They entered the homes of TB patients to persuade them to take their medicine. They followed women through difficult pregnancies, learned about charting, doing paperwork and following orders even while thinking for themselves.

They worked in slums from Oceanside to the South Bay to find out what it means to treat the total patient.

"We learned that it's not just, 'OK, give the patient a pill,' " said Maria Adajar, 24. "We learned to see the person in a whole context, with family, money, transportation, home environment and job problems – the whole psychosocial aspect of patient care."

The 61 women and six men who graduated from San Diego State University's School of Nursing yesterday represent the largest nursing class in its history, a size enlarged through $2 million in grants from 10 area hospital systems desperate to find more nurses. Seventy SDSU nursing school graduates will join the work force after the next semester in December.

And nearly all will go to work for hospitals in San Diego County.

The additional funds three years ago paid salaries for more faculty so the school could admit 90 students a semester instead of the usual 50, said Pat Wahl, nursing school director.

According to hospital and state estimates, California will need 25,000 more nurses in the next few years to replace those who quit and retire and to comply with tighter state nurse/patient ratios that go into effect in January.

San Diego County's hospitals could use 1,000 more nurses now, said Steve Escoboza of the Healthcare Association of San Diego and Imperial Counties. "The problem is severe," Escoboza said. Hospitals "believe we have to do whatever it takes to recruit people into educational programs to make sure we have enough nurses."

To fill the gap, most hospitals use traveling nurses, employees hired from for-profit companies for three-to six-month stints. That's fine, said Vic Buzachero, human relations vice president for Scripps Health, "but you have a group of people who don't have an ongoing commitment to your organization, which is important when you're building an organization to provide patient care."

A shortage of nurses often means hospital emergency rooms have had to divert ambulances to hospitals farther away, frenzied staff, longer hours and more fatigue, none of which are good for the patient, said Jill Furillo, director of national affairs for the California Nurses Association.

Furillo said the nursing work force has suffered from too many students who choose nursing with a romanticized view of the job, then "realize that it's far more challenging than they thought, with constant physical motion. They find out they may not be cut out for it," she said, and drop out soon after they start.

Wahl said SDSU is taking great pains to ensure its students understand the job when they start the three-year course after freshman year. In addition to having good high school and first-year college grades, many of these nursing students started college several years late.

With an average age of 28, Wahl said, "they don't have maturity issues they may have if they just came out of high school."

To make sure students know what they're in for, the course work involves working with hospital patients alongside regular nursing staff.

Many students juggled classes with regular jobs. Some also balanced marriage and children. And for some, the workload proved too much. One-fourth of the 90 students who started the program three years ago aren't graduating because they took time off to go back to work, tend to family matters or because they had to retake classes, Wahl said.

Despite that, Escoboza and several hospital nursing directors said they're delighted with the SDSU result.

"It's a hallmark of the state," said Mary Middleton, director of nursing at UCSD. "The hospitals told SDSU to make sure you keep producing good nurses, and we would help you do it."

Funding to support nursing programs is tight, Wahl and others said. Although Gov. Gray Davis added $60 million last year for special nursing education programs through community colleges and other schools, not enough of it will be spent in San Diego County, several nursing school officials said.