• Safety often feels secondary; low-cost vendor contracts affect workflow, documentation, and support.
• Management is disconnected and rarely engages with NPs directly.
• Surveys feel performative; meaningful change is minimal.
• Heavy workload with clunky documentation; allotted charting time often lost to meetings or travel.
• Pay inequity: new hires start significantly higher while existing staff get minimal raises (~1%).
• Work-life balance is advertised but not reflected; mental and physical exhaustion is common.
• High turnover; few clinicians stay beyond three years due to burnout.
• Culture leans on fear-based management: unrealistic metrics (85%+ completion efficiency) and small errors (expired or incorrect labs) can trigger performance improvement plans.