A constructivist grounded theory exploring why UK paramedics are leaving ambulance services to work clinically elsewhere in the NHS

Background and Aims

Paramedic retention is a challenge for UK ambulance services, placing increasing strain on delivering safe levels of care. Increasingly leavers are taking up relatively new clinical roles in General Practice and hospitals. Research into UK paramedic turnover is limited. This PhD aimed to identify the relative importance of employee turnover factors to this paramedic population and perceptions of their employment move and subsequent professional identity.

Methods

A constructivist grounded theory methodology was adopted, using semi-structured qualitative interviews. Paramedics who had left NHS ambulance services to work clinically in other areas of the NHS were recruited using snowball sampling followed by theoretical sampling. Nineteen paramedics were interviewed prior to theoretical saturation. Data analysis comprised initial, focused, and advanced coding leading to development of a framework explaining Ambulance Paramedic Turnover into the Wider NHS.

Results

Turnover is influenced by negative perceptions of ambulance service culture, in particular that the ambulance service does not value paramedics as individuals or care about their wellbeing. This exacerbates other leaving factors including poor mental health from the emotional impact of ambulance case work, coupled with a lack of informal and formal support mechanisms. Additionally, work-life conflict due to shift work and unpredictable late finishes leads to turnover. Some paramedics find that ambulance work lacks challenge. They seek clinical development and clinical career progression but are often unable to access these within ambulance services. This leads them to seek more challenging clinical work elsewhere in the NHS. Paramedics mostly retain a strong sense of paramedic identity and view their employment move as a change of job forming part of their paramedic career progression.

Conclusions

The combination of factors influencing UK paramedic turnover are unique to their context. The framework of Ambulance Paramedic Turnover into the Wider NHS explains paramedic turnover using their employment journey as its basis. Recommendations have been developed based on the findings across the identified turnover areas of ambulance culture, mental health, work-life conflict and lack of work challenge.