Improving resilience in pharmacy practice: optimising shift patterns

‘Hard working’ is often viewed as a virtuous personality characteristic. Hard workers are frequently praised, sometimes rewarded and rarely disrespected. In most organisations — including community pharmacies — the importance of hard workers in helping a business grow and succeed is clear. Managers and owners believe that pushing workers to their maximum potential is usually the pathway to productivity, profitability and economic vitality.

In any workplace, hard workers are highly valued. Although there is no precise definition of what it means to be a hard worker, it is usually associated with an individual who is able to generate productive outcomes over a longer-than-expected period of time, with a minimal number of complaints or problems^​1​. Given the option, most workplaces would prefer to have fewer employees, who each work for longer times each day and week, than to have a large number of employees who each only work a few hours or days a week^​2​. Such a workplace reduces managerial complexity and risk. This has translated into the notion of a ‘full-time’ employee who, in exchange for the stability and benefits of a defined work week agrees to sacrifice personal time, energy and enjoyment to help an employer achieve business objectives^​3​.

The meaning of full-time work varies considerably. For example, the technology sector in China expects workers to follow a ‘9-9-6’ schedule, in which workers clock-in between 9am to 9pm, six days a week, resulting in a 72-hour work week^​4​. In many countries, the work schedule for house officers and medical trainees has included 24-hour or even 36-hour days, based on a belief that it is essential that junior doctors observe first-hand the evolution of illness^​5​. Today, in professions such as pharmacy, the precise definition of full-time work varies considerably^​6​. In some unionised settings, full-time work may involve 32.5 hours of work time, while in other settings, it is anticipated that professionals will simply work until the work is completed.

Shift patterns and resilience

The hours we work each day, week, month and year are an important factor that influences our physical and mental health. It is often overlooked as a factor that contributes to occupational stress and burnout. In a 2021 study from Ontario, Canada, the concept of ‘resilience’ in community pharmacy practice was examined through the lens of adaptation to the COVID-19 pandemic^​7​. The objective of this study was to determine what resilient pharmacists did to ensure their health and wellbeing during a particularly stressful time period. The study findings suggested that pharmacists’ individual wellbeing strategies (e.g. yoga, jogging, meditation) had less of an impact on overall resilience than the managerial practices and policies used by the organisation — one of these was shift patterns.

An interesting finding from this study concerned how many hours worked each day represented optimal and safe practice. Across healthcare, including community pharmacy, many different shift scheduling variations exist. In the nursing profession, it is common for nurses to work 12-hour daily shifts for 3–4 days per week, rather than 5 days of 8-hour shifts. Similarly, in community pharmacy, some — especially pharmacists themselves — believe that it is ‘easier’ or ‘better’ to work fewer but longer days. For some, this is a practical issue: if we have to wake up, get dressed and arrange childcare, it is better to do this on fewer days in the week, even if that translates into longer hours worked on each of these days.

Long shifts

The consequences of longer-than-usual workdays, such as 12-hour shifts, have been explored in various non-pharmacy settings. For example, the results of meta-analysis, published in 2019, revealed that long working hours adversely affected both workplace performance and the health and safety of workers^​8​. Although this study did not examine pharmacists specifically, it did note that workplace conditions — such as multitasking, environmental stress and having multiple competing demands — further worsened outcomes of long workdays. The study authors also noted that, in many cases, individual workers may have been their own worst enemies. There can be perceived lifestyle benefits accorded to the 12-hour shift that disregards the actual impact of this work schedule on personal health and wellbeing. For this reason, the authors of this study concluded that managerial interventions focused on safeguarding workers’ health should override personal desires or beliefs, and that reduced workday and work-week schedules should be enforced.

Such a finding may be controversial in a profession such as pharmacy. Professionals are expected to self-monitor and ensure they are providing safe and effective care, and to not work in conditions that may compromise their ability to do so. Community pharmacy is the very definition of ‘hard work’: it is physically demanding, emotionally laborious and cognitively intense, all at the same time. While on occasion and in an emergency, it may be necessary to work long hours or weeks, the impact of chronic long scheduling on the personal health and wellbeing of pharmacists has not been adequately studied. In other similarly demanding professions — for example, airline pilots — there is a ceiling on the number of hours that can be worked in a row, in recognition of the reality of the work itself and the high-stakes nature of compromised, fatigued decision-making. Unions have been particularly focused on scheduling practices that reduce daily work time and mandate breaks.

Time limits on productive work

The results of occupational studies suggest that, at best, human beings are able to sustain productive work for approximately three to four hours daily, often coinciding with a circadian rhythm that favours morning work over afternoon or evening shifts^​9​. Studies also suggest that people are actually productive in their jobs for no more than three hours per day, with three additional marginally productive hours possibly based on the specific workplace conditions^​9,10​. A fully productive, safe and effective 8-hour workday does not appear to be possible in reality, let alone a 12-hour or longer workday. Of course, if one were to take these conclusions at face value, it may suggest either a 5-hour, 7-day work week — in order to equal 35 hours of pay — or reduced pay for a 5-hour, 5-day work week. Neither option seems palatable to most workers, so the stubbornly unchanging 35 to 40-hour Monday-to-Friday work week model persists, despite its many shortcomings.

How to improve shift patterns in practice

Given the competing pragmatic realities associated with workplace scheduling, how can community pharmacists integrate the findings from this research into their practice? 

First, we should all recognise that we do not necessarily know what is best for us as individuals. While on the surface it may seem advantageous for us to work fewer, longer days, the long-term impact on wellness and patient safety needs to be considered. There may be a role here for more assertive regulatory, employment-standards and management rules — similar to those seen with airline pilots or junior doctors — that put a ceiling on the number of hours per day or week that can be worked. 

Second, where economic reality means that eight-hour shifts, five days per week are needed, find ways to account for the reality that performance will deteriorate over eight hours. Consider scheduling practices that front-load ‘harder’ — more physically, emotionally and cognitively taxing — work at the start of a shift and leave time later in the shift for less demanding work. This might mean that instead of allowing for a full day ‘project day’ to relieve workplace pressure, ‘project hours’ in the second half of a regular workday might be preferable. Alternatively, think about scheduling that allows for some work tasks (e.g. conducting online follow-up or medication reviews) to be completed in a work-from-home arrangement. 

Third, productive workdays are highly dependent upon workplace conditions: the more chaotic a workplace is, the fewer productive work hours each day exist. Thus, to increase productive work hours, find ways to reduce the environmental/workplace chaos that increases cognitive, emotional and physical stress.

Conclusion

Upending decades-long traditions and expectations as to what constitutes hard work and a typical full-time job is not easy, but it will be essential if pharmacy is to address concerns regarding the wellbeing of its workforce. There is nothing sacrosanct or unchangeable about the 40, 48 or 50-hour work week that many pharmacists currently endure. Creativity and compassion are required to meet both organisational objectives and the health and wellbeing needs of the pharmacy workforce.