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Leader's Digest: Recruitment and Retention During the Pandemic

Leader’s Digest is a bimonthly column produced in partnership with Cambridge Consulting Group (CCG), a group of subject matter experts with expertise in paramedicine, ambulance operations of every organizational structure, and medical transportation services. Visit

Imagine you are in charge of preparing for a big old-fashioned family wedding. All the arrangements have been made. The date and venue have been secured. Everything from printing invitations to flowers to food and music has been ordered.

The day of the big event is here, and guests are starting to arrive. At first it’s a trickle, but soon hundreds of people are milling around the entry, and many have nowhere to sit. Your cell phone starts blowing up with calls from those complaining they never received their invitation. A family member tells you only half the food has arrived.

And now you hear the musicians will not be showing up. They’ve been on the road for seven of the last nine months and simply can’t take it anymore. Lastly, you receive a phone call from the celebrants’ assistant. She has fallen ill and been taken to the hospital. There will be no wedding today.

So what just happened? Even as solid planning ensured logistics over the past few months, it came down to not having enough people on the front lines to get the job done. Sound familiar? It is not my intent to contrast the impact of a botched wedding to the devastation of a worldwide pandemic, but you get the point.

At the time of this writing, more than 14 million cases of COVID-19 have been reported in the United States, and more than 277,000 have died. Worldwide there have been 65 million confirmed cases and 1.5 million deaths. The scary part is that we’ve had the most rapid escalation in those numbers during the past few months.

In EMS our preparation and logistics have improved greatly since the beginning of the outbreak. But all that means nothing if we don’t have the people to deliver the care. Are things like recruiting bonuses part of the answer? I have begun to soften in my conviction that a onetime bonus has any lasting impact.

It's been well documented that an employee typically does not leave an organization so much as leave their direct leader. Finding space and resources to help train and retrain supervisors to cultivate an improved culture shows frontline staff their employer really cares about them. Giving a voice, showing respect, and offering opportunities for the future are likely to produce a stronger return on investment than any other program of the week.

We connected with a few EMS leaders to ask how COVID has impacted their recruiting and if they had any advice for fellow leaders. 

Susan Long, Vice President of Operations, Allina Health EMS, Minn. 

How did COVID impact your ability to recruit and retain providers?

The biggest challenge during the first phase was that schools shut down, so people near graduation were stuck with no options. Also psychomotor testing was halted, so many could not finish to be hired. The state and NREMT created a provisional certification for those who were far enough along with clinicals to finish and take the written. Provisional status is granted until they are able to complete the psychomotor testing.

Given all that, the pool of potential candidates has been small, and all the services are struggling to find new ways to bring people in. We have been hiring some of those potential paramedic candidates and training them as ALS EMTs so we get them started and committed to us.

Any advice for others?

I think the best advice is think outside the box and make sure potential employees know the safety measures we are taking to keep employees safe in this challenging environment. Hennepin County really surprised all of us (an annoyed us, to be honest) by posting jobs for EMTs at $22 an hour to start, and they are paying them to go through paramedic school, and then they are committed to a neighboring service for three years. Not a positive move for us, as they grabbed 10 of our EMTs with this program, but I have to give them credit for thinking outside the box. 

Tom Bouthillet, NRP, Battalion Chief of EMS, Hilton Head Island Fire Rescue, S.C.

How did COVID impact your ability to recruit and retain providers?

Recruitment has been a significant challenge over the past few years. In our last round we advertised for fully qualified firefighter/paramedics. Out of the entire pool, we ended up hiring a single employee. As a result we'll be sending six EMTs to paramedic school in 2021.

I'm not entirely sure the degree to which COVID has added to this challenge. On the one hand you could imagine potential recruits thinking it's more dangerous to be an EMT or paramedic during the pandemic. On the other hand I think there is increased awareness of the importance of our first responders and frontline healthcare professionals.

Any advice?

My advice for organizations struggling with recruitment or retention would be the same with or without COVID: Pay a living wage with good healthcare benefits. Offer your employees a career path. Build a culture of continuous quality improvement based on justice and respect for people. Don't tolerate bullying. Create good policies and procedures and apply them in a spirit of fairness with the understanding that human decision-making is complicated. The worst thing you can do is reward or excuse employees—especially supervisors—who do not exemplify the organization's values.

Jonathan Washko, Assistant Vice President, Center for Emergency Medical Services, Northwell Health, New York City and Long Island, N.Y. 

How did COVID impact your ability to recruit and retain providers? 

Our successful recruitment and retention ingredients took years to evolve, and it’s all about an intentionally designed culture. Pieces of this include putting our staff’s safety and needs first, building trust, listening for input, course correcting, radical transparency, and neutral communication to staff during a rapidly changing and evolving environment. 

Any advice?

It’s all about your culture.

Juan Cardona, Division Chief of EMS, Coral Springs Fire Department, Fla. 

How did COVID impact your ability to recruit and retain providers? 

Honestly, we did not have much of an impact directly related to COVID. Luckily, we did not lose any providers. However, we have been paying a lot of attention to provider mental health following the loss of a firefighter four years ago and the Parkland school shooting. We established a full-time health and safety officer at a battalion chief level who works closely with a city-appointed trained mental health officer.

Any advice?

Listen to the experts. Learn about these issues and pay attention to the science, following CDC and other guidance from federal, state, and local resources to ensure you are positioning yourself and your agency for the best potential for a bright future.

While experiences vary around the country (and this is not a scientific poll), it seems clear COVID will be with us for some time as we march toward authorization and distribution of an effective and safe vaccine, influencing day-to-day operations including recruitment and retainment. Organizations that create a deliberate culture of caring for their communities, patients, and providers win the battle of recruitment and retention and separate themselves from the pack.   

Brian LaCroix, FACPE, NRP (ret.), is an executive advisor and cofounder of Cambridge Consulting Group (CCG). He serves as EMS coordinator at the Center for Patient Safety and is a retired EMS chief at Allina Health EMS in Minnesota. 


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