Every nurse undergoes rigorous training to ensure they're qualified to deliver safe patient care. Once they enter the workforce, they must continue to deliver care that falls within the scope of this training. Each state establishes its own set of laws to enforce these standards and regulate the profession at large. In Washington, these laws are outlined in the Washington Nurse Practice Act (NPA)
It's important for facility leaders to familiarize themselves with their state's specific nursing laws in order to appropriately enforce them within their care teams. In this article, we'll provide an overview of the Washington NPA and outline practical tips for promoting compliance.
The Washington State Nurse Practice Act at a Glance
The Washington State Board of Nursing oversees and enforces all state nursing regulations. The NPA in particular outlines key information on nurse credentialing, scope of practice requirements, and delegation rules for the following types of nurses:
- Registered nurses (RNs)
- Licensed practical nurses (LPNs)
- Advanced practice registered nurses (APRNs)
Below, we'll summarize key aspects of the Washington Nurse Practice Act and link to resources that can help you apply these provisions at your facility.
| Nurse Practice Act: Washington State Overview | |
|---|---|
| Legal Authorities | Revised Code of Washington:Title 18, Chapter 18.79Washington Administrative Code:Title 246, Chapter 246-840 |
| Nursing Licensure Requirements | In Washington, RNs and LPNs can get licensed by examination or endorsement.Steps to receivelicensure by examination:Complete an accredited nursing program.Send official transcripts to the WA Board of Nursing.Register for and pass the NCLEX exam.Submit application and pay fees through theSAW portal.Steps to receivelicensure by endorsement:Verify current licensure throughNURSYS.Complete anapproved refresher course(forinactivelicense holders).Submit application and pay fees through theSAW portal.More information aboutlicensure renewalcan be found directly on the Board of Nursing’s website. |
| Scope of Practice Guidelines | The Washington Nurse Practice Act broadly defines the practice of LPNs,RNs, and APRNs.TheLPN scope of practiceincludes:The performance of services requiring the knowledge, skill, and judgment necessary for carrying out selected aspects of nursing care under the direction and supervision of a registered nurse or other approved licensed health professional.TheRN scope of practiceincludes:The observation, assessment, diagnosis, care or counsel, and health teaching of individuals with illnesses, injuries, or disabilities.The administration, supervision, delegation, and evaluation of nursing practice.The execution of medical care as prescribed by a licensed physician, dentist, or other approved licensed health professional.TheAPRN scope of practiceincludes:The performance of the acts of an RN and an expanded role in providing health care services as recognized by the medical and nursing professions.The prescription of legend drugs and controlled substances contained in Schedule V of the Uniform Controlled Substances Act (upon board approval).For more information on the LPN vs. RN scope of practice, Washington State facility leaders can refer to theDepartment of Health’s advisory opinion. |
| Delegation Rules | In Washington,only RNscan delegate to surgical technologists, medical assistants, non-credentialed unlicensed assistive personnel within school settings, and nursing assistants and home care aides in community-based and in-home settings.However,both RNs and LPNsmay delegate tasks to nursing assistants in other settings.In general,delegation decisionsmust:Be made in the best interests of the patient.Fall within the competencies of the delegatee.Fall within the scope of practice of the delegating nurse.Be appropriately supervised and evaluated by the delegating nurse. |
| Violations and Penalties | Anyone who breaches the NPA is subject to up to $5,000 in fines and additional penalties imposed by the Washington State Board of Nursing. Nurse Practice Act abandonment rules, practice violations, and other specific prohibited acts are outlined inWAC 246-840-710. |
| Nurse Licensure Compact (NLC) State? | Washingtonispart of the NLC, meaning that nurses within the state can practice according to therules and guidelinesestablished by the NLC. |
Improving NPA Compliance: 3 Tips for Facilities
As you familiarize yourself with the Washington Nurse Practice Act, you may be wondering how to enforce these standards at your facility. Here are three additional tips to help you improve compliance and build a better culture of safety.
1. Ensure Staff Complete Continuing Competency Requirements
In Washington state, nurses are required to complete continuing competency courses and meet 96 practice hours every year in order to renew their licenses. It's important to ensure that your staff are keeping up with these requirements so that they can maintain active licenses without interruptions.
Each level of nursing has a different set of requirements. Send out annual email reminders that link to Board-approved courses and remind your staff to complete them before the renewal period is over.
2. Educate Your Staff About Assignment Refusals
The Washington NPA strictly prohibits patient abandonment. Sometimes, these laws get conflated with a nurse's right to refuse an assignment. Especially when floating to new units, nurses may be asked to carry out tasks that they don't feel qualified to perform. In these cases, refusing an assignment doesn't necessarily equate to patient abandonment.
It's important to educate your staff on what to do when they feel obligated to turn down an assignment. Staff should feel comfortable raising concerns when they're unable to safely handle certain tasks, and unit leaders should be ready to collaborate with them to find an alternative solution. This can help prevent other violations of the NPA, such as patient injury that stems from poor nursing judgment.
3. Utilize Guidance From Advisory Opinions
Some provisions in the NPA may not have all the information you need to fully understand how to apply them in practice. However, the Washington Board of Nursing regularly publishes new advisory opinions to help clarify these provisions.
While advisory opinions are not legally binding, they are a professionally-vetted resource for facility leaders seeking more guidance on how to interpret the NPA. They range in topics, from making delegation decisions to the nurse's role in infusion therapy management. For a full list of current advisory opinions, you can visit the Board of Nursing's website.
Stay Informed on the Latest Nursing Regulations
The Washington Nurse Practice Act and related nursing regulations are constantly being amended to reflect changing care standards. Looking for practical ways to keep up with the latest nursing news? Access our wide range of expert-written healthcare management tips and insights, designed to help you deliver efficient, high quality patient care.
Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.