Factors that affect Israeli paramedics' decision to quit the profession: a mixed methods study

The impact of professional mission on turnover intention among operating room nurses: a chain mediation model analysis of professional identity and job burnout

BACKGROUND AND AIM

To investigate the chain mediation effect of professional mission, professional identity, and job burnout on the turnover intention among operating room nurses.

METHODS

A convenience sampling method was used to conduct a questionnaire survey with 744 operating room nurses from 12 hospitals in Shandong Province, China. The study utilized a general information questionnaire, a professional mission scale, a professional identity scale, a job burnout scale, and a turnover intention scale to construct and test a chain mediation model.

RESULTS

Professional mission significantly influenced turnover intention through professional identity and job burnout, with a total indirect effect of -0.174. The chain mediation effect of professional identity and job burnout was -0.028, accounting for 16.90% of the total indirect effect.

CONCLUSION

The multiple mediation effects of professional identity and job burnout between professional mission and turnover intention were validated. Nursing managers should focus on enhancing nurses' professional mission, improving their professional identity, and reducing job burnout to decrease turnover intention among operating room nurses.

The influence of ergonomic factors on the work conditions of paramedics during the rescue of trauma patients in an ambulance

Introduction

The risk factors encountered in the work of paramedics include ergonomic, physical, psychological, and biochemical factors. This study identifies discomforts experienced by paramedics during medical procedures in ambulances, emphasizing their negative impact on musculoskeletal load and forming the basis for ergonomic and organizational recommendations.

Methods

The study employed non-invasive MyoMotion and EMG methods to measure musculoskeletal strain during typical stationary and transit medical procedures.

Results

Preliminary results showed musculoskeletal overloads resulting from paramedics assuming forced positions during medical procedures on trauma patients. Some of these positions, especially while the ambulance was in motion, were characterized by a high risk of injury.

Conclusions

An ergonomic ambulance interior can help reduce the risk of injuries during medical procedures.

Influence of working conditions on German paramedics' intention to leave the profession: a cross-sectional study

Introduction

It is well known that Germany's ambulance service (AS) suffers from a shortage of qualified personnel, which may increase in the following years. For this reason, this study aimed to determine the percentage of AS staff considering leaving their profession and to analyse the possible causes.

Methods

A self-developed questionnaire and the Employee Experience Questionnaire (EXQ) were used for this cross-sectional study.

Results

A total of 814 AS staff with a mean age of 35.71 [standard deviation (SD) 9.78] years were included in this study. Immediately leaving the AS was the intention of 17.27% of participants, with 2.86% having already resigned, 14.29% taking actions such as applying for a job, and another 14.04% specifically planning to leave the AS in the foreseeable future. Those who plan to leave the AS immediately [3.82 (SD 0.79)] showed significantly lower EXQ scores than the group who plan to stay in the EMS until retirement [4.92 (SD 0.87); pTukey ≤0.001]. At the same time, it is noticeable that EMS staff often suffer from unfavourable working conditions, such as not being granted breaks, work-related calls during free time, and over time, and significant correlations with the planned length of stay in the paramedic service and exit thoughts were identified here.

Conclusion

Unfavourable working conditions further aggravate the already existing shortage of qualified personnel in the ambulance service, so measures by various decision-makers are imperative.

Paramedics and emergency medical technicians' perceptions of geriatric trauma care in Saudi Arabia

BACKGROUND

Saudi ambulance clinicians face unique challenges in providing prehospital care to older trauma patients. Limited geriatric-specific training and complex needs of this population hinder effective management, leading to adverse outcomes. This study explores the perceptions of Saudi ambulance clinicians regarding geriatric trauma care and identify facilitators and barriers to improved care.

METHODS

A qualitative study was conducted using a purposive sample of Saudi paramedics and ambulance technicians from Riyadh and Makkah using online semi-structured interviews and analysed using the framework method.

RESULTS

The qualitative study recruited twenty participants and identified that they reported age-related challenges including physiological changes, polypharmacy, and communication difficulties. They all wanted training and guidelines to improve their knowledge. They reported struggling with communication difficulties, inaccurate adverse outcomes predictions, difficult intravenous cannulations, and cultural restrictions affecting care provision for female patients. We identified organisational barriers (e.g. lack of shared patient records and lack of guidelines) and cultural barriers (e.g. barriers to assessing women, attitudes towards older people, and attitudes towards paramedics) that influenced implementation of knowledge.

CONCLUSION

Ambulance clinicians in Saudi Arabia want guidelines and training in managing older trauma patients but these need to take into account the organisational and cultural barriers that we identified to facilitate implementing knowledge and changing practice to providing improved care.

Job satisfaction and social identification among paramedics in southern Poland

Introduction

Job satisfaction, based on professional and non-professional factors and individual characteristics of employees, is an important element influencing both the quality of care provided and employee turnover.

Material and method

The study included 137 paramedics employed in field teams and hospital emergency departments. The Job Satisfaction Scale (SSP), the Minnesota Job Satisfaction Questionnaire (MSQ), the Utrecht Work Engagement Scale (UWES), and the Three Dimensional Strength of Group Identification Scale (TSIG) were used to collect the data.

Results

The average job satisfaction score measured with SSP in the studied group of paramedics was 24.50 and the average job satisfaction score measured with MSQ was 74.16. The average value of the group identification in the study sample was 61.15. Of the three subscales, the highest scores were obtained in the affect toward the group subscale -22.44, and the lowest in the cognitive centrality subscale -18.78. The analysis showed that job satisfaction positively correlated with social identification (r = 0.43) and the ingroup ties (r = 0.43), cognitive centrality (r = 0.34) and ingroup affect (r = 0.37).

Conclusions

The studied group of paramedics showed moderate job satisfaction (measured with SSP) and work engagement, with a simultaneous high level of job satisfaction (measured with MSQ) and social identification with the professional group. Social identification of studied paramedics varied depending on gender. Women showed higher levels of cognitive centrality, which might mean that they might have had greater need to categorize themselves as paramedics.

The prevalence of depression among paramedical students and workers with highlights from the COVID-19 pandemic: A meta-analysis of prevalence

OBJECTIVE

To estimate the prevalence and risk factors of depression among paramedical workers/students.

METHOD

6205 paramedics (reported in 25 cross-sectional studies) were meta-analyzed after searching seven electronic databases. The main outcome was the prevalence of depression. Subgroup analyses were conducted based on year and country of investigation, pandemic status and wave, population type, and disease severity. Several risk factors were also examined (gender, marital status, and population type).

RESULTS

34% [95%CI: 26-43%] of paramedics have depression, mostly of the mild form [19%, 95%CI: 13-27%]. Depression was highest in India and Australia. Students [45%, 95%CI: 30-62%] were more vulnerable to depression than workers [29%, 95%CI: 18-40%]. No linear trend was observed for depression over the years. Depression was lower during the pandemic compared to the pre-pandemic period [25% vs. 39%] with similar rates across all pandemic waves. Male [MD = 1.40; 95%CI: 0.57: 2.23] and married paramedics [MD = -1.33, 95%CI: -2.04: -0.62] were significant predictors of depression; however, no significant difference in depression was noted between paramedics and non-paramedics [logOR = 0.08; 95%CI: -0.10: 0.25].

CONCLUSIONS

One in every three paramedics have depression, with higher rates among students and before the COVID-19 pandemic. Gender and marital status are risk factors of depression.

Causes of stress and poor wellbeing among paramedic students in Saudi Arabia and the United Kingdom: a cross-cultural qualitative study

BACKGROUND

Paramedicine presents students with numerous challenges, including factors threatening their wellbeing. Over the last two decades studies have illustrated that paramedics and paramedic students are more likely to have mental disorders than the general population. These findings suggest that course-related factors could be important in contributing to poorer mental health. However, few studies have examined factors related to stress in paramedic students, and none of these have included paramedic students from cross-culture. To address this, the present study (1) explored paramedicine students' training experiences and other education-related factors that could affect their wellbeing, and (2) illustrated the possible differences and similarities between two cultures (Saudi Arabia and the UK) to determine whether the students' cultural environment influenced factors related to their wellbeing.

METHODS

A qualitative exploratory research design was used. Twenty semi-structured interviews were conducted with paramedicine students from the United Kingdom and Kingdom of Saudi Arabia (ten participants from each country). Reflexive thematic analysis was employed as the analytical approach in this study.

RESULTS

Four major themes were identified which captured the contributors to paramedic students' stress levels: (1) exposure to potentially traumatic events, (2) relationships and communication, illustrating the student's personal and professional experiences with others, (3) programme atmosphere, demonstrating the challenges and support students encounter during their coursework and training, and (4) career, elucidating the pressure of future career expectations and predictions.

CONCLUSION

The study revealed contributors to stress were similar in both countries. Better preparation can help to reduce the negative impacts of the possible traumatic events encountered on placements and supportive relationships, especially with proctors, can boost student wellbeing. Universities are able to address both these factors and help foster a positive environment for paramedicine students. As such, these results should help educators and policymakers when identifying and delivering interventions to support paramedic students.

Medical shift work: a narrative review

Shift and night work combine training and practice in medical education, assuming an essential character in some medical specialties. Nevertheless, it is recognized that this work schedule affects biological functions, cognitive performance, and the safety of both patients and workers. The aim of this narrative literature review was to describe current knowledge about the impact of shift and night work in medical professionals. The LILACS, MEDLINE, and SciELO databases were searched for publications between 2010 and 2020 using the terms: "shift work schedule" and "physicians". A total of 12 publications reported outcomes on sleep quality, family relationships, burnout syndrome, and cardiovascular health. Despite these outcomes, the studies highlighted the importance of shift and night work in medical training, reflecting a loss of learning opportunities when limitations are placed on work hours. The studies suggested initiatives to mitigate the effects of shift work, including increased awareness by managers, a culture of respect for resting periods, the encouragement of family support networks, and the availability of natural light in the workplace.

Psychosocial Work Stress and Occupational Stressors in Emergency Medical Services

Emergency medical service (EMS) professionals often experience work stress, which escalated during COVID-19. High job demand in the EMS profession may lead to progressive decline in physical and mental health. We investigated the prevalence of psychosocial job stress in the three levels of EMS: basic, advanced, and paramedic, before and during the COVID-19 pandemic. EMS professionals (n = 36) were recruited from EMS agencies following the Institutional Review Board approval. Participants took surveys on demographics, personal characteristics, chronic diseases, and work schedules. Job stress indicators, namely the effort–reward ratio (ERR) and overcommitment (OC), were evaluated from survey questionnaires using the effort–reward imbalance model. Associations of job stress indicators with age, sex, body mass index, and working conditions were measured by logistic regression. Psychosocial work stress was prevalent with effort reward ratio > 1 in 83% of participants and overcommitment scores > 13 in 89% of participants. Age, body mass index, and work hours showed strong associations with ERR and OC scores. The investigation findings suggested that a psychosocial work environment is prevalent among EMS, as revealed by high ERR, OC, and their correlation with sleep apnea in rotating shift employees. Appropriate interventions may be helpful in reducing psychosocial work stress in EMS professionals.

Ambulance personnel's perceptions on their workplace well-being: A descriptive interpretative study

BACKGROUND

Ambulance personnel face numerous challenges during their working hours. Exposure to stressful situations and other factors in the outpatient emergency medical service can affect the health of ambulance personnel as well as their well-being.

OBJECTIVE

The main objective of this study was to explore the perceptions of ambulance personnel regarding their physical and mental well-being at the workplace.

METHODS

A qualitative descriptive-interpretative research design was used. Individual face-to-face and online interviews were conducted between February and April 2022. A total of 26 interviews were conducted to explore employees' perceptions regarding the impact of work on their health and well-being.

RESULTS

Ambulance personnel described in detail their perceptions of the impact of work on their physical and mental health and well-being. Three main themes emerged from our data: 1) the impact of work on the psychophysical condition of ambulance personnel; 2) the impact of work on the lifestyle of ambulance personnel; 3) the impact of work and the work environment on the lives of ambulance personnel.

CONCLUSION

Long-term work in emergency medical services affects the health and well-being of ambulance personnel. As demonstrated by this study, raising awareness on the importance of preventive and health promotion programmes, understanding employees' problems by considering their opinions, and providing relevant training are extremely important tools for preventing such problems among employees.

Paramedics' perceptions of job demands and resources in Finnish emergency medical services: a qualitative study

BACKGROUND

Paramedics' fatigue is rising. Stress factors show increased risk for burnout, fatigue, leaving the profession, decreased performance and risk for patient safety. Meanwhile, paramedics' strong community of practice, autonomy and a sense of professional respect are important factors in forming psychological resilience. We aimed to explore Finnish paramedics' perceptions of job demands and resources.

METHODS

Our study design was descriptive, inductive with a constructivist approach. Using reflexive thematic analysis, we analyse open-ended questions, from a web-based survey and essays written by Finnish paramedic masters-degree students. The study followed the SRQR checklist.

RESULTS

We identified paramedics' job demands as stress from a high workload, environmental factors and emotional burden. Performance expectations and a sense of inadequacy were further noted, as well as an organizational culture of hardiness, presenting lack of support and sense of inequality. Paramedics' job resources were pressure management strategies, which were expressed as positive coping mechanisms, agency to affect workload and professional self-actualization, expressed as psychologically safe work community, professional pride and internal drive to professional development.

CONCLUSIONS

Finnish paramedics exhibit resources and demands related to uncertainty and emotional burden as well as cultural hardiness and psychological safety in communities.

PATIENT OR PUBLIC CONTRIBUTION

This study was done based on survey data collected and analysed by the authors. No patient or public contribution was utilized for this study.

Mental Disorder Symptoms and the Relationship with Resilience among Paramedics in a Single Canadian Site

There is growing recognition in research and policy of a mental health crisis among Canada’s paramedics; however, despite this, epidemiological surveillance of the problem is in its infancy. Just weeks before the emergence of the COVID-19 pandemic, we surveyed paramedics from a single, large, urban paramedic service in Ontario, Canada to assess for symptom clusters consistent with post-traumatic stress disorder (PTSD), major depressive disorder, and generalized anxiety disorder and to identify potential risk factors for each. In total, we received 589 completed surveys (97% completion rate) and found that 11% screened positive for PTSD, 15% screened positive for major depressive disorder, and 15% screened positive for generalized anxiety disorder, with one in four active-duty paramedics screening positive for any of the three as recently as February 2020. In adjusted analyses, the risk of a positive screen varied as a function of employment classification, gender, self-reported resilience, and previous experience as a member of the service’s peer support team. Our findings support the position that paramedics screen positive for mental disorders at high rates—a problem likely to have worsened since the onset of the COVID-19 pandemic. We echo the calls of researchers and policymakers for urgent action to support paramedic mental health in Canada.

Psychological Effects of COVID-19 Patient Management Experience among Paramedics and Emergency Medical Technicians: A Nationwide Survey in Korea

Background

Materials and Methods

Results

Conclusion

Job Satisfaction and Performance Orientation of Paramedics in German Emergency Medical Services-A Nationwide Survey

(1) Background: Shortage of skilled workers is a relevant global health care problem. To remain competitive with other professions, job satisfaction is a critical issue; however, to date, there are no data available on the German EMS. This study aims to perform a statistical analysis of job satisfaction and performance orientation and to identify risk factors for low job satisfaction of paramedics in the German EMS. (2) Methods: Data were collected from 2590 paramedics through a nationwide cross-sectional survey, using the job satisfaction questionnaire by Neuberger and Allerbeck and the performance orientation questionnaire by Hippler and Krüger. Descriptive and regression statistical analysis were performed. (3) Results: The participants scored significantly lower than the reference sample on job satisfaction, with “organization and management” and “payment” being the lowest rated subscales. Around 9% of employees feared losing their jobs. While work attitude toward performance and success enhancement was high, fear of failure was also common. (4) Conclusions: Job satisfaction of paramedics in the German EMS is below that of the reference sample. Discontent with payment and organizational issues is common. Performance orientation is high, but fear of failure is frequent. Current and future efforts that aim at an attractive working environment should reflect on these findings.

Social Prestige of the Paramedic Profession

Background: There is a lack of research on social image, prestige, and the position of the paramedic profession in the social structure. The main objective of the study was to determine the place of the paramedic profession in the hierarchy of prestige of professions as viewed by the public. In operationalizing the term ‘prestige’, we deemed the word ‘respect’ to best fit the sense of the subjective evaluation of prestige with regard to a profession. Material and methods: The data comes from cross-sectional survey-based research. The research was carried out on a group of 600 people over 18 years of age. The sample was of a random nature, and the selection of respondents was calculated on the basis of them being representative of the Polish population. Results: The median of respect declared for the paramedic profession, on a scale of 1 to 5, was 4.49, which placed the profession in fourth place in the ranking. The assessment of respect for paramedics among other medical professions placed them in third place, directly after doctors and midwifes. Conclusions: The profession of paramedic is characterized by high social prestige, locating it at the forefront of the medical profession and other examined professions, but its social position, expressed by objective measures (earnings, structural possibilities, social power), is significantly lower.

Paramedics in pandemics: protecting the mental wellness of those behind enemy lines

Besides a global health crisis, the COVID-19 pandemic has potential to have a severe and long-lasting psychological impact on frontline healthcare workers such as paramedics. It is imperative to shed light on these mental health issues and employ interventions to protect the mental wellness of this vulnerable group of healthcare workers.

Impact of perceived inappropiate cardiopulmonary resuscitation on emergency clinicians' intention to leave the job: Results from a cross-sectional survey in 288 centres across 24 countries

INTRODUCTION

Cardiopulmonary resuscitation (CPR) in patients with a poor prognosis increases the risk of perception of inappropriate care leading to moral distress in clinicians. We evaluated whether perception of inappropriate CPR is associated with intention to leave the job among emergency clinicians.

METHODS

A cross-sectional multi-centre survey was conducted in 24 countries. Factors associated with intention to leave the job were analysed by conditional logistic regression models. Results are expressed as odds ratios with 95% confidence intervals.

RESULTS

Of 5099 surveyed emergency clinicians, 1836 (36.0%) were physicians, 1313 (25.7%) nurses, 1950 (38.2%) emergency medical technicians. Intention to leave the job was expressed by 1721 (33.8%) clinicians, 3403 (66.7%) often wondered about the appropriateness of a resuscitation attempt, 2955 (58.0%) reported moral distress caused by inappropriate CPR. After adjustment for other covariates, the risk of intention to leave the job was higher in clinicians often wondering about the appropriateness of a resuscitation attempt (1.43 [1.23-1.67]), experiencing associated moral distress (1.44 [1.24-1.66]) and who were between 30-44 years old (1.53 [1.21-1.92] compared to <30 years). The risk was lower when the clinician felt valued by the team (0.53 [0.42-0.66]), when the team leader acknowledged the efforts delivered by the team (0.61 [0.49-0.75]) and in teams that took time for debriefing (0.70 [0.60-0.80]).

CONCLUSION

Resuscitation attempts perceived as inappropriate by clinicians, and the accompanying moral distress, were associated with an increased likelihood of intention to leave the job. Interprofessional collaboration, teamwork, and regular interdisciplinary debriefing were associated with a lower risk of intention to leave the job. ClinicalTrials.gov; No.: NCT02356029.

Paramedics and Physician Assistants in Israel

Israeli emergency medicine is undergoing change. The paramedic is experiencing high separation rates because the position is understaffed, overworked, and underpaid. Physician assistants (PAs) were introduced into the emergency department by training paramedics and to date they seem satisfied with this new role. Experience in other countries indicates that PAs can improve access to care, reduce errors, increase efficiency and have satisfying roles in health systems. The Israeli health system will need to determine if additional roles for PAs will be accepted by the public and physicians alike.