wa-law.org > bill > 2025-26 > SB 5335 > Original Bill
The legislature finds that sustainable change is needed for rural health care nursing education. Nursing is the largest health care profession in the United States, yet rural hospitals, affiliated clinics, and underserved rural communities are experiencing a shortage of skilled registered nurses, including nurse practitioners who begin their careers as registered nurses, making it even more difficult to meet the health care needs of rural and underserved populations.
The legislature finds the major barriers that rural nursing students face are lack of access to affordable child care, lack of transportation and safe and extended commute times, and lack of access to internet services and computers. The added burden of the COVID-19 pandemic, subsequent reports of staff burnout, nurses leaving the profession, and higher salaries in urban areas has made it difficult for rural health care facilities, such as the state's 39 critical access hospitals, to compete with larger hospital systems in attracting and retaining a qualified workforce. Nurses living and working in rural communities are in short supply and high demand. Rural hospitals rely heavily on a substitute workforce such as traveling nurses, which is costly, unsustainable, and has significant recruitment and retention challenges.
The legislature recognizes the rural nursing education program, a statewide program created in 2023 by a collaboration of health care stakeholders, addresses the concerns of the rural nursing workforce. The program fosters community-based collaborations between academic institutions, students, and rural community health care partners and has developed a remote grow-your-own nursing education plan that educates prelicensure students as registered nurses who want to learn, live, and work in their rural communities as registered nurses. The program plans to initially offer associate degree prelicensure education with the addition of future programs when resources are available. The legislature intends to codify the program as the rural nursing education program to create a future where underserved rural communities are fully staffed with qualified nurses and thrive with robust health care services staffed by local talent.
The definitions in this section apply throughout sections 3 and 4 of this act unless the context clearly requires otherwise.
"Institution of higher education" has the same meaning as in RCW 28B.10.016.
"Nurse" or "nursing" has the same meaning as in RCW 18.79.020.
"Participant" means a student at a participating institution of higher education who is admitted into the program.
"Participating hospital" means a rural hospital licensed under chapter 70.41 RCW that is participating in the rural nursing education program.
"Program" means the rural nursing education program established under section 3 of this act.
"Rural" means a geographic area that has a shortage of nursing health services, as determined by the department.
"Rural nursing education" means education and training programs with access to distance nursing education and training opportunities designed to prepare students for initial licensure as registered nurses, provided or developed in collaboration with an institution of higher education and rural community partners.
The rural nursing education program is established within the department to provide distance nursing education, sustain lasting change in rural health care nursing education, and improve quality nursing care for underserved rural populations across the state.
In administering the program, the department shall:
Develop participant selection criteria, including the requirement that an eligible participant:
Is eligible to enroll in a nursing education or training program; and
Has declared an intention to serve in a rural area upon completion of the participant's nursing education or training program;
Develop a program application in collaboration with rural health care community partners, rural hospitals, and participating institutions of higher education;
Collaborate with rural health care community partners, including academic partners, local workforce development councils, the Washington state board of nursing, the Washington state hospital association, and exclusive bargaining representatives of nursing professions in the development of a remote rural nursing education program to connect participants, institutions of higher education, and community partners. The program must address barriers and provide support services to assist participants in learning, living, and working within their rural communities;
Collaborate with rural health care community partners, including critical access hospitals and other rural hospitals, rural health clinics, federally qualified health centers, long-term care facilities, community and behavioral health sites, and tribal health systems to identify, evaluate, and address rural nursing shortages; and
Collaborate with participating institutions of higher education and rural health care partners to design innovative and uniquely tailored models of rural nursing education, such as dedicated education units and innovative maternal health and pediatric clinical experiences, including the use of remote simulation and learning.
Participating rural hospitals and health care facilities shall:
Establish and update methods to identify and recruit active employees who meet or are likely to meet participant selection criteria and conduct communications and outreach to these potential participants; and
Encourage potential participants to contact the program and a participating institution of higher education for application information.
Participating institutions of higher education shall:
Establish and update methods to communicate with community partners to identify and recruit students who meet or are likely to meet participant selection criteria and conduct communications and outreach to these potential participants;
Establish a program cohort within the institution's nursing program for participants; and
Implement innovative and uniquely tailored models of rural nursing education and clinical experiences for participants as established in subsection (1)(e) of this section.
By November 1, 2026, the department shall submit a preliminary report to the appropriate committees of the legislature, in accordance with RCW 43.01.036, on the demographics and number of participants, preceptors, and clinical faculty training participants of the program established in section 3 of this act.
Beginning November 1, 2028, and every two years thereafter, the department shall report to the appropriate committees of the legislature, in accordance with RCW 43.01.036, the outcomes of the program established in section 3 of this act. The report must include:
The number and demographics of participants;
The number of participants who have completed the program;
The number of participants who have completed the program and are employed as registered nurses in rural communities;
The number of preceptors and clinical faculty training participants; and
Program outcomes, including clinical sites and experiences, satisfaction surveys, and evaluation measures.
Sections 2 through 4 of this act are each added to chapter 43.70 RCW.