The Washington State Legislature passed its 2023-25 operating budget on April 23, and the final budget includes nearly $70 billion in state spending. The legislature approved major increases in spending for public schools, housing, and environmental and mental health programs. The budget also includes a major investment in funding for salaries and benefits of state workers. Additionally, the legislature increased state spending on mental and behavioral health programs by $603 million. Most of that funding goes towards new treatment facilities and more community-based housing to support people with developmental and chronic mental illness. The legislature also made the largest increase in funding to public education since addressing funding in compliance to the McCleary decision in 2018.
Nearly $11 million dollars of the budget was allocated for the implementation of the Safe Staffing Bill. Most of that funding goes to the Department of Health and Department of Labor & Industries who are responsible for enforcing the law. An additional $2.7 million was allocated to the Department of Health to investigate the backlog of staffing complaints that accumulated during the public health emergency.
The legislature invested more than $10 million in public university nursing programs: $4.9 million for Eastern Washington University to launch a Bachelor of Science in Nursing Program for the 2023-24 academic year; $3.6 million for community and technical college nursing programs; more than $6 million to four public agencies to help increase the nurse workforce supply.
Note that as of April 24, 2023, some of the bills listed below have been passed by the legislature and are headed to the governor's desk but have not yet been signed into law.
All dollars reflect General Fund – State operating funds unless otherwise noted.
Hospital Staffing Standards
Department of Health (DOH)
Funding is provided to implement the Engrossed Second Substitute Safe Staffing Senate Bill 5236 (safe staffing), which modifies nurse staffing committee and staffing plan requirements, and makes changes to meal and rest breaks and overtime provisions for healthcare employees.
Department of Labor and Industries (L&I)
Funding is provided for rulemaking activities and for associated costs for implementation of SB 5236.
Office of the Attorney General (AGO)
Funding is provided for legal services to agencies to implement SB 5236.
Evergreen State College
Office of Administrative Hearings
Funding is provided for implementation of SB 5236.
Registered Nurses PTSD Insurance
Funding is provided for the implementation of SB 5454 (expand workers comp for nurses suffering from PTSD).
Board of Industrial Appeals
Hospital Complaint Investigations
Funding is provided to investigate a backlog of hospital complaints that developed during the COVID-19 pandemic.
University of Washington
Funding is provided for continued support for additional nursing slots at the Seattle campus in the existing accelerated Bachelor of Science in Nursing Program and for the School of Nursing and Healthcare Leadership at the Tacoma campus. A coordinated progress report with the Student Achievement Council is due to the legislature by June 1, 2023, and a final report is due by Dec. 1, 2024.
Nursing Educator Salaries
Washington State University (WSU)
Funding is provided to increase nurse educator salaries to support the College of Nursing's reaccreditation effort.
Nursing Program Equipment
Funding is provided for additional nursing program equipment.
Bachelor of Science in Nursing
Eastern Washington University
Funding is provided to fully launch the Bachelor of Science in Nursing program to serve 80 students beginning in academic year 2023-24.
Western Washington University
Funding is provided for the RN to Bachelor's in Nursing Program.
Community & Technical College System
Funding is provided to increase the number of slots in nursing programs by 200 in the 2023-25 biennium. A coordinated progress report with the Student Achievement Council is due to the legislature by June 1, 2023, and a final report is due by Dec. 1, 2024.
All dollars reflect General Fund – State operating funds unless otherwise noted.
Multistate Nurse Licensure Compact
Funding is provided to implement Substitute Senate Bill SB 5499 (multistate nurse licensure).
Washington State Patrol
Funding is provided to implement SB 5499, which requires individuals applying for license to submit fingerprints for the purpose of obtaining criminal history record information.
Nursing Pool Transparency
Funding is provided to the Department of Health to conduct rulemaking requiring nursing pools (nurse travel agencies) to register and disclose corporate structure and ownership as provided in SB 5547 (concerning nursing pool transparency).
Funding is provided for the implementation of a high school certified nursing assistant pilot program and the licensed practical nurse (LPN) apprenticeship program, and rulemaking for Engrossed Second Substitute Senate Bill 5582 (nurse supply).
Funding is provided for implementation of the high school certified nursing assistant pilot program, the LPN apprenticeship program, and a career and technical education grant program in health sciences as provided in SB 5582.
Community & Technical College System
Funding is provided for the State Board for Community & Technical Colleges (SBCTC) to develop a plan to train more nurses and to design and implement an online curriculum and pathway to earn a licensed practical nursing credential, as provided in SB 5582. A report on the plan is due to the legislature by Dec. 1, 2024.
Funding is provided for the implementation of a career and technical education grant program in health sciences, as provided in SB 5582.
Rural Nursing Workforce
One-time funding is provided for a rural workforce initiative to support nursing students remaining in rural areas.
Department of Retirement Systems
Funding is provided for implementation of Substitute Senate Bill 5538 (post-retirement/nursing).
Health Care Licenses
Funding is provided to implement HB 1503, which requires health professionals to submit demographic information upon initial licensure and renewal.
Nursing Care Quality Assurance Commission (NQAC) Staffing & Licensure
Expenditure authority is provided for the Nursing Quality Assurance Commission (NQAC) to increase staffing levels to meet the increased demand for nursing licensure and updates to policies and regulatory framework.
Nursing Commission Grant Program
Funding for the Washington NQAC to manage a grant process to incentivize nurses to supervise nursing students in healthcare settings. The goal of the grant program is to create more clinical placements for nursing students to complete required clinical hours to earn their nursing degree and related licensure.
Health Professions/ SUD Program
Funding is provided to implement HB 1255, which modifies policies regarding health professionals with substance use disorders.
Funding is provided for DOH to contract with the Central Nursing Resource Center to gather data to assess current clinical placement practices and identify policy options and recommendations to help increase the number of clinical placement opportunities.
Vendor Rate Adjustment for Nurses
Department of Corrections
Funding is provided for vendor rate increases for nursing staff, which adjusts the registered nurse hourly rate from $75 to $100, and also adjusts the licensed practitioner nurse hourly rate from $57 to $85.
COVID- 19 Funding
Funding is provided for COVID-19 response activities, including the distribution of testing supplies, providing vaccinations, and overseeing vaccine logistics and distribution.
Public Health Information Systems
Funds are provided to maintain public health information systems that are used to collect, track, and report public health information.
Public Health Technology
Funding is provided to sustain information technology infrastructure, tools, and solutions developed to respond to the COVID-19 pandemic. DOH must submit a plan to the Office of Financial Management by Sept 15, 2023, that identifies a new funding strategy to maintain these information technology investments within the DOH’s existing state, local, and federal funding.
Military Spouse Employment
One-time funding is provided to implement HB 1009, which establishes requirements for certain state agencies and licensing authorities related to professional licensing of military spouses.
Reproductive Health Services
Ongoing funding is provided to maintain access to abortion care, including grants to providers and funding for patient outreach, workforce retention, recruitment incentives, and security investments.
Tobacco Use Prevention & Cessation
One-time funding is provided for programs that prevent initiation of tobacco usage and help people quit smoking.
Health Care Affordability Study
One-time funding is provided to study health insurance affordability.
Health Care Services/Access
Funding is provided to implement Engrossed Substitute House Bill 1469 (health care services/access), which establishes various protections for individuals receiving gender-affirming treatment and reproductive healthcare services.
Difficult to Discharge Pilot
University of Washington (UW)
One-time funding is provided to organize and facilitate a difficult-to-discharge taskforce to oversee a pilot program and make recommendations about how to address challenges faced with discharging patients from acute care settings and post-acute care capacity.
UW Hospital Support
Funding is provided for continued support of operations and teaching activities at the University of Washington Medical Center and Harborview Medical Center in fiscal year 2024.
Funding for Sexual Assault Nurse Examiner (SANE) training.
Coordinated Cyber/ Nursing Report
Student Achievement Council
Funding is provided for the Washington Student Achievement Council (WSAC) to coordinate with the four-year institutions and the State Board for Community & Technical Colleges on a progress report on new or expanded cybersecurity and nursing academic programs funded in the 2022 supplemental and 2023-25 biennial operating budgets. A final report is due to the legislature by Dec. 1, 2024.
Healthcare Workers Benefits
Department of Labor and Industries (L&I)
Funding and staffing are adjusted to implement Chapter 251, Laws of 2021 (ESSB 5190), which provides presumptive workers' compensation coverage for healthcare employees during a public health emergency if certain criteria are met.
Funding is provided for the implementation of SB 5217 (concerning the state's ability to regulate certain industries and risk classes to prevent musculoskeletal injuries and disorders).
Workers Compensation System
One-time funding is provided for the discovery-planning phase and procurement strategy of replacing the workers' compensation computer system.
Equity for Underserved Workers
Funding is provided for additional outreach staff and contracted services with community-based organizations to improve access to information and services for workers with limited English proficiency.
Workers Comp Training
Funding is provided for temporary staff to update workers' compensation training modules about strategically managing claims to prevent long-term disability over a four-year period.
Mental Health Claims
Funding is provided to implement House Bill 1197 (workers' comp. providers), which requires modifications of the Medical Information Payment System to add psychologists as attending providers for mental health-only claims.
Center for Work Equity Research
Funding is provided to create the Center for Work Equity Research within the Safety and Health Assessment and Research for Prevention Program.
E2SSB 5236 strengthens accountability to hospital staffing plans. If hospitals fall below 80% compliance with their staffing plans, they are required to report noncompliance to the Department of Health and the Department of Labor & Industries (L&I). Noncompliant hospitals will be assigned a corrective action plan by the departments. These corrective actions may include safe staffing standards set by the state that the hospital will have to follow. The bill also expands meal and rest break laws to include all frontline staff. It closes loopholes to mandatory overtime laws, which are fully enforceable, and the bill ensures hospitals follow the law. If more than 20% of breaks are missed in a month, L&I will issue escalating penalties. The bill is an agreed compromise between the healthcare unions and the Washington State Hospital Association. SB 5236 passed the Senate 35-13 and passed the House 92-6. The bill was signed by the governor on April 20. There is a rolling timeline for when different components of the bill take effect.
2SSB 5454 changes the workers compensation standard for nurses suffering from PTSD from an occupational injury to an occupational disease. As an occupational disease, nurses can now qualify for workers compensation for their on-the-job PTSD based on an accumulation of events. (The previous law required that nurses tie their PTSD to a specific event.) The bill includes a presumption that if a nurse contracts PTSD, that nurse got it on the job, and it is on the employer to prove otherwise. The final version of the bill passed the House 57-40 and passed the Senate 30-18. The bill takes effect Jan. 1, 2024.
SB 5373 would have required health carriers to reimburse advanced registered nurse practitioners (ARNP) and physician assistants at the same rate as physicians for providing the same service in the same service area. The bill passed out of the Senate Health Care Committee and received a hearing in the Senate Ways & Means Committee, but the bill did not make it out of Ways & Means by the fiscal cutoff deadline.
HB 1608 would have created statewide standing orders allowing school nurses to administer emergency medications like epinephrine, and funding for schools to purchase these medications. The bill builds on existing law that provides standing orders for Narcan in school settings. The bill was introduced but did not receive a hearing in the House Education Committee prior to the policy committee cutoff. School Nurse Organization of Washington (SNOW) members plan to work over the interim to educate their legislators about the importance of ensuring every student statewide has immediate access to life-saving medications. The bill is eligible to be considered in the 2024 legislative session.
SSB 5499 enters Washington state into the Nurse Licensure Compact (NLC). Under the NLC, nurses in Washington state can obtain a multistate license allowing them to practice in other compact states without having to be licensed in those states. Nurses from other compact states may do the same when practicing in Washington state. Additional “trailer” language was added to the bill that created several requirements to improve state control over nurses practicing in Washington state. As a condition of employment, compact licensees must complete a one-time suicide assessment, treatment, and management training and any demographic data surveys required by Washington’s Nursing Commission. . Healthcare entities must report to the Nursing Commission every 30 days of employment all nurses who hold a multistate license issued by a state other than Washington and an attestation that those nurses have completed the tasks required as a condition of employment. The bill passed the Senate 40-8 and the House 94-4. The governor signed the bill on April 20. The bill has several effective dates.
SB 5538 allows PERS and PSERS nurse retirees to return to their jobs without being financially penalized. Until July 1, 2026, PERS and PSERS retirees may work for a state agency for up to 1,040 hours per year in a non-administrative position as a licensed nurse while continuing to receive pension benefits. The bill passed the Senate 41-7 and passed the House 87-11. The bill was signed by the governor on April 14 and goes into effect immediately.
SB 5241 would have modified reporting requirements for mergers and acquisitions between hospitals, hospital systems, or provider organizations. The bill requires the attorney general to determine, through a public process, if the transaction would detrimentally affect the continued existence of accessible, affordable healthcare in the state for at least 10 years after the transaction occurs. The bill also required healthcare entities to submit additional documentation related to charity care. The bill made it all the way to the Senate second reading calendar but did not get a vote on the Senate floor. The bill was returned to Senate Rules for the next legislative session.
E2SSB 5582 helps increases resources to support the nurse workforce pipeline in underserved communities. The bill tasks the State Board for Community and Technical Colleges (SBTC) with creating a plan to train more nurses over the next four years. The plan is required to include RNs, LPNs, and CNAs. A report to the legislature is due Dec. 1, 2024. SBTC must select two colleges to develop an online LPN curriculum. SBTC must also conduct a salary survey on nurse educator compensation. The bill permits the Nursing Care Quality Assurance Commission (NCQAC) to grant approval to bachelor’s degrees in nursing programs where nurse administrators hold a graduate degree in nursing as sufficient experience. The bill also creates a Home Care Aid to LPN Apprenticeship Pathway Program and creates a grant to allow schools to expand health science program offerings. Additionally, NCQAC may now count one hour of simulation lab experience in place of two hours of clinical placement learning up to a max of 50% of the required clinical hours for nurse licensure. The bill passed the Senate and the House unanimously. The bill was signed by the governor on April 20. The bill is effective 90 days after legislative adjournment.
SB 5498 would have established the Nurse Loan Repayment Assistance Program under the Washington Health Corps for nurses at participating employers. The Office of Financial Assistance must establish award amounts and other requirements for participation. There would also be an employer matching funds account. This bill died in the Senate Ways & Means committee before being voted on.
SB 5503 would have required the Nursing Commission to limit the number of clinical or direct patient experience hours required for RNs and LPNs. Currently the Nursing Commission has a floor for clinical hour requirements but does not have a ceiling. The bill died in the Senate Rules Committee before getting a vote on the Senate floor.
2SHB 1009 establishes requirements for state agencies and licensing authorities, including the Nursing Commission, related to the professional licensing of military spouses. The bill allows a military spouse to terminate an employment contract without penalty after the person’s service member spouse receives orders for a permanent change of station. The bill passed the House and the Senate unanimously.
ESHB 1187 creates a privilege (from examination and disclosure) concerning any communication between a union representative or union employee made during union representation. There are exceptions to this privilege. The bill passed the House unanimously and passed the Senate 34-14. The bill goes into effect on July 22, 2023.
SHB 1068 allows an injured worker in a workers’ compensation claim to record the audio, video, or both of an independent medical examination, and to have a person of the worker’s choice present during the examination. The bill passed the Senate 31-16 and passed the House 67-29.
SHB 1200 requires certain public employers to provide exclusive bargaining representatives’ employee information (contact information, date of hire, salary, and jobsite location) of employees in bargaining units if the employer has that information in its records. The bill allows an exclusive bargaining representative to bring a court action if a public employer fails to comply with the requirement to provide information. The bill passed the Senate 29-20 and passed the House 57-39. The bill takes effect 90 days after the legislative session adjourns.
ESSB 5217 repeals the law prohibiting the Department of Labor & Industries (L&I) from adopting rules related to ergonomics or musculoskeletal disorders. The bill creates limitations on adoption of the new rules. The bill requires L&I to identify industries and risk classifications most likely to be selected for rulemaking, review and report certain claims data, and consider certain factors in rulemaking. The bill allows L&I to provide funding to certain employers to purchase additional equipment and requires up to three additional ergonomists to provide consultation to certain employers. The bill passed the Senate 27-21 and passed the House 51-46. The bill was signed by the governor on April 20 and goes into effect 90 days after the legislature adjourns.
SHB 1255 prohibits DOH and the Nursing Commission from posting information on a public website regarding enforcement action taken against an individual licensed by the Nursing Commission if the individual has successfully completed the terms of an agreement or order requiring the individual to contact and/or participate in an approved substance use disorder monitoring program. The bill passed the House 50-35 and passed the Senate 40-7. The bill was signed into law by the governor on April 20 and goes into effect July 22, 2023.
ESHB 1340 establishes that participation in reproductive healthcare services or gender-affirming treatment by healthcare providers does not constitute unprofessional conduct under the Uniform Disciplinary Act (UDA) and may not serve as the basis for professional discipline. The bill also establishes that a conviction or disciplinary action based on a healthcare provider’s violation of another state’s laws prohibiting participation in these services does not constitute unprofessional conduct under the UDA and may not serve as the basis for professional discipline. The bill details a few exceptions to the rule. The bill passed out of the House 57-40 and passed the Senate 38 – 19. The House concurred with the Senate amendments with a vote of 57-39.
School Nurse Organization of Washington (SNOW) supports school nurses in the delivery of health services designed to improve the health and academic success of students. WSNA and SNOW worked in partnership to lobby the legislature during this legislative session.
E2SHB 1238 provides free school breakfast and lunch to K-4 students at certain public schools. The bill phases in the provision of free school meals, beginning in schools with 40% or more of their students eligible for free or reduced-price meals in the 2023-24 school year, and then including schools with 30% or more of their students eligible in the 2024-25 school year. The bill passed out of the House 93-3 and passed the Senate 44-5. The House concurred with the Senate amendments with a vote of 92-4.
E2SHB 1479 would have prohibited certain isolation and restraint of students, including chemical and medical restraint. It would also phase out the use of isolation and isolation rooms by Jan. 1, 2026. The bill would also add training and professional development requirements and would direct the Office of the Superintendent of Public Instruction to provide technical assistance, monitoring, and compliance of the new requirements. SNOW joined with partner organizations, including the Washington Education Association, in advocating for professional development funding to support implementation of the new policies and procedures. The bill passed out of the House 63-31 and received a hearing, but not a vote, in the Senate Early Learning & K-12 Committee. It is eligible to be considered in the 2024 legislative session.
ESSB 5237 requires public schools to provide a minimum of 30 minutes of daily recess each school day that exceeds five hours for all elementary school students, beginning in the 2024-25 school year. The bill includes a waiver option for those schools unable to comply. The bill also specifies that before and after school time does not count toward the 30-minute requirement (nor does the time spent changing clothes) and that the recess must be supervised, held outside whenever possible, and student led. The bill passed out of the Senate 28-21 and passed the House 81-15. The Senate concurred with the House amendments with a vote of 27-18.