| Going beyond the usual institutional performance measures of cost, efficiency, and market penetration, in this institutional ethics study changing structures in home care were examined as forces shaping morality among a group of community health nurses. The nurses worked at Riverside, a public sector home care agency, purchased by a non-profit integrated health system just prior to this research. Analyzing the nurses' experiences with the market model unfolding in their work world presented a unique opportunity to study the role of institutions in morality and to understand how corporatization is influencing the meaning of caregiving in home care.;Guided by the assumption that understanding morality requires a focus on actual experience, data were generated by this ethnographic inquiry over four years using participant observation, interviews, and organizational archives. The findings show that the nurses were propelled through a disturbing moral career trajectory of depersonalization that left imprints on their identity, relationships, and actions. In that sense, institutions are actually part of personhood.;Starting out as "county nurses" and redefined as "corporate commodities," the nurses reflected, "We can't be nurses' anymore." Signaling the loss of personhood, their conclusion suggests that the marketplace is imposing a concept of nurse on health care that does not include person. Treating nurses as instruments for "making visits and making money," combined with objectifying patients, as "referrals" with "a pay source," transforms the good of caregiving relationships into an impersonal business arrangement.;Suspended in a turbulent liminal period, the nurses' work created a thin line between a humane home care system and a nearly universal mechanistic one. Refusing to fully integrate a corporate persona into their understanding of self, the nurses "adjusted things" on behalf of patients and wrestled with the marketplace to preserve their capacity to nurse. In doing so, their moral comportment serves as a model for resisting depersonalization in complex organizations and simultaneously highlights the schism between corporate health care and persons. If the nurses' stories are heard above the turmoil of the marketplace, it will be an opportunity to put persons into the picture of reform by addressing morally problematic aspects of health care institutions. |
