Paramedics face daily challenges in their profession. Shiftwork, physical workload, and dealing with life-and-death situations are often exceedingly stressful. Paramedics must cope with traumatic and morally challenging situations while making fast decisions that have significant outcomes for patients. The London Ambulance Service, for example, responds to thousands of calls for service each day. Many are routine and not life-threatening, but more serious situations occur regularly.
Meaning and purpose are essential for nearly all occupations. This is perhaps especially true for paramedics. Responding to emergencies and saving lives is intrinsically rewarding.
However, the daily grind of seeing others in dire need of help, combined with the organizational stress inherent in such occupations, may erode the idealistic core values that motivated joining the ambulance service in the first place. All too often, paramedics experience job burnout that may in turn lead to poor job performance, a cynical attitude, or leaving the ambulance service altogether.
An Empirical Study of Moral Values Among Paramedics
Understanding the role of meaning and purpose in such in extremis occupations may prove useful in recruiting and retaining skilled paramedics. London Ambulance Service training officer and paramedic Nicholas Kilpatrick recently completed his Master’s degree research project, which addressed the question of the role of meaning and purpose among London Ambulance Service front-line personnel.[1] These are the service members responsible for responding to over two million emergencies in London each year. Ranging from minor health issues that may be handled virtually to life-and-death situations, paramedics shoulder a tremendous and stressful daily workload.
Kilpatrick surveyed and interviewed 22 front-line ambulance service personnel. His study focused on how beliefs, personal meaning, and a sense of purpose help paramedics deal with the uncertainty, challenges, and hardship inherent in the job. His specific objectives included identifying, describing, and understanding the spiritual, philosophical, and human values that lead paramedics to enter and remain in the profession; to identify rituals or practices that paramedics use to prepare and recover from their shift; and to explore what factors enhance and detract from meaning and purpose in their jobs.
To address his research question, Kilpatrick posed 12 open-ended questions that probed respondents on their perceptions of meaning and purpose related to their occupation and how meaning and purpose aided them in navigating the demands and stresses of the job. He also asked each respondent to rate how much each of the 24 character strengths first described by Peterson and Seligman (2004) increased or decreased as a result of their paramedic experiences.[2]
The open-ended questions yielded 278 comments. A content analysis coded these responses into 249 first-order and 35 second-order codes. This analysis showed that for paramedics, meaning and purpose were facilitated by a sense of connection, active coping strategies, personal agency, growth orientation, a focus on service and charity, and a clear sense of identity. In contrast, challenges to meaning and purpose centered around moral injury—a common experience among paramedics.
To assess what core values are essential to serve effectively as a paramedic, the open-ended responses were coded into a word cloud. The most frequently mentioned core values were integrity, benevolence, kindness, teamwork, honesty, loyalty, and empathy. These core values map closely onto the moral virtues and supporting character strengths postulated by Peterson and Seligman.
Kilpatrick also explored the impact of working as a front-line paramedic on perceived changes among the 24 character strengths postulated by Peterson and Seligman to be universal among humans. To assess this, respondents rated how much each of these 24 character strengths increased or decreased because of their work as a paramedic. A 7-point scale was used, with -3 indicating a substantial decrease in that strength and +3 a substantial increase. A rating of 0 indicated no change in a particular character strength.
Respondents rated personal growth in five character strengths that they associated with their work. These were leadership, perspective, social intelligence, teamwork, and bravery. Five strengths showed negligible growth: hope or optimism, capacity to love, zest, forgiveness, and kindness. Of the 24 strengths assessed, hope or optimism received the lowest ratings on this scale.
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For Paramedics, Meaning and Purpose Matter
The results of this study show that meaning and purpose are of central importance to paramedics. Those who choose this career are motivated to do so, at least in part, by a desire to help others and make their community a better place.
At the same time, the realities of a paramedic’s job may threaten these core values. Paramedics witness severe injury, illness, and death daily. All too often, they respond to medical emergencies that are—in no small measure—brought about by careless behavior. Injuries and illnesses associated with chronic drug and alcohol use represent a sizeable portion of their workload. Combined with the stresses of shiftwork and a high volume of calls for service, it is easy for paramedics to question the value, meaning, and importance of their work.
In effect, Kilpatrick’s findings suggest a tension between a paramedic’s need for meaning and purpose and the threat of job-related moral injury. Successful paramedics must temper the idealism with which they enter the profession with the realities of day-to-day work. This requires a sense of perspective that may be difficult to maintain in the midst of their job demands.
Leader Actions May Promote and Reinforce Core Values
This speaks to the importance of leadership and management in the ambulance service in understanding the need to maintain meaning and purpose among front-line personnel. Leaders should take action to promote and sustain the core values of paramedics. Leaders are especially key to helping paramedics contextualize their experiences, to place them in a larger and more positive perspective, and to frame even the most daunting of experiences in a manner that reinforces rather than challenges their core values.
Finally, this study has important implications for the recruitment, training, and retention of front-line ambulance workers. Recruiting efforts should be framed to emphasize how personally rewarding the job may be. Training should include character education and strategies to find meaning and purpose in the profession. Doing so may reduce job burnout and enable the organization to better retain experienced, competent paramedics.
Note: The views expressed herein are those of the author and do not reflect the position of the United States Military Academy, the Department of the Army, or the Department of Defense.