Developing retention and return strategies for South African advanced life support paramedics: A qualitative study

AbstractIntroductionThere is a growing and dire shortage of advanced life support (ALS) paramedics in South Africa (SA). To further understand this phenomenon, a novel and comprehensive mixed method study was conducted. The study was undertaken in two Phases. In Phase One, the aim was to identify factors that influenced the migration and intended migration of ALS paramedics from SA. The aim of Phase Two was to provide, through consensus agreement, an expanded description of those factors, within the context of organisational policies and profession-guided beliefs. The findings of Phase One, published already, and Phase Two, presented in this study, were integrated to obtain an in-depth understanding of SA ALS paramedic migration. This understanding resulted in the development of steering principles, for a framework of strategies on how to retain or encourage the return of SA ALS paramedics. This article presents these steering principles, as well as the findings from Phase Two of the study.MethodsALS paramedics who qualified between 2001 and 2006 made up the study population. In Phase Two, purposive sampling was used to choose a subsample of the study population. In-depth interviews were conducted with this subsample; data were recorded, transcribed verbatim, and analysed thematically using qualitative research techniques.Results and discussionFindings suggest that the success of retention and return strategies depends on the degree of collaborative stewardship that must exist between the SA National and Provincial Department of Health, the Emergency Medical Service/s (EMS) statutory governing body, training institutions, and private and public EMS providers. In addition, the constructs of return and retention strategies have to extend as far as revising both acceptance criteria and candidate recruitment policies. Furthermore, while particular attention must be placed on improving working conditions, security, and remuneration of ALS paramedics, return and retention strategies have to be continuously monitored, and updated