (OR = 2.96, 95% CI = 1.65–5.32), no depression (OR = 3.02, 95% CI = 1.29–7.06), no anxiety (OR = 3.36, 95% CI = 1.69–6.66), no/little stress (OR = 3.60, 95% CI = 2.03–6.39), no burnout (OR = 10.32, 95% CI = 2.56–19.17), and higher ProQOL (OR = 15.44, 95% CI = 5.56–19.17; Table 3).

Table 3 also shows that compared with pharmacists whose workplaces provided little/no support, those whose workplaces supported higher wellness were significantly less likely to report worsening physical and mental health due to the pandemic (OR = 0.30, 95% CI = 0.17–0.53 and OR = 0.21, 95% CI = 0.17–0.58, respectively).

Self-reported Concerns of Medication Errors With Healthy Lifestyle Behaviors, Health Measures, and the Related Changes During COVID-19 Pandemic

Table 4 summarizes the self-reported concerns of having made a medication error by healthy lifestyle behaviors, health measures, and related changes during COVID-19 pandemic. Overall, 18% of the pharmacists reported concern of having made a medication error in the last 3 months. For all the measures, the self-reported concern of having made a medication error was higher among pharmacists with less healthy behaviors, poorer health, and those reporting having a negative impact on behaviors/health during COVID-19 pandemic than those with healthier behaviors, better health, and experiencing no negative impact on behavior/health during the pandemic. For example, 21.5% of the pharmacists with higher stress scores versus 9.1% of the pharmacists with no/little stress self-reported concern about having made a medication error; 22.6% of the pharmacists with burnout versus 10.0% of the pharmacists with no burnout self-reported concern about having made a medication error.

TABLE 4.

Self-reported Concern of Having Made a Medication Error With Health Lifestyle Behaviors, Physical/Mental health, and Their Changes Since COVID-19 Pandemic

	% With Concerns of Medication Error	Adjusted OR (95% CI) of Concerns of Medication Errora	P
All	18.0
Healthy lifestyle behaviors
Hours of sleep per night
<7 hr	20.9	1.59 (0.98–2.57)	0.061
≥7 hr	14.8	Ref
Minutes of moderate physical exercise per week
<150 min	19.8	1.40 (0.80–2.45)	0.235
≥150 min	12.8	Ref
Servings of fruits/vegetables per day
<5 servings	18.5	1.79 (0.64–4.97)	0.267
≥5 servings	10.9	Ref
Current smoker
No	18.2	Ref
Yes	7.7	0.38 (0.04–3.41)	0.387
Alcohol use
No/light drinker (≤3 times per week)	18.7	Ref
Heavy drinker (≥4 times per week)	13.3	0.82 (0.39–1.73)	0.604
Impact of COVID-19 pandemic on HLB
Sleep
No change	13.7	Ref
More/less sleep	21.9	1.57 (0.97–2.54)	0.066
Physical exercise
No change/exercise more	10.0	Ref
Exercise less	22.2	1.85 (0.58–5.88)	0.299
Diet
No change/eat healthier	14.8	Ref
Eat less healthy	22.6	1.32 (0.84–2.08)	0.230
Increased smoke since COVID-19 pandemic
No	18.0	Ref
Yes	20.0	0.53 (0.05–5.26)	0.584
Increased alcohol drink since COVID-19 pandemic
No	17.0	Ref
Yes	20.4	1.33 (0.81–2.17)	0.256
Physical/mental health
Physical health
0–5	22.6	1.34 (0.83–2.17)	0.228
6–10 (good)	16.2	Ref
Mental health
0–5	23.7	1.55 (0.97–2.47)	0.065
6–10 (good)	14.3	Ref
PHQ-2
<3 (no depression)	16.8	Ref
≥3	25.0	1.24 (0.69–2.25)	0.473
GAD-2
<3 (no anxiety)	15.4	Ref
≥3	25.0	1.36 (0.83–2.22)	0.220
PSS-4
0–4 (no/little stress)	9.1	Ref
5–12	21.5	2.08 (1.15–3.74)	0.015*
ProQOL-4
0–11	20.0	1.38 (0.61–3.13)	0.436
12–16 (high professional QOL)	8.0	Ref
Having burnout
No	10.0	Ref
Yes	22.6	1.97 (1.12–3.48)	0.019*
Impact of COVID-19 pandemic on physical/mental health
Physical health
No change/better	14.6	Ref
Worse	21.8	1.25 (0.78–1.98)	0.353
Mental health
No change/better	14.1	Ref
Worse	19.6	1.08 (0.62–1.87)	0.785

^aOdds ratio and 95% CI were derived from logistic regression models. Dependent variable—concern of medication error; primary independent variable—each health lifestyle behavior or physical/mental health variable; covariates—age, sex, race/ethnicity, marital status, number of children, degree, primary employer setting, perceived support of wellness at the place of employment, and hours of workday/shift. *P < 0.05.

GAD-2, Generalized Anxiety Disorder 2; HLB, healthy lifestyle behaviors; PHQ-2, Patient Health Questionnaire 2; ProQOL-4, Professional Quality of Life 4; PSS-4, Perceived Stress Scale 4; QOL, quality of life.

Table 4 also presents the multiple logistic regression model analyses results. The associations of stress and burnout with concern of having made medication errors sustained after adjusting for age, sex, race/ethnicity, marital status, number of children living at home, education, hours of workday/shift, primary employee setting, and workplace wellness support. Compared with pharmacists with little/no stress, those with higher stress were associated with double (OR = 2.08, 95% CI = 1.15–3.74) the concern of having made a medication error. Compared with pharmacists with no burnout, those reporting burnout also were associated with double (OR = 1.97, 95% CI = 1.12–3.48) the concern of having made a medication error in the last 3 months.

DISCUSSION

This is the first study with pharmacists to find that those with high levels of perceived workplace wellness support had better health and wellness outcomes than pharmacists with little/no wellness support. Pharmacists who had workplaces that supported wellness very much were 15× as likely to have high ProQOL and 10× as likely to have no burnout when compared with pharmacists with little/no wellness support. Increased likelihood of better wellness outcomes was also observed for good physical health, no depression, no anxiety, and no/little stress for pharmacists with workplaces supportive of wellness. Pharmacists whose workplaces supported a higher level of wellness were significantly less likely to report worsening mental/physical health due to the pandemic compared with pharmacists whose workplaces provided little/no support. These findings resemble other national studies with nurses and infection prevention professionals, building the evidence to support that perceived workplace wellness affects how people feel and what they do. ^10,21,22 Workplace wellness is important for improving healthy behaviors and mental health and mitigating the impact of COVID-19 stressors.

Most respondents indicated that COVID-19 had a negative impact on their healthy behaviors. Regarding sleep, physical activity, and fruit/vegetable consumption, less than 50% of respondents slept >7 hours/night, 25% obtained >150 minutes of physical activity/week, and less than one tenth consumed five or more servings of fruits/vegetables daily. While not ideal, these results are not substantially different from reported findings in the general public and other health professions. ^8,10,21,22 More than a third of US adults sleep less than 7 hours a night, 23.3% obtain >150 minutes of physical activity, and 10.0% to 12.3% meet the recommended daily fruit and vegetable intake. ^23–25

Symptoms of depression (15.0%) and anxiety (27.2%) were reported by numerous respondents but were lower than those reported in the general population earlier in the pandemic (41.5%). ²⁶ This could be related to screening time points. The current study screened pharmacists in May 2022, while Vahratian and colleagues²⁶ screened them in April 2021. A recent systematic review demonstrated that increases in depression and anxiety were observed at the beginning of the pandemic, spring 2020. ²⁷ Reports of depression and anxiety decreased by month and predominately returned to prepandemic rates by summer 2020. Stringent COVID-19 policies have been associated with worse mental health outcomes due to their impact on social connectedness. ²⁸ Now that such policies are no longer active in the United States, it is hoped that improvements in depression and anxiety will occur. Worksites must communicate that it is a strength, not a weakness, to seek help when people are depressed. Mental health stigma must be combatted because a leading cause of death in America is suicide. ²⁹

Burnout was high in health-system pharmacists who responded to the survey. Sixty-four percent reported burnout, which resembles rates reported in pharmacists (65.3%) ³ and nurses (65.5%) ²¹ in 2021. Burnout often results from system failures, including staff shortages, long working hours, payment discrepancies, and unrealistic performance metrics. ^1,2,4,11,30 Ending strict COVID-19 restrictions may have helped alleviate depression and anxiety, but system failures that impact burnout remain. The burnout epidemic has reached such immensity that the US Surgeon General, Dr Vivek Murthy, released an advisory about this urgent public health issue. ³⁰ Burnout impacts more than the individual as it can also increase medical and medication errors in patient care. ^10,11,31,32 In the current study, pharmacists with burnout were 2× as likely to report concern about having made a medication error when compared with pharmacists without burnout. A significant increase in concern of having made a medication error also was reported by pharmacists with high stress when compared with pharmacists with little/no stress.

Along with addressing system failures, adopting an organizational culture that is supportive of wellness is also an evidence-based approach to improving health worker wellness outcomes, which in turn improve patient care and hospital costs. ^30,33 Directing attention to burnout and wellness are aligned with ASHP’s 2022 strategic recommendation of promoting and implementing approaches to improve employee resilience and well-being to mend pharmacy workforce issues and patient safety concerns. ¹² Implementing organizational cultures of wellness goes beyond providing wellness programming. It requires leaders who are actively engaged in promoting and role modeling wellness, clear communication, and the integration of wellness across the continuum of care (ie, mission statements and work policies). ³⁴ Organizations successful in building wellness cultures and not burnout cultures provide: chief wellness officers with sufficient resources, clinicians with more flexibility, family friendly policies (eg, paid parental leave), reasonable workloads, encouraged time off, destigmatized mental health conversations, and mental health programming tailored to pharmacist needs. ^30,34

While this study demonstrated correlations among pharmacist wellness outcomes, the impact of COVID-19, and workplace wellness support, there were some limitations. For example, the correlations observed were not causative. The study used a cross-sectional design, which cannot demonstrate the impact of wellness cultures over time. Nonetheless, the protective factor of wellness support at the workplace has remained consistent in multiple studies. ^10,21,22 The response rate was small, 6.4%, and there was likely response bias in those who completed the survey, which may influence generalizability of the findings. However, random sampling was used, which can improve generalizability and the likelihood that the sample was representative of the ASHP membership.

CONCLUSIONS

Pharmacists endured enormous stress in the COVID-19 era, which is reflected in the high burnout rates observed in this study (63.6%). Burnout may compromise patient safety as pharmacists with burnout were 2× as likely to self-report concern of having made a medication error when compared with pharmacists without burnout. A solution to this workforce issue exists as this study found that pharmacists who had workplaces supportive of wellness were 10× as likely to have no burnout when compared with pharmacists without wellness support. Leadership in organizations employing pharmacists and other healthcare professionals must promote and support wellness cultures and correct system failures to improve pharmacist well-being and health care quality/safety.