General wellbeing and work impacts among community pharmacists during crisis management

Keywords: community pharmacists, human resource management, leader member exchange, occupational self-efficacy, pandemic, pharmacy services, psychological safety, wellbeing.

Although community health workers are integral in communicating basic heath literacy information to the public and reducing the burden on health services (Boyce and Katz 2019), studies on the strategies to support this cohort are lacking, especially when they are faced with unprecedented challenges such as the coronavirus disease 2019 (COVID-19) pandemic in 2020.

Consumers trust pharmacists and consider them ‘drug experts’ (Salim and Elgizoli 2016). Moreover, community pharmacists are highly accessible for advice, as most pharmacies are open long hours and no appointment is needed (Eades et al. 2011). Pharmacists, and especially community pharmacists, play a critical role in the fight against COVID-19 (Cadogan and Hughes 2021). This includes supply of personal protection equipment (PPE), provision of continuing care to patients, consumer education, and medication consultation services (Carpenter et al. 2021; Visacri et al. 2021). In addition to the traditional role of dispensing prescriptions and provision of non-prescription items, community pharmacists frequently provide advice on minor ailments and may offer additional services such as blood pressure monitoring, assisting with management of diabetes, and medication reviews. Sim et al. (2020) note that community pharmacists can provide referral pathways for services provided by other health professionals (such as primary health providers, including general practitioners, infant welfare and community health nurses), including immunisation, diabetes education, lactation consultancy, asthma education, specialised compounding, wound care, and dementia care.

A few recent studies examined the impact of the COVID-19 pandemic on frontline pharmacists and the factors important for adaptability and resilience (Arain et al. 2021; Aruru et al. 2021; Austin and Gregory 2021; Smallwood et al. 2021). A recent study published by Austin and Gregory (2021) showed that strategies such as technology and the provision of PPE and non-physical measures such as the availability of professional guidance were essential for building provider resilience and coping mechanisms during crisis management (Smallwood et al. 2021). Other studies focussed on factors that are important for pharmacists to provide care for others, such as access to infection control measures and provision of PPE. Despite this, little attention to date has been devoted to managerial support needs for community pharmacists (Boyce and Katz 2019; Cadogan and Hughes 2021).

Positive relationships between managers and their staff have been shown to influence employee health outcomes, such as reducing job stress (Malik and Shahabuddin 2015) and increasing wellbeing (Brunetto et al. 2011). Measured in terms of Leader–Member Exchange (Dansereau et al. 1975), these relationships act as a buffer in the successful management of work stress, especially during a workplace emergency, such as the urgent response to the widespread COVID-19 pandemic. Leader–Member Exchange theory suggests that both leaders and followers develop specific relationships based on their social exchanges, and the quality of these relationships can influence employee outcomes in their workplace (Bauer and Erdogan 2015).

The perception of a supportive work environment can help improve employee wellbeing through a range of mechanisms (Casey et al. 2004). Occupational self-efficacy (OSE), which is an individual’s confidence in their own ability to carry out the tasks involved in his or her job (Rigotti et al. 2008), has been identified as an important personal resource that can protect employees from workplace stressors, including emotional labour (EL), and promote wellbeing, even in the face of difficulties (Rigotti et al. 2008). Occupational self-efficacy acts to mediate the relationship between Leader-Member Exchange and work performance (Jawahar and Schreurs 2018).

Supportive supervisors are particularly important to employees (Casey et al. 2004). Jawahar and Schreurs (2018) show that both leadership and psychologically safe workplaces play key roles in creating supportive work environments for employees. Luthans and Avolio (2003) argue that supportive supervision fosters employee optimism regarding future success within the organisation, which in turn may strengthen a desire to develop their current occupational role rather than leaving the organisation (Luthans and Avolio 2003). Meanwhile, psychological safe workplaces encourage team learning and performance in health care. Edmondson (2018) defined psychological safety (PS) as ‘the shared belief among team members that the team is safe for interpersonal risk-taking’; this concept refers to being able to speak freely with relevant ideas, questions and concerns. Moreover, psychological safety is implied to be present when colleagues trust and respect each other and feel able to be honest (Edmondson 2018). Management support also plays an important role in addressing the issue of emotional labour in health care (Karimi et al. 2014), which influence workplace interpersonal reactions and interactions (Morris and Feldman 1996; Elliott 2017). Lee (2021) highlighted the role of psychological safety in the workplace, as it has significant implications on human resources management practices. High psychological safety is associated with feelings of fairness, trust and autonomy. The authors also found that during a crisis, regular communication and feedback are essential, and contribute to the positive perception of interactional fairness between employees and managers (Lee 2021).

Given the challenges that community pharmacists faced with the COVID-19 pandemic in 2020, we assessed the challenges they had in their overall general welfare through different measures, including Leader–Member Exchange, self-reported general wellbeing, emotional labour, job stress, psychological safety, and occupational self-efficacy. Emotional labour is likely to be more pronounced during crisis management, leading to job stress and lower perceptions of wellbeing.

This study was conducted as an anonymous cross-sectional survey distributed to community pharmacists in Australia using Qualtrics (Qualtrics XM) during the COVID-19 pandemic in Australia from 20 September 2020 until 26 October 2020. Email invitations were sent to community pharmacists through various networks, such as professional journals (e.g. Australian Journal of Pharmacy and Pharmacy Daily) subscribers. Further invitations to the survey were also posted on Facebook group pages and professional organisations; hence, the actual number of potential participants who received the invitation cannot be easily quantified. The researchers only used the networks where pharmacists are the only subscribers. The survey included questions relevant to community pharmacists, and non-community pharmacists were not required to fill in the survey. Ethical oversight was provided by La Trobe University Human Research Ethics Committee (#HEC20304). A copy of the survey items is provided in Table 1, including an explanation of what each scale entails and how it is measured. The scales include the following: general wellbeing (scored as poorer self-related health), job stress, emotional labour, work ability, Leader–Member Exchange, occupational self-efficacy, and team psychological safety.

Table 1.  Description of the survey items.

Data were analysed using IBM SPSS Statistics 27 (SPSS Inc). Descriptive statistics were used in this study when analysing the responses. Pairwise deletion was adopted to manage missing values in statistical analyses. A two-tailed P-value <0.05 was considered statistically significant. A summed score for general wellbeing (scored as poorer self-related health), job stress (Job Stress, Time Stress, Job Anxiety), emotional labour (Frequency, Intensity, Variety, Surface Acting, Deep Acting), work ability, Leader–Member Exchange, occupational self-efficacy, and psychological safety was generated (see Table 1 for details of the scoring methods). The reliability of each scale was ascertained using Cronbach Alpha estimates. Means and standard deviations (s.d.) of these indicators were calculated and compared among the participants with different demographic characteristics using Student t-tests (for categorical variables of demographic characteristics) or Pearson correlation analyses (for continuous variables of demographic characteristics). Multivariate linear regression analyses were performed to confirm these associations after adjustment for variations in other variables.

A total of 100 surveys were returned, of which 65 (65%) were deemed complete. The remainder of the surveys had multiple sections filled, but not to completion. In 2020, it was estimated that there were 32 412 registered pharmacists in Australia and almost two-thirds (62%) were females, with approximately one-fifth (21%) around age 50 years. It is unclear how many of these are in full-time or part-time employment (Pharmacy Board 2020).

All the respondents were community pharmacists. The majority (80%) of participants identified as female, 25% were aged >50 years, and >82% regarded English as their first language. Of those who provided information related to both sex and current work role (n = 58), the majority of pharmacy owner/operators were male, whereas females were far more likely to be pharmacy managers and community employee pharmacists. All interns were female. Close to half of the participants (41%) obtained a postgraduate qualification. About 74% were working full-time, and 47% reported being employed in their current position for >3 years. The participants were spread across the six states: 30% from New South Wales; 30% from Victoria; 15% from Western Australia; 14% from Queensland; 6% from South Australia; and the remainder non-specified.

The mean values and standard deviations (s.d.) of these measurements are presented in Table 2. All of the measurements had >0.7 Cronbach’s α coefficient (Table 2).

Table 2.  General wellbeing and work impacts of study participants.

Females were reported to have lower perceptions of psychological safety. Those with English as their first language reported lower emotional labour, but higher occupational self-efficacy. Moreover, full-time workers reported high Leader–Member Exchange, and older age was associated with poorer self-reported health and lower emotional labour. Being in their current position for a longer time was associated with higher occupational self-efficacy, whereas working long hours was associated with higher psychological safety (Table 3).

Table 3.  Associations of general wellbeing and work impacts with sociodemographic characteristics of study participants: univariate analyses.

Leader–Member Exchange was positively correlated with psychological safety and negatively correlated with job stress. Poorer health was correlated with more job stress and emotional labour, and lower occupational self-efficacy. Job stress was correlated with higher emotional labour, but correlated with lower occupational self-efficacy and psychological safety. Emotional labour was associated with lower psychological safety. Higher work ability was associated with higher levels of Leader–Member Exchange, occupational self-efficacy, and psychological safety, and lower levels of job stress, emotional labour, and poorer health outcomes, as shown in Table 4.

Table 4.  Correlations of general wellbeing and work impact indicators.

The multivariate linear regression models confirmed several personal characteristics and work-related factors as predictors of some areas of work characteristics, after adjustment for variations in other variables, as shown in Table 5. Female pharmacists had lower occupational self-efficacy (β = −0.286, P = 0.024), but higher psychological safety (β = 0.234, P = 0.042). Higher work ability was associated with lower job stress (β = −0.529, P < 0.001), higher occupational self-efficacy (β = 0.511, P = 0.001), and better self-reported outcome (β = −0.659, P < 0.001). Higher Leader–Member Exchange was associated with higher psychological safety (β = 0.724, P < 0.001). Longer customer interaction was associated with higher occupational self-efficacy (β = 0.349, P = 0.010) and psychological safety (β = 0.245, P = 0.043), and better self-reported health (β = −0.325, P = 0.031).

Table 5.  Factors associated with general wellbeing and work impacts: results of multivariate regression models.

Community pharmacists in this study reported a positive level of general wellbeing during the COVID-19 pandemic, which is higher than what was reported in other studies (Johnston et al. 2021). The possible consideration is that almost 60% of the respondents being located in rural areas, which at the time was less affected by substantially long periods of lockdown and repeated outbreaks. Another possible consideration may be that the negative effects of the COVID-19 pandemic were yet to adversely affect community pharmacists. This study finding is not consistent with those published by Johnston et al. (2021). The authors found that pharmacists experienced burnout during the global COVID-19 pandemic. Male pharmacists experienced burnout as feeling disconnected more than their female colleagues. The authors also highlighted that the COVID-19 pandemic has changed work practices for pharmacists, with many of them working overtime and experiencing an increased workload (Johnston et al. 2021).

In the present study, gender seems to be the most significant demographic predictor of wellbeing and work impacts, which is consistent with the literature in which stress and burnout in health practitioners have been widely reported (Ledikwe et al. 2018). The present study also found that female pharmacists had lower occupational self-efficacy, but higher psychological safety during a crisis such as the COVID-19 pandemic. This is also consistent with another recent study that found that being female is a predictor of seeking coping strategies and help-seeking behaviour (Smallwood et al. 2021) to support with work-related stress.

This study highlighted that higher job stress is correlated with higher emotional labour and poorer self-related health, and lower occupational self-efficacy and psychological safety. Higher occupational self-efficacy is also associated with poorer self-related health. Higher work ability is linked to higher reported occupational self-efficacy, lower emotional labour, and poorer self-related health. These results are consistent with another study that investigated the relationship between psychological wellbeing and occupational self-efficacy among teachers (Salimirad and Srimathi 2016). The authors found that there was a significant positive correlation between the two variables, confirming that addressing occupational self-efficacy has the potential to improve wellbeing and decrease staff turnover (Schyns et al. 2007). The authors suggested that this could be undertaken by direct supervision of employees and ensuring a supportive work environment is in place to reduce work-related stress and high staff turnover. Furthermore, Fallatah et al. (2017) found that authentic leadership and a supportive work environment lead to an increase in the confidence of workers in their ability to manage change and challenging work situations.

Organisations that advocate and endorse caring values for others are more likely to return a better work ability score. The importance of appropriate management and supervision of workers, and the improvement of work ability and occupational wellbeing to achieve a win–win situation, seem to be the key ingredients. Most importantly, Leader–Member Exchange was positively associated with perceptions of psychological safety and negatively associated with perceptions of job stress. Work ability is formed by the work environment, as well as personal health and abilities; however, although individual factors remain significant predictors of work ability, Palermo et al. (2008) have found that other organisational factors such as occupational stress, job satisfaction, leadership effectiveness and the nurturing of workers, are significant positive predictors of work ability. These findings reinforce the importance of targeted human resource management strategies ensuring community pharmacists receive adequate support during a crisis.

The present study confirms that further studies on developing better understanding of how healthcare workers, including pharmacists, struggle at work in emergency situations like the recent COVID-19 pandemic, are warranted. Interventional studies should target different interventions customised for different sex and aged groups to better support healthcare workers during crises, as well and in the aftermath/recovery period, as this study found that females faced more challenges during crisis management. In particular, we would advocate for the further exploration of the outcome measures, as proposed by Dulebohn et al. (2012) to determine the impact and contribution of Leader–Member Exchange (Dulebohn et al. 2012).

This study has limitations, chiefly associated with the relatively low number of participants for an observational study involved, which might have been due to the time the survey was distributed during the height of a COVID-19 pandemic lockdown in Victoria. This possibly led to fewer pharmacists taking part in the survey due to work pressures. Second, the length of the survey was also another limiting factor, as it took almost 20 min to complete one survey, which may have contributed towards a relatively high incompletion rate reported in this study. Other limitations include: the self-reporting nature of the questionnaire is the unknown denominator; and recruitment challenges of the survey; a high proportion of pharmacists in this study have postgraduate qualifications.

Most importantly, although the number of participants who took part in the survey was low, the findings are consistent with the observed resilience and contribution of Australian community pharmacy personnel during the COVID-19 pandemic, an often-overlooked sector of the healthcare system.

This study highlights some of the occupational health issues and the required management support for community healthcare workers. The need for targeted interventions to support work environments for pharmacists during situations where there are high workloads, in particularly of female pharmacists and those who have newly entered the workforce, are required. The opportunity for the role that professional organisations can play is highlighted here, and represents opportunities for targeted professional support to address burnout and stress.

The authors are able to provide de-identified data upon reasonable request.

The authors declare that they have no conflicts of interest.

There was no external funding associated with this project.