Purpose The results of the 2015 National Certified Pharmacy Technician Workforce Survey are described.
Methods A survey was e-mailed to a randomized sample of 5,000 certified pharmacy technicians (CPhTs) throughout the United States, with response reminders employed. Survey items eliciting demographic and work characteristics and work life attitudes were generated from the literature and qualitative interviews. This study aimed to describe job satisfaction, sources of stress, profession and employer commitment, education and training, and reasons for entry into the profession among CPhTs and determine relationships between those variables and CPhTs’ level of involvement in various work activities, with particular attention paid to differences in practice setting. Frequency statistics, correlation analysis, and means testing were used to meet study objectives and identify significant differences.
Results A total of 516 CPhTs currently working as a pharmacy technician responded to the survey. The CPhTs reported high levels of involvement in more traditional activities but less involvement in those that involve greater cognitive load. Respondents reported moderate levels of job satisfaction and commitment and somewhat high levels of stress overall. Most CPhTs chose to be a pharmacy technician because they desired to enter a healthcare field and help people and were recruited. CPhTs derived benefit from all aspects of education and training evaluated and most from on-the-job training. Perceived value of education and training was associated with higher satisfaction and commitment and with lower stress. There were a number of differences in these work life attitudes across practice settings and by involvement in various job functions.
Conclusion The results of the survey indicated that job satisfaction and commitment were moderate and that stress levels were somewhat high among CPhTs. There were a number of differences in work life attitudes across practice settings and by involvement in various job activities.
Relationships were found between the involvement of certified pharmacy technicians (CPhTs) in various work activities and work attitudes, including their commitment to their employer and the pharmacy profession.
Education modalities of technicians were found to be very useful, even though incorporation of additional soft skills into their training could be beneficial.
The results of the survey indicated that job satisfaction and commitment were moderate and that stress levels were somewhat high among CPhTs.
The pharmacy profession has been evolving, with increasing participation of support staff in providing care to patients. There has been considerable investigation of pharmacists’ roles in the work force in order to move the profession forward and advance patient care. These studies have examined, among many other factors, pharmacists’ readiness to provide care,1 innovation,2 organizational culture issues,3–5 pharmacists’ roles in addressing healthcare disparities,6–12 financial considerations (e.g., lack of economic incentive for pharmacists to dedicate time to delivering cognitive services),13 and scope of practice regulations at federal and state levels that constrain or encourage advanced practice.14 However, little such attention has been focused on pharmacy technicians. Pharmacists’ practice is more likely to evolve when pharmacists can delegate certain tasks with greater confidence. For those responsibilities already handled by support personnel, there is growing recognition that it takes the proper mix of high-level attitudes, skills, and behaviors for optimal performance.15 Numerous reports from hospital and community pharmacy settings have described technicians taking on greater roles, including but not limited to medication reconciliation, assistance with discharge planning, and heightened involvement in patient and customer service activities.16–26
Pharmacists have been warming up to the professionalization of support personnel. Wilson et al.27 found good fit for a model of professional expertise for pharmacy technicians that included knowledge, patient assessment and education, reasoning and judgment, and virtues. Desselle and Schmitt28 found support among pharmacists for mandatory certification of pharmacy technicians and for activities for which technicians can assume greater responsibility.
Further delineation and development of pharmacy support personnel roles have been sought.29–31 Myers32 offered specific opportunities where pharmacy technicians could make the most impact on effective patient care and operations for health-system pharmacies. Wick33 posited that pharmacy’s optimization of technician use could enhance not only operational but also clinical capabilities of pharmacy organizations. The Council on Credentialing in Pharmacy weighed in to impart a more synchronous model of pharmacy care that considered the issues facing pharmacy, labor and work-force needs, and how the work of all pharmacy personnel can be organized for pharmacy to reach its full potential.34
Still, there has been little study on issues related to technician professionalization. Evidence suggests that pharmacy technicians experience relatively low job satisfaction and high levels of turnover.35,36 Pharmacy technicians have reported future uncertainty about their careers, which has a deleterious effect on their job satisfaction and quality of work life.37 Given their relatively low rates of pay compared with those of pharmacists, pharmacy technicians could potentially be lured away from their jobs, even while relatively small pay increases could foster greater loyalty and commitment.35
It was suggested over a decade ago that technicians might require more theoretical and hands-on education and training.38 It also has been several years since technicians reported on their general preferences for further training.35 The previously stated preferences were not parsed by practice setting, where education and training needs may differ. While there has been a modicum of research on technicians’ work lives, no study has linked their level of training, type of training, and preparedness for the current job with any aspect of their work life. There also is little information about the factors that attract technicians to the field of pharmacy.
As pharmacy continues its move toward more patient-centered practice, closer examinations of technician practice are required. The purpose of this study was to further explore technicians’ quality of work life and the education and training received by pharmacy technicians in the United States. The specific objectives of this study were to (1) describe the current state of work satisfaction, sources of stress, and profession and employer commitment among certified pharmacy technicians (CPhTs), (2) describe CPhTs’ level of involvement in various practice settings in a range of current and prospective job responsibilities, (3) identify the reasons that CPhTs entered their field of work, (4) describe the prevalence and perceived helpfulness of various training methods to prepare CPhTs for their current jobs, and (5) determine the relationships among practice setting, level of involvement in job responsibilities, education and training received, and perceived usefulness of training with levels of satisfaction, stress, and commitment of CPhTs to their employer and the profession.
Design and sample. Institutional review board exemption for study procedures was granted by Touro University and University of Mississippi. In this cross-sectional study, a questionnaire was used to survey a nationwide randomized sample of CPhTs. Using a sample-size calculation recommended by Dillman et al.,39 an estimated 384 respondents were deemed required to meet the study objectives. Assuming a response rate of approximately 10%, we sought contact information from the Pharmacy Technician Certification Board (PTCB) for 5,000 CPhTs to whom the questionnaire would be disseminated. Responses only from CPhTs working as a technician (part-time or full-time) were desired. Thus, the survey was designed to automatically terminate for any respondent who was younger than 18 years, retired, not working as a technician, or a full-time student in a doctor of pharmacy degree program.
Survey construction and implementation. This study’s sponsors—the Pharmacy Workforce Center, ASHP, and PTCB—provided a list of desired topics for investigation, including primary place of employment, experience as a pharmacy technician, various demographics, career commitment, job satisfaction, and job stress. A multistage process was used to refine the survey, including additional literature review; collecting data from in-depth, semi-structured interviews; and survey piloting.
Respondents used linear numeric scales to characterize their involvement in various job responsibilities, commitment to their employer and the pharmacy profession, job satisfaction, and job stress. The survey contained questions regarding practice setting, demographic characteristics, reasons for entering the profession, type of education and training received for the current pharmacy technician job, and the usefulness of the education and training received. Respondents’ geographic location was also collected.40
The survey was built using Qualtrics software (Qualtrics, Provo, UT). Investigators sent the CPhTs a notice via e-mail regarding the impending survey during the first week of October 2015. A URL with a copy of the survey and a cover letter informing the 5,000 CPhTs of their rights was distributed during the second week of October 2015. Reminder e-mails were sent approximately 1, 2, and 3 weeks after the survey was e-mailed. The survey was closed on November 9, 2015.
Data analysis. The data were prepared for analysis using IBM SPSS Statistics for Windows, version 21.0 (IBM, Armonk, NY). Frequency distributions were tabulated for all relevant questions. Survey scales were subjected to a principal components analysis with varimax rotation, item analysis, and internal consistency reliability analysis to determine construct validity, internal consistency reliability, and appropriateness of each item. Correlation analysis (Pearson’s correlation coefficient) was used to determine relationships between two or more continuous variables. The linear numeric scales of stress and job satisfaction were summed, and the sums were used as dependent variables in one-way analyses of variance (ANOVAs) and F tests or with independent sample t tests, with practice setting and demographic characteristics serving as independent variables. Relationships between level of involvement in activities with geographic location and rurality and between method of training and quality of work life variables were assessed using similar one-way ANOVAs.
Respondent characteristics. A total of 702 CPhTs completed the survey. Of those, 516 (73.5%) were currently employed as a technician, 73 (10.4%) were employed in another pharmacy- or health-related field, 8 (1.1%) were retired, 39 (5.6%) were unemployed and looking for work, and 20 (2.8%) were unemployed and not seeking work. The results detailed further in this report are from responses tallied from the respondents working currently as a pharmacy technician (full- or part-time) and not enrolled in a doctor of pharmacy degree program (n = 516). Respondents’ demographic characteristics are shown in Table 1. Most respondents were female. The mean ± S.D. age of respondents was 40.17 ± 12.60 years, their mean ± S.D. years of experience as a technician was 11.30 ± 9.76 years, and their mean ± S.D. number of years with the current employer was 7.90 ± 7.89 years. Responses were gathered from all parts of the country and representative of various practice settings. For the purposes of further analysis, respondents from large and small chain, mass merchandiser, independent community, and supermarket settings were characterized as respondents from the community setting; respondents from hospital and health-system inpatient and outpatient settings were characterized as respondents from the hospital setting. Respondents from the community and hospital settings plus all other respondents represented the total number of respondents.
Table 2 provides data regarding community pharmacy technicians’ level of involvement in various job activities and the importance they place on those activities and their perceptions of the degree of importance their employers place on those activities. Levels of involvement were rather similar across activities, mostly quite high. Respondents were least involved in verifying the work of other technicians and maintaining automated technology. Respondents rated collecting and communicating patient information, filling prescriptions, and assessing prescriptions as their most important activities, though they indicated that their employer’s perceived these activities as lower in importance. The biggest differences in those perceptions were for collecting patient information, filling a prescription, and communicating with insurance companies.
Data regarding hospital pharmacy technicians’ level of involvement in various job activities are shown in Table 3. Respondents reported being highly involved in maintaining floor stock and dispensing cabinets, unit inspections, and repackaging activities, with less involvement in dispensing medications with remote video supervision, assisting with medication assistance programs, and criterion-based screening of medical records. The largest gaps between self-ascribed importance and perceived importance by the employer were related to compounding nonsterile products (excluding chemotherapy), repackaging activities, supervising other technicians, and replenishing unit dose carts.
Respondents from home healthcare, long-term care, and pharmacy benefits management companies self-reported activities in which they were involved. The most frequently cited activities were compounding, inventory management, patient safety initiatives, customer and patient service, medication reconciliation, and benefits and plan reviews.
Impetus for becoming a pharmacy technician. Table 4 provides information on the reasons reported by survey respondents for choosing to become a pharmacy technician. General interest in a health career and the desire to help people were the reasons most commonly cited. It should be noted that recommendations, support, and recruitment by others played a prominent role, with nearly 40% of respondents citing a recommendation of a friend, recruitment by a pharmacist, or both as their reason for pursuing their career as a pharmacy technician. Approximately 1 in 6 respondents indicated that they were attracted by salary or a fulfilling career.
Technician training and education. Over 75% of the respondents indicated that on-the-job training (OJT) was included in their training, and an even higher percentage of technicians from community pharmacy reported the same. While over 25% of respondents completed an accredited program through their employer or a vocational school, approximately 1 out of 6 respondents completed a program of which they were unsure of its accreditation status.
Table 5 provides respondents’ ratings of the helpfulness of various education and training modalities in preparing them for their current work responsibilities. Formal OJT with the current employer was rated most highly, followed by previous technician work experience and guidance and mentorship from supervisors and peer technicians. PTCB certification was rated higher than vocational training, but both were rated rather highly. Community CPhTs reported higher levels of helpfulness for most training methods than did hospital CPhTs.
Quality of work life: Satisfaction, stress, and commitment. The principal components and item analyses of the summated scales of job satisfaction and stress demonstrated solid construct validity and internal consistency reliability, with Cronbach’s alphas of 0.88 and 0.79, respectively. The mean ± S.D. score on the 10-item, aggregated work satisfaction scale, with a possible range of 10–60, was 41.02 ± 9.65. The mean ± S.D. score on the 9-item, aggregated stress scale, with a possible range of scores from 9 to 45, was 25.64 ± 6.30.
Table 6 provides respondents’ levels of satisfaction with various aspects of their job, broken down by practice setting. CPhTs reported the highest levels of satisfaction with their pharmacist coworkers, work schedule, and opportunity to use their knowledge. They reported being least satisfied with their level of stress, opportunity for advancement, and pay. Nearly 30% of respondents were highly dissatisfied (a response of 1 or 2 on the 6-point scale) with the opportunity for advancement, level of stress, and pay.
CPhTs reported that their highest levels of stress were related to being short-staffed, their volume of work, and other employees not doing their fair share of work (Table 7). Community CPhTs reported high levels of stress related to patients who are rude or impatient and from a lack of rest breaks. Hospital CPhTs reported being highly stressed due to poorly designed workflow and disagreements with peers.
CPhTs’ commitment was evaluated in several ways, including the duration they expected to remain with the current employer. More than half of respondents indicated plans to remain with their employer for at least 5 years; in fact, 140 (33.7%) of 415 respondents planned to stay at least 10 years. Still, 1 in 5 respondents reported either looking to leave or planning to keep options open. The mode response to a separate question indicated that many respondents were susceptible to “shocks,” such as being lured away to an alternative career.41 Many respondents who did intend to remain or might have been contemplating a career change indicated that they would like to remain in a healthcare field, and fewer than 10% indicated considering leaving for a nonhealthcare-related field.
Overall, satisfaction was highly correlated with commitment to the employer (r = 0.53, p < 0.01) and commitment to the profession (r = 0.29, p < 0.01). Stress levels were inversely correlated with employer commitment (r = –0.20, p < 0.01) and profession commitment (r = –0.13, p < 0.05), which reinforces the idea that while stress (or lack thereof) may influence satisfaction and commitment, stress is its own unique construct.
Respondent age was correlated with profession commitment (r = 0.11, p < 0.05) but not with commitment to the employer. Years with the current employer was related to commitment to the employer (r = 0.28, p < 0.01) and commitment to the profession (r = 0.17, p < 0.01).
Table 8 provides a matrix of correlations among satisfaction, commitment, work stress, and perceived usefulness of various education and training modalities. Satisfaction was highly correlated with employer commitment and inversely correlated with stress. Satisfaction was highly correlated with profession commitment. Stress levels were inversely correlated with satisfaction but also with commitments to the employer and profession. Work stress was not associated with perceived usefulness of training. There was a strong relationship between employer and profession commitments. Perceived usefulness of OJT, supervisor mentoring, and peer mentoring were related to work life measures (i.e., if a technician perceived usefulness of any of these training methods, then he or she was more likely be satisfied, more committed, and less stressed on the job). Perceived usefulness of PTCB certification was associated with higher levels of profession commitment, satisfaction, and commitment to the employer but not with job stress.
Quality of work life and entry into the profession. Profession commitment was higher among those who came into the profession because they were recruited by a pharmacist (t = 3.12, p < 0.01) or due to the desire to seek a fulfilling career (t = 2.97, p < 0.01). Technicians who reported having completed an accredited standalone training program from a vocational school reported higher levels of stress than did other respondents (t = 2.15, p < 0.01), yet there were no other statistically significant relationships between method of training and quality of work life.
Additional analyses by practice setting, geographic region, and rurality. For CPhTs in community pharmacy, those who were more involved in patient counseling also reported being more stressed (r = 0.17, p < 0.01). Also, those involved in the use of technology reported higher profession commitment (r = 0.14, p < 0.01). With respect to CPhTs in hospitals, higher stress levels were reported by those technicians more involved in compounding chemotherapeutic agents (r = 0.22, p < 0.01) and in criteria-based screening of medication records (r = 0.28, p < 0.01). Technicians more involved in purchasing activities reported lower stress levels (r = –0.21). Technicians who reported greater involvement in floor stock maintenance (r = 0.25, p < 0.01), inventory management (r = 0.25, p < 0.01), controlled substance management (r = 0.21, p < 0.05), billing activities (r = 0.19, p < 0.01), and repackaging activities (r = 0.22, p < 0.01) reported higher levels of commitment to the profession. There were several associations between geographic region and the likelihood of involvement in various activities, such as helping with medication assistance programs, supervising other technicians, and assisting with controlled substance system management. There were no associations between rurality (size of city in which they worked) and any of the other variables.
This study examined, among other things, CPhTs’ involvement in various activities and the relationship between that involvement with quality of work life components. While this study did not undertake a formal task analysis, it provided an update on a comprehensive analysis undertaken by PTCB nearly 2 decades ago.26 While there are plentiful accounts of technicians taking on new roles in single organizations, the current study found that wholesale change in technicians’ responsibilities since PTCB’s task analysis has not been very rapid. Both community and hospital technicians reported high levels of importance for nearly all activities examined in this study. Coupled with the finding that certain activities were associated with higher commitment levels, employers should note that technicians might be amenable to taking on greater responsibility.
Employing organizations might take note of other results in this study related to CPhTs’ quality of work life. While job satisfaction was relatively high overall, it was lower in regard to stress environment and perceived fair treatment from management. This corroborates previous research findings that technicians have amicable relationships with most of their peers and with their supervising pharmacists but believe that employers sometimes view them as replaceable.37
CPhTs indicated high levels of stress due to being short-staffed, other employees not doing their fair share, and the total volume of work. CPhTs might hold employers more accountable for these things as opposed to their supervisors and peers. Some of the differences in reported stress levels across job settings can be anticipated. For example, disagreements with peers might occur more frequently in hospitals than in community settings due to the number of peers with whom technicians interact in the hospital. CPhTs in the community setting are more likely to come into direct contact with patients and their caregivers, so it is only natural that interactions with them are a greater source of stress, even though these interactions also contribute to job satisfaction. Employers might want to examine policies and procedures associated with undue stress and invest in processes that leverage technicians’ positive interactions with patients.
This study likely represented the most comprehensive evaluation of CPhTs’ commitment to their employer and the pharmacy profession. Approximately half of respondents reported that they intended to remain with their current employer for at least 5–10 years. Nearly 2 in 5 respondents indicated a possibility of leaving should something unexpected happen, but nearly the same number expressed hope to make their job a long career. As such, respondents expressed a desire for stability but might be quite susceptible to aforementioned “shocks” due to dissatisfaction with stress and levels of pay.41 The findings from this study are not dissimilar from similar surveys of nursing assistants, who, like pharmacy technicians, are making strides toward professionalization but have less time and money invested into their careers and also are paid less than most other healthcare professionals.42
In this study, a large proportion of CPhTs claimed that they were mandated to become certified, more by employers than by state governments. In addition, approximately one third of respondents indicated that they had completed a vocational training program, with many of those programs being accredited by ASHP. However, some respondents completed an unaccredited program or were not aware if their program was accredited, which is cause for concern. Educational institutions should take the opportunity to inform the technicians and other stakeholders on the importance of accreditation.
To our knowledge, this is the first study to examine CPhT education and training alongside work life issues, which could be important in promoting greater commitment, less burnout, more stability, and increased attractiveness of technician work as a career. It also could point out issues to be adjudicated in education and training design. While respondents ascribed relatively high value to nearly all types of education and training, it is not surprising that they would ascribe the highest value to OJT. This reinforces the need for employers to take an active role in creating an environment for self-evaluation, skill assessment, and patient centeredness. The fact that perceived value of education and training was associated with quality of work life requires further examination. The finding that technicians experience high levels of stress from dealing with patients and sometimes peers might prompt vocational institutions and PTCB to add elements to education and training that provide more exposure to time management, patient communication, conflict resolution, and other so-called “soft skills.”43
This study is also the first to examine technicians’ primary reasons for entering the profession. Nearly two thirds of respondents indicated a preference for a career in a healthcare field. Many also expressed a desire to help people and to serve the public and also indicated being recruited by a friend, colleague, or pharmacist. Moreover, CPhTs who were recruited by a pharmacist or otherwise entered the profession to seek a fulfilling career reported higher levels of commitment to the profession. These findings suggest that technicians may be effective in recruiting future technicians and that pharmacists should be involved in the recruitment process.
The geographic regional differences found among CPhTs in this study warrant further investigation. In the hospital setting, a greater number of CPhTs from the West were involved in activities related to the management of systems; it might not be coincidental that those respondents also reported higher levels of profession commitment.
The results of this study should be considered within the context of various strengths and limitations. The low response rate limits generalizability of the results to the entire CPhT population. The survey was administered only to technicians certified through PTCB. Some states (and employers) do not require certification; as such, work attitudes from technicians who voluntarily become certified may differ from those who were mandated to acquire certification or those not certified at all. The use of e-mail versus postal or hybrid mechanisms of survey delivery has been associated with lower response rates and could also introduce bias.44 It is also possible that responses came more readily from those feeling either very favorable or very unfavorable toward their jobs. However, the use of a randomized sampling procedure across an entire nation of CPhTs provided a foundation of representativeness in the survey responses. The proportions of respondents across practice setting, sex, age, and geographic location were commensurate with expectations. Responses to the quality of work life questions aligned with expectations, and psychometric evaluation of responses demonstrated very good internal consistency reliability. Even so, their being crafted specifically for the study versus using commonly reported instruments makes comparisons across different studies more difficult. While various mechanisms were used to ascertain commitment attitudes, these attitudes do not necessarily translate directly into actual turnover behavior. The list of potential reasons for entering the profession was not necessarily an exhaustive one.
This study further explored CPhTs’ work life situations and updated previous task analyses. It also was the first to link work attitudes with CPhTs’ level of involvement in various work activities. There are a number of findings on which pharmacy leaders, educators, and employers can take action to strengthen the pharmacy technician work force and leverage their involvement to enhance operations and to better prepare pharmacy support personnel to enhance patient care.
The results of the survey indicated that job satisfaction and commitment were moderate and that stress levels were somewhat high among CPhTs. There were a number of differences in work life attitudes across practice settings and by involvement in various job activities.
The authors thank the pharmacy technicians who participated in the pilot survey and those who responded to the survey.
This article will appear in the July 1, 2017, issue of AJHP.
Funding for this study was received from the Pharmacy Workforce Center, American Society of Health-System Pharmacists, and Pharmacy Technician Certification Board. The authors have declared no potential conflicts of interest.
- Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.