Out of the Silo: A Qualitative Study of Paramedic Transition to a Specialist Role in Community Paramedicine

Abstract

Community paramedicine is an evolving specialist stream of paramedic practice comprising two dominant service delivery models; those aligned with an Extended Care Paramedic (ECP)-type model and those aligned with a Community Paramedic (CP)-type model. The underlying philosophy of community paramedicine is to provide patients in the community with options to navigate more efficiently the healthcare system and avoid unnecessary presentations to a hospital emergency department. Community paramedicine contrasts with 'traditional' paramedic practice by targeting non-urgent patients who may benefit from an expanded scope of practice in both scheduled and unscheduled out-of-hospital care. However, little is known about the process of transition of paramedics from a work role in traditional paramedicine to a specialist work role in community paramedicine. To date, specialist work role transitions in paramedicine have been largely neglected in the literature. This study aims to illuminate how qualified paramedics can transition to a specialist role in community paramedicine. The study recruited ECPs (n=25) from two Australian jurisdictions and CPs (n=11) from a Canadian provincial health service, in a qualitative study exploring their experiences of transition. The data from the three study sites were pooled and interpreted using constructivist grounded theory methodology, as informed by Charmaz (2014). The analysis revealed transition to a work role in community paramedicine involved four phases. The first phase represented a junctional point in a paramedic’s clinical career trajectory in which the decision to enter a community paramedicine pathway was made. Three 'active' phases of transition followed in which participants engaged formally in the transition process. Additionally, four core categories of transition were interwoven through each active phase of transition; Engaging in a Community of Practice, Adjusting to Organisational and Cultural Change, Developing Critical Thinking and, Mastering Skills. The evolution of each of the four core categories contributed 'ancillary markers' of transition, that coalesced to define the end-point of transition: Adequate proficiency in the work role. The significance of this PhD research is demonstrated by positioning the study beyond the practical transferability of extant work role transition theories. Certainly elements of leading work role transition theories in paramedicine (Devenish, Clark, & Fleming, 2016; McFarlane, 2010), nursing (Barnes, 2014; Benner, 1984; Boychuk Duchscher, 2009) and generic organisational literature (Nicholson, 1984), resonates with the current study. For instance, experiencing negative emotions early in the transition experience was a common finding across the literature. However, no existing theory of work role transition can illuminate adequately the complex interplay between the elements, core categories and phases that comprise the community paramedicine transition experience. This PhD study makes a significant contribution to the understanding of how paramedics transition to a specialist work role in community paramedicine. The unique knowledge generated by this study allows for additional targeted intervention points for paramedics to navigate more efficiently the transition experience. Ultimately, the precision gained in understanding the relationships between the various elements of transition within a conceptual and temporal framework, may decrease the time frame to deploy high-quality, ready-to-work paramedics in the community.