Jones & Bartlett Learning Health Blog

    Don’t Go Into That House! Helping Students to Avoid Horrific Jobs

    Posted by sharonb on Mar 2, 2015 3:00:11 AM

    2014 Headshot_Short HairAs spring and graduation approach, the focus for many of us in academia is on helping students to prepare for their careers and finding a new job. Two years ago, I blogged about employability. In that post, I took the perspective of the needs of the employer and what they are looking for in candidates. In this post, I will be talking about job searches from the other side of the desk, that of the candidate and how to help your students avoid going into a house of horrors.

    Pre-Gaming the Interview
    Faculty members insist on students doing their homework. In a job search, the rule still applies. Here are some areas where students can find public information in newspapers, online articles, and state and local government websites on indicators of dysfunction in healthcare organizations.

    High leadership turnover, i.e., frequent Changes in Chief Executive Officers (CEOs), Chief Operating Officers (COOs), or Chief Financial Operators (CFOs) can indicate turbulence within an organization. Some changes in leadership can be positive. However, when an organization changes leadership at the top every year or two, there’s a problem. Politics and financial issues are often at the root of this turmoil. Tumultuous leadership means chaos and erratic organizational direction.

    Fraud and abuse scandals, never a good thing, are particularly toxic in healthcare. It is a betrayal of the public trust at a deep level. Those who are fired may not always be the guilty parties. They can be scapegoats for the actual wrong-doers. Going into an organization with this kind of history can be a major risk. Who will be the next victim?

    High staff turnover is reflected in the frequency of job postings and the vacancy rate. If a department is supposed to employ eight people, yet there are only four, there is a problem. Pressure cooker environments, the “Queen Bee Syndrome”, and bullying in the workplace lead to “churning”, i.e., rapid employee turnover. If the same position is posted repeatedly, it may not reflect growth; it may reflect a dearth of good managers.

    High healthcare provider turnover, especially in managed care organizations, is a major indicator of discontent. Physicians, nurse practitioners, nurses, and other healthcare providers are in demand. With a recurrent nursing shortage and a looming physician drought, these expensive employees can be selective. Good healthcare providers need not stay with bad organizations. Follow the leaders to find good places to work. Tell your students to ask healthcare providers about an organization’s reputation before applying.

    High client/patient/enrollee turnover is also an indicator of a poorly managed organization. Fragmented systems that treat patients like numbers will not keep them for long. Patients, like healthcare providers, can choose, and as you will see in the next bullet, lots of information is available at their fingertips.

    Low patient satisfaction scores are frequently associated with low employee and provider satisfaction and a poor response to patient issues and concerns. These scores are a reflection of the organization’s culture. already provides a searchable website for consumers to compare hospitals. Similar websites exist in Centers for Medicare and Medicaid Services (CMS): Nursing Home Compare and Physician Compare. In April, 2015 the Centers for Medicare and Medicaid Services will be launching a five-star rating system in its Compare websites. Using these websites can provide valuable clues on where to apply and where not to apply for a job.

    During the Interview
    If your students do their homework and find all indicators are positive, some trapdoors may still be ahead of them. Tell them to be on the lookout for the following clues.

    Vague responses to questions about previous employees in the position are an indicator of a hasty or discordant departure. Employees who were promoted or left for better positions are usually spoken of in positive terms. If no indications are provided about why someone left the job, the student should proceed with caution.

    Lack of contact with prospective co-workers is unusual in this era of team-driven programs and projects. Most employers utilize group interviews where a candidate meets other team members over lunch or in a conference room setting. A culture of teamwork insists on assessing the goodness of fit of a new team member. If that option is not provided, the applicant should ask for it and observe the interviewer’s response.

    Multiple reporting relationships are common in matrix organizations. However, even in the early 1900’s Taylor spoke against this, calling for a delineation of authority. Clear reporting relationships are critical. While an employee may be “on loan” for a team or task force to another manager, the employee needs to have someone to go to in times of conflict or concern. An employee is not likely to please multiple bosses all of the time.

    Disrespectful interviewers are the exception, rather than the rule—one hopes. However, in my four decades of job interviews, I recall the worst, not the best ones. In the 1980’s, I interviewed at a medical school for a research assistant position. I had a Master’s degree and I was a Registered Nurse. The interviewer glanced at my resume, mulled aloud that he had no idea why I was called in for the interview, told me point blank he “wouldn’t know what to do” with me, smirked and said, “Can you type?” I stared at him and said, “No.” A few months later, I walked back into that same medical school with my team from a major medical publisher to meet with his boss, a physician. The look of dismay on the interviewer’s face was priceless.

    After the Interview
    As professionals, we know what should be done after a job interview, but our students don’t always have that knowledge embedded in their coursework. Be sure to advise them to:

    Write a thank you note, and, if withdrawing their application, provide a polite reason. Say the commute is too far, the job is not a good fit, or a better opportunity came along.

    Do not burn bridges. Healthcare is a large business, but it is a local one. Healthcare managers will see the same people they met on their job searches when they go to association meetings or conferences.

    Desperation, anger, bitterness, and vindictiveness are not attractive qualities in any job candidate. No matter how badly the interview went, or how disrespectful the interviewer was, the student/graduate must rise above the occasion.

    Remember, we were all there once. Support your students and graduates in their job search and remind them they are not required to accept the first job they find. If we have done our jobs, they will be competent, confident, reflective practitioners who will make meaningful contributions to healthy organizations.

    Sharon B. Buchbinder, RN, PhD

    Sharon Buchbinder is Professor and Program Coordinator for the MS in Healthcare Management at Stevenson University in the Graduate and Professional School and former chair of the Association of University Programs in Health Administration (AUPHA). She is also the author of three books from Jones & Bartlett: Introduction to Health Care Management, Cases in Health Care Management, and Career Opportunities in Health Care Management.

    Here are some references if you are interested in this topic:

    Balik B., Conway J., Zipperer L., & Watson J. (2011). Achieving an exceptional patient and family experience of inpatient hospital care. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement. Available on

    Bernabeo, E. & Holmboe, E.S. (2013, February). Analysis & commentary: Patients, providers, and systems need to acquire a specific set of competencies to achieve truly patient-centered care. Health Aff 32(2):2250-258; doi: 10.1377/hlthaff.2012.1120

    Buchbinder, S.B. (2013, May 6). Employability: If you don’t A.S.K, you don’t G.E.T.

    Drexler, P. (2013, March 6). The tyranny of the Queen Bee Syndrome

    Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).

    Kusy, M. & Holloway, E. (2009). Toxic workplace! Managing toxic personalities and their systems of power. San Franciso, CA: Jossey-Bass.

    Office of Minority Health. (2001). National standards for culturally and linguistically appropriate services in health care: Final report. Washington, DC: US Department of Health and Human Services.

    Patterson, K., Grenny, J., McMillan, R. & Switzler, A. (2011). Crucial conversations: Tools for talking when stakes are high. New York, NY: McGraw-Hill.

    Stevens Institute of Technology. (2015). Samuel C. Williams Library. Frederick Winslow Taylor Collection.


    Topics: health administration, Health Administration, health care management, Sharon B. Buchbinder, Sharon Buchbinder Blog

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