Why this Cal State program produces some of the highest-paid grads in the country

What does the nursing program at Cal State East Bay have in common with Stanford University, the academic powerhouse down the road in Silicon Valley?

You would be right if you guessed that groups of students from both schools earn some of the highest salaries in the nation, four years after graduating. You would be wrong if you said the Stanford grads earn more.

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Stanford students who qualified for a Pell Grant - need-based federal student aid - earned a median annual salary of $136,959 in 2024 dollars, the most recent data available from the U.S. Department of Education.

Cal State East Bay's nursing students left those Stanford graduates in the dust. Pell Grant recipients from the nursing program who were employed in 2022 and 2023 took home $150,921 - the highest median salary for graduates of any nursing bachelor's program in the country.

Those nursing graduates also earned a higher median salary than federal aid recipients overall at every other university in the country except MIT and Caltech, which ranked first and second, respectively.

"Oh my God. Wow. Amazing! It's crazy," said Magdalena Guerrero, 21, a Cal State East Bay nursing student who receives federal aid - which does not stretch far enough to cover the $450 she pays each month to commute from Union City, where she lives with her parents. The nursing program operates on the university's Concord and Hayward campuses.

Guerrero, who says she was born to be a nurse, is not going into it for the money. Even so, "a salary like that would honestly be a blessing," she said. "It's stability, security, and the chance to build a better future for myself and my family while helping others at the same time."

Nationwide, 1,248 nursing programs award bachelor's degrees, including several in the U.S. territory of Puerto Rico, whose graduates tend to earn the least. The top seven for salaries are all in the Bay Area, with San Francisco State University landing the No. 2 spot.

The other five, in highest-earning order, are Dominican University in San Rafael, Samuel Merritt University in Oakland, Sonoma State, University of San Francisco and Pacific Union College in Angwin near Napa.

The three California State University nursing programs in this group also happen to be among the CSU campuses in desperate need of attracting more students, having lost thousands in recent years due to demographic and economic shifts.

All three considered the possibility that the salary data could help them do that - not directly, but by relying on graduates of community colleges, which also produce highly paid nurses.

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Why Bay Area nurses earn so much

Graduates of these seven bachelor's programs who took federal aid earned a median annual salary of $148,193. Depending on the school, that is 58% to 70% above the $88,910 earned by their nursing counterparts across the country.

The Bay Area nurses' median was not only higher than that of Stanford's Pell Grant recipients overall, but also well above the median salary of $113,172 earned by federal aid recipients from all eight Ivy League schools.

Nursing programs across California also dominated the top 40 national ranking of graduates' pay, occupying 37 spots.

One major reason for the eye-popping dollar signs is union clout - especially from the California Nurses Association, which represents all hospital nurses in the Bay Area and many across the state.

"It's our power to organize, establishing great contracts and better working conditions," said Michelle Gutierrez Vo, the union's co-president. "It's a really big deal."

For example, hospitals in California typically have lower nurse-to-patient ratios than in other states, making them more appealing for nurses to stay and grow their salaries, Gutierrez Vo said. Also, labor contracts in the Bay Area start with higher baseline pay than elsewhere because of the region's steep cost of living.

While heavyweight unions can explain state-to-state and regional salary trends, there are other reasons why some nursing programs rise to the top when it comes to graduates' salaries, said Monika Eckfield, nursing department chair at Cal State East Bay.

"It was kind of jaw-dropping" to learn from a reporter that Cal State East Bay produced the best-paid nurses with a bachelor's degree in the country, she said. "So I started doing a bit of research."

Eckfield and her colleagues began by asking themselves what kind of nurses the Bay Area's high-paying hospitals would be most interested in hiring and promoting.

They assumed the employers would want experienced applicants who were enthusiastic about the profession, familiar with the patient community and interested in remaining for the long haul.

"I can't even tell you how fun this was, how enriching it was, for me to start brainstorming about this," Eckfield said - especially when she realized that her program prepared students in ways that hit those buttons hard.

Cal State East Bay appears to produce graduates with more experience than many of their counterparts, she said, because its program requires a fifth semester - beyond the four and sometimes three at most other schools. During the extra semester, students pair up, one-to-one, with a working nurse in what is known in nursing circles as a "senior preceptorship."

Some students prefer a faster program, Eckfield said, and some schools have dropped the fifth semester that state regulations and accrediting standards don't require. But she and her colleagues see the added experience as a key benefit for students.

"It helps them really understand what they're getting into," Eckfield said, adding that she often hears hospitals complaining that their recent hires quit after only a year on the job. "We're not hearing that about our graduates."

Since 2018, Cal State East Bay has also required nursing students to spend time in communities over four semesters to learn more about the health needs of residents, she said.

"This is really unique," Eckfield said, because it gives students a deeper understanding about patients' access to healthcare, which in turn could lead them to be promoted faster later. "When leadership positions come up, our students are ready."

She said most Cal State East Bay nursing students are local, and want to stay local, which employers see as an asset.

"One thing hospitals have told me they really like about our students is that they want nurses who have roots here," Eckfield said. "If you're going to stay in a place, you'll climb up the clinical ladder and get more experience."

Finally, she praised the culture of her school, where faculty - mostly working nurses - provide a positive role model for the profession.

"I'm sure all schools hope this is true," she added. "But we don't feel that we're just a nursing mill. Our faculty provides a lot of support for people dealing with a lot of life challenges. We do a lot of mentoring."

Why top nursing programs struggle to grow

Cal State East Bay, San Francisco State and Sonoma State - surprising rock stars for nursing salaries - are also on CSU's fiscal watch list because they haven't been able to attract enough students to sustain themselves financially.

Applicants are eager to enroll in their nursing programs. But the vast majority are turned away.

Last fall, for example, 328 would-be nurses applied to San Francisco State, which admitted 28 of them, or 8.5%. By contrast, the campus overall admits 84% of applicants.

Why? Nursing education is unique in that every student must spend many hours working in a clinical setting. Nursing programs have to find hospitals willing to host students and have working nurses teach them while on the job. The larger the program's enrollment, the harder it is to achieve this.

It's why nursing is California's most selective major, eclipsing other choosy programs like engineering, business and computer science that have no such obligation.

It's also why, when San Francisco State, Sonoma State and Cal State East Bay were required to submit "enrollment recovery strategies" to CSU headquarters in December, none of them said they planned to expand nursing - despite the future salaries that might attract even more applicants.

"Clinical placements are the biggest bottleneck," said Carole Kulik, an associate professor of nursing at San Francisco State. "Ultimately, we're all competing for placements in the same hospitals."

The community college pipeline

But there's one secret weapon in all of this.

Enter California's community colleges and other two-year nursing programs. They also graduate registered nurses - but with an associate's degree, not the four-year bachelor's degree often prized by employers.

In 2010, the Institute of Medicine (now the National Academy of Medicine) recommended in its "Future of Nursing" report that schools increase the proportion of nurses with a bachelor's degree from 50% to 80% by 2020 because nurses were increasingly called on to do more than before: make critical decisions for patients needing "sophisticated, life-saving technology," step in for doctors and coordinate care among many providers.

Today, some hospitals are shifting away from that thinking, said Joanne Spetz, a health policy expert at UCSF. Nurses with an associate's degree often do just fine on the job and may be more likely to speak multiple languages, a valuable skill when working with patients.

Across the country, nurses with a bachelor's degree earn about $8,100 a year more than those with an associate's degree, according to the federal data. That median salary gap shrinks to less than $1,000 among Bay Area nursing schools that award bachelor's degrees vs. associate degrees in nursing.

"The No. 1 question we get is, ‘How much do nurses make? '" said Krista Altaker, chair of nursing at Sonoma State, where the median salary of Pell Grant recipients four years after graduating is $143,886.

"I mean, it's amazing, and I love hearing the actual numbers," Altaker said. "But philosophically, salary is not always the best marker for success for interested students because nursing is such a service-driven profession. You have to want to do it because you care about people."

Meanwhile, the CSU nursing programs have discovered that many nurses with an associate degree still want to pursue a bachelor's degree for the same reasons many non-nurses do. And it turns out that universities can open their doors to a lot more of them because the students have already done their clinical placements at the community college level.

"That's the area where it's easier for us to scale up the program," said Eckfield of Cal State East Bay, which saw flat enrollment last year. San Francisco State lost more than 7% of students, while Sonoma State dropped by nearly 14%.

"From an enrollment growth perspective, these salary data could really help," she said. "What I see is that this is a wonderful marketing tool."

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