Unmasking the Unrecognized: Exploring Registered Pharmacy Technicians’ Stressors During COVID-19 Through a Demands-Resources Inquiry and Looking Ahead

Abstract

Canadian registered pharmacy technicians (RPTs) were vital in supporting pharmacy operations during the pandemic. However, they have received little attention during or pre-pandemic. This study aimed to identify and understand the stressors experienced by Canadian RPTs during the pandemic and gain insights on lessons learned to help improve the profession. Through a descriptive qualitative design, virtual semi-structured focus groups were conducted with RPTs who were recruited through various sampling methods across Canada. Data were inductively analyzed and then deductively; themes were categorized using the Job Demands-Resources (JD-R) model. We reached data saturation after 4 focus group sessions with a total of 16 participants. As per the JD-R model, job demands included: (1) increased work volume and hours to meet patient demand; (2) drug shortages and managing prescriptions increased due to influx of orders coinciding with restricted access to medications; (3) fear of the unknown nature of COVID-19 met with frequent change in practices due to protocol changes and ineffective communication; and, (4) the pandemic introduced several factors leading to increased staff shortages. Themes pertaining to resources included: (1) poor incentives and limited access to well-being resources; (2) limited personal protective equipment delaying work operations; (3) and a general lack of knowledge or appreciation of the profession impacting work morale. Lessons learned from the pandemic were also provided. Overall, our findings revealed an imbalance where RPTs experienced high job demands with limited resources. Improved leadership within pharmacies, including improved communication between team members, is required. Furthermore, efforts to highlight and recognize the work of RPTs to the public is important to help improve enrollment, especially with their recent scope of practice expansion.

Keywords

registered pharmacy technicians qualitative pandemic stressors job demands-resources model lessons learned Canada healthcare

What do we already know about this topic?

Healthcare workers have been overworked during the pandemic.

How does your research contribute to the field?

To our knowledge, this is the first study that examined the stressors of Canadian registered pharmacy technicians (RPTs) during the pandemic, highlighting shared stressors among pharmacists but also outlining unique challenges, including feeling completely unrecognized for their work, even after expanding their scope of practice.

What are your research’s implications toward theory, practice, or policy?

Expanding the scope of practice for Canadian pharmacists and RPTs has the potential to optimize the health system with the key factor being the imperative need to hire more RPTs for optimal results while ensuring a balanced approach to job demands and resources, including compensation and benefits, remains essential.

Introduction

The COVID-19 pandemic had a profound impact on the healthcare system.¹ It exacerbated many pre-existing challenges for healthcare workers such as increased work demands, resource scarcity, and significant concerns for personal safety.^1,2 These challenges were a direct result of the influx of patient care and poor organizational preparedness.³

Frontline workers such as registered pharmacy technicians (RPTs) assisted in protecting the public and were vital in supporting pharmacy operations. Over 55% of RPTs in Canada work primarily in hospital settings while the rest work in community pharmacies.⁴ They possess many duties although their scope of practice varies between provinces. For example, RPTs in Alberta are permitted to develop a compounding protocol for medications, while they are unauthorized to do so in Ontario.⁴ Notably, RPTs are not regulated in Quebec or in the Territories. Nevertheless, common RPT duties include supporting pharmacists by maintaining inventories, dispensing and packaging prescriptions, and engaging in administrative and customer service-related tasks.⁴

The pandemic brought an increase of illnesses and chronic conditions, affecting the healthcare system.⁵ Consequently, the scope of practice for RPTs began to reshape to help manage system pressures in Canada. For example, Ontario technicians were permitted to conduct point-of-care non-laboratory testing (eg, checking glucose levels) as well as prepare and administer COVID-19 and influenza vaccinations under the pharmacist’ supervision.⁶

Though regulatory changes were developed to ease the pressures on pharmacies and by extension, the broader Canadian healthcare system during the pandemic, little is known about the impact of these changes on the wellbeing of RPTs. This is of concern since pharmacies in Canada remained patient-facing during the pandemic, including during lockdowns. Furthermore, results from various studies revealed that overall, pharmacy professionals faced significant challenges, including increased workload resulting in poor mental health outcomes, including burnout.^7-9

Although limited, research pertaining to Canadian pharmacies revealed challenges during the pandemic. A national study found that patients began seeking pharmacists instead of other healthcare settings to avoid contracting the virus, which led to an increase in their work, as they expended much of their effort in managing patient expectations and reassuring them when necessary.¹⁰ Moreover, in a qualitative study conducted in Ontario, Canada, thematic results demonstrated that registered pharmacists experienced higher-than normal workload, difficulties between level of supply and the expected demand, and communication challenges, including informational gaps pertaining to COVID-specific protocols.¹¹

While some research has shed light on the climate in Canadian pharmacies during the pandemic, there remains a dearth of knowledge concerning RPTs as a distinct healthcare group. This research gap existed prior to the pandemic, indicating that RPTs have received comparatively less attention to other healthcare professionals, such as pharmacists. Thus, the primary aim of this study is to identify and understand the stressors experienced by RPTs during the pandemic, with a focus on highlighting lessons learned as healthcare workers transition beyond the pandemic.

Methods

Our study received approval from the University of Guelph’s Research Ethics Board (22-03-001). In this descriptive qualitative study, we held focus groups with Canadian RPTs from various provinces to learn about pandemic stressors and lessons learned moving beyond the pandemic. Focus groups are an effective way to collect data as they allow for in-depth facilitated discussions that promote interactive participation and exploration of group dynamics, including healthcare workers.¹²

Participants

Eligible participants (1) had work experience in pharmacy settings before the onset of the pandemic, (2) maintained an active status as RPTs during the study period, and (3) were employed in any Canadian province, excluding Quebec and the Territories. We carried out a multi-strategy recruitment effort, including collaboration with provincial regulatory bodies and professional associations who disseminated the recruitment ad on our behalf. We utilized social media platforms as an added recruitment strategy. Finally, we employed a snowballing approach to expand our outreach, where existing participants shared recruitment information within their networks. As an incentive, each participant received a $50.00 gift card. As fraudulent activities have become a growing concern with online recruitment where there are monetary incentives,¹³ we cross-referenced participants’ names with public registries and verified their job roles at the start of each focus group.

Data Collection

Focus groups were held virtually via Microsoft Teams. Each focus group was led by a primary (MS or BG) and a secondary moderator (AK). Focus groups were held between July 2022 and January 2023. Each participant was contacted individually to obtain informed and consent before the focus groups. The study’s objectives, approach, risks, and benefits were re-iterated at the beginning of each focus group. To maximize confidentiality, participants were assigned alias names and were asked to refrain from providing potentially identifying information (eg, names of colleagues).

A semi-structured interview guide (Appendix A) with questions developed by the research team who possess expertise in qualitative research, workplace mental health, pharmacy practices, and public health was used in this study. This interview guide was piloted in smaller-scale studies (ie, provincial) and with different healthcare groups. First, participants provided general demographic information. Next, probing questions consisted of semi-structured inquiries about pandemic related stressors that affected their work and personal lives. Participants were also asked to discuss lessons learned from the pandemic to improve wellbeing and their profession. As a form of member-checking to ensure the credibility of the data, the moderators paraphrased participants’ responses and sought additional context where necessary.¹⁴ Data saturation was reached after information from the focus group sessions became increasingly redundant with no new information.^15,16

Data Analysis

Data analysis was conducted using NVivo Software v.12.¹⁷ We used Braun and Clarke’s¹⁸ 6 stages of thematic analysis for our data. For data familiarity, AK and PND attended and audio-recorded the focus group sessions then transcribed the data verbatim, which was reviewed by BG to improve its accuracy. Using a Codebook Thematic Analysis approach, an inductive-deductive approach was applied to the data.¹⁹ For coding generation, an inductive approach was used whereby 2 researchers (AK & PND) independently examined the data without predetermined categories with the goal of organically identifying patterns and emerging concepts. Each coder compared the codes with each other and with new data as it was collected. Codes were cross-referenced and underwent 3 rounds of review by both coders to capture any discrepancies. These codes were then used to construct categories, which then helped produce meaningful themes that were discussed and refined with the research team.

Following initial theme development, a deductive approach was applied, which was guided by the Job Demands-Resources (JD-R) model,²⁰ where themes were refined then categorized as either a job demand or a resource. The JD-R model postulates that to maintain the employee’s wellbeing and productivity, resources need to be compatible with demand levels according to the employee’s physical and cognitive capabilities.²⁰ In essence, the model provides a structured lens through which the interplay between demands and resources can produce 4 possible outcomes: (1) low job demands coupled with low job resources may lead to disengagement; (2) low job demands coupled with high job resources may result in poor productivity; (3) high job demands with high job resources may lead to optimal employee performance and job satisfaction; and (4) high job demands and insufficient job resources may result in poor work performance and burnout.

The JD-R model has been helpful to predict employee wellbeing in crisis situations such as COVID-19.²¹ The authors note the interplay between work and personal life is important to consider to effectively evaluate employee wellbeing. Additionally, the model has been used to evaluate personal, organizational, and community level strengths and needs of various healthcare employees, including pharmacists during the pandemic.^8,22-24

Findings

Data saturation was reached after conducting 4 focus groups, with a sample of 16 participants (Table 1). Focus group durations ranged between 50 and 80 min, with an average of 75 min. Almost all participants identified as women (n = 15). The participants’ age ranged from 26 to 56 years (M = 40.5, SD = 8.6). They worked in different provinces with the majority residing in either Ontario or Alberta. Nine participants worked in a hospital setting and 7 worked in a community pharmacy setting. Of those in community pharmacies, 5 worked in independent pharmacies, and 2 worked in big retailer pharmacies. Most of the participants worked in urban settings (n = 14).

Table 1.

Participant Characteristics.

Age	Gender	Region	Setting	Marital status	Urban/Rural	Work experience (years)
20-29 = 2	Woman = 15	ON = 10	Hospital = 9	Married/Common law = 12	Urban = 13	Min. = 3
30-39 = 4	Man = 1	AB = 3	Independent = 5	Single = 1	Rural = 2	Max. = 35
40-49 = 7		NS = 1	Big retailer = 2	Divorced = 3	Mixed = 1
50+ = 3		NFL = 1
M = 40.5		BC = 1
SD = 8.6

Our findings revealed the following themes classified under job demands, including (1) increased work volume and hours to meet patient demand; (2) drug shortages and managing prescriptions increased due to influx of orders coinciding with restricted access to medications; (3) fear of the unknown nature of COVID-19 met with frequent change in practices due to protocol changes and ineffective communication; and (4) the pandemic introduced several factors leading to increased staff shortages. The experiences described directly affected job demands.^20,21 Themes pertaining to resources included: (1) poor incentives and limited access to wellbeing resources; (2) limited personal protective equipment (PPE) delaying work operations; and (3) a general lack of knowledge or appreciation of the profession impacting work morale. Lessons learned from the pandemic were also provided.

Job Demands

Increased work volume and hours to meet patient demand

RPTs expressed challenges with extended working hours and increased tasks on several occasions (Table 2). This included working overtime and working through holidays. In addition to a notable increase in prescriptions since the pandemic, which in turn increased their work volume, they explained their scope of practice also expanded. Specifically, RPTs explained that in response to the pandemic, regulatory bodies expanded their scope of practice to include controlled acts such as the preparation and administration of COVID-19 and influenza vaccines to optimize vaccination rollout. Reportedly, extending their scope of practice helped alleviate the burden on vaccination clinics and the overall healthcare system. However, alongside these changes, participants expressed feeling increased levels of exhaustion and stress from working overtime and trying to meet set deadlines.

Table 2.

Job Demand Themes and Corresponding Excerpts.

Themes: Demand	Excerpts
1.1	FG-18: There are so many orders coming in and you have little time. And most times you have to work overtime because if you have work you can just, you cannot just sign off and go home. So, um, having to work overtime and having to compile a lot of drugs it, it’s, it’s really stressful.
	FG-60: In a lot of aspects also with the increased hours, like, myself, I, I was on call pretty much 24 h a day.
	FG-61: Our profession, like they, they change our scope of practice with, uh, giving us like, the immunization of the vaccine and also the, the flu vaccine now and everything. And, and like, I, I went for the, the training and everything.”
1.2	FG-19: Um, in the first wave of the pandemic, a lot of places started trying to sort of panic-buy medication, and, and our supplier put a hard-stop on ordering and put limits on every single drug.
	FG-28: There was a 30-day, cut a time and then by the time, ‘cause like some other patient wants 3 months and then they only allowing 30 days. And then they’ll be like arguing too on top of, “what’s going on,” “why am I only getting a month?” “I will be paying more than the usual.” So, you have to explain what’s going on.
	FG-19: So, we didn’t have enough medication for certain patients at certain times and had to get new medication orders.
1.3	FG-23: Working short staffed because all of a sudden, you know, people are afraid and don’t pull up to work. It was, it was very, it was the most stressful time I’’ve ever worked and I think part of that was the unknown. Right?
1.3	FG-19: So, I was coming home and changing in the garage and going and showering and cleaning absolutely everything that I had brought with me to work.
1.4	FG-22: And, um, I think one of the biggest problems that led to was, is that because of the regulations implemented by the government or the hospital or whatever, if somebody got COVID or had exposure to COVID in the beginning it was like “oh we’re sending everybody that came into contact with this person home.”
	FG-110: “Um, yeah, again, we, just staffing like, um, um, there are quite a few colleagues that do have like small children and like this, like when the school was closed and stuff, like they have to stay home so then the rest of us has to pick up the extra work.”

Drug shortages and prescription management increased due to influx of orders coinciding with restricted access to medications

Participants highlighted the occurrence of a supply and demand imbalance which caused suppliers to reduce ordering limits. Due to medication shortages, provinces were compelled to implement restrictions on ordering limits to patients. For instance, participants mentioned a 30-day dispensing limit was introduced to help reduce the risk of consumer behaviors of hoarding and panic buying. However, there were still insufficient quantities of certain medications which put significant pressure on RPTs who had to connect with physicians, dispense alternative medications, and engage in additional compounding while addressing patient dissatisfaction.

Moreover, participants explained the scarcity of certain medications led to delays in fulfilling prescriptions which compromised the quality of patient care. Consequently, patients were unable to keep up with their regular treatments which disrupted their recovery process. The interruption in the supply and demand chain intensified the RPTs’ work demands, who were tasked with dispensing higher volumes of prescriptions within condensed timeframes all while reassuring worried patients.

Fear of the unknown nature of COVID-19 met with frequent protocol changes and ineffective communication

Participants explained that compared to some other healthcare settings, pharmacies maintained their provision of in-person care to patients, with RPTs typically serving as the initial point of contact. As such, there was the inherent fear of exposure to the COVID-19 virus. In the initial stages of the pandemic, participants noted that because little was known about the COVID-19 virus and its impact on health, they had to take extra precautions when entering personal spaces to avoid threatening the well-being of loved ones, for example, changing in the garage or thoroughly showering before sitting down with family members.

In addition to the unknown nature of the virus, RPTs were challenged by rapid changes in their practices as knowledge about the virus evolved. The frequent changes in practices caused an increase in work demands. Specifically, RPTs had to learn or re-learn practices then apply them into their work. Participants mentioned constant change in policies increased confusion amongst pharmacy teams. This increased demands as they were required to allocate time away from completing tasks to ensure proper protocols were being understood and followed.

In a hectic environment where RPTs experienced fear of being exposed to or transmitting the virus along with frequent changes in practice, exacerbated by poor communication across pharmacy teams. Reportedly, poor team communication led to misunderstandings between the pharmacy and the patients resulting in frequent errors, which typically were resolved by RPTs. RPTs expressed that the time it took resolve issues and address patient concerns slowed their progress in other areas of the pharmacy and “emotionally” depleted their energy, causing deferral of tasks to subsequent shifts.

The pandemic introducing factors leading to increased staff shortages

Participants identified staff shortages as a significant stressor present throughout the pandemic. Several factors contributed to increasing staff shortages such as strict government regulations that obligated individuals to stay home for an extended period specifically during the first wave. Participants noted that childcare was a major determinant for staff shortages since many RPTs had children who were sent home from school or daycare due to symptoms or outbreaks. Hence, staff mentioned they would return home to care for their families leaving pharmacies short staffed. A significant consequence of staff shortages was the increase workload for the RPTs who remained on duty. Notably, RPTs explained that staff shortage is not a new issue in their field and historically has been a cause for concern. However, the issue was magnified during the pandemic.

Job Resources

Poor incentives and limited access to wellbeing resources

During the pandemic, participants noted an evident lack of appropriate incentives and compensation which prompted feelings of exhaustion and burnout (Table 3). Participants mentioned their increased responsibility due to longer hours and changes in scope of practice did not match their compensation which led them to question their worth. Several participants also mentioned reduced work morale and questioned the value of staying in the profession.

Table 3.

Job Resources Themes and Corresponding Excerpts.

Themes: Resources	Excerpts
2.1	FG-60: We’re always at work and it all came down to what are we doing it for? We’re not getting anything more like we don’t get paid for this. We’re not being reimbursed or not being, you know, appropriately paid for the increase in demand.
	FG-110: It’s kind of like, you know, it’s not very encouraging for like technicians to want to like, continue with this like, with the profession. They don’t think the pay is worth it.
	FG-22: I think a lot of those services, especially if people had access to it for free, was all overloaded.
2.2	FG-19: And another thing I was going to mention was the lack of personal protective equipment during the first wave. We were restricted on mask use. We were not allowed any N95s and that really impacted patient care because we couldn’t speak with patients in person.
2.3	FG-63: We get, we get nothing for it I mean for RPTS appreciation day we got what seemed like a bag of leftover candy and stuff from previous hospital event and it was like they were giving us almost expired like little big chip and like fruit by the foot. Like (. . .) I think that’s just it you just feel so underappreciated and it you’re just so tired.”
2.3	FG-61: Our own college, we’re not even acknowledged as in the name of it. . .We pay our license to the college just like the pharmacist, and this should be updated so at least we would get the acknowledgment. And it’s the resentment like . . .. what we’re doing is not important.

In addition to compensation, participants reported limited accessibility to wellbeing resources during the pandemic. Restrictions due to the pandemic combined with insufficient benefits disallowed RPTs to engage in self-care, including recreation centers and mental health support. Participants who had extended benefits through their employer cautioned that the coverage amount is insufficient to seek ongoing treatment. They further expressed concern regarding access to free supports within the community. Specifically, they noted booking a community mental health therapist was a significant challenge due to pent up demand with long wait lists. Finally, 1 participant mentioned the method of receiving mental health support was online based with limited technical support.

Lack of PPE threatened personal security delaying work operations

Participants expressed that during the pandemic, there was a consequential lack of PPE that threatened personal security as many RPTs were providing in-person care. They felt they were left exposed to the virus without the appropriate protection. For example, participants stated that in hospital settings, due to the scarcity of PPE, they were unable to enter clinical areas and speak to patients directly or update medication carts in a timely manner. They specified how the lack of PPE overall led to delayed operations and reduced patient interactions causing mental and physical stress for both the patient and RPT. They indicated that having access to protective supplies could help them feel safer to complete their tasks and ensure patients receive their appropriate medications.

A general lack of knowledge or recognition of the profession impacting work morale

RPTs voiced that the public has a little understanding of their role and are often viewed as “just an assistant” to the pharmacist, rather than a regulated healthcare provider. They added the issue is more discouraging as they do not often feel acknowledged or recognized by their employer or from a regulatory perspective. Participants reported feeling undervalued as there was little gratitude and recognition of their work. For context, 1 participant noted that for RPT celebration day, they received what appeared to be “leftover” sweets.

Lessons Learned

Improved organizational leadership in pharmacies with adequate and timely communication

RPTs highlighted that improved leadership within pharmacies is required to improve employee morale and pharmacy practices. A focus on employee needs, including an evaluation of their compensation and adequate extended benefits and resources, is required. Specifically, participants expressed dissatisfaction with leadership’s inability to provide timely clinical updates, causing communication issues. They also noted a lack of emotional support and limited access to mental health resources during the pandemic. Emphasizing the need for improved staff communication, they highlighted its potential to reduce medical errors, customer dissatisfaction, and increased workload.

Development of an emergency preparedness plans with sufficient resources

Participants acknowledged the pandemic offered a valuable lesson for pharmacy personnel, where emergency preparedness is necessary. They advised having clear and ready protocols advising on practices when dealing with infectious viruses is required. They also advised the need to have a stock full of PPE to work in a safe environment.

Discussion

To our knowledge, this is first Canadian study to explore the experiences of RPTs during the pandemic. Its aim was to understand their stressors and determine lessons learned beyond the pandemic. Using the JD-R model, our findings discovered an imbalance between job demands and resources (Figure 1). RPTs faced higher workloads, longer hours, and the need to adapt to new practices while dealing with factors like drug and staff shortages. They operated in a fearful environment due to limited PPE access and miscommunications. Additionally, their morale has been affected due to inadequate compensation and receiving little recognition from the public, employers, or their regulatory body.

Figure 1.

Identified themes suggesting increased job demands with limited resources.

The mismatch between demands and resources has been consistent across various healthcare groups worldwide throughout the pandemic.^22-25 For example, Havaei et al²⁵ found nurses faced increased workplace demands, staff shortages, concern for personal safety, poor support from their organization, and difficulty accessing resources such as PPE. The participants reported these factors to be a driver for emotional distress and poor patient outcomes during the pandemic.

Experiencing higher-than-normal job demands among RPTs is not a unique issue in healthcare.²⁶ However, it is crucial to examine the implications of expanding RPTs’ scope of practice during that period. RPTs were tasked with acquiring new skills and becoming proficient in new controlled acts, all while managing their existing responsibilities, leading to a formidable challenge. Accordingly, their workload was not solely increased in familiar tasks they were accustomed to performing; rather, it involved novel and high-risk responsibilities, adding further stress.

From a Canadian perspective, some of themes identified in this study resembled findings in national and provincial investigations examining the experiences of pharmacists during the pandemic.^10,11,27 These commonalities encompassed stressors such as heightened workloads, extended working hours, the need for patient reassurance and problem-solving, strategies to cope with supply shortages, variability in PPE access, and challenges associated with protocol adjustments. Additionally, the receipt of timely health-related information was a stressor found among RPTs and this finding is also consistent with studies concerning pharmacists.¹¹ These commonalities suggest the identified stressors are broadly a concern for Canadian pharmacies, rather than it being a profession-specific challenge.

Inadequate communication among team members was identified as a contributing factor to medical errors, occasionally straining the relationships between pharmacy staff and patients. The significance of effective communication in a pharmacy context has been well-documented.²⁸ However, given the substantial work demands imposed by the pandemic, the potential for reduced communication is amplified, emphasizing the critical need for improved communication practices during such times. Ineffective communication affects RPTs more than pharmacists, as pharmacists typically manage pharmacy operations.

Moreover, the results indicate staff shortage is a common concern among RPTs that existed pre-pandemic; however, the situation worsened during the pandemic. Staff shortages can be seen as a limited (human) resource; however, we categorized it under job demands due to its consequences. For example, staff shortages cause operational delays and increased workload for the existing staff. Staff shortage in healthcare is a common concern, especially during the pandemic, which impacts service provision and patient safety.²⁹ However, staff shortage among RPTs in Canada warrants further consideration as the data on employee retention among RPTs is lacking.³⁰ Despite the lack of data on employee retention, poor mental health and job dissatisfaction is common among pharmacy professionals.^30,31 The findings from our study highlights that RPTs are at a greater risk due to insufficient well-being resources and limited compensation. These factors could, in part, be affecting job retention.

A primary concern that RPTs expressed was that their profession was not well known within the healthcare landscape even though they are regulated healthcare providers. Despite their unique roles, they are often mistaken for unregulated assistants or clerks. While a qualitative study acknowledged pharmacists also felt unrecognized by the public for their contributions during the pandemic,¹¹ RPTs are largely more disadvantaged in that there is limited awareness from the public about their roles as regulated healthcare workers. This issue, existing before the pandemic, has become more apparent due to increased job demands and expanded scopes amid limited resources.

The trend of expanding the scope of practice among regulatory bodies in Canada,³² driven by the pandemic, allows RPTs to take on additional roles such as administering vaccinations, and thus, enhancing pharmacy efficiencies.^33,34 RPTs in the healthcare team benefit pharmacies, especially as pharmacists’ scope of practice has also expanded in many provinces^35,36 with implications for public healthcare by relieving pressures in primary care settings. While this expansion shows promise, it will likely increase the workload for pharmacists. Involving RPTs to support pharmacists may be a logical next step, contingent on adequate recruitment, compensation, and recognition, as pharmacies play a crucial role in expanding the healthcare system.⁴

Recommendations

As previously stated, there is limited research on Canadian RPTs before and during the pandemic. With the notable scope expansion, more research is required to assess their needs in various work settings and geographical locations across the country. This type of research would mitigate job attrition and improve pharmacy practices.

Our recommendations mirror those provided by the participants. First, pharmacies require strong and compassionate leadership. Supportive leaders can recognize the needs of their staff, acknowledge challenges and finding appropriate solutions. Supportive leadership improves perceived organizational support, employee satisfaction and organizational commitment.^37,38 Likewise, effective communication is required to ensure the efficiency of the practice and the safety of the patients. Small communication efforts such as “huddles” was found to be an effective method in keeping up to date during the pandemic, connecting with leadership members, and aided in improving patient care.³⁹

Participants noted resources were scarce throughout the pandemic which made it difficult to fulfill their tasks. To improve the smooth implementation of policies into the pharmaceutical system, the integration of pharmacy perspectives into policymaking should be considered.³⁰ A study conducted in India also highlighted the importance of including pharmacy professionals in policymaking. The authors emphasized this inclusion could improve patient care and medication safety.⁴⁰ Additionally, a US paper indicated pharmacy professionals and policymakers rarely collaborate which has caused failure in advocacy for the practices of pharmacy professionals.⁴¹ We recommend organizations have preparedness plans (ie, financial readiness and resource availability), which must include the involvement of RPTs to ensure a prompt and effective response to future pandemics. Finally, we call on regulators and advocacy groups to help publicly recognize RPTs as employees and as professions. Discussing their roles and their contributions would help improve employee morale and would likely help provide necessary recognition to a somewhat forgetting profession. This can be done in various ways such as social media and coverage by news and radio networks.

Limitations

An innate limitation of qualitative research is the inability to generalize the results. Furthermore, due to recruitment challenges, we were unable to gain adequate representation from some provinces and individuals working in rural settings. Despite the small sample size, we effectively reached data saturation as no new quality data was being produced. Results from a systematic review demonstrated that data saturation can be reached with as low as 4 focus groups.⁴² Furthermore, some of the stressors presented mirrored those found among pharmacists, suggesting consistencies in the findings. Moreover, despite our recruitment efforts, it was challenging to recruit from all provinces. This could, in part, be due to the notable stressors discussed in the study, affecting participation. Yet, from a geographical context, we still managed to capture experiences from various Canadian regions.

Conclusions

Guided by the JD-R model, our results qualitatively revealed a discrepancy between RPTs job demands and necessary resources during the pandemic. Participants reported increased work demands, including higher work volume to meet patient needs, drug and staff shortages, fear of the unknown nature of COVID-19. Limited resources included, poor incentives and limited access to wellbeing resources, limited PPE, and a general lack knowledge or appreciation of the profession impacting work morale. Participants acknowledged having effective leadership and communication among pharmacy, and a crisis preparedness plan are essential lessons learned. As both pharmacists and RPTs’ scope of practices expand, there is a need to consider the pharmacy structure, where RPTs can be beneficial in various pharmacy settings, increasing pharmacy efficiencies and revenue. Accordingly, adequate compensation and other incentives need to also be considered. Finally, with reported poor job morale and low enrollment into the profession, more public acknowledgments and recognition is needed by employers and policymakers.

Supplemental Material

sj-docx-1-inq-10.1177_00469580241241391 – Supplemental material for Unmasking the Unrecognized: Exploring Registered Pharmacy Technicians’ Stressors During COVID-19 Through a Demands-Resources Inquiry and Looking Ahead

Supplemental material, sj-docx-1-inq-10.1177_00469580241241391 for Unmasking the Unrecognized: Exploring Registered Pharmacy Technicians’ Stressors During COVID-19 Through a Demands-Resources Inquiry and Looking Ahead by Ayesha Khan, Patricia Nicole Dignos, Andrew Papadopoulos, Behdin Nowrouzi-Kia, Myuri Sivanthan and Basem Gohar in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Footnotes

Acknowledgements

We would like to thank Michael Gardiner Davis and Monique Nasser for their support with the data transcription. We would also like all our participants and RPTs for their dedication.

Author Contribution Statements

All participants contributed to this study and the final draft of this paper. BG, BNK, and AP were involved in the study’s conceptualization and methodology. MS, AK, and BG were involved in the investigation. AK, PNG, and BG were involved in the analysis. AK was involved in original draft preparation, and all authors contributed to the editing and review. BG sought funding and oversaw the study in its entirety.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Canadian Institutes of Health Research (CIHR; EG7- 179466).

Ethical Statement

This study was approved by the University of Guelph’s Research Ethics Board (REB# 22-03-001) for studies involving human participants.

Informed Consent

Informed written consent was obtained from all participants involved in the study.

ORCID iDs

Behdin Nowrouzi-Kia

Basem Gohar

Supplemental Material

Supplemental material for this article is available online.

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