The Henry Street Settlement was an independent nursing service where Wald

lived and worked. This later became the Visiting Nurse Association of New York City, which laid the foundation for the establishment of public health nursing in the United States. The health needs of the population were met through addressing social, economic, and environmental determinants of health, in a pattern after Nightingale. These nurses helped educate families about disease transmission and emphasized the importance of good hygiene. They provided preventive, acute, and long-term care. As such, Henry Street went far beyond the care of the sick and the prevention of illness. It aimed at rectifying those causes that led to the poverty and misery. Wald was a tireless social activist for legislative reforms that would provide a more just distribution of services for the marginal and disadvantaged in the United States (Donahue, 1985). Wald began with 10 nurses in 1893, which grew to 250 nurses serving 1,300 clients a day by 1916. During this same period, the budget grew from nothing to more than $600,000 a year, all from private donations.

Wald hired African American nurse Elizabeth Tyler in 1906 as evidence of her commitment to cultural diversity. Although unable to visit white clients, Tyler made her own way by “finding” African American families who needed her service. In 3 months, Tyler had so many African American families within her caseload that Wald hired a second African American nurse, Edith Carter. Carter remained at Henry Street for 28 years until her retirement (Carnegie, 1991). During her tenure at Henry Street, Wald demonstrated her commitment to racial and cultural diversity by employing 25 African American nurses over the years, and she paid them salaries equal to white nurses and provided identical benefits and recognition to minority nurses (Carnegie, 1991). This was exceptional during the early part of the 1900s, a time when African American nurses were often denied admission to white schools of nursing and membership in professional organizations and were denied opportunities for employment in most settings. Because hospitals of this era often set quotas for African American clients, those nurses who managed to graduate from nursing schools found themselves with few clients who needed or could afford their services. African American nurses struggled for the right to take the registration examination available for white nurses.