Clinical Excellence, but too High a Cost: The Metropolitan Life Insurance Company Visiting Nurse Service (1909‐1953)

Abstract

Abstract In the winter of 1909, Metropolitan Life Insurance Company, a large company within the private sector, identified visiting nurses as a means of lowering mortality rates, while improving the image of the company. Although initially associated with the nurses of Lillian Wal&dcar;s Henry Street Settlement House, the Metropolitan Visiting Nurse Service eventually formed an alliance with over 650 Visiting Nurse Associations across the United States, caring for over 30 million policy holders. The purpose of this historical research was to analyze the liaison between business and the profession of nursing, identifying factors that served as an impetus for the origin, growth, and decline of the Metropolitan Visiting Nurse Service. Data were gathered in the Metropolitan Life Insurance Company Archives; the Visiting Nurse Association Archives of New York and Chicago; the New York Public Library; Chicago Historical Society; Schlesinger Library at Radcliffe College in Cambridge, MA; Haven Emerson Public Library in New York; National League for Nursing Education Historical Collection in New York; Walter Library, University of Minnesota, Minneapolis, MN; American Public Health Association Historical Collection, Washington, DC; and Special Collection of Virginia Commonwealth University in Richmond, VA. The results indicate that visiting nurses were masters of improvisation, demonstrating clinical excellence under demanding conditions. Although both nursing and business leaders demanded efficiency, nursing focused on quality of nurses, while business viewed cost of a nursing visit as the priority. Unfortunately for the profession, increased educational sources for nurses coupled with declining volume of visits drove the cost of a nursing visit higher than Metropolitan was willing to pay. Consequently, in 1950 Metropolitan made the decision to terminate the service. In a time when the nursing profession seeks both clinical excellence and cost containment, this study uses the past to stimulate questions about the future: Can the nursing profession provide quality care in an era where cost of care is emphasized? Can the profession use the knowledge and principles of the business world to reach mutually satisfying goals of quality patient care and cost effectiveness? Can nursing balance the values inherent in achieving a cost/care attitude?