Reflective practice is standard for most healthcare professionals, so why not pharmacists?

Working as the responsible pharmacist on a male acute mental health ward has unfortunately exposed several distressing interactions. Over time, it became normal for patients to make inappropriate or explicit comments towards myself and my colleagues. 

It was a pivotal moment when a patient touched me inappropriately during a discussion about his medication. I walked away from the interaction feeling shocked, but as the day went on, a sense of violation kicked in and I found myself feeling tearful and overwhelmed.

Although the situation was dealt with correctly, including reporting to the police and completing incident forms, it left a lingering impact. Ward staff had access to regular reflective practice groups where they could process experiences such as these. But, in pharmacy, there was no such space. Fortunately, there are colleagues to speak to informally, but what about those people who don’t have this support network available to them?

Why do pharmacists need access to reflective practice?

Pharmacists — particularly those working in acute mental health — may be exposed to emotionally distressing environments where they are often working alone in representing pharmacy on the ward. Yet they often lack a dedicated space in which to process the challenges they face.

At the start of their career, newly qualified hospital pharmacists may find themselves suddenly responsible for a ward and expected to challenge experienced doctors on prescribing decisions. They are likely to be involved in making complex clinical decisions early in their career, while simultaneously consolidating their knowledge and establishing themselves as valued members of the multidisciplinary team (MDT).

Reflective practice enables healthcare professionals to examine their experiences to critically evaluate them. By challenging personal biases and gaining self-awareness, more effective clinical judgement can be developed. Group reflective practice takes this one step further. It creates shared spaces where healthcare professionals can process their experiences together and learn from one another^​1​. 

Psychologists, nurses, doctors and other healthcare professionals routinely participate in group reflective practices, which is regarded as a valuable tool for increasing confidence, improving delivery of care and reducing burnout^​2​. However, in my experience, pharmacists are often excluded from these structures. 

This absence of reflective practice can create an emotional disconnect and contribute to reduced confidence and increased feelings of isolation. Over time, these pressures may affect how pharmacists interact with their colleagues, deliver patient care and impact their overall wellbeing.

The Royal Pharmaceutical Society’s 2024 Workforce and Wellbeing Survey revealed that 87% of the pharmacy workforce is at risk of burnout. Contributing factors include lack of support, long hours and emotional exhaustion^​3​. Similarly, a longitudinal study measuring wellbeing of UK pharmacists during the COVID-19 pandemic, results of which were published in December 2024, identified feelings of sadness, low morale and hopelessness, with participants highlighting support from colleagues as the most valuable resource to manage stress^​4​.

Burnout not only affects individuals, but it can also impact patient safety. Systematic reviews have revealed that emotional exhaustion is associated with increased clinical errors and reduced quality of care^​5​. 

Reflective practice interventions have been shown to reduce burnout, boost self-esteem and improve team communication. These interventions have resulted in improved patient care in professions, such as nursing and medicine^​2​.

Despite such clear evidence, structured group reflective practice groups are still not a formal requirement within pharmacy practice. Without regular opportunities to reflect and process difficult experiences, pharmacists may internalise stress and begin to disengage from their roles. It is time for the profession to acknowledge that pharmacists are not exempt from the emotional demands of frontline healthcare.

What prevents pharmacists from engaging in reflective practice? 

For decades, pharmacists’ primary responsibility was the safe and accurate dispensing of medications. Traditionally, this meant limited patient contact — particularly in hospital settings — and minimal interaction with other healthcare professionals^​6​. As a result, pharmacy developed into a task-focused and technically-driven profession, with little emphasis placed on the emotional demands of being a healthcare provider.

However, the role of a modern pharmacist has evolved significantly. Pharmacists now work alongside doctors, nurses and other healthcare professionals in acute clinical settings and are increasingly recognised as crucial members of the MDT. Many become independent prescribers and develop highly specialised knowledge within their fields, contributing to the development of evidence-based treatment guidelines^​7​.

Despite this, the profession still carries its historic identity of being solitary, procedural and risk-averse — and reflective practice remains underutilised. 

Moreover, a sense of identity as ‘the unremarkable character’ — a term coined by Elvey et al.  in 2013^​8​ — to describe pharmacists’ feeling of being invisible, underappreciated and often misunderstood, may mean pharmacists struggle to see themselves as deserving of the same psychological support structures available to other healthcare professionals.  

From a practical perspective, pharmacists’ time is often divided between several wards, the dispensary, meetings and training. Time constraints are likely to be a significant barrier, with clashing schedules and high patient turnover placing additional strain on dispensary services.

On a relational level, pharmacists are often spread across different clinical and non-clinical environments, which means they spend limited time with both the ward team and their pharmacy colleagues. This may reduce opportunities for team-based reflective practice, or even informal conversations that may contribute to a sense of professional isolation.

Reflective practice should be integral, not optional

It is time for the pharmacy profession to recognise the importance of reflective spaces, not as a ‘nice to have’, but as a core component of pharmacy practice. 

In high-pressure environments, such as acute and mental health inpatient settings, group reflective practice should be embedded into routine practice. These sessions could be held monthly or bi-monthly and integrated into existing team meetings or wellbeing initiatives. Sessions could be facilitated by senior pharmacists who receive the appropriate training, clinical psychologists or other trained reflective facilitators. 

Some may argue that time pressures and high workload may make reflective practice impractical. Therefore, rather than aiming for full attendance, a flexible, drop-in model could accommodate pharmacists’ varied schedules. Alternatively, small peer-led groups could offer a safe space to explore difficult experiences and create a sense of connection among colleagues. Pharmacy leads would play a crucial role in advocating and allocating time for reflective practice as a valued component of professional development.

Importantly, reflective spaces must be psychologically safe and voluntary. Not all pharmacists will feel comfortable sharing in groups, therefore a ‘one size fits all’ model is unlikely to succeed. Flexibility in group size and setting must be emphasised when conducting reflective practices to meet the needs of individuals. 

Some may view reflective practice as ‘too soft’ or irrelevant to a pharmacist’s analytical role. However, in 2019, Mantzourani et al. highlighted its value for professional growth, especially for trainee pharmacists, noting benefits such as improved self-evaluation, better clinical decision-making and reduced emotional distress^​9​. Their findings suggest that pharmacists are not only capable of engaging in reflective practice, but also benefit from it.

Reflective practice has still not been formally established in my workplace, but my experience on the ward started important conversations. Informal debriefs with colleagues have helped process what happened and showed me I wasn’t alone. Since then, there has been a shift from trying to fit the mould of the ‘resilient pharmacist’ who copes in silence, to sharing experiences more openly and supporting one another. These conversations are gaining momentum and highlighting a shared need for structured, psychologically safe spaces to reflect and learn.

Embedding reflective practice into pharmacy is not without its challenges, but the risks of doing nothing are far greater. Pharmacists are deserving of dedicated time and space to process the emotional realities of our work. With a shift in culture and leadership support, reflective practice can become a meaningful and sustainable part of pharmacy practice.