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P. Brittany Vickery, PharmD, BCPS, BCPP
Assistant Professor, Wingate University School of Pharmacy, Hendersonville North Carolina
Clinical Pharmacist, Park Ridge Health Inpatient Psychiatry

Nancy C. Brahm, PharmD, MS, BCPP
Adjunct Clinical Professor, University of Oklahoma College of Pharmacy

Pharmacist burnout syndrome has been reported as early as the 1980s. Common elements of burnout include emotional exhaustion, depersonalization, and a sense of powerlessness to achieve the desired result.1 It is important to be able to say “no” gracefully and realize that in doing so, you are protecting other commitments and ensuring that the things you are saying “yes” to receive your full attention and focus. As Michael Porter says: “The essence of strategy is choosing what not to do,” but it is important to remain tactful, diplomatic, and professional.2

One reason individuals may have difficulty saying no or setting limits is because doing so may prompt negative feelings of selfishness, disobedience, guilt, discomfort, or decreased likeability.3 With this arises a disdain for setting limits. Prioritizing and planning in advance (before being asked to take on something more) may help illuminate how limited your time and abilities are currently. Try to stay abreast of obligations and the time-commitments they require.

As a pharmacist, whether new to the profession or practice, you are amongst a vulnerable population. You will eventually be asked to do more than you can reasonably manage. Many feel pressured to accept these additional opportunities, thereby further increasing stress and discontent. An assessment of the timeliness and requirements of the task should be done before accepting an invitation to participate. A problem that can influence decision-making in today’s culture is the urge to say “yes” too quickly. This is often brought on by the overwhelming desire to please. It is acceptable to ask probing questions before committing (see Table 1). It may be appropriate to express interest and ask for a meeting to discuss these items before giving a firm answer. Table 2 provides some examples of situations where a “no” may be more appropriate than a “yes.” This list is not all inclusive, and your current work load, life events, personal goals, and priorities must factor into each decision. After analyzing the situation, a decision to accept or decline can be made. Suggestions for responses are included in Table 3.  

In this article, you will find two scenarios and examples of potential responses with phrasing suggestions. A firm “no” might not be appropriate to each situation; there are strategies to help mediate the situation and request.

Situation 1: The residency director (or department chair) comes to you with an additional project for you to complete. This is an opportune time to take a deep breath (step 1) and calmly respond (step 2) with examples from Table 1, particularly by requesting a follow-up meeting. In the interim, carefully review your calendar and obligations (teaching, research, staffing). Use this time to outline some of the aspects of the project you would like to discuss that specifically draw on your strengths and how this project will help with your professional development.

When you meet, have your materials and calendar organized for review. Indicate the progress on each task and due dates that may apply. Again, probing questions from Table 1 can help narrow the scope into something specific and, hopefully, manageable. Verbally thank the other person for help prioritizing, restate your understanding of the meeting, and send a follow-up email with your thanks and understanding.

Situation 2: Your co-resident or junior faculty colleague appears with a look you know too well: “Help! I have reached overload!” Calmly ask your colleague to sit down, take a deep breath, and explain what brings him/her to your desk. You learn that the residency director/department chair presented your colleague with a project, and he/she would like your help. You have experience in this area and provide counsel to help your colleague.

If help is still requested, consider Tables 1 and 2 as helpful tools. Building relationships upfront, knowing someone well, being bonded, and showing concern will also help with setting limits and the colleague’s acceptance of your “no.”3 You might consider saying, “I’m in the same situation.” If you have other circumstances, like interviews, teaching duties, and/or family obligations that cannot be rearranged, be upfront and gently, but firmly, decline. Be sure to express empathy and thank your colleague for asking you to participate. If you truly cannot decline and/or feel pressured to help in some way, consider a partial “yes” by asking your peer to break down the project into specific tasks. See which ONE component best fits your skill set and taking that one ONLY.

Give careful consideration of how granting this request could impact your workload. In cases where “no” is the only option, provide a reasonable and legitimate rationale why the request cannot be granted. If the deadline is not time-sensitive, respond that you need more time for consideration and provide a date for your expected response. Regardless of the outcome, thank the person who has presented you with a new opportunity.

Residencies and faculty appointments represent a time of tremendous personal and professional growth. New skills are needed in some cases. One of these may be developing the art of saying “no” with tact and diplomacy. Practice little “nos” along the way to prepare you for the feelings and emotions that may accompany big “nos.”3 Be flexible and work for win-win situations for all parties involved. Regardless of the setting, always be sure to thank the other person for the opportunity. In addition you might want to include thanking him/her for thinking of you, the positive contributions you might be able to provide, and for his or her contribution to the organization.

References

  1. Maslach C, Jackson SE. The measurement of experienced burnout. J Occup Behav 1981; 2:99-113. 
  2. Porter ME. What Is Strategy? Harvard Business Review. 1996; 74: 61–78. 
  3. Cloud, H., & Townsend, J. S. Boundaries: When to say yes, when to say no to take control of your life. Grand Rapids, Mich: Zondervan Pub. House. 1992.
  4. Stanier MB. The Coaching Habit Say Less, Ask More & Change the Way You Lead Forever. Box of Crayons Press. 2016.
Table 1 Probing questions to ask when determining to accept an opportunity or decline3,4
1. This is an interesting opportunity; can we meet to discuss the details?
2. Why was I selected for this task/role?
3. Who else was considered or asked?
4. What sort of timeline do you have in mind?
5. What other responsibilities should/could I let go of so that I can focus on this?
6. Can elements of this project be combined with projects already in progress?
7. Would this work as a team-based project, or is this a separate initiative?
8. How can I help (if a direct request has not been made clearly)?

 

Table 2 Times to consider declining an opportunity3,4

1. When you are being asked to do things that do not align with you or your department’s priorities or goals
2.When you are being asked to pick up a coworker’s slack (especially repeatedly)
3. When you feel you are taking on more work to avoid a tough conversation.
4. When you are consistently being asked to redo work to meet unreasonable expectations.
5. When you find yourself saying “yes” for praise or because you are expecting too much fulfillment from work (and have not yet attained it)
6. When you begin taking work-stress home and it is impacting important relationships

 

Table 3 Phrases for gracefully accepting or declining an opportunity3,4

1. Now is the opportune time for this. Yes. I would very much like to participate.
2. This is such a great project/idea, but the timing is all wrong.
3. This is not a good fit for my skill set.
4. I am able to do part of this, but not the entire project with my current work load. (You may state what you are willing to take on, or let the other party decide.)
5. I am afraid I will have to say no to this. (Provide reasoning if you are able or inclined.)

 

 

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