Nonsense, Normative or Necessity: The Purpose of Repeating a Modified Internship for Qualified Paramedics to Move between Australian States: Perspective from One State Service

Introduction If a paramedic moves interstate in Australia, they are often required to undertake a local state-specific internship in the state or territory they are moving to. The small differences in roles undertaken between the states and territories are not sufficient to explain this requirement. In order to better understand this expectation, the authors explored the national and organisational cultural factors that could explain its purpose. Methods Semi-structured interviews were conducted with six major stakeholders of an internship, and interpreted using organisational and national-cultural dimensions derived from the work of Hofstede, Waisfisz and Minkov. Results Seven core themes were identified, layered according to the stakeholders that have the greatest influence over the theme, and discussed using the study's interpretive framework (cultural dimensions). These core themes describe the concerns the respondents had about elements of the paramedic internship, including the culture of the internship, attitudes, education, communication, the profession, the organisation, and recruitment and selection. Conclusion The insights gained into the cultural characteristics of the ambulance organisation help us to better understand the need for the internship. From a cultural perspective, paramedics need to be able to balance risk aversion (policy/procedure) with risk taking (unpredictable work demands); structure (militaristic) with independence (autonomy); a hierarchy-based power relationship and a competency-based power relationship and, finally, indulgence (socialisation for organisational acceptance) with restraint (becoming a professional). This balancing of judgement and actions is extremely complex, delicate and organisation-specific, thus explaining the importance for the individual organisation of having a prolonged observation period during which ‘a feel’ for these ‘balances’ can be obtained to ensure that the paramedic ‘fits’ into the specific organisation to become ‘one of us’.