Public-health nursing was slow in coming to Texas. In England, Florence Nightingale had established many of the precepts essential to public-health nursing in the 1850s. By the end of the century Boston, New York, and other major cities had established programs, New York's Henry Street Settlement (1893), for instance. Not until 1908 did a formal public-health nursing program exist in Texas. That year a Houston school principal requested nursing services for the city's schools. The school board approved the request, and the Houston Settlement Association responded by forming the Visiting Nurse Service, currently operating as the Visiting Nurse Association of Houston. Charitable Houston women were also instrumental in urging the Settlement Association to provide nursing services; their target population was new mothers. For years they had been distributing milk to mothers with newborn infants, but they realized that someone needed to assess the health needs of these mothers and infants and to instruct mothers in caring for their babies. From the beginning, Texas public-health nurses focused on providing services to mothers, infants, and schoolchildren.
The years between the turn of the century and World War I were busy ones for Texas nurses. During this time their first association, the Texas Graduate Nurses Association, was formed, the first Nurse Practice Act was passed (1909) to set up licensing requirements, and public-health nursing grew rapidly. By 1912 the members of the Houston Visiting Nurse Service had founded, in cooperation with the medical society, the first free medical clinic service. In other parts of the state, public-heath nurses were active in mounting campaigns against smallpox through immunization of schoolchildren and quarantines. After the war the Red Cross placed nurses and financed their services in many Texas counties. By the end of 1922 there were fifty-eight county nurses, all financed by the Red Cross. The Great Depression forced many private-duty nurses to seek other forms of employment. They, along with nurses from other fields, received jobs through the Federal Emergency Relief Act and the Civil Works Administration. Texas school nurses participated in the 1930s Five Points Project, which encouraged the practice of good health habits, correction of health defects by such means as eyeglasses, and immunization against smallpox and diphtheria. In the summer of 1930 the first course specializing in public-health nursing was offered; the Texas Graduate Nurses Association (now the Texas Nurses Association) collaborated with the University of Texas to provide this course in Austin for registered nurses.
A severe nursing shortage began in the 1940s and continued until the late 1970s. Public-health nurses were in demand after it became apparent during World War II that occupational health nurses were essential to well-managed factories and businesses. The number of school nurses jumped from 146 to 394 by 1949. Venereal disease clinics were established by public-health nurses throughout the state during this period. Sabin Oral Sundays, a series of Sundays during which children received oral polio immunization in the early 1960s, found these nurses at the forefront of one of the most successful public-health efforts in history. Public-health nurses have been instrumental in the implementation of many health-care programs, including Migrant Health and Medicare-Medicaid. Today public-health nurses have modified their approach. Now, instead of the focus being on individuals, the target is the entire community, and the strategy is health promotion. The current practice of Texas public-health nurses is based on the knowledge that many health problems are best approached on a community-wide level. Examples of modern-day public-health nursing goals include the following: to require seat-belt use in order to reduce the mortality on our highways; to provide more smoke-free public places to reduce the incidence of heart and lung disease; to promote parenting skills to reduce the incidence of child abuse; to provide better access to health care for the poor; and to utilize funds better through assessment of community needs, program planning, and evaluation.