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Managing the part-time experienced caregiver

Organizations can benefit from an experienced medic working for them on the side, but it takes special handling

There is an excellent chance that, like many EMS administrators, managers and supervisors, you work a part-time “night job” as a paramedic at another organization.

Many do this to maintain clinical skills that their day job may not provide, to remain active as a hometown volunteer, or just to afford to live in the community they serve, which often requires working up to 80 hours a week.[1]

Velcro patches on a work shirt

I first ran across this practice when getting details on a line-of-duty death following an ambulance accident in a rural resort community.

The driver of the ambulance worked 40 hours a week at Fire Department A, and part-time as an ambulance driver for Rescue Squad B on Thursday and Sunday nights. The EMT caregiver-in-charge was a volunteer member of Rescue Squad B, but was considered injured-on-duty through her industrial fire brigade job. The paramedic was on-duty and staffing a fly car with the municipal EMS service, but qualified for benefits through his volunteer fire department membership.

I more recently encountered this while working in a suburban area where most of the caregivers were working 50 to 90 hours a week, some with two full-time jobs. Many had work shirts and jackets with Velcro patches to change the organization’s logo as they moved from job to job.

Blurring of roles

While the “night job” bosses appreciate the experience these part-timers bring, many describe challenges with how the part-time caregiver approaches their “night job” role.

The part-time night job paramedic may state:

  • “That’s not how it is done at my day job.”
  • “I don’t need to do that task — do you know who I am during the day?”
  • “We do not need to follow the night supervisor’s order; I was a supervisor longer than he has been a paramedic.”
  • “Make me do it — I know how far I can push this issue.”
  • “I am just here to keep my certifications and could care less about the needs of the night organization.”

Volunteer roots

EMS evolved from community-based organizations established to meet a need through the efforts of volunteers. This rich and selfless organizational foundation creates challenges as paramedic services evolve into paid caregivers and a different organizational structure.[2]

While the quaking heart could care less who is operating the defibrillator, the structure required to deliver that skilled caregiver in a timely fashion is different. Volunteer, community-based organizations are more “me” oriented, significantly affected by the personality of the leaders. A poor leader can destroy a voluntary organization.[3]

Paid organizations tend to have a more resilient structure that can function under a wide range of personalities. It is “position” oriented, focused on the duties required of each position within the organizational chart.[4]

The National EMS Management Association (NEMSMA) issued a white paper on EMS management and leadership development. It notes: “Communities, the public and employees expect EMS agencies to evolve and to be managed and led by capable and qualified officers. The EMS systems of today and tomorrow demand more than a scattered, on-the-job approach to officer development.”[5]

Setting night job expectations

Administrators and managers in smaller and newer organizations struggle when working with senior caregivers who come from larger or more established organizations. The aura of the “day job” interferes with the needs of their role as a “night job” caregiver. Here are five recommendations for the night job supervisor:

1. Provide the role and task expectations of the night job. Make sure your expectations match the personnel regulations of your agency or organization.

2. Provide boundaries for what to do while working the night job. Acknowledge that the caregiver may have different boundaries during their day job.

3. Identify areas of difference. There are significant work hour, leave and documentation rules when working at a for-profit EMS agency versus a hospital-based one.

4. Enforce boundaries. It is understandable when an experienced caregiver will short-cut a procedure, but the supervisor’s role is to assure consistency.

5. Consider changing procedures that are not consistent with the rest of the region. There seems to be an inverse relationship between the size of the organization and the number of special procedures and policies.

Experienced caregivers can provide valuable service to their night job colleagues. The challenge for the supervisor is to keep them within the roles and tasks for the night job.


1. Bureau of Labor Statistics (2012) Occupational Outlook Handbook, 2012-13 Edition, EMTs and Paramedics. Washington, DC: U. S. Department of Labor.  Accessed January 15, 2014 at: http://www.bls.gov/ooh/healthcare/emts-and-paramedics.htm

2. Page, J. O. (2004) “Making A Difference: The History of Modern EMS. Version 2.0.” (DVD) San Diego, CA: Mosby/JEMS.

3. Perkins, K. B. and J. Benoit (1996). The Future of Volunteer Fire and Rescue Services: Taming the Dragons of Change. Stillwater, OK: Fire Protection Publications.

4. Yukl, G. A. (2012) Leadership in Organizations, 8th edition. Upper Saddle River, NJ: Prentice Hall.

5. NEMSMA (2008 October) “Emergency Medical Services Management and Leadership Development in America: An Agenda for the Future.” Encinitas, CA: National EMS Management Association. Accessed Jan. 15, 2014 at http://www.nemsma.org/Portals/3/NEMSMA%20Leadership%20Agenda%20FINAL.pdf

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