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Is your EMS operation lacking boundaries?

The EMS industry research has spoken: tradition and old cultural norms and beliefs don’t apply to the evolution of EMS today


“For an organization to thrive, it must first be clear on and lean into its values and beliefs,” writes Abbas.

Photo/Jim Michaud/ Boston Herald/Tribune News Service

When professional and/or personal boundaries are violated, anger and resentment build in the workforce. Organizational longevity and retention hinge on setting boundaries and honoring them. An organization that’s done the internal work will have clarity on their organizational beliefs and values. Once clarity is achieved, the real work begins. The expectations and boundaries must be lived. Organizations willing to sacrifice productivity to put the health and wellbeing of their workforce first will see cost savings and longevity long-term.

The 4th Annual EMS Industry Turnover Study conducted by The American Ambulance Association and Newton 360 showed a 6% increase in 2022 voluntary turnover when compared to 2021. EMS agencies are experiencing a full turnover of staff every 3-4 years. The study also revealed more than one-third of new hires turn over within the first year of employment.

When conducting a holistic review of EMS industry workforce and turnover studies, there are three common reasons our workforce decides to leave the profession:

  1. Poor compensation
  2. Poor leadership/management
  3. Poor health and wellness

To address poor leadership, health and wellness, we first need to do the internal work, getting clear on our organizational beliefs and values. Then we can begin to work on our expectations.

Below are a few common symptoms and suggested remedies to blurred organizational boundaries.

Symptom: The organization’s internal turnover rate is not tracked or measured. There are many position vacancies.

Solution: Begin measuring and tracking turnover. Set a turnover rate goal for the organization. Begin holding employee forums to gather feedback. Complete exit interviews and track responses.

Symptom: There is an absence of internal talent and succession planning.

Solution: Investigate how talent is defined for your organization. Is your hiring process selective? What is your agency’s word on the street? Is your compensation competitive? Look to hire the strongest people in EMS and begin developing them into your future leaders. Remove toxic team members.

Symptom: Money is invested into sign-on bonuses.

Solution: Reallocate those funds into a better compensation package and retention bonuses.

Symptom: Leadership team members are expected to work copious amounts of overtime with their door always open.

Solution: Set the example; work normal working hours as much as possible and publicly celebrate vacations. Allow for schedule flexibility at all levels of the organization. Curate schedules to allow for deep project work.

Symptom: Overtime is unmonitored and limitless for field personnel. A policy does not exist around working hours and/or it is not honored.

Solution: Enlist feedback from personnel related to work demands and hourly preferences. Create a policy and procedure addressing working hours and work demands. Begin measuring and monitoring staff working hours and overtime.

Symptom: Ambulance utilization and time on task is not monitored in real time. Overutilization is undefined.

Solution: Begin monitoring and tracking people metrics. Create a policy and procedure for unit utilization and time on task based on industry research and optimal work demands. Move away from increased contractual work demands as an organization until the workforce stabilizes.

Symptom: There is no organizational policy and procedure for fatigue and fatigue mitigation.

Solution: Develop a policy and procedure addressing fatigue and create a workforce fatigue mitigation program

Symptom: Organizational drama is frequent stemming from inappropriate romances, family dynamics and favoritism.

Solution: Implement accountability conversations and selective hiring, let go of toxic personalities. Develop a policy and procedure addressing workplace relationships.

Symptom: An organizational desire to move quickly and get things done is valued without the organizational push for continued learning and growth. Repetitive action without evolution or innovation is favored.

Solution: Slow down as a team and begin taking small project bites. Encourage new ideas, and time to think and brainstorm creatively. Encourage continuing education and professional development.

Symptom: Organizational policy and procedure are often breached to maintain staffing.

Solution: It’s easier to breach policy and leave problems unaddressed. Get uncomfortable and begin having conversations about accountability and delivering clear expectations. When making the switch to an accountable culture, expect to turnover people who don’t align with your values and beliefs. Invest in strengthening your middle management teams.

For an organization to thrive, it must first be clear on and lean into its values and beliefs. If we practice the status quo or if we believe we are victims that cannot make the changes necessary to support longevity and retention of our workforce, we will fail to set clear boundaries. The EMS industry research has spoken: tradition and old cultural norms and beliefs don’t apply to the evolution of emergency medical services today. An industry that’s long believed the chicken came before the egg needs a new perspective. The egg, very well, can come before the chicken.

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 and 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 degrees. Her unique consulting approach is detailed, honest and highly personalized. Andrea offers a variety of EMS leadership and wellness courses to EMS agencies and departments. She’s an avid blogger, national speaker, podcaster and consultant. You can contact her at: