Washington Administrative Code

Registered nurse (RN) and licensed practical nurse (LPN) applicants educated in a United States (U.S.) jurisdiction and applying for licensure by interstate endorsement shall:(1) Have graduated and hold a degree from a nursing education program approved by a board of nursing or r…

Registered nurse (RN) and licensed practical nurse (LPN) applicants educated outside United States (U.S.) jurisdictions and applying for licensure by interstate endorsement shall:(1) Have graduated and hold a degree from a nursing education program outside U.S. jurisdictions prep…

(1) Applicants applying for a multistate license under the Enhanced Nurse Licensure Compact (eNLC) shall meet all requirements outlined in this chapter and RCW 18.80.020(3).(2) Individuals that hold a multistate nurse license issued by another compact jurisdiction outside of Wash…

The board conducts background checks on applicants to assure safe patient care. Completion of a fingerprint-based national background check may cause a delay in licensing.(1) The board may issue a temporary practice permit to an applicant who has met all requirements for licensur…

The board adopts RCW 34.05.482 through 34.05.494 for adjudicative proceedings requested by applicants, who are denied a license under chapter 18.79 RCW or chapter 246-840 WAC for failure to meet the education, experience, or examination prerequisites for licensure. The sole issue…

A registered nurse (RN) or licensed practical nurse (LPN) licensed under this chapter with an expired license as defined in WAC 246-12-010 may return their license to an active status. During the time the license is expired, the nurse cannot practice in Washington state.(1) If th…

A registered nurse (RN) or licensed practical nurse (LPN) licensed under this chapter may place their license in an "inactive status" as defined in WAC 246-12-010.(1) To place a license in inactive status, the nurse shall comply with the requirements in WAC 246-12-090.(2) An inac…

(1) A registered nurse (RN) or licensed practical nurse (LPN) may place their license in "retired active" status as defined in WAC 246-12-010 by meeting the requirements of this section.(2) An RN or LPN who holds a retired active license may only practice in intermittent or emerg…

Patients, families, and communities expect safe, competent, and compassionate nursing care. WAC 246-840-200 through 246-840-260 establish a self-directed continuing competency program which includes participation in active practice and continuing nursing education for registered …

The definitions in this section apply throughout WAC 246-840-200 through 246-840-260 unless the context clearly requires otherwise.(1) "Active nursing practice" means engagement in paid, unpaid, or volunteer activity performing acts requiring substantial nursing knowledge, judgme…

(1) Upon license renewal a nurse shall attest on a form provided by the department of health declaring completion of the required active nursing practice hours and continuing nursing education hours.(2) A nurse shall complete within a 12-month period prior to the renewal of licen…

(1) Nurses must complete a minimum of two hours of health equity continuing education every year upon license renewal as described in WAC 246-12-800 through 246-12-830.(2) The hours spent completing health equity continuing education under this section count toward meeting applic…

(1) The board may conduct a compliance audit:(a) Through random selection; and(b) At the discretion of the board, on nurses under the disciplinary process.(2) The board will notify a nurse selected for compliance audit at the address on record with the department.(3) The nurse sh…

(1) All nurses applying for reactivation from an expired license shall meet the requirements of WAC 246-12-040 and 246-840-111.(2) If a license has been expired for more than one year, and the nurse has not held an active nursing license in any United States (U.S.) or Canadian ju…

(1) All nurses applying for reactivation of an inactive license shall meet the requirements of WAC 246-12-100, 246-12-110, or 246-840-120.(2) If a license has been inactive for more than one year, and the nurse has not held an active nursing license in any United States or Canadi…

The scope of practice of a licensed ARNP is as provided in RCW 18.79.250 and this section.(1) The ARNP is prepared and qualified to assume primary responsibility and accountability for the care of patients within their roles of ARNP licensure: Certified nurse practitioner (CNP), …

(1) ARNP designations recognized by the commission include:(a) Nurse practitioner (NP);(b) Certified nurse-midwife (CNM);(c) Certified registered nurse anesthetist (CRNA); and(d) Clinical nurse specialist (CNS).(2) An ARNP must maintain current certification within his or her des…

A person who holds a license to practice as an ARNP shall have the right to use the title "advanced registered nurse practitioner" and the abbreviation following the nurse's name shall read "ARNP" or "NP."An ARNP may also use the applicable title or abbreviation, or designation a…

(1) An ARNP holding an active license, without sanctions or restrictions, under one or more of the following previously existing advanced practice certification designations, may continue to renew his or her license as an ARNP:(a) Community health;(b) Maternal-gynecological-neona…

(1) An applicant for licensure as an ARNP shall have the following qualifications:(a) An active Washington state RN license, without sanctions or restrictions;(b) A graduate degree from an advanced nursing education program accredited by a national nursing accreditation body reco…

(1) An applicant for interstate endorsement for Washington state licensure as an ARNP shall meet the following requirements:(a) Have an active RN and ARNP license, or recognition in another state or jurisdiction, as practicing in an advanced practice role, without sanctions or re…

(1) An applicant for ARNP licensure in Washington state, educated and licensed outside the United States, shall:(a) Apply for and be granted an active RN license, or recognition in another state or jurisdiction, without sanctions or restrictions, issued by a regulatory entity out…

(1) An applicant applying for ARNP license renewal, shall have:(a) An active Washington state RN license, without sanctions or restrictions;(b) Current certification from a certifying body as identified in WAC 246-840-302; and(c) Thirty contact hours of continuing education obtai…

The thirty contact hours of continuing education required for the two-year renewal of ARNP licensure must:(1) Be acceptable to the certifying body identified in WAC 246-840-302(3);(2) Be obtained from courses in which the contact hour is at least fifty minutes;(3) Not include the…

To apply for an inactive ARNP license, an ARNP shall comply with WAC 246-12-090 or 246-12-540, if military related.(1) An ARNP may apply for an inactive license if he or she holds an active Washington state ARNP license without sanctions or restrictions.(2) To return to active st…

When an ARNP license is not renewed, it is placed in expired status and the nurse must not practice as an ARNP.(1) To return to active status when the license has been expired for less than two years, the nurse shall:(a) Meet the requirements for initial and renewal credentialing…

(1) An ARNP licensed under chapter 18.79 RCW when authorized by the nursing commission may prescribe drugs and medical devices pursuant to applicable state and federal laws.(2) The ARNP when exercising prescriptive authority is accountable for competency in:(a) Problem identifica…

(1) An ARNP who applies for prescriptive authority must:(a) Hold an active Washington state ARNP license, without sanctions or restrictions, issued by the commission;(b) Provide evidence of thirty contact hours of education in pharmacology, including didactic and clinical applica…

Prescriptions for drugs and medical devices must comply with all applicable state and federal laws and be within the ARNP's scope of practice.(1) An ARNP must sign prescriptions and include the initials ARNP or NP.(2) An ARNP may not, under RCW 18.79.240(1) and chapter 69.50 RCW,…

(1) ARNP prescriptive authority must be renewed at the time of renewal of the ARNP license. For renewal of ARNP prescriptive authority, the licensee must:(a) Meet the requirements of WAC 246-840-360; and(b) Provide a written declaration on forms provided by the commission of fift…

(1) The fifteen hours of pharmacotherapeutic continuing education must:(a) Relate to the ARNP's scope of certification and scope of practice; and(b) Be obtained from continuing education courses in which the contact hour time is not less than fifty minutes.(2) The same course tak…

WAC 246-840-460 through 246-840-4990 govern the use of opioids in the treatment of pain in the acute, perioperative, subacute, and chronic phases. Treatment modalities including opioid use can serve to improve the quality of life for those patients who suffer from pain, as well a…

WAC 246-840-460 through 246-840-4990 do not apply to:(1) The treatment of patients with cancer-related pain;(2) The provision of palliative, hospice, or other end-of-life care;(3) The treatment of inpatient hospital patients; or(4) Procedural premedications.(5) The treatment of p…

The following definitions apply in WAC 246-840-460 through 246-840-4990, unless the context clearly requires otherwise.(1) "Aberrant behavior" means behavior that indicates misuse, diversion, or substance use disorder. This includes, but is not limited to, multiple early refills …

(1) The practitioner shall provide information to the patient educating them of:(a) Risks associated with the use of opioids as appropriate to the medical condition, the type of patient, and the phase of treatment;(b) The safe and secure storage of opioid prescriptions;(c) The pr…

The practitioner shall consider multimodal pharmacologic and nonpharmacologic therapy for pain rather than defaulting to the use of opioid therapy alone whenever reasonable as evidence-based, clinically appropriate alternatives exist. A practitioner may combine opioids with other…

(1) In order to prescribe an opioid in Washington state, an advanced registered nurse practitioner licensed to prescribe opioids shall complete a one-time continuing education requirement regarding best practices in the prescribing of opioids. Additionally, a chronic pain managem…

The advanced registered nurse practitioner shall include the diagnosis or the International Classification of Diseases (ICD) code on all opioid prescriptions.[Statutory Authority: RCW 18.79.800 and 2017 c 297. WSR 18-20-086, § 246-840-4657, filed 10/1/18, effective 11/1/18.]

Prior to prescribing an opioid for acute nonoperative pain or acute perioperative pain, the advanced registered nurse practitioner shall:(1) Conduct and document an appropriate history and physical examination including screening for risk factors for overdose and severe postopera…

The advanced registered nurse practitioner shall comply with the requirements in this section when prescribing opioid analgesics for acute nonoperative pain and shall document completion of these requirements in the patient record.(1) The advanced registered nurse practitioner sh…

The advanced registered nurse practitioner shall comply with the requirements in this section when prescribing opioid analgesics for perioperative pain and shall document completion of these requirements in the patient's record.(1) The advanced registered nurse practitioner shall…

The advanced registered nurse practitioner shall comply with the requirements in this section when prescribing opioid analgesics for subacute pain and shall document completion of these requirements in the patient record.(1) Prior to prescribing an opioid for subacute pain, the a…

(1) The advanced registered nurse practitioner shall recognize the progression of a patient from the acute nonoperative or acute perioperative phase to the subacute phase and take into consideration the risks and benefits of continued opioid prescribing for the patient.(2) If tap…

The advanced registered nurse practitioner shall evaluate and document the patient's health history and physical examination in the patient's health record prior to treating for chronic pain.(1) The patient's health history shall include:(a) The nature and intensity of the pain;(…

(1) When the patient enters the chronic pain phase, the advanced registered nurse shall reevaluate the patient by treating the situation as a new disease.(2) The chronic pain treatment plan must state the objectives that will be used to determine treatment success and must includ…

The advanced registered nurse practitioner shall use a written agreement for treatment with the patient who requires long-term opioid therapy for chronic pain that outlines the patient's responsibilities. This written agreement for treatment must include:(1) The patient's agreeme…

(1) The advanced registered nurse practitioner shall periodically review the course of treatment for chronic pain. The frequency of visits, biological testing, and prescription monitoring program (PMP) queries are determined based on the patient's risk category:(a) For a high-ris…

(1) The advanced registered nurse practitioner shall consider and document referring the patient for additional evaluation and treatment as needed to achieve treatment objectives. Special attention should be given to those chronic pain patients who are under eighteen years of age…

An advanced registered nurse practitioner is not required to consult with a pain management specialist as defined in WAC 246-840-493 when the advanced registered nurse practitioner has documented adherence to all standards of practice as defined in WAC 246-840-460 through 246-840…

The advanced registered nurse practitioner is exempt from the consultation requirement in WAC 246-840-485 if one or more of the following qualifications are met:(1) The advanced registered nurse practitioner is a pain management specialist under WAC 246-840-493;(2) The advanced r…