The impetus to become organized as a profession would come from within the nursing movement itself. First organized training occurred in hospitals, and then in training institutes situated within hospitals. The first trained nurse graduated with a diploma in the United States in 1873. At the same time, the American Nurses Association took root, representing nurses in both the United States and Canada. Nursing journals hit the press sharing news and best practices, and shaping the new profession.
The first university to graduate nurses was Columbia University, where classes began in the late 1800s. The University of Michigan awarded nursing degrees to six students in 1893. In 1909, the University of Minnesota bestowed the first bachelor's degree in nursing. Yale University's nursing-degree program began in 1924, and just a year later included a requirement that applicants complete two years of college education before applying to nursing school. Yale continued to lead with the academic standard for nursing education; in 1934, applicants needed an undergraduate degree to apply.
A controversy was inevitable. Who produced the best nurses, the practical, hospital-based training institutes which became entrenched in colleges, or the theoretical courses offered through universities? Despite the establishment of a nursing honor society in 1922, Sigma Theta Tau, the push to move nursing education onto the university campus would continue to be challenged. In the 1940s, the Committee on the Study of Nursing Education and the Committee on the Grading of Nursing Schools stated that "only college graduates be regarded as professional nurses."
Nursing education continues to be debated by those within the profession. While nurses can begin their career with a diploma, the Bachelor of Science in Nursing degree is "essential for nurses seeking to move up the career ladder and eventually away from the bedside." As well, the degree can make a "real difference in how a nurse is perceived by other health care professionals" who are required to have degrees in order to practice.