Get Another Job

We were dropping off a regular patient at one of the hospitals the other day. A chronic PCP user. The “crusty” old nurse in the psych ward threw a fit complaining that she had just dealt with him two nights before. The fit was not good-natured banter, but clearly a I’m being imposed upon and you are a piece of shit fit. I felt like saying to her you are either (despite your age) brand new or you have been here too long. Burn out is an occupational hazard, which I have found infects either the relatively new or those whose lives outside of work have grown unpleasant. I will give everyone a period to outlast their burnout, but then you need to find another job or take time off to fix your own life Repeat patients are the territory in emergency medicine. No one likes working with miserable people. I’ll accept burnout a little more in EMS than in nursing because it seems to me nurses have more options to seek employment than EMS. Tired of the urban ER, go work in a Dr.s office or a walk-in clinic in a suburb or take a 9-5 job in endoscopy. To newer EMS burnouts, whose burnout has lasted longer than 3 months, get out now and find something that makes you less miserable because you don’t get a pass forever.

I am sitting in my ambulance outside a McDonald’s right now (using their free wi-fi). I am watching one of their employees, quite possibly even their manager, walking around the outside of the building, picking up every stray scrap of paper on the ground he can find. He has a broom and dustpan. When he is done, he will get a hose and wash the sidewalks down. He does this every morning. You can’t find a cigarette butt in his parking lot. This man has a good work ethic. I am the only one watching him, but he is performing like he is before a sellout audience in Carnegie Hall.

Who you work with is important not only to your health but the health of your organization. I have been doing this over twenty years and can say that burnout is not an isolated problem. It is an infectious contagion. At times I have seen in EMS and in EDs burnout become almost a badge of honor, as if being burnout makes you an official member of the tribe. When I first started I thought the crusty old burned out triage nurse was a great character. Some I liked to think had hearts of gold, others clearly were just plain mean. One nurse would punch everyone having chest pain, if they groaned, she put them in the waiting room. You can’t have musculoskeletal pain and a real medical problem at the same time, she seemed to think.

Recently, I heard a triage nurse chastise a patient for wasting the system’s resources. The nurse was quite nasty and aggressive about it. It took me aback because it had been years since I had heard something like that where years ago it was much more common place. I almost said to the nurse, you could get fired for talking like that to someone. EMS used to talk like that all the time. I even talked like that a few times many years ago, but I don’t do it anymore, and it is rare in my organization. There is something positive to be said for manners and correctness.

I go into many hospitals and they all have their own vibe, the same I think is true of ambulance services. A paramedic from one service recently was fired from his part-time job at another service. The reason was attitude. Doing what was permissible and part of the culture at one service was clearly not at the other service. To which I say, bravo.

If you are miserable and hate our patients, I don’t want you working with me. My best partners have always been the most pleasant people. If I have a partner who bitches all day, i find myself bitching as well and go home feeling miserable.

I wonder what the guy here at McDonald’s thinks as he sweeps up the cigarette butts. Is he thinking “f-ing slobs. I hate these f-ing people.” Or is he is thinking, “My sidewalk is glistening, the sky is blue, today is going to be a good day.”


  • Jon LeRoy says:

    First time replying to a post, but from a frequent reader: thanks for echoing my sentiments exactly. I’ve been in EMS 15 years and tell colleagues this frequently: you’ve chosen to take care of the sick and injured. If you can’t stand people who are having a bad day, choose a different career path.

  • Nathan says:

    I’m echoing Jon LeRoy here. Thank you for this article, and I hope everyone in EMS reads it. I was fortunate in that my EMT-B class was very open about the fact that most of our work is non-emergency and not to have expectations of saving lives every day and I think that is part of why I love my job so much. Now, many years later as a paramedic, I don’t ever feel like I was duped. And, having come to this career later in life and after several other careers including retail and corporate, I can honestly say that this is the BEST job in the world. Folks who complain about it are either simply not cut out for it, or simply don’t know any better and should go find out.

  • paul says:

    Well written. I was blessed to have two jobs in my life that I loved,being a Paramedic was one of those jobs. That being said, there are times when the stress of the streets can become overwhelming. The many hours of sitting in an ambulance, the low pay, the family stresses all can make people unhappy. I have found times in the past that good medic bad medic does work but all patients, no matter how many times we see them should be treated with respect and kindness. I was injured and taken out of commission in 2008, but I will always remember my time as a paramedic, I know that I treated people well and always attempted to give them 100%, no matter what the complaint or how many times I had dealt with them in the past.

  • elliott says:

    Great post! Required reading for all EMT’s (and nurses, too).

  • Stephen RB says:

    I always remember two adages given to me by two excellent training officers I was fortunate to be under:

    1) You choose this job and to care for patients regardless of what situation. The patient on the other hand does not have the fortune of choosing you.

    2) We are all gods creatures / we are all human beings (for the non religeous.

    I try to stick to that each day in my career. These patients do not choose me as a responder, but they would choose to be treated with decency and respect. Even the most trying and challenging patient can provide the best rewards when you make a breakthrough in communicating with them.

  • Tami says:

    Just last week we transported a patient past the closet hospital (she was very stable) to go to her preferred hospital. Upon arriving at the patient’s chosen ED the triage nurse says, “She WANTED to come HERE?!” while in the presence of the patient. I replied that this was her preferred hospital (although I don’t know why after this!!). He gruffed about ‘finding her a bed”…they are a small ED and only have 8 beds.

    I did not want to transport this lady all the way across the county – I would have rather transported to the ED which is 15 minutes from my station – but this patient’s choice was a 40 minute trip to the ED then back to my station. BUT I did it with a smile, with empathy for her feelings, and with the pleasure of working in this field. And yes, I’ve been a paramedic for 25 years this year.

    I do not tolerate coworkers treating patient’s badly, nor do I tolerate receiving hospitals doing the same….I agree, get out if your burned out and get out NOW while I might still have a shred of respect for you.

  • Fox says:

    Being an EMS provider who now spends way too much time on the other side from an injury and chronic illness I hated working with people with bad attitudes and as a pt I REALLY hate getting treated like crap by providers with bad attitudes. I don’t want to be in your ambulance or ER again, but I’m sorry that my blood pressure is 240/170 again. I guarantee you I’m having a worse day than you did having to deal with the “chronic PCP user” again. I’ve dealt with long shifts, system abusers, devastating losses, amazing saves, crummy co-workers and an amazing EMS family. I miss it like nothing else and would give everything to be sitting in an ambulance than to be sitting in a wheelchair, or on a bad day on your hospital cot. If you don’t feel the same, get out and find something that does make you love life. EMS is not just a paycheck. A few wks ago I was sick and not wanting to use EMS or ER got an appt at my Dr office. He immediately called EMS and I was transported less than 1/2 mi to the ER. The paramedic who cared for me could have been rude, inpatient and ticked off about having to do this. Instead he had a great attitude, got me to laugh about hwo ridiculous I thought it was, and reassured me that although close he didn’t want to be driving next to someone that ill either and he was happy to do it. I know that call was not the most exciting life saving, chest pumping trauma arrest save… but in a bad day his attitude made mine just a bit easier to deal with. Sorry I know that was long, but I hope my experience will help you understand a bit better.

  • Sue says:

    Love this. A good reminder as I make my way in to work today. I always try to maintain a good attitude and stay away from those with bad ones as they bring me down. Also, if I ever AM crabby give me food…hunger is generally the reason!

  • CS says:

    Well said.

  • I wholeheartedly agree, the attitude of a manager can completely affect the entire health of the organization and everyone under him. I’ve been in both situations with a not-so-great manager and I’ve also had the pleasure of working for a really awesome one, both in retail. Everyone becomes motivated and excited to work when the awesome manager is working alongside everyone else. I find that burnout is the cause in a lot of no-so-great managers. Then there’s those that are just on a power trip and act like that all the time.

  • damellman says:

    This is bullshit. Where I’m from paramedic don’t get paid enough to live on their own at the cost of living. That’s why all the firefighter paramedic wannabes who can’t get a career for whatever reason goes into nursing. Well I say screw that cuz I’m not gonna waste my time trying to take out loans with bad credit ( that’s not my fault) paying a high interest rate for the rest of my life. …. I’m gonna try to do something entry level or warehouse related cuz it pays bout the same if not more and I don’t have to worry about spending money and taking tests maintaining the stupid certifications. Don’t get me wrong I love be a Paramedic. but I can’t survive alone where I am with this job . Money effects everything. Your driving record your health , yur social status, your credit and your job applicability and ect. Ect…. ( license suspended cuz I couldn’t pay the insurance between job’s I …haha) …OVERALL if I had any advice for anyone. . Unless they know someone who will offer a high paying medic job .. Don’t waste your time ….plz… I’m a Paramedic and I’m homeless right now. Hahaha. …… figure that one out!

  • Michael Corley says:

    I am in that spot. Have done rural, metro, been a combat medic in Iraq, flight, and was an ER tech for years. My compassion for the patient has never changed, and treat everyone on that stretcherr like family. My gripe is the management. Medial benefits and pay at best, unthankful, and demeaning. Supervisors try to get out of every call they can, and are as burned out as we are. Promoting people based on ethnicity or gender and not capability. I am so close to done I could scream. I know I care, but the service doesn’t, lax protocols, no education, and no community involvement. Will soon be in factories or retail, cause this is not worth it.

  • Anonymous says:

    21 yrs of both the majority of my time in the private realm and 8.5 of those yrs on a big city fire department,I can honestly say I am burned out or just plain tired an need a change. This is all I’ve ever done since I was 20 years old. Now I find myself needing a change.Its a rewarding job but after my spinal surgery I just had I think it may be time to say bye bye to the behind bus! Let the youngsters have their fun now!

  • Pissed off Medic says:

    “tHiS is WhAT yOU sIgnED uP FOr”
    That’s bullshit. I didn’t sign up for nurses and doctors treatment me like I’m a human taxi, or incompetent. I didn’t sign up for dispatcher stacking calls on me and running me into the dirt so company X can have a little more change in their pocket, and grandma Betty can get a ride home. I didn’t sign up for “open door policies,” that become “sorry don’t care not my problem, just deal with it”. And those of you saying “IF yOU dON’t LiKe YOur jOB fInd aNotHeR”, it’s not that simple. Especially when you don’t live in a large metropolitan area. No one wants to hire paramedics. You get trapped doing this because of the money you make with OT, and can’t possibly afford to leave the income behind for anything else. Not to mention, the burnout makes it difficult to deal with paper pusher “emergencies” after experimenting legitimate ones. Simply put, fuck you guys, and fuck ems for making us sacrifice our physical, mental, and emotional wellbeing for the sake of a job. No one else would do it for us if the shoe were on the other foot.

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