Retention in the World of Frontline Ambulance Staff: The Seesaw Balance of Frustration and Contentment

By Carl Betts  

We as a cohort of individuals who work within the varied roles of the ambulance sector are one of the key threads that keep the fabric of pre-hospital emergency and urgent medicine intact.

Through multiple factors these threads are now wearing thin, fraying, and starting to fall apart which is having a direct impact on our crew’s health and wellbeing as well as the care that ambulance services offer patients.

Currently the retention rate within the frontline ambulance sector is dire which, if it came with warning lights, would light up a dashboard like a Christmas tree. As this issue has worsened over time, we have grown to live with the situation. We now find ourselves at present with the warning lights being so bright that they are ready to combust. This issue has been present for a long time and will only carry on getting worse if significant changes are not made to the profession, and within the wider scope of the NHS.

For many of us in frontline work the general feeling of being a back stop for the NHS can and does cause a lot of frustration to crews who feel like they are mopping up other NHS services work that are also under considerable strain. Now let’s please be clear, this is no fault of our other NHS service colleagues directly. This, as with many other sectors, is due to years of mismanagement and a clear lack of long-term vision. The lack of vison has left primary and community care at crisis point. By its very nature this is causing a knock-on effect, increasing the pressure in the acute setting.

The word frustration is a key one at this point. We all to work to do the best we can for the patients that are in our care. We as a cohort of staff did not join this profession to see one or two patients in a 10-hour shift and spend the rest of it sat in a hospital car park with a patient who needs hospital treatment and assessment. This current state of play seems to be a now “Business As Usual” (BAU) with no clear end in sight.

Currently the “frustration seesaw” is hugely biased to the wrong side. Whatever role we work in, if the positives outweigh the negatives, we can gain some contentment. No role is perfect unless you’re very lucky, but there is a balance to be had between the level of negativity and where that negativity sits in your day-to-day life.

As we all know a “seesaw”” has two ends and a pivot point in the middle. The weights at either end are that of contentment and frustration with the central pivot being the patients. Frustration and contentment aren’t discussed a lot taken as a pair in the ambulance service. In isolation, the word frustration is used daily, but sadly I can’t recall the last time I heard a colleague hint at being content at work!

The things that never change are the patients, thus becoming the central pivot. Yes, over time the acuity and the volume of patients we see may have changed, but the steadfast part of the ambulance world is that there will always be patients and they should be at the centre of all we do. However, without a content workforce and functioning organisation we will never be able to offer the best service to our service users. If a service looks after its staff then staff will look after the service and help to ensure the best service possible is available for our patients.

The seesaw within the ambulance sector is currently hugely frustration heavy. When we become frustrated lacking a vison then the feeling of contentment disappears. If we cannot be content, we will always be looking for a way out and if frustration is the key weight on the seesaw, then the positive / negative equation will always be out of balance favouring frustration.

This imbalance leads to staff becoming disillusioned, annoyed, angry, and burnt out, resulting in high levels of staff absence. On occasions really good staff leave the ambulance service altogether.

It is imperative that this seesaw is weighted the other way so that contentment becomes the key gold standard and the only acceptable option. Currently I cannot see where this will come from which is a very depressing situation and leaves me feeling genuinely sad that this great career path is very quickly becoming a no-go for many. The increased risk of burn out being ever present for the staff that do choose to do continue. This mental burn-out not only has profound long-term consequences for the person involved, but also for their nearest and dearest.

We must act now with all the vigour and resources available to the sector to ensure the seesaw is tipped from “frustration to contentment” for the long term. Many Trusts are looking at rotational opportunities for clinicians as accepted by Health Educational England’s Model. As for Emergency Care Assistants, there are now opportunities to complete their Associate Ambulance Practitioner (AAP) as well as accepting that flexible working agreements are key to supporting our colleagues. This is positive but is it too little too late to alter the trend of organisational staff retention issues? The seesaw has been weighted the wrong way for far too long and has affected far too many colleagues and families for it to be acceptable. This is now the legacy we have been left with and it’s not one to be proud of. If the world of ambulance life is to be seen as a long-term career option things must change and some very big decisions way out of the normal organisational cultural boundaries need to happen. One such way is humanising our colleagues and understanding their other skills and attributes. By doing this we should then be guiding people into short term redeployment before they are too far down the burn out road and be actively doing all we can to stop staff going off sick as this not only adds value to the person but also the organisation.

I am genuinely fearful for our profession in the frontline ambulance setting. Staff being unable to cope and the potential long-term damage our profession is doing to some wonderful human beings who will bend over backwards to support their colleagues and patients. The question is: Who will bend over backwards to support them? I would love to be able to offer you the answer to this question, but I can’t and that just leaves me feeling sad.

The profession I love and the people who I highly respect and admire are crumbling in front of our eyes. Let’s hope that one day soon our seesaw will be firmly weighted to contentment and that this fabulous career will be seen as just that again, as opposed to a job that will make you ill and fill you with disillusion.

Carl Betts – Paramedic