Moral Distress and workism in pharmacy


Is your work life starting to affect your overall health? Curtis Ruhnau believes it’s important to define just why many pharmacists may be struggling to deal with work/life issues   

There are two terms I came across recently: one is called Moral Distress and the other is Workism.

‘Moral Distress’ was first defined in 1984 by Andrew Jameton. He defines it later as “the experience of knowing the right thing to do while being in a situation in which it is nearly impossible to do it”[i].

Moral distress was originally coined to describe situations found in a nursing context where organisational structure was a factor working against acting in the way a practitioner feels to be morally ‘right’ but consider the following:

  • You are working on what would be a normal day, but you have someone (or a few people) away on sick leave. You want to spend time with a patient who has had a recent cancer diagnosis and just needs your reassurance, but you can’t because you’re short staffed and you have a backlog of scripts
  • You have a patient who you know can’t afford to pay the brand price premium (BPP) for Asmol or Ventolin, but Zempreon is out of stock, and has been for weeks. Even though you want to, you know that you can’t NOT charge the BPP[ii]
  • You have a patient who has previously had Closing The Gap (CTG) written on their scripts, and who you believe can’t afford their medicines without this measure. But the recent changes to the CTG system show that they haven’t been properly registered and the scripts receive a rejection message from Medicare when you try to claim them as CTG
  • A young woman presents for the morning after pill with a man. The man answers all of the questions and barely lets her speak, leaving you worried about whether there is an issue with consent or coercion within their relationship
  • Workloads which mean that doing a DD balance at time of dispensing is very difficult
  • Pharmacy teams (including pharmacy owners) who work in split teams, such that one team works with the pharmacy owner and another team never sees them. This can cause distress to the owner and the team.
  • As a pharmacy owner, not being able to afford to employ enough team members to allow for unexpected absences, sick leave or unexpected increases in workload

All are situations where the pharmacist involved may be experiencing moral distress, adding to the general levels of stress we all deal with on a daily basis.

Is work the centre of your life?

Workism is described as “the belief that work is not only necessary to economic production, but also the centerpiece [sic] of one’s identity and life’s purpose”[iii]. If you define yourself first and foremost as a pharmacist, how does that affect you when you find your work stressful, often thankless and interspersed with situations of moral distress?

How do these two concepts collide to explain some of the pressures on working pharmacists in Australia?

Our work is specialised. It is at times stressful and often feels unsupported. A quick read through any one of a number of pharmacist forums shows that we are often operating on insufficient information, with insufficient resources and nowhere near enough time to complete our work to the standards we feel are acceptable to us and safe for our patients.

Yet if we identify as pharmacists as a core factor in our sense of self then what does it mean if we don’t love the career we have chosen?

I have always wanted to be a pharmacist. Couldn’t think of being anything else. I toyed with the idea of a career change many years ago, but have realised that being a community pharmacist is what really makes me happy. The interaction with our patients on a daily basis; the week after week, year after year follow up that I have been privileged to experience has reinforced this for me.

But what if we find out that the career we chose, which we dreamt about and worked so hard for doesn’t live up to our expectations? Does that affect our sense of who we are and how we fit into the world?

Even if we still love our work and our careers, does a sense of powerlessness to make meaningful changes and feelings of moral distress affect who we are and how we see ourselves?

Further, if we are worried about the way we practise, are we worried about being reported for an error or other situation occurring at work? And if we are reported and sanctioned, what does that do to our sense of self, of who we are?

Workism as a concept tells us that if we are stopped from being pharmacists we may lose an important part of our identity.

In this always-on world we are told that we are more connected than ever. But to whom are we connected? To ourselves? To our family and friends? Or to our work, our colleagues and our patients?

And if our most significant connections are to people we are our co-workers, who we are with by happenstance, what does that do to our sense of connection, especially if we are separated by being on different teams, by being subject to self-isolation, simply by the difficulties of managing rostering?

Defining the issues 

So, what changes if we have definitions for Moral distress and Workism? Perhaps nothing. Sometimes, just having a label to attach to our feelings allows us to connect with the feelings we are having, to voice them to ourselves and each other, and then to start to do something about it.

I had a patient many years ago who struggled with her health. Lots of nondescript stuff, but she just never ‘felt good’. When the diagnosis of coeliac disease finally was presented to her, the relief she felt was easy to see. Finally she had a reason for the way she was feeling.

I’d like to think that explaining Moral Distress and Workism might help some of us to explain how we are feeling, and then do something to improve it.

Moral distress is a real thing, and it’s probably more frequent than we might like to think. We know the way we want to practise and work, but we may be prevented from doing it.

Those of you who have read my musings before will know that about now I recommend you check in on someone. It may be for their benefit, but you will gain from it too. Connection, understanding and a sense of not being alone are all things you can look forward to.

Stay safe, look after yourselves and each other, and if you need to reach out for help the amazing volunteer pharmacists at the Pharmacists’ Support Service are available for pharmacists, intern pharmacists and pharmacy students 365 days a year 8am-11pm EST.

If you’d like to read up further on this, I can thoroughly recommend the American Pharmacists Association site linked here [iv]

My heartfelt thanks as always to my wonderful wife Margaret and to the PSS Executive Officer Kay Dunkley who helped me to pull this all together.

References:

[i] https://journalofethics.ama-assn.org/article/what-moral-distress-nursing-history-could-suggest-about-future-health-care/2017-06

[ii] https://www.servicesaustralia.gov.au/organisations/health-professionals/services/medicare/pbs-pharmacists/about#a4

[iii] https://www.welcometothejungle.com/en/articles/workism-during-covid                                                                                                           

https://aphanet.pharmacist.com/current-views-and-perceptions-pharmacy-profession-well-being-and-resilience-pharmacists-and-student

[iv]  https://aphanet.pharmacist.com/current-views-and-perceptions-pharmacy-profession-well-being-and-resilience-pharmacists-and-student

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