Exploration and implications of the long work patterns in the UK National Health Service (NHS): an emergency health perspective

This paper explores the implications of extreme work in the emergency ambulance service in the UK NHS. The current discourse on ‘extreme work’ provides an interesting facet to understand organisational workings in a wide range of settings. This is of particular interest to the emergency services which traditionally involve working in extreme situations, often long hours, in emotionally challenging circumstances dealing with various exigencies often involving threat to life. Based on an ethnographic study in England, the paper examines the ‘extreme-normal’ contrast by exploring the expectations of the ambulance workers as ‘adrenaline junkies’ versus ‘district nurses’. Meaningful insights are provided about the nature of the work by the ambulance personnel in highlighting cultural and management differences from being seen as an emergency service, driven by fast response as against the wider public expectation of a professional, clinically trained healthcare service. The paper further analyses the nature of the ambulance work, the various drivers for long work, the coping behaviour of the ambulance staff and the resultant consequences of such extreme work patterns for the organisation, individuals and society in general. Based upon study findings, the paper identifies the historical and cultural factors grounded in the professional identities of institutional actors in providing explanations about these seemingly contradictory positions. The paper provides future research avenues.