Early in the twentieth century, trained nurses from New York's Henry Street Settlement House collaborated with Metropolitan Life Insurance Company (MLI) for the purpose of improving the health of working class Americans. Although nursing legend suggests that the partnership was stimulated and directed by Lillian Wald, a historical account of the social, financial, and personal factors which gave rise to the rise and decline of the Metropolitan Visiting Nursing Service (MVNS) has not been told.

This study describes the conditions of society and the insurance industry which served as antecedents for the origin of Metropolitan's Welfare Division and Visiting Nurse Service.

This study argues that as the social conditions and business needs altered, the decline of the MVNS began. By 1932 Metropolitan no longer needed to tend to the health needs of the working class. As the federal government moved into health care, disease patterns changed, medical treatment shifted towards cure, hospital utilization increased. Metropolitan no longer saw nursing as a profit making endeavor. More interested in investments and sales, Metropolitan executives' fascination with the MVNS waned. Yet nursing, unable to view nursing as a business, clung to the belief that quality patient care and improved educational standards would keep the profession marketable.

The story of the rise and fall of the MVNS suggests that nursing is dependent upon social factors. Although nursing perceives itself as an autonomous profession, the practice of nursing is closely tied to medical technology, disease patterns, consumer needs, and financial issues. Higher education of nurses and quality patient care did not outweigh the impact of social factors. (Abstract shortened with permission of author.).