How to Create a Culture of Workforce Engagement in EMS

By the National Association of Emergency Medical Technicians (NAEMT)

When a co-worker decides to quit, it can be hard on those who remain on the job. They may have to pick up the slack for the EMT or paramedic who left, and it may make them question their own loyalty to a job that demands so much of them physically and mentally.

Over the past few years, turnover at EMS agencies has been relentless. It’s contributed to workforce shortages that have led to cuts in services and stress for EMTs and paramedics who remain at work. The loss of experienced EMTs and paramedics threatens not just the health of the agency, but the communities that count on EMS practitioners. 

Solving retention challenges in EMS won’t be easy. It will take a multi-pronged approach involving everything from better pay to greater support for EMS from the federal level on down. But one thing that EMS agencies can do today to strengthen their ability to retain personnel is by developing a culture of workforce engagement.

Employee engagement is the extent to which employees feel invested in the success of an organization. According to, engaged employees feel “connected and committed to their organization.”

Research has shown that engaged employees are not only more likely to remain in their jobs, they also perform better on multiple performance outcomes. They have lower turnover, lower absenteeism and fewer patient safety incidents or safety incidents of any kind.

Continue reading for tips on creating a culture of workforce engagement at your agency!

What Is a Culture of Workforce Engagement?

It’s an organizational practice to create an environment of norms and behaviors defined by meaningful work, deep employee involvement and connection and job and organizational cohesiveness, with the goal of encouraging and supporting a high level of employee commitment, passion and loyalty through strong organizational leadership.

Why Is It important?

Engagement of the workforce is a critical driver of organizational success. Engagement strengthens the mental and emotional connection of team members toward their workplace.

According to Gallup:

  • 32% of American workers are engaged in their jobs
  • 52% say they’re “just showing up”
  • 17% describe themselves as “actively disengaged”

Team members want to feel valued and respected in today’s workplace; they want their work to be meaningful and have their ideas heard. Highly engaged team members are more productive and committed to the organizations in which they work. 

What Are the Benefits to an EMS Agency?

The driving benefit of creating a culture of workforce engagement for EMS agencies is retaining EMS practitioners. Workforce engagement improves performance, productivity, employee morale, recruitment and retention, quality of work and reduces employee-related problems. 

According to the American Ambulance Association’s (AAA) Newton 360 Ambulance Industry Employee Turnover Study, voluntary turnover remains in the 20 to 30 percent range annually for EMS, while 32 percent of EMS practitioners leave within the first year. The study highlighted the cost to replace an employee, including the cost to attract, screen, hire, onboard and train a new employee. Onboarding a new EMT averages about $6,780, while replacing a full-time paramedic can cost about $9,113. Retention equals revenue.

Cost-Effective and Simple Ways to Create a Culture of Workforce Engagement in Your EMS Agency

  1. Take time to get to know your team members personally, celebrate and grieve during personal moments of significance and recognize their accomplishments. In a survey of nearly 1,300 EMTs and paramedics conducted by NAEMT, only 35 percent of respondents agreed or strongly agreed that their EMS agency provided recognition and praise for excellent performance, while 40 percent disagreed or strongly disagreed. (The remaining answers were neutral). 
  2. Support work-life balance. Encourage extracurricular activities and scheduling for school, family and personal needs. One of the biggest areas of stress for EMS practitioners is the feeling that their work-life balance is off – only 37 percent in the NAEMT survey felt they had a good work-life balance while 40 percent felt they didn’t. About 37 percent also felt that their work schedule lacked flexibility to allow time with family and friends.
  3. Communicate often, both informally and formally with your workforce. In the survey, 48 percent of respondents said that their managers failed to provide “clear and consistent information to personnel.”
  4. Schedule structured rounding, a concept adopted by hospital leadership to schedule time for management to engage their departments, supervisors, team members and support services on a regular basis.
  5. Pair leaders, emerging leaders and team members in mentor partnerships. Mentors can be sounding boards for sharing ideas or challenges, provide career guidance, assist with goal setting and provide encouragement and emotional support. NAEMT recently launched the Lighthouse Leadership Program, which pairs experienced EMS leaders with up-and-coming leaders who can benefit from help with developing a career plan, and a strategy for achieving their goals. We need more of this throughout our profession!
  6. Provide opportunities for leadership training or other career-enhancing education. Many EMS practitioners want to learn and be the best providers they can – provide opportunities for growth in their skills and knowledge.
  7. Create workplace committees that include field practitioners. Consider designing some that are employee-led and adopt outcomes or goals from these committees.
  8. Create a process for empowering team members through autonomous decision-making within their scope of position.
  9. Be encouraging of and willing to discuss differing viewpoints and decisions.
  10. Conduct annual employee engagement surveys and share results with your workforce.
  11. Conduct stay interviews and exit interviews to gain insights about your agency’s strengths and weaknesses. Stay interviews are structured discussions that leaders have with employees to learn specific actions that can be taken to strengthen the employee’s engagement and retention. Exit interviews are held with employees about to leave an organization, to understand their reasons for leaving and their experiences working for you.
  12. Create a mission, vision and values statement that embraces diversity, equity and inclusion, and is developed with your employees’ input. Your mission statement should articulate your agency’s reasons for being, while the vision statement looks ahead to where your organization hopes to go and what it’s trying to achieve.
  13. A values statement highlights the core principles that guide the agency and its culture. Your values statement guides the organization in decision-making, and is a framework for the type of environment employees – and prospective employees – can expect from their workplace.
  14. Then when you create these, stick with them! Refer back to them and make sure your agency is living up to its ideals.