On the road to recovery – Graduates

Oct 06, 2022

On the road to recovery

How Alejandro Moreno and Nightingale Nurses are helping fill gaps in America’s healthcare system

Subject: Alex Moreno (MBA 1988)

Topics: Health-Healthcare and TreatmentHuman Resources-Selection and StaffingLeadership-Managing Change

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Photo by Andrea Sarcos

Alexandre Moreno (MBA 1988) knew little about travel nursing when he chanced upon a fellow entrepreneur at a child’s birthday party in 2003. The man was planning to start a new business providing staffing assistance to hospitals in the country. Moreno, who had bought his first company while still at HBS and had recently sold his investments, was intrigued by the opportunity. Travel nursing had its beginnings in the 1980s, and its biggest player had recently gone public, revealing a wealth of data on the sector. “To me, it looked like an industry that was going to grow and prosper,” Moreno recalls.

He was right, but Moreno, who went on to become co-owner and CEO of Nightingale Nurses, couldn’t have predicted the dramatic ups and downs of the industry, from the 2008 economic crisis to the passage of the Care Act. (ACA), in 2010, to the ongoing pandemic. He also did not fully understand the impact his business could have on individuals. “We get letters from patients – I got one about a year ago from a patient who is eternally grateful,” he says. “This was a heartwarming letter from a patient who was treated very specially by our nurse.”

But there was a steep learning curve. When Nightingale Nurses got its start, Moreno’s partners only had staffing experience in areas such as IT and clerical staff, and Moreno had run businesses in areas such as engineering and environmental tests. But none of them had experience in the health field. “If you’re a computer programmer, people’s lives don’t depend on your job,” says Moreno. “It’s very different for nurses.

The traveling nursing industry also had different regulatory challenges and significantly higher expenses than other recruitment businesses. But the team weathered the first five years and withstood the recession, when high unemployment rates reduced demand for traveling nurses to meet the short-term staffing needs of hospitals nationwide. “I call that part ‘hanging off the cliff,'” notes Moreno.

With the implementation of the ACA in the early 2010s, however, Nightingale Nursing – and indeed the entire travel nursing industry – entered a growth phase as newly insured people sought health care and the demand for nurses was increasing. During this time, many of Nightingale’s competitors sold out to private equity firms. But Moreno took the opposite view; he was in it for the long haul. In 2022, he bought out the last of his associates and became the sole owner of a company that today employs around 1,000 traveling nurses.

For Moreno, Nightingale Nurses is a business that can achieve positive goals for patients and nurses. In fact, “doing good” is the company’s motto. “That’s what we tell our nurses and staff, and that’s the real purpose of the company,” he says.

More than two years into a pandemic, this simple mission can be a difficult task. “Our nurses have had a tremendous impact on the upkeep of hospitals and the operation of other health care facilities. If itinerant nursing hadn’t existed, I can’t even imagine what would have happened during the pandemic,” observes Moreno. “Literally, some hospitals would have been understaffed and they would not have been able to care for patients.” And with this increased demand comes increased pressure on traveling nurses themselves. “They work very long hours. They are far from home. It’s just a tough place for them, that’s why they burn out.

Still, Moreno sees better days ahead of him. The pandemic has shone a light on the importance of nurses in the health care sector, and the high demand for their skills has given nurses greater bargaining power to negotiate higher wages and better working conditions. Before the pandemic, Nightingale Nurses charged about $85 an hour for its nurses (about 75% goes to the nurse, about 25% to the company). Today the average is around $160 per hour. “I think the industry has been permanently transformed,” says Moreno, a boon to nurses and the patients who depend on them.

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