It is an extremely political environment and promotions are granted because of politics, not based on performance, expertise, or ability. Some people in leadership positions (Director and above) are only marginally competent.
Benefits are horrible. You can find some cheap options, but the frustration level when you actually try to use those benefits is enormous. Prepare to spend hours on the phone with HR and the insurance companies just trying to get them to cover what they said they would cover or fix a mistake they made. It's almost enough aggravation to drive you mad!! Benefits have been cut over the past year and more cuts are coming.
Management puts a "spin" on everything. They have hired more communications people to help with marketing to different audiences, including internal. However, if you read a story they wrote about your department or how great the organization is to employees, you would be shocked and not even recognize the place they are describing! It is amazing how selective they are in listening. They only hear what they want to hear, and you'd better only speak up if you agree. Otherwise, keep your mouth shut and you might just be able to keep your job for a littel while longer. Asking for honest feedback is a ploy, and they will retaliate if you speak up.
Management is not consistent in how they treat employees or problems, and speaking up can cost you. There are pockets of good management, and if you are fortunate enough to work in those areas, you will really enjoy your work and benefit from the leadership and mentoring you will receive. However, the environment created and tolerated by the senior leadership usually drives those good managers away eventually, which is disheartening to those hoping for positive change.
Unless you are a nurse, expect your pay to be less than competitive. Perhaps they are counting on the mission to attract and keep you there. If you ask for a raise, you may be lumped into a category of someone who is "driven by money" and that is seen as negative and will hamper any advancement you were hoping for. Even HR leaders speak negatively of those who try to negotiate, provide a counter offer, or otherwise don't accept what you are given or told to do.
Processes are bureacratic and cumbersome. You have to jump through too many hoops to get things done. Too many approvals are required, don't expect to be able to think for yourself or make your own decisions. You will be stripped of any professional judgment that you bring to the job.
If you are not in management, communication is poor regarding changes. We are VERY title-conscious, so if you don't RANK, you will not receive much respect or communication.