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• Large organization vs. small. Large organizations generally bring
the tradeoff of stable job expectations vs. more rigid, hierarchical
management structure, while smaller organizations may tend to be
more responsive to new ideas but offer less direction. If you like
having the opportunity to create and test new initiatives, to jump in
and volunteer on new projects, and to contribute across multiple
departments, this is often much easier to do in a small organization.

• Local or community-based vs. national. Local or community-based
groups often invest more in being community citizens, but are prone
to mirror the ups and downs of the local economy, whereas national
organizations may have less of a commitment to the community but
are also less damaged by its economic woes. In addition, a national
organization might offer the potential for greater growth opportunity, as
long as you don’t mind relocating.
• Focused on patients, students, customers, clients, or business
colleagues. The nature of the working relationship and the
expectations of those we work for/with shift based on the organizations
we work within; which most appeals to you? If you love working directly
with patients, then you know that this is the setting that will make you
happiest. Love teaching, training, and coaching? Then a learning-
focused career will bring you the greatest reward (there is a strong
need for nurse educators).
Thrive in a business-to-business (B2B) environment? Then working
for a vendor might be ideal. And if you like working collaboratively with
“business colleagues,” that is, in management, HR, or IT roles, then
you’ll want to apply your knowledge of nursing processes and issues to
supporting the internal, strategic goals of the organization.

Now go through the same exercise for the choices below:
Workplace environment. Working environments can bring out our best
abilities to contribute or throw us into a black hole of bad morale. Some of
the options include:
• Structured vs. unstructured. Do you do your best work in a
structured environment, or thrive in its absence? For example, most
hospitals have a strongly structured environment, while a private clinic
or community health center might be less structured.
• Hierarchical vs. flat organization style. This choice is about how
decisions are made. Hierarchical enterprises are primarily top-down,
flat ones are more likely to distribute decision-making responsibilities
(which may impact quality and speed of decisions).

• High accountability/reward vs. more moderate accountability/
reward. The former usually is found in the for-profit world; although it
can be financially lucrative, it can also carry a substantial stress factor.

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10 | Transforming Healthcare Through Education