“Among nurses who quit, toxic culture is more than twice as predictive of their overall satisfaction than compensation or workload,” said coauthor Donald Sull, a senior lecturer at the MIT Sloan School of Management and cofounder of CultureX, a startup that leverages proprietary AI to measure and improve corporate culture.

For the article, “The Real Issues Driving the Nursing Crisis,” Sull and coauthor, Charles Sull, mined the open-ended, free-text comments from 150,000 Glassdoor reviews of current and former nursing employees since the onset of COVID-19. The results revealed the four factors that most shape nurses’ job satisfaction — compensation, workload, toxic culture, and organizational support.

Additional findings include:

• There is a wide variation in how nurses rated different employers. One might think that all nurses are uniformly miserable across all employers since all health care systems have been impacted by COVID, a shift to older patient populations, and regulations. However, some employers do much better than others in providing a healthy workplace for nurses. When comparing which factors best predict how nurses rated their employer before and after the pandemic, toxic culture experienced the largest gain in relative importance post-COVID-19.
• Nurses who work for staffing agencies are, on average, much more satisfied than other nurses. Compensation is only part of the story. Staffing agencies excel at addressing nurses’ concerns and transparent communication that builds trust. Nurses in full-time staff positions rate hospitals and health care systems higher than staffing agencies on learning and development (including promotion opportunities and reimbursement for training), benefits, and colleagues.

The authors have created the “Nursing Satisfaction Index,” an online interactive tool that compares how 200 large health care employers rank in the eyes of nurses. Users can see which large employers are the most/least toxic, have the highest-rated/lowest-rated top leadership, etc. The index is sortable by nurses’ overall ratings, their assessments of the top leadership, and the four most powerful predictors of nurses’ satisfaction: compensation, workload, organizational support, and toxic culture. 

To improve the work lives of nurses, and all health care workers, leaders must collect and act on their feedback. The single most important step is to listen to nurses in the first place: Leaders must better understand what’s happening at the bedside.

The MIT Sloan Management Review (MIT SMR) article, “The Real Issues Driving the Nursing Crisis,” publishes 8 a.m. ET on Oct. 18.

Methodology
The authors analyzed the free text of 150,000 reviews written by U.S. nurses from the beginning of the pandemic through June 2023. For each review, they analyzed whether it mentioned one of 200 topics and assessed whether the nurse spoke about that topic positively or negatively. The topics were derived from research on various elements of employees’ experiences, including culture, compensation and benefits, work schedules, and perceived organizational support. They clustered related topics together into two dozen broader themes.

The authors used the topics as features in an XGBoost model that predicted each nurse’s overall rating of their current or former employer on a 5-point scale. They then calculated SHapley Additive exPlanations (SHAP) values, which assign an importance value to each feature in a model to directly compare the relative importance of different topics in predicting job satisfaction by measuring the overall rating each nurse gave their employer. They also used textual analysis to compare how favorably travel nurses spoke about topics compared with nurses on staff at health care systems.

About the Authors
Donald Sull (@culturexinsight) is a senior lecturer at the MIT Sloan School of Management, where he directs the Strategic Agility Project and the Culture 500. He is also a cofounder of CultureX, which leverages proprietary AI to measure and improve corporate culture. The Economist named him “a rising star in a new generation of management gurus,” and Fortune listed him among the 10 new management gurus. 

Charles Sull is a cofounder of CultureX. He leads successful consulting engagements for top teams worldwide around a variety of strategic and cultural issues. He has published several articles about related research in leading journals, including MIT Sloan Management Review.

About MIT Sloan Management Review
MIT Sloan Management Review (MIT SMR) is an independent, research-based magazine and digital platform for business leaders, published at the MIT Sloan School of Management. MIT SMR explores how leadership and management are transforming in a disruptive world. We help thoughtful leaders capture the exciting opportunities — and face down the challenges — created as technological, societal, and environmental forces reshape how organizations operate, compete, and create value.

Connect with MIT Sloan Management Review on:

[i] B. Martin, N. Kaminski-Ozturk, C. O’Hara, et al., “[Examining the Impact of the COVID-19 Pandemic on Burnout and Stress Among U.S. Nurses](https://www.journalofnursingregulation.com/article/S2155-8256(23)00063-7/fulltext),” Journal of Nursing Regulation 14, no. 1 (April 2023): 4-12; and G. Berlin, M. Lapointe, M. Murphy, et al., “[Assessing the Lingering Impact of COVID-19 on the Nursing Workforce](https://www.mckinsey.com/industries/healthcare/our-insights/assessing-the-lingering-impact-of-covid-19-on-the-nursing-workforce),” McKinsey & Co., May 11, 2022, www.mckinsey.com.

Tess Woods
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617-942-0336

SOURCE MIT Sloan Management Review