Meanwhile, employers began raising pay. Average annual salaries for full-time registered nurses have increased to about $69,000 in 2006 from $52,000 in 2000, a 32% gain, according to a May study by the state legislative analyst's office.
The rising pay and improved working conditions have attracted thousands of students to the nursing field. But a bottleneck has developed. The average wait to enter nursing school is now two to three years, primarily because of a shortage of classroom space and nursing educators, who can make more money in hospitals than schools.
Worsening the problem, 25% of those who are admitted to community college nursing programs drop out and another 25% do not graduate on schedule, the legislative analyst's office found. The attrition rate is far higher than for University of California and California State University students; experts believe it is caused in part by the community colleges' admissions process, which uses lotteries or first-come, first-served selection methods rather than strictly academic merit.
Gutierrez, for example, said half or more of her entering class of 70 students have struggled academically and been held back or dropped out of the program entirely. She defended the lottery system, however, saying it opened nursing to a broader range of students.
State community colleges abandoned the academic merit system in 1988 after the Mexican American Legal Defense and Educational Fund sued them for disproportionately excluding Latino students. Even today, however, the nursing workforce in California remains predominantly white, with 22% Asian American, 6% Latino and 4% African American.
Several organizations are mobilizing to improve those numbers, as research shows that a community's health improves when those who deliver the medical care reflect its demographics, experts say.
"I personally don't think it takes an A student to be a good nurse," said Gutierrez, who described herself as a B student with fluent Spanish and a good bedside manner. "It's the heart."
Hospitals, meanwhile, have also heavily relied on foreign nurses to fill the shortfall.
Foreign nurses in the United States have grown from 5% of newly licensed registered nurses in 1997 to 14% in 2003, according to a study published last year by Paul F. Clark, a Penn State University labor professor, and two colleagues. In California, they make up about 18% of the state's 230,000 registered nurses.
But some health professionals worry about the ethics of affluent nations like the U.S. depriving poorer countries of badly needed medical professionals. Most nations are currently suffering nursing shortages, including 30,000 vacancies in the Philippines, according to Clark.
"It's a real ethical dilemma," Clark said. "Nurses in developing countries have every right to immigrate for a better life.... But by going into a developing country and actively recruiting, you end up having a very adverse effect on countries that are very poor and marginal."
In any case, few believe that foreign nurses are the best answer to America's mounting medical needs.
"In the interim, do we need them?" asked Jan Emerson, spokeswoman for the California Hospitals Assn., referring to foreign nurses. "Absolutely we do. But it's a Band-Aid on the bigger problem. We as a state and country have to fix the problem by putting enough resources into the education system to produce the nurses we need."
One local hospital trying to do just that is Downey Regional Medical Center. The hospital has deliberately decided against relying on foreign nurses and instead produces its own nurses through partnerships with two community colleges.
Heather Conwell, Downey's chief nursing officer, said the hospital's experiences with foreign nurses weren't ideal. Several Filipino doctors retrained as nurses couldn't quite make the transition, she said, and a pair of Canadian nurses quit in mid-contract because, the hospital was told, Downey wasn't "close enough to the beach."
Downey now pays one of its nurses to teach at Cerritos College and contributes to a nursing student scholarship with the East Los Angeles Community Union at East L.A. College. In exchange, the hospital is able to hire 45 new nurses from the two campuses each year, asking for a one- to two-year commitment.
"We found we get a bigger bang for the buck with these two strategies," Conwell said. "We serve a Hispanic population, but very few international nurses speak Spanish. By recruiting in East L.A., we also get nurses who are culturally sensitive to our population."
That includes young women like Gutierrez, a 22-year-old Fresno native who distributes meal trays and performs other jobs as a student worker at Downey. She plans to apply for the hospital's scholarship to help her finish nursing school.
Gutierrez was first exposed to nursing by her mother, who worked in the field in Mexico for 20 years. But it was a personal experience with caring nurses during her gallbladder surgery five years ago that clinched her decision to enter the field.
Gutierrez said her mother also wants to return to nursing but hasn't yet passed the U.S. licensing exams.
If her mother, now a U.S. citizen, could win a little financial help to pay for a review course, Gutierrez said, that would be one more nurse to help fill the shortage.
"It doesn't make sense to help foreign nurses come here, when we can help our own," she said.