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J Oncol Pract. 2007 November; 3(6): 310–311.
PMCID: PMC2793771

Screening New Hires? Identifying Potentially Disruptive Players

How would you like to work with this person: A staff member's been given an order for some laboratory work, but the physician's directions confuse her. So, within earshot of other staff members and in the presence of a patient, she snaps: “What is this doctor, an idiot?”

This might sound like a line from the sitcom Scrubs, but it's actually taken from a medical review on the Internet, written by the very patient who heard it—and whose complaint is known to anyone who logs on the site and reads the commentary. In today's web-venting world, an ill-tempered or unstable employee is no longer just a vexation to coworkers, but a threat to office reputation—at the touch of only a few keystrokes.

In an era of workforce shortages in nursing and other areas of health care, toxic employees, as they now often are called, seem to be showing up in greater numbers in health care settings. There are also more common-law torts than ever before, curbing the capacity of employers to monitor employee behavior.

What to do—don't hire these problematic people in the first place. That's the solution, according to experts in human resources and organizational behavior. Or, as an article on the topic that appeared last year in American Medical News, put it: “Cull them out in the hiring stage.”1 Of course, that is easier said than done.

There are ways to make sure that, in the quest to clinch good employees, potentially disruptive players can be sifted out. “Have the individual meet with a variety of team members across the system to ensure that the perception of others is taken into account,” advises Susan Pilatzke, RN, BScN, MPH, who is director of Clinical Oncology Systems Regional Cancer Care for the Thunder Bay Regional Health Sciences Centre in Ontario, Canada. “Check references diligently and look for frequent moves,” she adds. Other items on her must-do list include making sure a probationary evaluation, specifically regarding clinical work performance, is in place and that the ability to work well in a team is part of that assessment.

One other important aspect of hiring is to provide a truthful job description, one that is “upfront about the real practice challenges and workload,” she states. In fact, Pilatzke's cautionary note on this point is one that is cropping up in the medical literature, as well. Disillusionment has been linked to early hostile behavior, and such noxious employees can prove emotionally infectious to others. As an interview-based study in Health Care Management Review pointed out, there is “emerging evidence of negative effects on employees” amid sudden change, and bullying in the workplace is one of them.2

David Fox, PhD, a clinical psychologist who practices in the Los Angeles, California, area points out most people are relatively clueless when it comes to their own irksome behavior, or, rather, unaware about the degree to which it impacts other people. This is particularly true in situations in which the offender is surrounded by subordinates, who may be loathe to register any criticism. That predisposes full-blown “OPD,” he said, or as he calls it “obnoxious personality disorder.”

There is no sure-fire cure for OPD, he adds, but modeling “good behavior,” particularly if it is done by someone in a leadership role, can help reduce the incidence and expression of OPD in others.

The nature of a job in patient care—the need for sensitivity, the demand for intimacy—is stressful, Fox says. However, in both his professional and personal experience, he has found that most medical staff manage the pressure. As an example, he cited many of those who helped care for his mother during a hospitalization before her death; almost all showed remarkable compassion, even orderlies who had only passing contact with her, he says.

How can you determine if a job candidate possesses such qualities? Fox suggests that the job description itself should include some of the desired characteristics, such as empathy, so that these personality attributes can be explored during reference checks and in the interview process.

Recommendations may not be very revealing because some past employers fear legal retaliation for negative responses. But asking job candidates directly for examples of coping ability probably isn't the best approach, either—inviting personal disclosures may be construed as prying, affirms Andrew Penn, senior staff attorney at the Bazelon Center for Mental Health Law in Washington, DC.

What if a candidate attributes his or her coping skills to years spent dealing with a mental illness? Or says that disability fostered personal growth and compassion? Passing over this applicant might prompt the job seeker to conclude that revealing a mental health condition cost him or her the job, a situation that could prompt a charge of discrimination.

One possible way to get at least a little insight into the personality of a job applicant—without the risk of crossing an ethical or legal line—is to provide a few hypothetical work situations, then ask the candidate to describe how such situations might best be addressed, he suggested. In addition, a brief summary of the office's antidiscrimination policy can be given to anyone interested in a position. By making this a standard part of the application process, every possible employee will have an opportunity to read the stated values of the workplace, he adds.

“I think it also helps to explain the rationale for the prohibition on pre-employment inquiries,” Penn says. Historically, many employment applications and interviews asked questions about an applicant's physical or mental condition, and this information was used to exclude applicants with disabilities before their ability to perform the job was even evaluated. The Americans with Disabilities Act seeks to stem this discriminatory practice by prohibiting employers from asking disability-related questions until after making a conditional offer of employment to the applicant.

The law also asks employers to make reasonable accommodations for personal beliefs, such as those expressed in religious practice or written expression. But, to take a couple of examples from clinical practice by some wish-to-be-anonymous members of the medical profession: What about the phlebotomist who thinks she should be able to place a poster extolling her religion above the counter where she draws blood? Or the clerical worker who applies for a receptionist job while sporting a beret, explaining—I wear hats all the time. I don't like to style my hair. I just want to get up and go!

The First Amendment only goes so far, according to Robert D. Miller and Rebecca Hutton, both lawyers at the University of Wisconsin Hospital and Clinics, Madison, Wisconsin. “Employee grievances that are not matters of public concern are not protected. This right (first amendment protection) does not extend to employees of private employers,” they advise in a discussion titled “Discipline and Dismissal,” which appears as part of a larger text on staff relations.3

They cite the example of a nurse who was fired for reporting work-related incidents to a local newspaper. “She would not be entitled to any more protection than other at-will employees of private employers,” they note. In contrast, 5 years ago in California, a jury awarded nearly $50,000 to a probationary nurse who was fired by a health clinic after she refused to dispense the morning-after pill, by claiming it was against her religion to do so.4

What about the beret-wearing receptionist? Can she be told to go hatless? Only if a dress code has been in place barring such attire. Besides, she might have great people skills, which could compensate for a few raised eyebrows. That seems to be one message arising from a recent look at job candidacy and its new age complications, which was published this year in the Harvard Business Review.

In a case study on a fictional dream applicant with a solid-gold resume, experts were asked to weigh in on a possibly troubling finding that turned up during her consideration for hire: her blog, which was detected during an internet search of her name and where she advocated a social activism that could relate to the very area in which she was being considered for employment.5

Four different authorities offered varying viewpoints on the socially conscious candidate “Mimi,” and no one seemed to offer a similar take. One proclaimed Mimi a “digital native” and warned that “hiring standards have to change or you just won't be able to hire great people.” Another confessed he just didn't find Mimi all that impressive, and so why not take a pass?

An artist's rendering of Mimi in the magazine shows a suit-clad, high-heel-wearing young woman meeting her prospective new boss. There is no beret plopped on her bobbed hair nor new-age icon pinned to her lapel. She is shown, however, clutching the one accessory that can drive supervisors as nutty as a mad hatter: the omnipresent cell phone, which now apparently is so de rigueur it's practically portrayed as a piece of jewelry—even in an illustration of a job interview.


1. Vogt K: Handling the toxic employee: How to avoid – or dilute – the poison. American Medical News: 24-31, 2006
2. Hutchinson M, Vickers MH, Jackson D, et al: I'm gonna do what I wanna do: Organizational change as a legitimized vehicle for bullies. Health Care Management Review 30:331-336, 2005. [PubMed]
3. Miller RD, Hutton RC: Problems in Health Care Law, ed 8. Gaithersburg, MD, Aspen Publications, 2000
4. Pollitt K: Special Rights for the Godly? The Nation, June 24, 2002
5. Coutu D: We Googled you. Harvard Business Review: 37-47, June, 2007

Articles from Journal of Oncology Practice are provided here courtesy of American Society of Clinical Oncology