Photo by Andrea Sarcos

Alejandro Moreno (MBA 1988) didn’t know much about travel nursing when he met a fellow entrepreneur by chance at a child’s birthday party in 2003. The man was considering starting a new business providing staffing assistance to hospitals around the country. Moreno, who had purchased his first company while still at HBS and had recently sold his investments, was intrigued by the opportunity. Travel nursing had gotten its start in the 1980s, and its biggest player had recently gone public, revealing a wealth of data about the sector. “To me, it looked like an industry that was going to grow and prosper,” Moreno recalls.

He was right, but Moreno, who became part owner and CEO of Nightingale Nurses, could not have predicted the dramatic ups and downs of the industry, from the 2008 economic crisis to the passage of the Affordable Care Act (ACA), in 2010, to the ongoing pandemic. Nor did he fully understand the impact his business could have on individuals. “We get letters from patients—I received one about a year ago from a patient who is eternally grateful,” he says. “It 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 had staffing experience only in areas like IT and office personnel, and Moreno had led companies in sectors such as engineering and environmental testing. But none of them had a background in health care. “If you are an IT programmer, people’s lives don’t depend on your work,” Moreno says. “It’s very different for nurses.”

The travel-nursing sector also had different regulatory challenges and significantly greater expenses than did other staffing businesses. But the team made it through the first five years and weathered the recession, when high unemployment rates lessened the demand for traveling nurses to answer the short-term staffing needs of hospitals around the country. “I call that part ‘hanging off the cliff,’” Moreno notes.

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

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

More than two years into a pandemic, that straightforward mission can be a tall order. “Our nurses have had a humongous impact on maintaining hospitals and keeping other health care facilities operating. If travel nursing had not existed, I can’t even imagine what would’ve happened in the pandemic,” Moreno observes. “Literally, certain hospitals would have run out of staff, and they would not have been able to take care of the patients.” And with that increased demand comes increased pressure on traveling nurses themselves. “They’re working very long hours. They’re away from home. It’s just a tough place for them to be, which is why they’re burning out.”

Yet Moreno sees brighter days ahead. The pandemic has put a spotlight on the importance of nurses within the health care sector, and the high demand for their skills has given nurses greater bargaining power to negotiate higher salaries and better working conditions. Prior to 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 about $160 per hour. “I think the industry has been permanently transformed,” Moreno says—a boon to both nurses and the patients who depend on them.

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