A nurse’s scope of practice is defined by each state’s Nurse Practice Act. In Washington state, this is encompassed in the Revised Code of Washington (RCW) and Washington Administrative Code (WAC). Let’s unpack each of these and learn how they affect nursing practice in Washington state.
RCWs are collections of statutes written by the Washington State Legislature. Each statute is written, amended and approved by the Legislature and signed into law by the governor. RCWs governing nursing practice are under RCW 18.79. These cover scope of practice, delegation, education, discipline, licensing and other matters pertaining to nursing practice of RNs, LPNs, ARNPs and nurse techs. They also outline the scope and purpose of the Nursing Care Quality Assurance Commission (NCQAC).
The Uniform Disciplinary Act is found in RCW 18.130 — this is the specific RCW that determines the threshold for formal discipline (what is considered a chargeable offense) for all health professions in Washington state.
WACs are rules that provide interpretive support for those covered by RCWs. They carry the full force of the law. WACs pertaining to nurses are written and adopted by the secretary of health or NCQAC. WACs pertaining to nursing practice begin at WAC 246 – 840 and cover education, practice, continuing competency, nursing education, pain management, nurse techs and other areas of practice.
It sounds complicated, but it’s hugely beneficial to structure things this way. WACs can get much more specific about the details of nursing care. Those rules are made for nurses, by nurses — which is much better than trying to get lawmakers to understand the various nuances of what nurses do (there are very few nurses in the legislature). This also means that NCQAC can involve the public and nursing stakeholders through public comment, meetings and other ways of soliciting feedback in a time frame that isn’t limited by the legislative session. WACs are not permitted to contradict RCWs in terms of content or interpretation.
Changes to WACs are also known as “rulemaking.” Rules are created through a process involving public meetings and hearings. NCQAC will post notices of these sessions on its website and its email alerts. RNs are invited to provide input to these changes either by attending or writing to the commission.
A complete list of rules in progress, workshops, hearings and directions for providing comments is on the NCQAC website.