EMS Employee Engagement Often Misses the Mark
By Michael Heidbreder, DSL, FP-C, NRP, EMT-P
There has been a lot of talk in the past few years on EMS retention and what can be done about it. But the discussion has been happening since before I entered the EMS field in 1999. The discussion and retention strategies have changed over the decades; some argue that more advanced protocols will keep your employees challenged, and by proxy, they will stay. Others see pay, benefits, and long work hours as the main issues facing the field. This is not an exhaustive list, but these are the topics I see when I look at trade magazines, websites, etc.
Yet, there is one retention strategy that doesn’t seem to get much exposure: employee engagement. I see many articles discussing work engagement, engagement with protocols, medical direction, and even education engagement. One reason I feel the subject of employee engagement is skipped over is due to the fact many people do not know what it is. How do we engage with EMS professionals? What impact would a higher focus on engagement have on retention? There has been very little conversation on this extremely important subject, and this humble piece was written to hopefully bring it back into the general focus so that our field can have a more holistic discussion on why so many EMS professionals walk away.
We must first define what employee engagement is and what it isn’t. An engaged workforce is an empowered workforce, thus leading to higher retention.1 Engaged employees tend to not only have a positive outlook of the company,2 but their work output is also positive.3 Engaged employees tend to have higher rates of retention. Retention happens when employees find a convergence of their values, their work, working environment, and leadership’s engagement, which increases their desire to stay with the organization.4
Within the last 15 years there has been a renewed focus on creating an engaged workforce, and by proxy, keeping those engaged employees longer. EMS stands as an exception to this. Healthcare systems, medical and nursing schools, and even dental schools are looking at how employee engagement impacts retention. Yet, EMS has not placed a high level of importance on this subject, which can be seen in the lack of academic research on the subject during the past 10 years.
Many EMS organizations, and dare I say EMS trade publications, look at employee engagement as what the employee can do for the organization and the profession. That mindset needs to be swapped to what EMS agencies can do for the employee. This mindset was seen in a small study conducted in western North Carolina. A paramedic in the region who lacks self-awareness and self-preservation did a study for their doctorate on EMS/fire retention and found that of the major issue(s) facing that department was how they viewed employee engagement.5 The study found most captains and battalion chiefs viewed employee engagement as department focused, not employee focused5; 90% of the study participants couldn’t define employee engagement. Lastly, when they were asked how they engaged with their employees, 83% of captains and battalion chiefs viewed meetings, trainings, and other department-centric activities as employee engagement.
These findings stood in stark contrast to what the rank-and-file members viewed as employee engagement. Of those who participated in the study, 85% viewed employee engagement as employee centric. Things such as family days, organizational dinners/lunches, and most importantly, being talked to and engaged with on a personal level from the officer corps ranked the highest. This disconnect is not unique to this one department yet is prevalent throughout EMS and fire service and has been for quite some time.
In case you haven’t noticed yet, nowhere in this study was pay one of the top issues when it came to engagement. The frontline staff cared more about how the department valued them (one could argue pay is part of that) more than benefits, pay, and hours.
EMS needs to take a multi-faceted approach to this issue. Employee engagement is more than just words; it’s an organizational focus that requires all stakeholders to be active participants. We’re talking changes in department culture, organizational design, and shifting from a management-focused organization to a leadership-based design. I’m not talking about advanced protocols, buying the newest shiny toy to put on the truck, hours of staff meetings that talk about the same things, endless training days, or bureaucratic station drop-ins.
As this study showed, that isn’t what people want. They crave genuine engagement that speaks to them on a personal level. They want to know they matter to the department and that they are more than a warm body on the rig. They want and need to receive feedback from their leadership team in a timely manner.6 This goes beyond a yearly evaluation, staff meetings, or mandatory trainings. Another way to look at this, anytime the employee is required to be at an event, it isn’t engagement. Engaged employees are the foundation for any agency that has or wants high retention rates. Employee engagement is critical in both retention and recruitment, but also in employee empowerment.7 Empowered employees will eventually start to take ownership not only of themselves, but their peers, their work product, and the direction of their department.
As a field, we have been talking about retention rates for decades. Yet, despite the myriad articles, data sets, and symposiums on this subject, employee engagement is rarely brought up. Why are we so afraid to simply sit down with our people and ask them why they leave? What can be done to help them stay? What are their hopes, wishes, and dreams for the department? What can the department do to help them achieve their goals? This isn’t a comprehensive list of subjects; but the idea stays the same. One way to help increase retention is for departments and those in command to actively, and daily, talk to and engage with their people. This may seem like a simple thing, yet, as this study showed, it’s desperately needed/
References
1. Tumolo, S. M. (2020). Receptive communication. The International Journal of Servant-Leadership, 14(1), 405–428. https://doi.org/10.33972/ijsl.36
2. Gutermann, D., Lehmann-Willenbrock, N., Boer, D., Born, M., & Voelpel, S. C. (2017). How leaders affect followers’ work engagement and performance: Integrating leader-member exchange and crossover theory. British Journal of Management, 28(2), 299–314. https://doi.org/10.1111/1467-8551.12214
3. Schneider, B., Yost, A. B., Kropp, A., Kind, C., & Lam, H. (2018). Workforce engagement: What it is, what drives it, and why it matters for organizational performance. Journal of Organizational Behavior, 39(4), 462–480. https://doi.org/10.1002/job.2244
4. Pandita, D., & Ray, S. (2018). Talent management and employee engagement – A meta-analysis of their impact on talent retention. Industrial and Commercial Training, 50(4), 185–199. https://doi.org/10.1108/ICT-09-2017-0073
5. Heidbreder, M. Effects of leadership training on employee engagement and retention in the emergency medical and fire services industry.
6. Liu, S., Wang, J., & Wang, R. (2023). Transforming passive employee engagement into active engagement: Supervisor development feedback valences on feedback-seeking behavior. Psychological Reports, , 332941231213842-332941231213842. https://doi.org/10.1177/00332941231213842
7. Dartey-Baah, K., Issahaku, L., & Akwetey-Siaw, B. (2025). Authentic leadership and employee engagement: The mediating role of employee work environment. Industrial and Commercial Training, 57(1), 118–134. https://doi.org/10.1108/ICT-06-2024-0045
