Abstract
In 1958, the American Nurses Association (ANA) formally endorsed federal health insurance for the aged, a position contrary to that of organized medicine and hospitals. Understanding how ANA's organizational culture and position on health policy evolved was the purpose of this research. ANA documents from 1933 until passage of Medicare legislation in 1965 and interviews with four contemporary nursing executives of that period were analyzed. Powerful professional and economic external forces and internal divisions limited ANA's ability to influence health policy. Ultimately ANA's cultural values of caring and professional autonomy enabled dedicated leaders to build support, national alliances, and recognition for nursing.