Trapped

In 2013, I wrote a post called Get Another Job.

Here’s how it went:

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.”

***

I received a number of comments on the post at the time, and then this comment came in just yesterday:

“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.

***

Last year, I wrote another post called Moral Injury.

Here’s how that one went:

Check out this powerful You-tube video

When I see another provider who is burned out, my reaction has always been:

“Get another job.  You have no business doing this kind of work.”

Until I saw this video, I never really considered the concept of moral injury.

If a fellow paramedic hurts his back lifting or wrestling with a patient, I would never thing to say, “Get another job.  You don’t belong in this work work anymore.”

Companies take great precautions to make our work physically safe.  There have been great innovations in stretcher design (when I started we used a two man dead lift), stair chairs, safety nets, and driver safety systems.  And while most services have employee assistance programs, I can’t think of any preventative measure routinely taken in EMS to prevent moral burnout.  Long shifts, holdovers, too few cars on the road, 911s holding, order-ins.

Meat in the seat.

There is always a new hiring class to pick up the fallen stethoscopes and take their places on the front lines. 

It is hard to change things overnight.

I am glad there seems to be an awakening ahead.

***

Back to the comments I received yesterday.  Unfortunately, there is some truth to what the commenter says.  While it easy for some people to “get another job” when they burn out or suffer “moral injury,” the nature of EMS, particularly commercial EMS, is such that people get trapped in the job.

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

Many who don’t have a college degree, get into EMS and because of near unlimited overtime, they got locked into a situation where they can’t make a comparable amount in any other line of work.  I have seen young EMTs and paramedics, buy new 4x 4 trucks, get married, have kids, buy houses all while long shifts working 6 days a week, and then they suddenly find they hate their jobs (and in many cases their lives), but they can’t quit because they are overwhelmed with debt.  While I have had the ability to get a second job as an EMS coordinator, due to my education, if I hadn’t, I would find myself now in my sixties unable to physically keep up with the hours I used to work when I was out there six days a week.  As a commercial paramedic, I made over $100,000 a year easily (with overtime) and did so year after year, and this was 10-20 years ago.

While I sympathize with the commenter, I still don’t want him out on the street anymore.  Whether unable to lift due to a broken back or unable to care due to moral injury, you can’t due this job anymore.  As a profession, we need to have healthy responders.  We also need to have a system in place to help those who can no longer work at the standard, physical or mental, that is required, and a system in place to try to try to help people before its too late.

I know one local service used to give its employees financial planning sessions to help them understand things like debt, life insurance and planning for your kid’s college.

Good luck to all out there.  Stay safe and take care of yourselves and your families so you can take care of your patients in the same manner you would want your loved ones to be cared for.

 

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