By Patrick Ciardullo, MA, CEMSO, NREMT-P, NCC, LPCA
A few months ago, I came across an article by Dr. Kevin Dean, titled, “The things they don’t tell you about being a nonprofit CEO.” He was right about a lot of it: the weight of the position, the responsibility of leading an organization that belongs to the community it serves.
But his framing couldn’t fully capture my experience, because leading my agency means holding three distinct professional identities in a single seat. What struck me most was his description of nonprofit leadership as one of the loneliest jobs in the world.
I agree.
But I also realize that my experience as a nonprofit CEO is different because the chair I occupy spans three professional worlds at the same time.
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I serve as the chief and CEO of a private, nonprofit EMS agency providing paramedic transport services in an urban center in Connecticut. In that role, I am simultaneously a nonprofit director, a healthcare executive and a public safety chief.
Each identity carries its own responsibilities, expectations and professional culture. Each requires a different language, relationships and way of thinking. The challenge is that none of these roles exist independently. They all occupy the same chair.
That intersection is where the loneliness lives.
The public safety chief
As a public safety chief, I operate within a system built largely around government structures. I work alongside police chiefs, fire chiefs, department heads and elected officials responsible for serving our community. I report to the mayor’s office on system performance, service delivery, contract obligations and capital requests — much like a municipal employee.
Yet I am not a municipal employee. The agency I lead is a private, nonprofit organization.
While I have been fortunate to build strong relationships with city leaders, there is an undeniable reality that comes with being an outsider to that shared government experience. The police chief, fire chief and municipal leaders often rose through pathways that are fundamentally different from my own. Their organizations are government agencies. Mine is not.
The result is a unique leadership challenge. I participate in unified command, emergency planning and discussions about public safety readiness, while also representing an organization that exists outside the traditional governmental structure. With these unique circumstances, there is sometimes an unspoken question of absolute belonging.
The healthcare executive
At the same time, I am a healthcare executive.
This healthcare agency operates as a high-reliability organization grounded in a just culture, delivering emergency medical treatment and generating revenue through fee-for-service billing. We provide emergency medical treatment and transportation, operate under physician oversight, manage quality improvement programs, and abide by HIPAA requirements along with corporate compliance and healthcare regulations. The standards we are held to are healthcare standards. When regulators have questions, I answer them. When clinical performance is reviewed, I am at the table.
Yet EMS often occupies an unusual position within healthcare. We are essential when patients need us most, but our voice is not always weighted equally when larger healthcare decisions are being discussed. We are expected to meet healthcare standards while sometimes struggling to secure healthcare influence.
That tension creates another form of professional isolation. We belong in the healthcare system, yet we often find ourselves explaining why.
The nonprofit executive
My third identity is nonprofit leadership.
I report to a volunteer board of directors. I am responsible for organizational sustainability, fundraising, donor cultivation, grant development, governance and community engagement. Like every nonprofit CEO, I carry responsibility for an organization that ultimately belongs to the community it serves.
But EMS nonprofits such as ours face a unique challenge.
People see ambulances, uniforms, emergency lights and vehicles bearing the city’s name. Most assume we are fully funded government services. They assume we are tax-funded and city-managed. They rarely see the nonprofit structure underneath. The same community that relies on us during emergencies is often unaware that charitable support, grants and community partnerships play a role in sustaining the organization.
As a nonprofit executive, I spend significant time helping people understand not only what we do, but what we are.
Three roles; one chair
Individually, each of these leadership roles is demanding. Together, they create something far more complex.
The public safety chief focuses on response readiness, life safety and service.
The healthcare executive focuses on compliance, outcomes and quality.
The nonprofit executive focuses on sustainability, stewardship and governance.
Most organizations require fluency in one of these worlds. Some require two.
Few require all three simultaneously.
The challenge is not simply understanding each role. It is knowing which identity needs to lead in a given moment, while ensuring the others are not neglected. The expectations are different. The priorities are different. Sometimes they are even in direct conflict.
That is where the loneliness described by Dr. Dean takes on a different dimension.
My loneliness is not within my organization. It exists at the intersection of these professional worlds. It comes from occupying a role that is recognized in pieces but rarely understood in its entirety.
No playbook exists
What I have learned is that there is no graduate program designed specifically for this intersection. There is no professional association that fully encompasses all three domains. There is no established roadmap for navigating the combined responsibilities of nonprofit governance, healthcare leadership, and public safety command.
The agency does not belong to you. But the playbook does.
Every leader who occupies this space arrives through a different path, shaped by their community, their experiences and the unique demands of the organization they serve.
That reality can be intimidating. It can also be liberating.
Dr. Dean was right. Leadership can be lonely.
What he could not fully capture is that some of us are navigating that loneliness across three different worlds at once. But loneliness, approached well, fosters growth, creativity and self-reflection. The absence of a template is also the absence of a ceiling. And for those of us who lead at that unmapped intersection, we know this complexity is not a burden. It is the privilege of the role.
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ABOUT THE AUTHOR
Patrick Ciardullo is the chief and CEO of New Britain Emergency Medical Services (NBEMS), a 501(c)(3) nonprofit emergency medical services agency serving New Britain, Connecticut. He holds a Master of Arts in Clinical Mental Health Counseling and has served in EMS for over two decades, rising from EMT to chief. He serves as a member of the board of directors for NEMSMA and is currently a licensed paramedic and a nationally certified counselor actively practicing in both fields.
