ASHP InterSections ASHP InterSections

July 28, 2020

Creative Ways to Support Staff Resilience During the COVID-19 Pandemic

Mayrim Millan-Barea, Pharm.D., M.B.A., discusses strategies to practice mindfulness at work, holding a sign that reads, “Pause, Take One Mindful Breath. Observe, Resume.”

ASHP’S MEMBERS ARE IN VARIOUS STAGES of preparing for, responding to, and recovering from the COVID-19 pandemic. During this challenging time, it is imperative for pharmacists, residents, student pharmacists, and pharmacy technicians to step up well-being for themselves and the healthcare workforce community.

During the 2019 Midyear Clinical Meeting, ASHP held two sessions where pharmacists shared the various ways their hospitals and health systems support workplace joy. With new guidance in place for social distancing and other measures to reduce the transmission of the virus, pharmacists are taking creative approaches to promote staff well-being and resilience.

Share what works for you

“There is greater and greater recognition that burnout is an issue, and many institutions have started putting initiatives in place to prevent it from happening,” said Mayrim Millan-Barea, Pharm.D., M.B.A., who just completed her Health System Pharmacy Administration and Leadership Residency, at the Johns Hopkins Hospital, and is an ASHP member since 2015.

She led two roundtable sessions on well-being, resilience, and burnout at the 2019 ASHP Midyear Clinical Meeting. “More awareness needs to be raised as there is still a stigma associated with this topic,” said Dr. Millan-Barea. She recalled one session participant who shared that a colleague of theirs was afraid to ask others if they were burned out, “because they did not want to accept that they could be burned out as well.”

Although some institutions are in the early stages of addressing burnout, others are moving full steam ahead with solutions to build staff resilience and well-being. For example, pharmacists at Dr. Millan-Barea’s institution share their daily accomplishments and medication error “good catches” during shift changes. These short meetings also offer an opportunity to present a clinical pearl or celebrate a birthday, Dr. Millan-Barea said. “These meetings have worked for us as a good way to engage with staff,” she emphasized. However, due to the COVID-19 pandemic, staff has had to adapt and leverage electronic platforms to celebrate, engage, and care for one another. “During such difficult and unprecedented times, the Department of Pharmacy launched a newly built website that included internal and external well-being and resilience resources. Additionally, we hosted a small virtual contest where staff was encouraged to share a picture of their favorite well-being/wellness resource or activity. The idea is to emphasize that we should all feel empowered to identify the resources that resonate with us,” said Dr. Millan-Barea.

Pharmacy kudos board

Creating opportunities for more staff interaction is one approach to cultivating happiness in the workplace, said Jennifer M. Schultz, Pharm.D., Clinical Pharmacy Supervisor and PGY1 Residency Program Director in the Pharmacy Department at Bozeman Health Deaconess Hospital. She is an ASHP Fellow and member since 1994 and co-led one of the roundtable sessions. “Feeling engaged with others and having a culture that values the role of pharmacists energizes people,” she said.

Some participants at the session Dr. Schultz co-led said they have been creating calm and fun workplace environments in several ways, including having an aromatherapy room where staff can relax if they are feeling overwhelmed or stressed.

Jennifer M. Schultz, Pharm.D.

“At my institution, we have ‘white elephant parties,’ where somebody draws a name and brings that person a little gift,” said Dr. Schultz. Other pharmacists said they recognize and engage staff efforts by giving employees who have worked exceptionally hard a long lunch. Other sites said they encourage peer-to-peer recognition through an e-card function in their institutional intranet, allowing staff to send appreciative notes to their colleagues.

Dr. Schultz’s hospital has what they call a “Kudos Board, which is a whiteboard where colleagues can give each other kudos for a nice gesture or a great job using Velcro stickers and different shapes,” she said. “At the end of the month, we hold a drawing for all of the kudos received, select a coffee card winner, and publicize why that person got kudos,” she said. “It’s a simple way to support and recognize each other.”

The more that staff feel connected with and valued by each other and hospital leaders – whether through a kudos board, by checking in on each other and seeing how their workload is going – the less likely they are to experience burnout, Dr. Schultz said. “We like to think of our pharmacy department as a phamily, with a ‘ph,’” she quipped.

Something Dr. Schultz said session attendees broadly recognized the value of is extracurricular hobbies. Having something to look forward to outside of work helps create a fulfilling work-life balance, she said. “People who are very, very engaged only in their work and don’t do much outside of work seem to be more stressed and burned out,” Dr. Schultz said. “We need to get out and have hobbies – it doesn’t matter what they are, but we all have to do something for ourselves.”

Adding food and fun

Nicole Clark, Pharm.D., MHA, FASHP, Director of Pharmacy Services at Melrose Wakefield Healthcare, always relied on enjoyable non-pharmacy activities to have fun outside of work. Her favorite hobby was going to Boston Celtics games with her friends and husband, who is also a pharmacist. “That’s where we hang out and don’t talk pharmacy!” she said. “It’s an example I share with my students to encourage them to do something for themselves – and not feel guilty about it.”

Nicole Clark, Pharm.D., MHA, FASHP

With the COVID-19 pandemic, fun hobbies like this have been put on hold, so it has been important to find other things to do to remain resilient during these tough times, she noted. For example, Dr. Clark hosts video gatherings with friends, including her “Celtics Family,” the friends she has made through the Celtics. “It allows us to check in with each other and support each other through this challenging time,” she said.

Dr. Clark, who also co-facilitated an ASHP session on well-being, burnout, and resilience, said her organization has a wellness committee that has developed a range of activities focused on the health and well-being of employees. These activities have taken on a new look during the COVID pandemic.

For example, staff can attend a regular meditation call or well-being webinar series, noted Dr. Clark. “Awards and celebrations are continuing, just in different ways from before,” she added. During hospital week, hospital leadership greeted employees coming to work with a DJ and thank you signs. Ice cream treats, care packages, and meals were also given to staff.

“These small gestures meant a lot to staff and made them feel valued during this difficult time,” said Dr. Clark, an ASHP member since 2008. “During the holiday season, our department participates in an adopt-a-family program that? gives to a family in need, which helps us feel the holiday spirit.”

While planned events and well-considered institutional initiatives to address well-being and burnout are critical, Dr. Millan-Barea of the Johns Hopkins Hospital believes building pharmacy staff resilience does not always require much money or time.

“Simply saying ‘good morning’ can be a small but important step towards building community and increasing recognition,” she said. “We live in such a rushed world that we can forget to acknowledge each other.”


By David Wild

April 22, 2019

Overcoming Burnout: Advice from Your Pharmacy Peers

MORE THAN 50 PERCENT OF PHARMACISTS WHO PRACTICE IN ACUTE AND AMBULATORY CARE SETTINGS EXPERIENCE BURNOUT, which is characterized by exhaustion, cynicism, and/or a low sense of personal accomplishment. While burnout is devastating on a personal level, the syndrome can also affect a pharmacist’s ability to fulfill their duties, which can negatively impact patient care.


Often when we have a problem, we turn to our peers for support and guidance. ASHP InterSections asked a student pharmacist, a new practitioner, and a pharmacy leader to share their thoughts on resilience and burnout. Here’s their advice.


ASHP InterSections: What have you found most challenging about thriving at work or school?


Sydney Stiener

Sydney Stiener

ASHP member since 2015

Student Pharmacist and Pharm.D. Candidate (May 2019)

University of Wisconsin-Madison School of Pharmacy

“The biggest challenge for me has been finding the right balance between meeting school-related priorities and dedicating myself to hobbies that help me recharge and be efficient and successful. As a pharmacy student pursuing a residency and facing a competitive job market, there is a constant expectation to do more. On top of rigorous course work and other demands of pharmacy school, students spend many hours a week involved in student organizations, taking on leadership positions, participating in research — and the list goes on and on. Beyond these extracurricular activities, it’s a challenge to find time to care for ourselves by doing things that make us happy outside of school. Without these things, it’s easy to lose perspective and forget the reasons you wanted to become a pharmacist in the first place.”


Shannon Kraus, Pharm.D., BCPS

Shannon Kraus, Pharm.D., BCPS

ASHP member since 2015

PGY1/PGY2 MS/Pharmacy Administration Resident

Riverside Methodist Hospital, Columbus, Ohio

“It’s been challenging to me as a new practitioner to balance providing quality care with the realities of needing to do so in a cost-effective way, both across the organization and within the pharmacy service line. For example, while I try to provide optimal patient care and work toward outcomes like decreased readmissions through pharmacist-led counseling at discharge, having limited resources has certainly tested my resilience.”


Paul Bush, Pharm.D., M.B.A., BCPS, FASHP

ASHP member since 1975

Chief Pharmacy Officer and HSPA/MS Residency Program Director

Duke University Hospital, Durham, N.C.

“I currently lead a large pharmacy program that includes 428 staff and complex pharmacy operations, so there are many moving parts that I need to be thinking about. It can be challenging to manage the many details and the demands of my job.”


ASHP InterSections: How do you ensure your well-being and resilience?


Stiener: “I can’t always control the challenges that can lead to symptoms of burnout but I can control my attitude toward those challenges. A philosophy that’s helped me bounce back from a bad exam grade, get through long hours of studying, learn from mistakes, and ultimately excel in my program is Hal Elrod’s 5-Minute Rule, which says it’s OK to be upset, angry, frustrated, or negative when something unfavorable happens to you, but you get only five minutes to feel that way. So, I allow myself five minutes to feel those emotions, but then I force myself to put it behind me, learn from it, and move on with my day with a positive attitude and a smile on my face.


“I also prioritize activities that make me happy and recharge my overall well-being, like running outside in the fresh air and spending time with friends and family.”


Dr. Kraus: “Every morning at 4 a.m., I fill up my resilience bucket by first reflecting on what I am grateful for from the previous day. After that, I go to my local fitness studio. Exercising strengthens me both physically and mentally.


“Throughout the day I try to spread my positive energy with my residency family. I’ve even developed Wellness Wednesday, where I send an email focused on physical, emotional, intellectual, spiritual, or financial health with the hope of providing others with an uplifting moment and helping them build resilience.”


Paul Bush, Pharm.D., M.B.A., BCPS, FASHP

Dr. Bush:I think the key to stepping up and leading in challenging situations is simply to stay focused. A book called The 7 Habits of Highly Effective People by Stephen Covey — and specifically the idea of putting first things first — has helped me get through the week and stay focused.


“I go full speed for five days a week, 10 hours a day, so recharging over the weekend with family is very important to maintaining well-being. During the week, I get on the treadmill for 20-30 minutes a day, which is both physically helpful and a good diversion. I also eat a healthy diet and try to sleep for seven hours a night. And I watch my favorite TV series and sports.”


ASHP InterSections: What advice would you give others in your position to help them thrive and rebound from burnout?


Stiener: “Surround yourself with positive and supportive friends, classmates, mentors, family members, and others who can see you through stressful times and help you maintain perspective. Also, make time for your own hobbies outside of school. It’s amazing how much easier it is to focus and stay engaged when you invest a little time in yourself.”


Dr. Kraus: “The triggers of burnout are often our own self-limiting beliefs. However, we can also choose to cultivate joy in our everyday life and remember that, as E.E. Cummings said, ‘The most wasted of all days is one without laughter.’”


Dr. Bush: “Give yourself time to recover from stressful events and reduce your workload when these things happen. Maintain a sense of hope, optimism, and self-efficacy and focus on feeling joy at work. Joyful activities such as ensuring patients have positive experiences and improving patient outcomes are healing, create connections, and add meaning and purpose. Make sure you have strategies for self-care and draw on your social safety nets and support from your organization and your peers.”


By David Wild








October 5, 2018

Pharmacy and the Art of Resilience

PAUL MILLIGAN, PHARM.D., a Medication Safety Pharmacist at BJC HealthCare in St. Louis, has worked in the pharmacy profession for 35 years. His career, while incredibly rewarding, has required him to contend with plenty of daily stress, manage the expectations of doctors and other practitioners at busy healthcare facilities, and regularly face the pressure that comes with saving lives. When the rewards of the job don’t outweigh the struggle, however, Dr. Milligan said it can leave him feeling burned out.

Pharmacy Sculpture

Pharmacists are increasingly suffering from professional burnout, which is why Dr. Milligan was immediately interested when the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience issued a call for submissions for original artwork from healthcare professionals. The organization’s goal was to curate a digital art gallery that shows how clinicians are affected by burnout. By allowing healthcare providers to creatively express their experiences with burnout, Expressions of Well-Being: An Art Exhibition captures critical moments in their journey toward well-being.

Paul Milligan, Pharm.D., used sculpture to capture the moment a clinician holds a patient’s hand to make them feel safe and comfortable.

Dr. Milligan, who serves as Director-at-Large of the ASHP Section of Inpatient Care Practitioners, has created sculptures as a hobby for the last decade and welcomed the opportunity to submit his artwork for a project that is so close to his heart. He sent images of two of his works, and one was accepted for the project. He named the sculpture “Treat the Person, Treat Yourself,” at title that aptly sums up the professional mission that has carried him through his career.

“I wanted to capture that moment when a clinician is holding a patient’s hand and making them feel safe and comfortable,” he said. “It is really a two-way street at that point. These are the moments that I remember most, the ones that keep me going.”

Opioid Imagery

ASHP member Elizabeth Canterbury, Pharm.D., an emergency department resident at SwedishAmerican Hospital in Rockford, Ill., is another contributor to the NAM collaborative’s digital art gallery. She saw the project as a way to comment on current challenges plaguing the healthcare system.

”Don’t Slip“ was created by Elizabeth Canterbury, Pharm.D., who used Photoshop to superimpose a photo of herself on a chair with prescription bottles spilling on the floor.

Dr. Canterbury submitted a powerful image of herself on a chair superimposed with prescription bottles spilling on the floor, an image she created with the magic of Photoshop. The work is a commentary on the opioid epidemic, which in 2016 alone killed more than 42,000 Americans, according to the Centers for Disease Control and Prevention (CDC).

At age 26, Dr. Canterbury is closer to the beginning of her career, but she’s already found ways to stay levelheaded and avoid burnout. In addition to her artwork, she remains involved in activities that allow her to network with colleagues, which provides an outlet to voice her concerns with like-minded people.

“Holding leadership positions and taking advantage of opportunities like attending ASHP’s Midyear Clinical Meeting and doing a resident rotation at ASHP headquarters have helped me stay engaged and feel like I am contributing to the growth of the profession in addition to helping the patients I see on a day-to-day basis,” she explained.

A Portrait of Pharmacy

Evan Slagle, Pharm.D., BCPS, Antimicrobial Stewardship Pharmacist at Penn State Health St. Joseph in Reading, Pa., has also found solace and stress relief in activities outside of his job. Dr. Slagle, an avid runner, lived in South Philadelphia while attending the Jefferson College of Pharmacy. He would frequently go for runs toward the northern end of the city. The route would always take him past the Edgar Allen Poe National Historic Site, a tribute to the beloved 19th-century writer.

Evan Slagle, Pharm.D., BCPS, based “Imp of the Perverse” on a portrait of Edgar Allen Poe.

Dr. Slagle became fixated on a mural of Poe at the site. The writer, Dr. Slagle said, approached the themes of depression and anguish in uniquely expressive ways. One day, Dr. Slagle felt especially inspired after his run. The endorphins were rolling, he said, and so he sat down to recreate the portrait as best he could recall it. It took him four hours to complete, and he then submitted the work to the collaborative’s digital art gallery.

Over time, Dr. Slagle has come to realize that creative expression through art is a way to help him process the stress of his job. In fact, doing so became a necessity early in his career. Dr. Slagle initially dropped out of his PGY1 residency program because of stress, but later completed his PGY1 at a different hospital.

“I experienced burnout before I could define it,” he said. “Detaching yourself a little bit from the work and getting some perspective is the key. You need to totally separate yourself from time and the constant bombardments you get on a daily basis. We all need a reprieve from that.”


By Jessica Firger


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