What factors are causing pharmacists the most distress during the COVID-19 pandemic?
The Pharmacists’ Support Service normally receives around seven to 10 phone calls a week from pharmacists who are distressed, having trouble with their workload, or experiencing conflict.
But Kay Dunkley, executive officer of the organisation, has told the AJP that there’s been a sharp increase in pharmacists reaching out for help – and they’re mostly worried about aspects of the COVID-19 crisis.
“Early on, we had 21 calls in a week – we’ve never had 21 calls in a week before,” she said. “The next week it was still over 15, around 18 calls. The vast majority, around 95%, of the increase is related to COVID-19.”
One of the reasons pharmacists are calling is that they are concerned that as frontline workers, they may become sick with the novel coronavirus themselves – or could bring infection home to vulnerable family or household members.
“There are pharmacists who’ve been concerned because of their own health: they’re immunocompromised, or taking medicine that causes them to be immunocompromised, or they have a condition that makes them more vulnerable.
“They definitely feel like they’re at extra risk, and feel like there hasn’t been clear guidance around what PPE (personal protective equipment) they should wear, whether they need masks, and whether there’s any benefit to wearing gloves,” Ms Dunkley said.
“They’re concerned about their clothing, that they could go home and that their clothing could carry the virus into their home, and how to manage that.
“There are people who will not wear their daytime shoes into the house – they’ll leave them outside, go straight to the bathroom and bag up their clothes and have a shower first thing, to protect their family.
“There are also fears about what to do if they do become infected – how are they going to isolate themselves if they’re living with someone vulnerable, and they have to share bathrooms?”
Initially there was provision in some jurisdictions for doctors and nurses to utilise hotel accommodation, which was later expanded to hospital pharmacists.
“My understanding is that if someone was tested at a hospital and they were unable to self-isolate at home, at the moment because there hasn’t been a big surge in cases, they had an option to stay in hospital until they got the test back, but of course people don’t know that till it happens to them.
“So people have the anxiety of not knowing what would happen if they were positive but not severely unwell… and how could they manage that, even apart from having to pay for accommodation?”
Kay Dunkley says that there have been several calls where pharmacists have seen colleagues not complying with new legislation such as dispensing limits, or they have been expected to disregard it themselves.
“We’ve had some calls where a pharmacist was doing the right thing by the legislation, and refusing supply, but other members of the team were not following the new legislation or the boss was ordering them to give people what they want,” she says.
“There were also people who were not well informed and more or less directing pharmacists to ignore the restriction on supply, and it felt unfair to those who wanted to do the right thing.
“The calls to us are around how they resolve it. They don’t want to dob in their boss, but do want to know what they can do – there’s a need for reassurance around being an independent practitioner.”
Georgina Woods, professional officer at PDL, says that it is also fielding an increased number of calls from worried members, and that this issue is a significant one.
“I’ve seen several cases involving employed pharmacists who are having to come up against management instructions,” she told the AJP.
“We support pharmacists working autonomously and doing the right thing, because there are implications if they don’t – it can lead to a report against them personally, so it is very important that they practise the way they want to. We can provide support in how to communicate that to owners.”
In some cases pharmacists have been threatened with having their employment terminated if they do not comply.
“It’s very stressful and difficult, especially for early career pharmacists,” Ms Woods said.
Ms Dunkley pointed out that another person cannot direct a pharmacist to do “something that’s considered to be poor practice or illegal”.
“They hold responsibility for their own behaviour as pharmacists.”
When communicating about these expectations, Ms Dunkley suggests “having those conversations at an appropriate time – not in the dispensary in front of everyone”.
“Set aside time to have that discussion with colleagues around what the new legislation directs, and how that impacts on the practice at a time when everyone’s not under such pressure, such as before work or at a staff meeting.”
She advised seeking information from the PSA’s website – the COVID-19 sub-site has been made available to all pharmacists, not just members – or the Guild or SHPA’s resources on the novel coronavirus.
Georgina Woods said that prior to the COVID-19 pandemic, around 3% of calls to PDL professional officers were about aggressive and intimidating behaviour from customers – and this has now jumped to around 10%.
“We feel that’s certainly related to the stress that patients are feeling, and the anxiety – but it’s unfortunately manifesting in aggressive and unpleasant behaviour towards our members,” she said.
“We recommend that they stay calm and look after themselves, and seek help from PDL or the Pharmacists’ Support Service.”
Kay Dunkley said that pharmacists continue to experience significant anxiety about difficult behaviour, “particularly when people are resistant to limited supply, or upset about that, and taken it out on the pharmacist asking the questions.”
Customers don’t need to be aggressive to cause anxiety, either – they could simply not follow best practice when it comes to measures to prevent infection.
“There’s been the odd person who doesn’t believe in the pandemic, and doesn’t want to comply,” Ms Dunkley said.
“The handling of money has been discussed quite a bit and it’s quite an issue – there are some people who refuse to use cards rather than cash, or don’t have access to card – and how do you manage that? Because you don’t want to be unpleasant to an older person who’s simply not using a credit card.
“This is where the use of hand sanitiser is important. Unfortunately, we’ve also had pharmacists report that the hand sanitiser they had on their bench for their own use was stolen.
“And a lot of people are not aware that they should cough into their elbow, and they’re coughing openly into the environment.”
Kay Dunkley also suggested a few steps pharmacists could take to help manage their stress during the pandemic:
- Talk it over with someone.
- Be well-informed about risks and how to avoid them, and ensure you and colleagues are up-to-date with legislation.
- Ensure you get adequate rest and good nutrition.
- Consider “taking a complete break” from COVID-19-related information when not at work – this could include taking a break from social media.
- “Instead, do things you can relax and enjoy, so that you are fully recovered when you do go back to the workplace.”
- Pharmacists with underlying medical conditions can manage anxiety around them by consulting their GP and ensuring they are managing their condition as well as possible.
- “Have your flu vaccine – if you can get hold of it!” said Ms Dunkley.
- Understand that it is normal to feel anxious at the moment.
- “Accept that this is going to take a while to resolve. We won’t be back to business as usual for quite a long time, so pace yourself – it’s a marathon, not a sprint.”
For 24/7 confidential incident support for employee and owner pharmacists, call PDL on 1300 854 838 Australia wide.
Any readers who are distressed can call 1300 244 910 for anonymous and confidential support from a pharmacist colleague over the phone through the Pharmacists’ Support Service (PSS), available 8am to 11pm EST 365 days of the year.
For urgent assistance when PSS is not available, call Lifeline on 13 11 14.