What innovations help with the recruitment and retention of ambulance staff: a rapid evidence summary

Abstract

Ambulance waiting times across the UK have increased in recent years. The numbers of ambulance staff leaving services across the UK is increasing every year. Strategies to help recruit and retain all ambulance staff, including paramedics are important. This rapid evidence summary aimed to investigate what innovations can help with their recruitment and retention.Eight primary studies were identified:RecruitmentEvidence from a UK survey suggests that factors negatively influencing paramedic recruitment include competitive job market, lack of locally trained professionals, and newly qualified professionals starting with higher debt. Evidence from the US suggests that factors supporting recruitment concern future paramedics wanting to enter a caring profession or an exciting job. Additionally, strategies to recruit emergency medical technicians need to include the motivational aspects of growth, advancement, recognition, and responsibility. Evidence indicates that factors hindering recruitment of emergency medical technicians and/ or paramedics include rural working, and ambulance services not seen as a primary career path.RetentionEvidence from a UK survey suggests that pay, reward, stress and workload are factors that hinder paramedic retention. Evidence recommends retention strategies for paramedics, such as reviewing banding, improving work conditions and career progression, changing the way ambulances are dispatched to calls, and providing retention premiums. Evidence from the US suggests that pay, benefits, opportunities for advancement, continuous professional development, burnout, stress, workload, nearing retirement and career change are factors that influence retention of emergency medical technicians and/ or paramedics. Evidence from Thailand suggests that remuneration and professionalism are factors supporting paramedic retention.More up-to-date information is needed on the recruitment and retention of ambulance staff in UK settings. Further research providing a more detailed investigation of factors influencing recruitment and retention may be useful. The development or implementation of future strategies to help the recruitment and retention of paramedics and emergency medical technicians should be accompanied by a planned impact evaluation.Funding statementThe Wales Centre For Evidence Based Care was funded for this work by the Wales Covid-19 Evidence Centre, itself funded by Health & Care Research Wales on behalf of Welsh Government.Wales COVID-19 Evidence Centre (WCEC) Rapid Evidence SummaryWhat innovations help with the recruitment and retention of ambulance staff: a rapid evidence summary Report number – RES00050 (November 2022)Rapid Evidence Summary DetailsReview conducted byThe Wales Centre For Evidence Based CareReview Team▪Deborah Edwards▪Judit Csontos▪Liz Gillen▪Judith CarrierReview submitted to the WCEC on:24thNovember 2022Stakeholder consultation meeting: 14thNovember 2022Rapid Evidence Summary report issued by the WCEC in: December 2022WCEC Team:Ruth Lewis, Adrian Edwards, Alison Cooper and Micaela Gal involved in drafting the Topline Summary and editing.This review should be cited asRES00050, Wales COVID-19 Evidence Centre. A rapid evidence summary of what innovations help with the recruitment and retention of ambulance staff. November 2022DisclaimerThe views expressed in this publication are those of the authors, not necessarily Health and Care Research Wales. The WCEC and authors of this work declare that they have no conflict of interest.What innovations help with the recruitment and retention of ambulance staff: a rapid evidence summary Report number – RES00050 (November 2022)TOPLINE SUMMARYWhat is a Rapid Evidence Summary?Our Rapid Evidence Summaries (RES) are designed to provide an interim evidence briefing to inform further work and provide early access to key findings. They are based on a limited search of key resources and the assessment of abstracts. Priority is given to studies representing robust evidence synthesis. No quality appraisal or evidence synthesis are conducted, and the summary should be interpreted with caution.Who is this summary for?Welsh Ambulance Service NHS TrustBackground / Aim of Rapid Evidence SummaryAmbulance waiting times across the UK have increased in recent years, with emergency service performance targets missed. Reasons for the decreasing performance include increasing demand, problems with moving patients through the system, and workforce issues. The numbers of ambulance staff leaving services across the UK is increasing every year with the most acute retention problems affecting paramedics. Strategies to help recruit and retain all ambulance staff, including paramedics are important, therefore this rapid evidence summary aims to investigate what innovations can help with their recruitment and retention.Key FindingsEight primary studies were identified.Extent of the evidence base▪Quantitative descriptive surveys (n=6) and qualitative studies (n=2)▪Studies were from USA (n=6),UK (n=1)and Thailand (n=1).Recency of the evidence base▪The review included evidence available up until October 2022. Included studies were published between 2005 and 2021 with the UK study published in 2015.Summary of findings▪Participants were paramedics (n=3), emergency medical technicians (EMTs) (n=2), paramedics and EMTs (n=2), and emergency medical service directors (n=1).▪Studies focused on factors and strategies influencing ambulance staff recruitment (n=5) and/ or retention (n=7).Recruitment▪Evidence from aUK surveysuggests that factors that negatively influenceparamedicrecruitment includecompetitive job market, lack of locally trained professionals, and newly qualified professionals starting with higher debt.▪Evidence from the US suggests that factors supporting recruitment concernfuture paramedicswanting to enter a caring profession or an exciting job. Additionally, strategies to recruitEMTsneed to include the motivational aspects of growth, advancement, recognition, and responsibility.▪Evidence from the US indicates that factors that hinder recruitment ofEMTs and/ or paramedicsinclude rural working, and ambulance services not seen as a primary career path.▪There wereno studiesthat evaluated theeffectiveness of innovations or strategies to improve ambulance staff recruitment.Retention▪Evidence from aUK surveysuggests thatpay, reward, stress and workloadare factors that hinderparamedicretention.▪Evidence from aUK surveyrecommends retention strategies forparamedics, such as reviewingbanding, improving work conditions and career progression, changing the way ambulances are dispatched to calls, and providing retention premiums.▪Evidence from the US suggests that pay, benefits, opportunities for advancement, continuous professional development, burnout, stress, workload, nearing retirement and career change are factors that influence retention and job satisfaction ofEMTs and/ or paramedics.▪Evidence from Thailand suggests that remuneration and professionalism are factors supportingparamedicretention.▪There wereno studiesthat evaluated theeffectiveness of innovations or strategies to improve ambulance staff retention.Implications for practice and research▪More up-to-date information is needed on the recruitment and retention of ambulance staff in UK settings.▪Further research that provides a more detailed investigation of factors influencing recruitment and retention may be useful, in particular regarding reasons for leaving the profession.▪The development or implementation of future strategies to help the recruitment and retention of paramedics and EMTs should be accompanied by a planned impact evaluation.

Shuffling toward paramedic practitioners in the United States

“…These factors impact on opportunities for career progression within the profession, access to advanced and continuing education, competitive remuneration, and staff retention. 19,20 While it is evident that the U.S. has not embraced higher education for paramedics, 21 there is also little paramedic-led research, and paramedics have limited professional autonomy. 22,23 Their professional aspirations are frustrated by antiquated regulatory structures and an occupational culture that limits efforts to professionalise.…”