In the past two years, legislatures across the country have begun to search for solutions to the nursing shortage.

The laws and bills show promise, nursing experts say. Many make it easier for people to go to school to become nurses or encourage collecting information on the shortage regionally to better understand the problem. Others offer ways to increase recruiting and retention.

But the legislation has potential pitfalls, and whether its promise is realized still remains to be seen, experts say. Few of the laws have been in place long enough to evaluate whether they're working, experts said. Others aren't yet funded and are a potentially hard sell to states struggling with budgets in the red.

The federal Nursing Reinvestment Act exemplifies the problem. As written, it's one of the most exciting pieces of legislation yet passed. Signed into law by President Bush in late July, the act would increase the number of nursing school admissions by setting up nursing scholarships and increasing faculty.

It would establish career-ladder programs and provide grants for employers to test new ideas to improve working conditions and patient care. It also would push health care employers to meet the American Nurses Credentialing Center's criteria for becoming a Magnet hospital.

Although the act is now law, it's essentially toothless until funded. The American Association of Colleges of Nursing is asking for $250 million to put it into action. But in a depressed economy, that's an ambitious sum, said Debbie Campbell, director of government affairs for the AACN. "It's certainly an uphill battle, and we are going to do everything we possibly can to get there," she said.

Even if the act receives the full $250 million, the nursing shortage still is far from solved, Campbell said. "I think the best thing you could say is it's a step in the right direction," she said. Fixing the problem will take "a coordinated and collaborative effort on a whole lot of levels."

At the state level, the first steps began last year, according to information compiled by the National Conference of State Legislatures. The majority of the 25 laws passed that year set up nursing scholarships and loans for nursing students who agreed to work in a certain area of the nursing field for a certain length of time. Other issues included mandatory overtime and nurse-to-patient staffing levels.

Two typical 2001 laws come from Texas and Arkansas. The Texas law set up a program to increase enrollment in nursing schools and create a nursing data center. The Arkansas law establishes a scholarship and loan program for rural advanced nursing practices.

Experts say pieces of legislation like these are encouraging, but that it's too soon to know how much good they'll do.

As with the federal government, state governments are facing lean economic times, according to Rose Gonzalez, head of legislative affairs at the American Nurses Association.

"That's a big problem. If they can't put funding toward the program, how do you implement the program?" she said.

Joanne Spetz, an adjunct fellow at the Public Policy Institute of California at the University of California, San Francisco, agreed that the legislation is encouraging, but that it has some potential problems. "I think there's a lot of hope that the proposals submitted could handle a lot of the problems we've had in the past," she said.

The problem lies less in laws designed to increase the supply of nurses than in legislation to change working conditions for nurses, Spetz said. For example, while minimum nurse-to-patient ratios are a good idea in concept, they may not work in practice, Spetz said.

Given the shortage, even hospitals that try their best may have a difficult time finding nurses, Spetz said. Another problem is that after establishing ratios for nurses, employers may cut nursing assistants, leaving the nurses with as much work to do as before, she said.

"Most of the changes that need to happen with nursing working conditions can't be legislated," Spetz said. "You can't legislate 'You have to be a nice employer,' " she said.

"That comes down to industry stepping up to the plate to make nursing as attractive a career as hospitals possibly can," she said.

A group of hospitals in Arizona is starting to take that step. The Campaign for Caring, an organization made up of and funded by 30 Arizona hospitals and two foundations, is devoting one-third of its energy to improving working conditions. The group also is starting a public relations and advertising campaign to attract men and minorities to nursing, and is partnering with nursing schools, professional groups and legislators to attract more people into nursing.

The campaign will provide small grants for hospitals, from $5,000 to $50,000, to test ideas for improving staff satisfaction and reducing turnover, said program director Anne McNamara, Ph.D., RN. It also will act as a roaming reporter for best practices, recording successes in different hospitals and presenting them to all the hospitals, she said.

"We really do not want to dictate and tell hospitals what they have to do, but we want to provide a mechanism for them to improve," McNamara said. "The good news is that times of crisis are when people get innovative."

Contact Jessica M. Scully at Jessicam_scully@yahoo.com.