Study: Staffing Agencies Outperform Hospitals in Nurse Satisfaction

Ann Feeney
Updated November 17, 2023
Edited by
    Working for a staffing agency vs. a hospital is associated with higher nurse satisfaction. Learn more about the differences and how hospitals can improve nurse satisfaction.
    Two happy nurses in a hospital roomCredit: Getty Images
    • Nurses who work for staffing agencies are more likely to be satisfied than hospital employees.
    • Higher compensation for staffing agencies vs. hospitals was a smaller part of the satisfaction gap than work culture.
    • Addressing cultural factors such as solving nurses’ problems and open, honest communication can bridge the gap and increase work satisfaction.

    A recent study, “The Real Issues Driving the Nursing Crisis,” published in MIT Sloan Management Review examined the nurse staffing agency vs. hospital employee satisfaction gap. Nurses who work for staffing agencies reported much higher satisfaction on crucial factors such as honest communication, resolving issues efficiently, and building trust. The key difference is that staffing agencies perceive nurses as clients and provide a better experience for nurses than hospitals.

    Learn more about their recommendations for increasing nurse satisfaction and retention.

    Staffing Agencies vs. Hospitals: What the Data Revealed

    For the study, the authors performed text analytics on the reviews that nurses posted to, comparing the ratings and experiences of nurses employed by staffing agencies vs. hospitals. They categorized 150,000 reviews from the start of the COVID-19 pandemic across almost 200 topics to identify the top factors driving nurse satisfaction and outcomes, such as nurse burnout.

    Work Culture/Toxic Culture

    The authors previously identified five behavioral attributes that make a work culture toxic: disrespectful, noninclusive, unethical, cutthroat, and abusive. A toxic work culture was the top predictor of overall dissatisfaction when considering nurse satisfaction across a nurse’s career.


    Compensation is typically higher for staffing agency vs. hospital employees, and compensation was the highest predictor of satisfaction with a current employer. The authors noted, “Compensation was the top predictor of satisfaction among nurses reviewing their current employer, which is not surprising, given that inflation eroded the purchasing power of take-home pay during the period we analyzed.” Across nurses’ entire careers, compensation was the third-highest predictor of nurse satisfaction.

    Organizational Support

    Nurses value being supported by their management, but most dissatisfied nurses reported that upper-level hospital staff, in particular, are “unaware of the challenges that nurses struggle with in the workplace.” They also rate hospitals considerably lower on efficient processes and honest communication.


    Workload was the second-most important driver for nurse satisfaction. Only 16% of nurses who work for hospitals rated their employers highly for addressing work-related stress, compared to 58% of travel nurses, a major staffing agency vs. hospital difference.

    Suggestions for Improving Overall Nurse Satisfaction

    The decline in nurse satisfaction and the rising rate in which nurses leave healthcare is not a revelation. Still, this study identified factors that employers can address. Many of these are consistent with previous studies on addressing nurse burnout and increasing nurse satisfaction and retention.

    Addressing a toxic culture is key, as the study noted, “Among nurses who had quit, toxic culture was more than twice as predictive of their overall satisfaction compared with compensation or workload.”

    [when] nurses discussed how managers understood life at the bedside, their comments were negative 9 times out of 10.”

    This perception of leadership as out of touch applies most to the highest levels of hospital administration. “Nurses are particularly critical of members of the senior executive team for their disconnectedness. The top team was 10 times more likely than front-line supervisors and middle managers to be criticized for being out of touch.”

    In addition to listening, upper management must create psychological safety to speak up, the study points out. “Staffing agency nurses are more positive about having the psychological safety to speak up about difficult issues and be heard.” Staffing agencies are also more likely to do something about nurse complaints. “Nurses speak highly of how quickly staffing agencies respond to their questions and concerns. In contrast, nurses frequently complain that other types of employers are slow to respond to emails raising issues, if they get a reply at all.”

    While the nurses were more satisfied with staffing agencies vs. hospitals in this study, hospitals have the advantage in learning and development, benefits, and colleagues. The authors recommend, “Health care systems should invest in their comparative advantages and emphasize them when communicating their value proposition to potential and current employees.”

    Explore the study results for the top 200 individual employers for nurse satisfaction, or sort the data to see which employers ranked highest for various drivers. The authors recommend exploring the text results for specific and actionable nurse recommendations.