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Changing Expectations: Cognitive Dissonance and Finding Happiness in EMS

In his latest article for EMS World—5 Things We Must Stop Complaining About—Sean Eddy touches on a few common expressions of the striking discontent many EMS providers feel at work. Even in a field notorious for high levels of danger, stress and burnout, the level of unhappiness within our ranks often seems staggering. Old EMTs, young EMTs and even EMT students can all frequently be heard grumbling around the proverbial water cooler. A casual listener might wonder why anyone chooses to work on an ambulance at all if it is such a terrible job.

Within our circle, of course, we get it. Behind-the-scenes ranting is just a way to help each other bear the burdens that come with the territory of an EMS career: late calls, missed meals, excessive overtime, little sleep, non-emergent emergencies, etc. We can all recite a list of stressors like the chorus of a favorite sad song. We put on a happy face when people are watching (or at least we should) and go about our work because, somewhere deep down, we still believe it’s worth it. If a bunch of life-savers want to let their hair down and blow off steam among fellow travelers once in a while, who cares?

After years of growing discontentment and escalating work tantrums of my own, I decided it was time for me to step away. A little distance has done wonders for my outlook. I still work a few shifts each month as a paramedic, but now I find I rarely get upset about all of the things that used to provoke explosions of rage in the cab of the ambulance.

Initially I attributed my tenuous new inner peace to the fact that my butt simply wasn’t in the seat as often, and I'm sure this is partly true. Gradually, however, I have come to believe that the actual secret of happiness in EMS lies not in the gluteal, but in the cerebral. It is neither the profession itself, nor the time we spend engaged in it, that make us unhappy campers in the long run. Our own inaccurate expectations of how the profession should be cause our grief. We must figure out how to change those expectations if we want to have long, fulfilling EMS careers.

Cognitive dissonance is a term for the stress we feel when our values, expectations and experiences don’t match up. It can be caused by having values or beliefs that conflict with each other, doing something that conflicts with our beliefs, or experiencing something that challenges our previously-held beliefs.1 For example, someone who believes it is wrong to steal might experience cognitive dissonance after shoplifting. EMS examples might include a paramedic allowing a patient to refuse treatment even though he believes the patient requires medical attention, or providing resuscitation efforts that he believes to be futile.

We are all familiar with the mental and emotional stress that comes from dealing with situations like these, but I have come to believe that most of us are missing the bigger picture: It’s not what the job IS that causes us to hate it so much; it’s what the job IS NOT that we can’t stand.

One of the most telling conversations I had with another EMS provider occurred shortly after a major outbreak of tornadoes hit our town in 2011. It was a true disaster; an all-hands-on-deck mass casualty incident the likes of which most of us had never experienced and will likely never experience again as EMS providers. A veteran co-worker was telling me about a new employee offering to relieve her in the hours after the event occurred (and hours after her scheduled shift was over). She was outraged. “I have waited my whole career to be involved in something like this!” she exclaimed. “You think you can jump in and take my place just like that? Not a chance.”

Disasters, high-profile traumas, complex medical issues and challenging procedures are the reasons we all wanted to be here in the first place. We spend countless hours studying, practicing, rehearsing and training so that when the big moment comes we will be prepared. In my own practice, I have noticed that often my most peaceful, empowering moments as a paramedic happen right in the middle of the most terrible situations. Watching an ET tube slide through the vocal cords, establishing a difficult IV, realizing that a pulse has been restored, administering a medication that corrects a problem—these are the moments of validation we live for, that let us know without a doubt that we have done a good job and we’re in the right place, that all those hours of preparation were well-spent. These are the moments when our job is exactly what we want it to be. Reality and expectations are in complete harmony.

But these moments are so, so rare. With the exception of any Utopian systems out there that only send ALS ambulances to actual emergencies, the things we spend so much time learning and practicing are not the things we do on a day-to-day basis. We go through the motions over and over again for patients with vague complaints who really just need a ride to the hospital. We transfer endless waves of stable patients to and from various facilities. Who knew there were so many uncontrolled psychiatric patients in the world? Who knew so many couples' marital problems required public safety intervention? Who knew so many minor fender benders resulted in excruciating neck pain and the threat of life-altering paralysis? I didn't. They never showed Gage and DeSoto doing any of this stuff!

So there it is. Most of the time, being a paramedic is not really like what we thought it was. It's a boring, mundane, stressful for the wrong reasons, routine job like any other job. Reality does not match expectations. This leads to cognitive dissonance, which can lead to anger, discontent and burnout. If you can find a way to change reality, overhaul the system and transform EMS into the high-speed, adrenaline-packed rocket ship ride of your dreams feel free to do so. I bet you can't, though, so if you want to be happy riding around in an ambulance the only other option is to change your expectations.

I don't go to work expecting to save lives any more. Chances are the only procedure I will perform during a shift is lifting the stretcher. I still work hard to keep my skills and knowledge up to date and sharp, just in case, but I understand that it is unlikely I will need to use them. I excel at BLS transfers. I work just as hard at being nice to my patients, listening to them and doing everything I can to make them comfortable. I always carry my jump bag with me on emergency calls. I also always carry a blanket for the patient. Can you guess which one I use more often?

Next time you work, try going in actively thinking about what a busy, routine, boring, mundane shift it's going to be. Remind yourself that you get paid the same amount of money no matter what happens. See if you can make yourself feel content with the day you know you are about to have instead of hoping for the things you are unlikely to experience. Show up knowing you are going to run transfers so that you don't go crazy when you are assigned to one. Think about how you probably will not get off on time, so that when you get a call 10 minutes before your shift ends you won't lose your mind. Tell yourself that it really is your job to deal with the frivolous complaints of patients who may or may not think they are experiencing a true emergency, and you won't feel the need to blow up at them. Nurses who don't listen, doctors who don't care and patients who act foolish can't get under your skin when you come prepared to encounter them.

Know that by simply doing your job and having a great attitude, you are making a monumental difference in the lives of the patients and co-workers you encounter. Align your expectations with your reality. No cognitive dissonance, no anger, no discontent, no burnout. Happiness.

One of my favorite song lyrics is by a band called Sister Hazel: “If you want to be somebody else, change your mind.” You can't change the reality of EMS, but you absolutely can change your expectations to fit that reality. You can be happy in your EMS career. If you spend your days at work seething with rage, you need to become someone else. All you have to do is change your mind.


1. Wikipedia, the free encyclopedia. 2016. Cognitive dissonance.

Jody Marks, BS, RN, NRP, has been a paramedic for 14 years. He currently works as a registered nurse specializing in post anesthesia care and is pursuing his nurse practitioner degree. He lives and works in Huntsville, Alabama.

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