wa-law.org > bill > 2025-26 > SB 5051 > Original Bill

SB 5051 - Nursing assistant regulation

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Section 1

  1. The state board of nursing is established, consisting of 17 members to be appointed by the governor to four-year terms. The governor shall consider nursing members who are recommended for appointment by the appropriate professional associations in the state. No person may serve as a member of the board for more than two consecutive full terms.

  2. There must be seven registered nurse members, two advanced registered nurse practitioner members, two licensed practical nurse members, two certified nursing assistant members, a registered nurse or licensed practical nurse member, and three public members on the board. Each member of the board must be a resident of this state.

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    1. Registered nurse members of the board must:

      1. Be licensed as registered nurses under this chapter; and

      2. Have had at least three years' experience in the active practice of nursing and have been engaged in that practice within two years of appointment.

    2. In addition:

      1. At least one member must be on the faculty at a four-year university nursing program;

      2. At least one member must be on the faculty at a two-year community college nursing program;

      3. At least two members must be staff nurses providing direct patient care; and

      4. At least one member must be a nurse manager or a nurse executive.

  4. Advanced registered nurse practitioner members of the board must:

    1. Be licensed as advanced registered nurse practitioners under this chapter; and

    2. Have had at least three years' experience in the active practice of advanced registered nursing and have been engaged in that practice within two years of appointment.

  5. Licensed practical nurse members of the board must:

    1. Be licensed as licensed practical nurses under this chapter; and

    2. Have had at least three years' actual experience as a licensed practical nurse and have been engaged in practice as a practical nurse within two years of appointment.

  6. Certified nursing assistant members of the board must:

    1. Be currently employed as certified nursing assistants, licensed under chapter 18.88A RCW; and

    2. Have at least two years' experience as a certified nursing assistant.

  7. The registered nurse or licensed practical nurse member must be currently either a program director or educator in an approved nursing assistant training program.

  8. Public members of the board may not be a member of any other health care licensing board or commission, or have a fiduciary obligation to a facility rendering health services regulated by the board, or have a material or financial interest in the rendering of health services regulated by the board.

Members of the board hold office until their successors are appointed.

When the secretary appoints pro tem members, reasonable efforts shall be made to ensure that at least one pro tem member is a registered nurse who is currently practicing and, in addition to meeting other minimum qualifications, has graduated from an associate or baccalaureate nursing program within three years of appointment.

Section 2

  1. The state board of nursing is established, consisting of 17 members to be appointed by the governor to four-year terms. The governor shall consider nursing members who are recommended for appointment by the appropriate professional associations in the state. No person may serve as a member of the board for more than two consecutive full terms.

  2. There must be seven registered nurse members, two advanced practice registered nurse members, two licensed practical nurse members, two certified nursing assistant members, a registered nurse or licensed practical nurse member, and three public members on the board. Each member of the board must be a resident of this state.

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    1. Registered nurse members of the board must:

      1. Be licensed as registered nurses under this chapter; and

      2. Have had at least three years' experience in the active practice of nursing and have been engaged in that practice within two years of appointment.

    2. In addition:

      1. At least one member must be on the faculty at a four-year university nursing program;

      2. At least one member must be on the faculty at a two-year community college nursing program;

      3. At least two members must be staff nurses providing direct patient care; and

      4. At least one member must be a nurse manager or a nurse executive.

  4. Advanced practice registered nurse members of the board must:

    1. Be licensed as advanced practice registered nurses under this chapter; and

    2. Have had at least three years' experience in the active practice of advanced practice registered nursing and have been engaged in that practice within two years of appointment.

  5. Licensed practical nurse members of the board must:

    1. Be licensed as licensed practical nurses under this chapter; and

    2. Have had at least three years' actual experience as a licensed practical nurse and have been engaged in practice as a practical nurse within two years of appointment.

  6. Certified nursing assistant members of the board must:

    1. Be currently employed as certified nursing assistants, licensed under chapter 18.88A RCW; and

    2. Have at least two years' experience as a certified nursing assistant.

  7. The registered nurse or licensed practical nurse member must be currently either a program director or educator in an approved nursing assistant training program.

  8. Public members of the board may not be a member of any other health care licensing board or commission, or have a fiduciary obligation to a facility rendering health services regulated by the board, or have a material or financial interest in the rendering of health services regulated by the board.

Members of the board hold office until their successors are appointed.

When the secretary appoints pro tem members, reasonable efforts shall be made to ensure that at least one pro tem member is a registered nurse who is currently practicing and, in addition to meeting other minimum qualifications, has graduated from an associate or baccalaureate nursing program within three years of appointment.

Section 3

Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

  1. "Alternative training" means a nursing assistant-certified program meeting criteria adopted by the board under RCW 18.88A.087 to meet the requirements of a state-approved nurse aide competency evaluation program consistent with 42 U.S.C. Sec. 1395i-3(e) and (f) of the federal social security act.

  2. "Approved training program" means a nursing assistant-certified training program approved by the board to meet the requirements of a state-approved nurse aide training and competency evaluation program consistent with 42 U.S.C. Sec. 1395i-3(e) and (f) of the federal social security act. For community college, vocational-technical institutes, skill centers, and secondary school as defined in chapter 28B.50 RCW, nursing assistant-certified training programs shall be approved by the board in cooperation with the board for community and technical colleges or the superintendent of public instruction.

  3. "Board" means the Washington state board of nursing.

  4. "Competency evaluation" means the measurement of an individual's knowledge and skills as related to safe, competent performance as a nursing assistant.

  5. "Department" means the department of health.

  6. "Executive director" means the executive director of the board hired pursuant to RCW 18.79.390.

  7. "Health care facility" means a nursing home, hospital licensed under chapter 70.41 or 71.12 RCW, hospice care facility, home health care agency, hospice agency, licensed or certified service provider under chapter 71.24 RCW other than an individual health care provider, or other entity for delivery of health care services as defined by the board.

  8. "Medication assistant" means a nursing assistant-certified with a medication assistant endorsement issued under RCW 18.88A.082 who is authorized, in addition to his or her duties as a nursing assistant-certified, to administer certain medications and perform certain treatments in a nursing home under the supervision of a registered nurse under RCW 18.88A.082.

  9. "Nursing assistant" means an individual, regardless of title, who, under the direction and supervision of a registered nurse or licensed practical nurse, assists in the delivery of nursing and nursing-related activities to patients in a health care facility or an individual, regardless of title, who uses their nursing assistant credential to work as a long-term care worker as allowed by RCW 18.88B.041(1) (a) or (b). The two levels of nursing assistants are:

    1. "Nursing assistant-certified," an individual certified under this chapter; and

    2. "Nursing assistant-registered," an individual registered under this chapter.

  10. "Nursing home" means a nursing home licensed under chapter 18.51 RCW.

  11. "Secretary" means the secretary of health.

Section 4

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    1. A nursing assistant may assist in the care of individuals as delegated by and under the direction and supervision of a licensed (registered) nurse or licensed practical nurse or work as a long-term care worker as allowed by RCW 18.88B.041(1) (a) or (b).

    2. A health care facility shall not assign a nursing assistant-registered to provide care until the nursing assistant-registered has demonstrated skills necessary to perform competently all assigned duties and responsibilities.

    3. Nothing in this chapter shall be construed to confer on a nursing assistant the authority to administer medication unless delegated as a specific nursing task pursuant to this chapter or to practice as a licensed (registered) nurse or licensed practical nurse as defined in chapter 18.79 RCW.

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    1. A nursing assistant employed in a nursing home must have successfully obtained certification through: (i) An approved training program and the competency evaluation within a period of time determined in rule by the board; or (ii) alternative training and the competency evaluation prior to employment.

    2. Certification is voluntary for nursing assistants working in health care facilities other than nursing homes unless otherwise required by state or federal law or regulation.

  3. The board may adopt rules to implement the provisions of this chapter.

Section 5

  1. No person may practice or represent himself or herself as a nursing assistant-registered by use of any title or description without being registered by the board pursuant to this chapter.

  2. No person may by use of any title or description, practice or represent himself or herself as a nursing assistant-certified without applying for certification, meeting the qualifications, and being certified by the board pursuant to this chapter.

  3. No person may practice, or represent himself or herself by any title or description, as a medication assistant without a medication assistant endorsement issued under RCW 18.88A.082.

Section 6

In addition to any other authority provided by law, the secretary has the authority to:

  1. Set all nursing assistant certification, registration, medication assistant endorsement, and renewal fees in accordance with RCW 43.70.250 and to collect and deposit all such fees in the health professions account established under RCW 43.70.320; and

2.

Employ staff that are hired and managed by the executive director provided that nothing contained in this section may be construed to alter any existing collective bargaining unit or the provisions of any existing collective bargaining agreement.

Section 7

In addition to any other authority provided by law, the board may:

  1. Determine minimum nursing assistant education requirements and approve training programs;

  2. Approve education and training programs and examinations for medication assistants as provided in RCW 18.88A.082;

  3. Define the prescriber-ordered treatments a medication assistant is authorized to perform under RCW 18.88A.082;

  4. Prepare, grade, and administer, or determine the nature of, and supervise the grading and administration of, the competency evaluation for applicants for nursing assistant certification, using the same competency evaluation for all applicants, whether qualifying to take the competency evaluation under an approved training program or alternative training;

  5. Establish forms and procedures for evaluation of an applicant's alternative training under criteria adopted pursuant to RCW 18.88A.087;

  6. Define and approve any experience requirement for nursing assistant certification;

  7. Adopt rules implementing a continuing competency evaluation program for nursing assistants;

  8. Establish forms, procedures, and the competency evaluation necessary to administer this chapter;

  9. Issue a nursing assistant registration to any applicant who has met the requirements for registration;

  10. Maintain the official record for the department of all applicants and persons with registrations, certificates, and medication assistant endorsements under this chapter;

  11. Exercise disciplinary authority as authorized in chapter 18.130 RCW;

  12. Deny registration to any applicant who fails to meet requirements for registration as a nursing assistant;

  13. Deny certification to applicants who do not meet the training, competency evaluation, and conduct requirements for certification as a nursing assistant;

  14. Deny medication assistant endorsement to applicants who do not meet the requirements of RCW 18.88A.082;

  15. Issue a medication assistant endorsement to any applicant who has met the requirements of RCW 18.88A.082;

  16. Delegate certain disciplinary functions to staff where no clinical expertise or standard of care issues are involved;

  17. Issue a nursing assistant certificate to any applicant who has met the training, competency evaluation, and conduct requirements for certification under this chapter; and

  18. Adopt rules to enable it to carry into effect the provisions of this chapter.

Section 8

  1. The board shall issue a registration to any applicant who pays any applicable fees and submits, on forms provided by the board, the applicant's name, address, and other information as determined by the board, provided there are no grounds for denial of registration or issuance of a conditional registration under this chapter or chapter 18.130 RCW.

  2. Applicants must file an application with the board for registration within three days of employment.

Section 9

  1. The board shall issue a medication assistant endorsement to any nursing assistant-certified who meets the following requirements:

    1. Ongoing certification as a nursing assistant-certified in good standing under this chapter;

    2. Completion of a minimum number of hours of documented work experience as a nursing assistant-certified in a long-term care setting as defined in rule by the board;

    3. Successful completion of an education and training program approved by the board by rule, such as the model medication assistant-certified curriculum adopted by the national council of state boards of nursing. The education and training program must include training on the specific tasks listed in subsection (2) of this section as well as training on identifying tasks that a medication assistant may not perform under subsection (4) of this section;

    4. Passage of an examination approved by the board by rule, such as the medication aide competency examination available through the national council of state boards of nursing; and

    5. Continuing competency requirements as defined in rule by the board.

  2. Subject to subsection (3) of this section, a medication assistant may perform the following additional tasks:

    1. The administration of medications orally, topically, and through inhalation;

    2. The performance of simple prescriber-ordered treatments, including blood glucose monitoring, noncomplex clean dressing changes, pulse oximetry reading, and oxygen administration, to be defined by the board by rule; and

    3. The documentation of the tasks in this subsection (2) on applicable medication or treatment forms.

  3. A medication assistant may only perform the additional tasks in subsection (2) of this section:

    1. In a nursing home;

    2. Under the direct supervision of a designated registered nurse who is on-site and immediately accessible during the medication assistant's shift. The registered nurse shall assess the resident prior to the medication assistant administering medications or treatments and determine whether it is safe to administer the medications or treatments. The judgment and decision to administer medications or treatments is retained by the registered nurse; and

    3. If, while functioning as a medication assistant, the primary responsibility of the medication assistant is performing the additional tasks. The board may adopt rules regarding the medication assistant's primary responsibilities and limiting the duties, within the scope of practice of a nursing assistant-certified, that a nursing assistant-certified may perform while functioning as a medication assistant.

  4. A medication assistant may not:

    1. Accept telephone or verbal orders from a prescriber;

    2. Calculate medication dosages;

    3. Inject any medications;

    4. Perform any sterile task;

    5. Administer medications through a tube;

    6. Administer any Schedule I, II, or III controlled substance; or

    7. Perform any task that requires nursing judgment.

  5. Nothing in this section requires a nursing home to employ a nursing assistant-certified with a medication assistant endorsement.

  6. A medication assistant is responsible and accountable for his or her specific functions.

  7. A medication assistant's employer may limit or restrict the range of functions permitted under this section, but may not expand those functions.

Section 10

  1. The board shall issue a nursing assistant certificate to any applicant who demonstrates to the board's satisfaction that the following requirements have been met:

    1. Successful completion of an approved training program or successful completion of alternative training meeting established criteria adopted by the board under RCW 18.88A.087; and

    2. Successful completion of the competency evaluation.

  2. In addition, applicants shall be subject to the grounds for denial of certification under chapter 18.130 RCW.

Section 11

  1. The board shall adopt criteria for evaluating an applicant's alternative training to determine the applicant's eligibility to take the competency evaluation for nursing assistant certification. At least one option adopted by the board must allow an applicant to take the competency evaluation if he or she:

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      1. Is a certified home care aide pursuant to chapter 18.88B RCW; or

      2. Is a certified medical assistant pursuant to a certification program accredited by a national medical assistant accreditation organization and approved by the board; and

    2. Has successfully completed at least twenty-four hours of training that the board determines is necessary to provide training equivalent to approved training on topics not addressed in the training specified for certification as a home care aide or medical assistant, as applicable. In the board's discretion, a portion of these hours may include clinical training.

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    1. The board, in consultation with the secretary, the department of social and health services, and consumer, employer, and worker representatives, shall adopt rules to implement this section and to provide for a program of credentialing reciprocity to the extent required by this section between home care aide and medical assistant certification and nursing assistant certification. The secretary shall also adopt such rules as may be necessary to implement this section and the credentialing reciprocity program.

    2. Rules adopted under this section must be consistent with requirements under 42 U.S.C. Sec. 1395i-3(e) and (f) of the federal social security act relating to state-approved competency evaluation programs for certified nurse aides.

Section 12

An applicant with military training or experience satisfies the training or experience requirements of this chapter unless the board determines that the military training or experience is not substantially equivalent to the standards of this state.

Section 13

  1. The board shall examine each applicant, by a written or oral and a manual component of competency evaluation. The competency evaluation shall be limited to the purpose of determining whether the applicant possesses the minimum skill and knowledge necessary to practice competently.

  2. Any applicant failing to make the required grade in the first competency evaluation may take up to three subsequent competency evaluations as the applicant desires upon prepaying a fee determined by the secretary under RCW 43.70.250 for each subsequent competency evaluation. Upon failing four competency evaluations, the secretary may invalidate the original application and require such remedial education before the person may take future competency evaluations.

The board may approve a competency evaluation prepared or administered by a private testing agency or association of licensing agencies for use by an applicant in meeting the credentialing requirements.

Section 14

An applicant holding a credential in another state may be certified by endorsement to practice in this state without the competency evaluation if the board determines that the other state's credentialing standards are substantially equivalent to the standards in this state.

Section 15

Applications for registration, certification, and medication assistant endorsement shall be submitted on forms provided by the board. The board may require any information and documentation that reasonably relates to the need to determine whether the applicant meets the criteria for registration, certification, and medication assistant endorsement credentialing provided for in this chapter and chapter 18.130 RCW. Each applicant shall comply with administrative procedures, administrative requirements, and fees determined by the secretary under RCW 43.70.250 and 43.70.280.

Section 16

The uniform disciplinary act, chapter 18.130 RCW, governs unregistered, uncertified, or unendorsed practice, issuance of certificates, registrations, and medication assistant endorsements, and the discipline of persons registered or with certificates under this chapter. The board shall be the disciplinary authority under this chapter.

Section 17

  1. A nursing assistant meeting the requirements of this section who provides care to individuals in community-based care settings or in-home care settings, as defined in RCW 18.79.260(3), may accept delegation of nursing care tasks by a registered nurse as provided in RCW 18.79.260(3).

  2. For the purposes of this section, "nursing assistant" means a nursing assistant-registered or a nursing assistant-certified. Nothing in this section may be construed to affect the authority of nurses to delegate nursing tasks to other persons, including licensed practical nurses, as authorized by law.

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    1. Before commencing any specific nursing care tasks authorized under this chapter, the nursing assistant must (i) provide to the delegating nurse a certificate of completion issued by the department of social and health services indicating the completion of basic core nurse delegation training, (ii) be regulated by the department of health pursuant to this chapter, subject to the uniform disciplinary act under chapter 18.130 RCW, and (iii) meet any additional training requirements identified by the board. Exceptions to these training requirements must adhere to RCW 18.79.260(3)(e) (vi).

    2. In addition to meeting the requirements of (a) of this subsection, before commencing the care of individuals with diabetes that involves administration of insulin by injection, the nursing assistant must provide to the delegating nurse a certificate of completion issued by the department of social and health services indicating completion of specialized diabetes nurse delegation training. The training must include, but is not limited to, instruction regarding diabetes, insulin, sliding scale insulin orders, and proper injection procedures.

Section 18

  1. The department has the authority to:

    1. Establish forms, procedures, and examinations necessary to certify home care aides pursuant to this chapter;

    2. Hire clerical, administrative, and investigative staff as needed to implement this section;

    3. Issue certification as a home care aide to any applicant who has successfully completed the home care aide examination, and renew such certificates;

    4. Maintain the official record of all applicants and persons with certificates;

    5. Exercise disciplinary authority as authorized in chapter 18.130 RCW, except that the state board of nursing has disciplinary authority over nursing assistants licensed under chapter 18.88A RCW working as long-term care workers under this chapter; and

    6. Deny certification to applicants who do not meet training, competency examination, and conduct requirements, including background checks, for certification.

  2. The department shall adopt rules that establish the procedures, including criteria for reviewing an applicant's state and federal background checks, and examinations necessary to implement this section.

Section 19

(1) This chapter applies only to the secretary and the boards and commissions having jurisdiction in relation to the professions licensed under the chapters specified in this section. This chapter does not apply to any business or profession not licensed under the chapters specified in this section.

Section 20

Section 21

(1) Sections 1 and 3 through 20 of this act take effect July 1, 2026.

Section 22

Section 1 of this act expires June 30, 2027.

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