Study: Turnover has significant impact on quality of care among EMS personnel

Western Kentucky University and the Kentucky Emergency Medical Services Academy

BOWLING GREEN — The Kentucky EMS Academy (KEMSA) and Western Kentucky University has released their data on a research topic: "EMS Turnover: Determinants and Predictors".

This research is based on a survey conducted in early 2002.  Dr. Marilyn M.
Gardner, PhD, spearheaded this project.

The data was compiled and analyzed by WKU Public Health faculty and staff, which thanks the EMS community for their support. 

"Taking the time to fill out surveys is tedious but EMS research is minimal.  Our intent is to continue with EMS research, and with your help, we can increase the awareness in our profession," wrote Lee Brown, director for the Kentucky EMS Academy.

This report is being released nationally.

A recent study by researchers at Western Kentucky University (WKU) and Kentucky Emergency Medical Services Academy (KEMSA) sought to identify factors associated with turnover. Two surveys were administered: 1) a phone survey to the managers of all transporting ambulance service providers in the state of KY with a paid workforce (N=137); and 2) a written survey of full and part-time paid EMS staff at these facilities (N=562). Measures included job satisfaction; adequacy of education and training and professional development; occupational injuries; reasons for turnover; and intention to remain in the EMS field.

The most surprising finding of the Manager Survey was that nearly 24% of managers reported that they had no turnover. Further, among those reporting attrition, the mean annual rate of 8% is far lower than anecdotal reports and below turnover rates in other medical professions.

While to date there has been little systematic study of the causes of EMS turnover, employee burnout has been largely suspected as the primary cause of attrition. Factors unique to EMS that are reported in the literature as being associated with burnout and attrition, however, were not viewed by most respondents as contributing to turnover. Similar findings were noted with regard to the harm scale that assessed how frequently repeated, cumulative exposure to occupational injuries associated with EMS burnout caused physical or psychological harm.

Rather, in this study, three primary factors emerged as being associated with intention to leave, which is viewed as a proxy measure for turnover: 1) compensation; 2) education and training; and, 3) job position, or more specifically, being a paramedic.

Compensation

Salary was identified most often in the qualitative responses of both the Manager Survey and EMS Staff Survey as being the primary reason for turnover. Among all respondents, salary also was noted as contributing greatly to turnover and was the most frequent reason provided for intent to leave the EMS field among those planning to do so.

While annual salary itself was not predictive of intent to leave, those employees intending to do so had higher levels of dissatisfaction with their salary and other compensation than those employees intending to remain in the EMS field. On the surface, this finding could suggest that in terms of employee retention, feeling adequately compensated is more salient to employees than actual remuneration.

Education and Training

Many education and training inadequacies were noted when assessing how well initial education and training prepared respondents for overall job performance, as well as for specific emergencies encountered in the field. In general, these inadequacies were not noted for subsequent professional development (with the exception of a few items that will be discussed later), except among those intending to leave the EMS field. Overall, employees intending to leave the EMS field had significantly lower scores on both the initial education and professional development scales than those planning to remain in the EMS field. This finding suggests the need to explore whether additional and/or higher-quality education and training can be used as an effective retention tool.

Job Position

More than half of the paramedics responding intend to leave the EMS field; approximately 65% of those paramedics plan on leaving within the next two years. The impact of losing such a significant number of these professionals, should they follow through on their intention, has significant implications. Paramedics are the only ones that provide advanced life support. Without this expertise, it is quite likely we will see an increase in bad patient outcomes due to the lack of ALS intervention in the pre-hospital care. Additionally, there will be a need to educate and train additional paramedics to fill the void left by those leaving their positions.

Why paramedics intend to leave the field of EMS significantly more often than any other job position is unknown. Their higher mean scores on the scale measuring how often various injuries and incidents go unreported, though, may indicate greater exposure to occupational injuries, which is an area of burnout identified in the literature.

It would behoove managers and researchers to explore these differences further so that we may identify areas in which we can intervene to stave off loosing this valuable cohort.

Additional Findings

The need for more education and training in certain areas -- bioterroristic events, chemical terroristic attacks, and incidents involving battered children -- is evident. These areas, along with stress management, were identified as being deficit areas in both the initial education phase and in professional development. At present, there has been no systematic assessment of the education and training needs in these areas. Such an assessment is necessary to meet the challenges inherent in the role EMS plays in homeland security.

Another area that warrants further investigation is the gender inequity found in this study. While it is commendable that women are represented proportionally in the managerial ranks, the pay disparity and disparity in benefits are troubling. Women earned significantly less money than men in the same positions for the same length of time.

When looking at satisfaction with salary and intention to leave the EMS field in women, a different picture emerges than what was reported earlier: Women were significantly less satisfied with their salaries than men, yet there was no difference in between men and women in their intentions to leave the EMS field. This finding could be explained perhaps, in part, by what could be inferred as a strong dedication to the medical field among women respondents: Among those planning to leave the EMS field, more women than men planned on entering into another medical field.

Conclusions

Burnout does not appear, within the confines of this study, to be a significant predictor in turnover, though some of this finding may be due to the limited value of using intention as a proxy measure for turnover – especially intention beyond the immediate future. Rather, compensation, education and training are areas identified as being associated with intent to leave and each has a vast body of literature that may suggest appropriate intervention strategies. Further, assessing the specific needs of paramedics through focus groups and other techniques is a necessary next step if we are to identify ways in which to retain these employees. Lastly, gender inequities should be investigated and addressed.

This research was supported (in part) by a pilot project research training grant from the University of Cincinnati. The University of Cincinnati, an Education and Research Center, is supported by Training Grant No. T42/CCT510420 from the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health. The contents are solely the responsibility of the author(s) and do not necessarily represent the official views of the National Institute for Occupational Safety and Health.

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