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10 ways to avoid the great resignation (that aren’t wage increases)

As an employer, the pressure is on to captivate the workforce and stand out in a competitive job market


While competitive wages are necessary, we now know our workforce is experiencing a paradigm shift and wanting more from their work.


The U.S. 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,” identifying 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. It’s important to acknowledge this barrier while understanding that a competitive wage is one of many factors that contribute to the retention of top talent.

So, what do our employees want from work? Here are 10 factors that 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 toward management. Without any background or rapport, employees will rely heavily on perceptions and assumptions of team members – this 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 that can 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 who 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 unit-hour-utilization are flawed and how they affect our people is paramount to longevity and safety. Allowing people to do human things like sleep, eat and use the restroom 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 with wage a differential degrade morale and can destroy relational chemistry. Truck utilization directly correlates to the health and well-being of our personnel. Seventy-five percent of the EMS workforce is 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 and also referred to as the sleep diplomat, cites 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.) 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 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 employee’s 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, they packed up and left to work for another ambulance outfit.

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 attract the wrong people and highlight 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, it 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 who 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 who 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.


Learn more

On-demand Webinar: Fatigue in EMS - Measuring the prevalence and efficacy of fatigue management initiatives

Ongoing research into fatigue and strategies to both prevent and manage it with Dr. Daniel Patterson

7. Authentic intentional employee recognition

Employee recognition 10 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 given 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 add? A personalized approach internally shows authenticity and deepens relational chemistry.

8. A great relationship with a direct supervisor or manager

Fifty percent of people who leave their employer leave due to a poor relationship with their direct supervisor or manager. According to Gallup, the great resignation is really the great discontent. Employee engagement is strongly correlated to retention and a big part of engagement is the relationship staff 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 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 mechanical CPR 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 who 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” or the “Great reshuffle.” 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 U.S. 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.

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: