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EMS Recruitment & Retention Beyond the Wage and into the Future

Updated: Feb 15, 2022

What can we do to retain staff outside of wage increases?

The US Bureau of Labor and Statics projects EMT and paramedic employment will grow 11% from 2020 to 2030, faster than the average of all occupations. In addition, Dr. Daniel Patterson of the University of Pittsburg published a study called, The Longitudinal Study of Turnover and the Cost of Turnover in EMS, indicating the cost of turning over one on-boarded EMT as $68,000.

In many states, EMS is not considered an essential service. The flawed funding mechanism behind EMS leaves many in the industry with economic challenges. Acknowledging this barrier while understanding that a competitive wage is one of many factors that contribute to the retention of top talent is a very real challenge for most agencies.

So, what do our employees want from work?

How can we improve employee retention and attract talent?

1. Relational chemistry and a sense of belonging

Employees who don’t have strong relationships within an organization are less likely to feel a sense of belonging and loyalty. Personnel who don’t interact with their leadership team lose a sense of connection with the organization and feel less trusting towards management. Without any background or rapport, employees will rely heavily on perceptions and assumptions of team members, which of course can be dangerous. It’s important that leaders invest in casual conversation and communication through activities such as: visiting stations, walking through departments, holding virtual or in-person forums, emails, communication videos, etc. These small acts show a sense of investment and curiosity that can lead to relational chemistry and a positive perception with employees. Employees who are able to create relationships with their team feel a deeper sense of belonging and loyalty. This should include the leadership team.

“Leaders who are rarely seen are rarely heard.”

2. An agency image to be proud of.

The image an organization conveys relates to the values and beliefs of the organizational culture. This can show up in many ways: social media campaigns, the providers an organization chooses to hire, the image projected in their community through appearance (uniforms, ambulances), the reputation and quality of service the agency provides, etc.

People want to feel a sense of pride when it comes to the work they do. The image an organization projects represents each team member within that entity and advertises the organizational culture. Those that resonate with the values and beliefs constructed from the image will be attracted to the organization and seek more information and potentially employment there. It’s important we curate our image carefully and that starts with what’s happening internally.

3. People centered truck utilization

Understanding that operational metrics such as time-on-task and UHU are flawed and that how they affect our people is paramount to longevity and safety. Allowing people to do human things like sleep, eat, and use the bathroom scratches the surface of Maslow’s hierarchy of needs. People want respect, and this comes with operational boundaries. Mandatory overtime, inappropriate holdovers and moving trucks into high response markets without a wage differential degrades morale and can destroy relational chemistry. Truck utilization directly correlates to the health and wellbeing of our personnel. 75% of the EMS workforce are classified as overweight or obese. “Short sleep” defined as any cycle lasting between 4-7 hours is associated with an increased risk of coronary artery disease, stroke, type 2 diabetes, obesity and weight gain, depression, workplace accidents and mortality. Dr. Matthew Walker PhD, sleep scientist referred to as the ‘sleep diplomat’, cites that sufficient sleep is our mental health first aid.

“The Rand Corporation did an independent survey and found that insufficient sleep will cost most nations about 2% of the GDP (their gross domestic product.),” said Walker. “That’s a staggering amount when you quantify it looking at just three countries. In the US that equates to $411 billion of lost productivity due to insufficient sleep.”

4. An open mind and willingness to listen and compromise

A first responders’ workspace is a big deal and is often overlooked as an engagement tool. During my career I’ve witnessed all out screaming matches between administration and personnel over ALS ambulances being squeezed into BLS vans. One morning, I arrived to witness one of these conflicts and couldn’t help but listen as the employee advocated and then drew the boundary, refusing to work in a BLS van as an ALS unit. This employee felt unwilling to deliver critical care in a truck that didn’t properly stow equipment and allow for the space to run a critical call. The leader refused to listen with an open mind and issued written discipline to the employees file for refusing to work in the van. After being sent home, the employee arrived back at work the next day and was placed in a more ALS appropriate ambulance. A few weeks later the employee packed up and left to work for another ambulance outfit.

“The person who sweeps the floor chooses the broom.”

5. Cleanliness matters

No one wants to spend time in a dirty station. Visiting the living quarters of an ambulance operation is so revealing. Stained beds, dirty dishes, broken furniture, and disorganization attracts the wrong people and highlights a lack of accountability within an organization. Creating a comfortable living space for crews that attracts top talent is important. If we hire the right people, set the standard, and provide a great living space, we will retain good people.

6. Sleep & rest and flexibility

Sleep and rest are essential to health and wellness. Providing people with schedules that allow for sufficient rest will pay off in dividends when it comes to productivity. There is plenty of research correlating fatigue to poor performance. Further, providing personnel with sleep hygiene education is not only good for the provider, but it also helps their families understand what to expect when they return home from work. Much research has been done showing adults require 7-9 hours of sleep for each 24 hour period. Naps on shift help, but research shows short sleep windows between 2-7 hours can have a negative impact on health. Those that don’t get sufficient sleep show higher rates of obesity, cardiovascular disease, cancer, and diabetes. To cultivate a sleep centered environment, create safe sleep areas for crews, provide sleep education and make a point of operational oversight when it comes to 24-hour shifts.

Additionally, providing flexibility in schedules allows for a more non-traditional approach to EMS work. If we build in 8-hour shifts and allow for flexibility, we will open the door for single parents and those that value 8-hour days to come into our organizations. We cannot wait for staffing to improve before doing this. If we want to attract more talent, we need to do this now.

7. Authentic intentional employee recognition

Employee recognition ten years ago was less frequent and typically done internally. While it’s great to see companies take to employee recognition on a much larger scale, internally and externally, some are not hitting the mark when it comes to delivery. How the recognition is done matters. It’s important to consider, if a true sense of appreciation is being expressed to those being recognized? Did the leadership team reach out expressing gratitude? Or was a photo posted externally recognizing the employee bolstering the reputation of the company on a social media post? A personalized approach internally shows authenticity and deepens relational chemistry.

8. A great relationship with a direct supervisor or manager

50% of people that leave their employer leave due to a poor relationship with their direct supervisor or manager. According to Gallup workplace, the great resignation is really the great discontent. Employee engagement is strongly correlated to retention and a big part of engagement is the relationship they have with their direct manager. Our middle managers are provided few leadership resources and tools when they enter administrative roles. It’s paramount we provide EMS leadership training and education to prepare our EMS leaders. Good managers don’t necessarily make great leaders, but just as with any other skill, leadership can be cultivated through training and education.

“Gallup finds that it takes more than a 20% pay raise to lure most employees away from a manager who engages them, and next to nothing to poach most disengaged workers”.

9. Engagement through equipment and beyond

Having quality equipment that’s right for your operation is essential and can influence recruitment and retention. High quality cardiac monitors, power cots and Lucas devices are a few items providers look for when searching for employment. There is also a great opportunity to engage providers when selecting a new piece of equipment. Considering a new vendor for gloves or trying out and comparing cardiac monitors offers education while engaging the staff. Who better to select the equipment than those that will be using the equipment daily? Ambulance services that survey staff before transitioning equipment not only engage their workforce but also learn valuable insight into how the equipment being considered may or not fit into the organization.

10. Professional development

A lack of succession planning and professional development can stifle retention. High performers have a drive for continued growth and development. If opportunities for advancement are not available, people look outside of their organizations for growth. Providing professional enrichment is essential regardless of the size or type of service. A small rural agency can create team lead, FTO, and supervisory positions to allow for career growth. While some are satisfied with the skills they have and how they use them, many have the desire to expand their knowledge and engage in something new. Identifying those that have a desire to grow and providing them the opportunity is an excellent engagement tool and cultivates retention. Investing in personnel through professional development is a must.

People are calling it the Great Resignation. While competitive wages are necessary, we now know our workforce is experiencing a paradigm shift and wanting more from their work. Gallup found more than 48% of the current US working population is job searching or watching for opportunities. As an employer, the pressure is on to captivate the workforce and stand out in a competitive job market. We can get there if we’re willing to evolve, adapt and take risks.


How Much Sleep Do We Really Need? Published: The National Sleep Foundation.

Evidence-Based Guidelines for Combatting Fatigue in EMS, Daniel Patterson Published: JEMS 2.1.2018.

Fatigue Risk Management in SA Ambulance Service eLearning content. Government of South Australia.

The Dangers of Sleep Deprivation, David F Peterson Publication: Firehouse. 12.1.2016.

Dr. Matthew Walker, Why We Sleep. Lewis Howes Podcast, Why We Should Prioritize Sleep.

The Dangers of Too Little Sleep Published: EMS World December 2021 ISSN 50

The Great Resignation is Really the Great Discontent Published by Gallup workplace. Author: Vapula Ghandi 7.22.21

How to Win the Great Resignation Published by Gallup Workplace. Author: Scott Miller. 11.1.21

Author Bio:

About the author: Andrea is the owner and author of The EMS Professional. With over 20 years of EMS industry experience in various leadership roles including Field Training Officer, Supervisor, Quality Assurance & Compliance Manager, EMS Director, and Programs Management Andrea is skilled in system management, training, education, administration, and project management. She has work experience in frontier, rural, suburban, and urban EMS systems. In addition to her leadership experience, she brings years of experience working in the ambulance and emergency department. Andrea holds her National Registry Paramedic license, Community Paramedic certification and Instructor Coordinator license in addition to her formal education and degree’s. Her unique consulting approach is detailed, honest and highly personalized. Andrea offers a variety of EMS leadership courses to EMS agencies and departments. She’s an avid blogger, national speaker, podcaster, and consultant.

Today, Andrea also holds the position of EMS Programs Manager with the Michigan Center for Rural Health (State Office of Rural Health) and continues to work part-time as a paramedic locally.

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