Formal nursing education was initiated in Texas in 1890 at John Sealy Hospital in Galveston. The school was established by a group of philanthropic ladies of that city as an educational entity independent of the hospital. In 1896 the school was subsumed by the University of Texas Medical Branch and became financially dependent on it. Training schools opened subsequently throughout the state in hospitals. While serving as the nursing staff at hospitals, student nurses soon proved their worth, and training schools for nurses came to be thought of as an essential part of hospitals. In the majority of hospitals the actual education students received was secondary to their service in the wards caring for patients. This pattern of training nurses predominated until well into the 1960s. The fact that the schools were not in educational settings but rather in service institutions, and therefore valuable to the hospitals, impeded their move into institutions of higher education. In 1907 a group of concerned nurses banded together to form the Graduate Nurses' Association of Texas (see TEXAS NURSES ASSOCIATION). Their primary goal was to get legislation enacted to gain some control over the training of nurses and the practice of nursing in the state. Two years later they were successful in getting a nurse practice act passed in the state legislature, thus bringing Texas into a national movement that had begun in 1903. The act provided for a Board of Nurse Examiners required to provide "for the examination and licensing of nurses and to prescribe their qualifications, [and] to provide for the proper registration and for revocation of certificates" (see EXAMINING BOARDS). It was soon realized, however, that the nurse practice act of 1919 did not actually enable the board to do much about the quality of nurse education. The act only stipulated that the course of training was to be two years "with a systematic course of instruction" and that graduates of the schools had to pass an examination prepared by the board to practice nursing professionally. In an effort to gain first-hand knowledge of how the training schools were conducted, the board asked its members to visit schools of nursing within the geographical area of their homes. The attorney general ruled that such a practice was not legal, and it had to be discontinued. The only solution was to write a new nurse practice act that contained the provision for a "training school inspector" on the board to visit nursing schools and pass judgment on them. The title "training school inspector" proved to be too ominous and was changed to "educational secretary" when the second nurse practice act was passed in 1923. Every school was to be visited annually. At the time, eighty-five accredited training schools were located throughout the state.
The advent of the educational secretary in 1924 provided a mechanism to bring pressure to bear on the inferior education being provided in training schools. The minutes of the board reflect considerable activity on the part of the first educational secretary in such categories as miles traveled, letters written, and visits to schools, but little action. The secretary resigned precipitously in 1928, and a new one was appointed. This time the Board of Nurse Examiners made it obvious that her agenda was to close the most inadequate schools and strengthen the others. When judged by the Standard Curriculum (1917) of the National League for Nursing Education, however, not one school in Texas met the minimum standards. In 1927 in its second such curriculum the NLNE elevated the standards somewhat and put the Texas schools even further behind. Closing all the schools in the state would not have been wise; instead, between 1928 and 1940, forty-three training schools for nurses were closed throughout the state. During the same period, the Great Depression of the 1930s increased the financial problems of the hospitals and training schools. In an effort to decrease the cost of maintaining laboratories, strengthen the curriculum, and give the students enrolled in schools of nursing bona fide academic credit, directors of schools were encouraged by the board to affiliate the schools under their control with junior colleges to provide courses for first-year nursing students. By 1940 ten schools had done so. Because nursing education was not in the mainstream of higher education, nurses desiring to earn baccalaureate degrees faced challenges. In some cases, nurses could enter a college or university that recognized their nurse-education diploma as equivalent to two years of college work. The student would take an additional two years of liberal arts courses and earn a bachelor's degree. In hospitals that were part of a university system the nurse could take two years of liberal arts courses first, then three years of the hospital's diploma program, and be awarded a degree upon completion.
The John Sealy College of Nursing, the first collegiate program for nurses in Texas, was established as a five-year program in 1923, although at the time the majority of students were still enrolled in the diploma program. Incarnate Word College and Harris College of Nursing followed in 1930 and 1946, respectively. Not until after World War II did the number of nurses earning college degrees begin to increase significantly. Aided by the Servicemen's Readjustment Act, popularly called the "G.I. Bill," many former members of the military were given financial assistance to return to school. Nurses were among those who did so. Concomitantly, the severe shortage of nurses occasioned by the war and the increased demand for nurses in expanding hospitals continued unabated. In the early 1950s, in an effort to relieve the shortage of nurses, Mildred Montag undertook a research project at Teachers College, Columbia University, to educate nurses in junior college in two years instead of the three years required in a diploma program. On successful completion, the graduate would be awarded an associate degree. The goal was to train nurses more efficiently in an academic setting and hasten them into the workforce. The holder of an associate degree was eligible to take the same licensing examination as graduates of diploma programs to become a registered nurse. The idea of the two-year program was not championed by the Texas Board of Nurse Examiners, however, which desired to make increased demands on the junior colleges. The BNE wanted to add an internship to the two-year curriculum, and went so far as to request a legal opinion regarding the "legality of the test pool examination service giving the professional nurse examination to graduates of non-professional schools of nursing." Nevertheless, associate-degree nursing education was introduced into Texas in 1960 under the aegis of a Kellogg Foundation grant, and although slow to get accepted, it eventually proved to be very successful. As of the academic year 1990–91 forty-four such programs were functioning in the state. Throughout the late 1960s, the 1970s, and the 1980s the number of diploma programs decreased and the number of baccalaureate and associate-degree programs increased until the latter outnumbered the former. The introduction of associate degree programs in 1960 hastened the demise of diploma education for many reasons. The peak of diploma schools was eighty-five programs in 1928. In the 1969–70 academic year the state had eighteen diploma schools, ten baccalaureate-degree schools, and twenty associate-degree schools. In 1992 there remained two diploma schools, forty-four associate-degree schools, and twenty-one baccalaureate programs.
Graduate education for nurses in the state began with an M.S. in nursing on the Galveston campus under the aegis of the University of Texas. The goal was to educate more teachers for the large number of nursing schools opening throughout the state and country as well as to provide well-educated nursing-service administrators for hospitals. Such education was slow to get established until the enactment of the Nurse Training Act in 1964 provided financial assistance for nurses pursuing advanced degrees. Graduate education for nurses expanded considerably after the provisions of the act became known among nurses. In early 1970s Texas Christian University opened the first doctoral program for nurses in Texas. The University of Texas at Austin followed suit in 1974. In 1992 the state had three doctoral programs for nurses. The general purpose of master's-degree education for nurses is to produce expert practitioners able to function in teaching, nursing-service administration, or providing primary care. Generally speaking, doctoral preparation is to prepare nurse researchers.