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  • Writer's pictureEric Liddle

Why EMT Sign On Bonuses Are Destroying Your Team Culture.

Two professional EMTs standing beside a well-maintained ambulance, ready for emergency response
Royal EMTs Rachel and Grant pose for a photo during their lunch break.

Over the course of the pandemic, it has undoubtedly come to your attention that the people who work in healthcare have faced immense pressure.

Much like our fellow healthcare teams, the team at Royal has been stretched and stressed by the pandemic, by no means escaping the stress. The scene plays out with team members as high as C-level executives donning EMT jackets to fill gaps in shifts as the team rises to meet the moment.

In the backdrop of The Great Resignation, this pressure serves as a reminder to double down on core promises to put team members first, digging deeper into culture, personal growth, and career building programs to attract and retain top talent.

Partnering with Hospitals, Health Systems, Skilled Nursing Facilities and more, Royal Ambulance facilitates nearly 10,000 trips per month across the Bay Area. The team provides critical infrastructure needed to move patients in and out of healthcare facilities throughout the region. Staying one step ahead and leading the creative charge, Royal has chosen to pursue the formation of a culture of growth and opportunity to attract and retain team members.

Finding top talent in the EMS industry is particularly tricky for a number of reasons, special schooling and certification is required, EMS is used as a building block into advanced healthcare roles, and it’s a physically demanding role. Tack on the pressures of the pandemic, with burn out, The Great Resignation, and hospitals ramping up recruitment for their own facilities – the playing field has shrunk considerably.

Now a few stretched organizations begin throwing big sign-on bonuses, and we arrive at the present moment, which is grim. The healthcare industry, especially ground ambulance services, are suffering from an acute staffing crisis.

To translate this to a non-healthcare reader, this means that ambulance companies don’t have enough team members to run calls, which means that patients can not be transported to and from hospitals in a timely manner.

It’s a big deal, and while each EMS operation is slightly different, we all live in a similar world and industry wide staffing shortages mean the same thing to all of us and patients across the nation.

But the challenge isn’t about the weather in the storm, it’s about how you weather the storm. Some EMS organizations have begun offering sign-on bonuses up to $20,000 in a “rob Peter to pay Paul '' battle as they fight to maintain performance with Hospitals.

Contrasting research from Daniel Pink’s book Drive, which indicates motivation, decrease in employee morale and the alienation of current team members, can be directly linked with an improper balance of extrinsic incentives.

The glaring question becomes: Are sign on bonuses a good idea?

And the reality is, they’re not.

In an excerpt from the HR Daily Advisor, “Consider the impact sign-on bonuses have on your current employees. Deep resentment could occur if loyal employees who worked through the crisis become aware you aren’t providing them with the bonuses you’re offering to new hires.”

After all, as a current hardworking team member, how would you feel about a new and unproven hire getting paid more, just for being new. You’d feel under appreciated & under valued… That’s how.

“We have no interest in promoting sign on bonus culture, it’s contrary to everything we’ve worked for and ruins team morale. It makes far more sense to elevate those who are loyal and work hard during their time at Royal” says Eve Grau VP of Human Resources at Royal.

Introducing sign-on bonuses might signal greener pastures for some, but the undercurrent signals a sure fire erosion of team culture that places an immediate and public rub between new and existing employees.

Companies have even tried raffling off cars to attract new talent! We understand efforts like this, and respect creativity and innovation, but it still leaves us scratching our heads; because ultimately you end up with one winner and countless losers… consider that reality for team morale.

Yes, Grau acknowledges, “It’s important to be compensated well for hard work, but non-financial perks make a considerable impact on employee engagement, job satisfaction and promote a healthy team culture.”

Close-up of a cheerful EMT smiling, seated in the back of an ambulance, ready to assist.

Leaders in the EMS industry should be providing team members with a clear path for growth within their organizations, offering tailored opportunities to increase or learn new skills and move into advanced roles. We know that most young healthcare professionals want to make a positive impact. By creating leadership tracks for young members to be successful, we all get to scale.


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