State by State Requirements
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      3. State by State Requirements

      Collaborating in Washington

      Review the requirements for collaborating in Washington

      State Regulations for Nurse Practitioners

      In Washington, Nurse Practitioners have Independent Practice Authority. 

      • Supervision is required for NPs who apply for licensure one or more years after graduation without practicing in another state. A total of 125 supervised practice hours for every year past graduation is required, not to exceed 1,000 hours. Supervision may be done by an NP or physician.  

      Delegation authority/process:

      • Is an agreement required?
        • Only if supervision is required. 
      • What form of agreement is required and what are the requirements for the substance of the agreement (is use of state template required?)
      • Where must the agreement be stored?
        • No requirement.
      • Does the agreement need to be filed with the state?
        • Only if supervision is required. 
      • Are there requirements to file the agreement after the initial filing (e.g., for updates or on a specified frequency)
        • No requirement.
      • Who must sign the agreement?
        • No requirement.
      • How often must the agreement be reviewed/reauthorized?
        • No requirement.
      • What are the qualifications for the collaborating provider (licensure, same scope, active practice in state, etc.)?
        • In the circumstance where supervision is required (see above), the supervisor must be in the same practice specialty in which the applicant is seeking licensure. 
        • The supervising NP or physician:
        • (i) Shall have an active NP or physician license, for two or more years, without sanctions or restrictions;
        • (ii) Must not be a member of the applicant's immediate family; or have a financial, business, or professional relationship that is in conflict with the proper discharge of the supervisor's duties to impartially supervise and evaluate the nurse;
        • (iii) Must not have current disciplinary action on their license;
        • (iv) Shall submit documented evidence to the commission verifying the applicant's successful completion of the required supervised clinical practice hours in an ARNP role.
      • What are the qualifications for the NP?
        • https://nursing.wa.gov/licensing/apply-license/arnp-license
      • Is an alternate collaborating physician required?
        • No requirement.

      Collaboration requirements

      • Are there ratios/limits on the number of NPs that a collaborator may supervise or enter into collaboration agreements? 
        • No requirement.
      • Is there an express requirement to review a certain number/percentage of charts?
        • No requirement.
      • Is there a requirement to meet and, if so, how often and how?
        • No requirement.
      • Are there proximity requirements? (e.g., between the NP/collaborator or practice site)
        •  No requirement.
      • Are there location-specific requirements? (e.g., that collaborator must go to practice site at some frequency)
        •  No requirement.
      • Is remote supervision allowed/are there limitations on remote supervision?
        • No requirement.
      • Physician and NP filing requirements – outside of filing the collab agreement, must the physician and/or NP file any separate forms? (e.g., notice of delegation of prescriptive authority, notice of collaboration, notice to PDMP, etc.) NOTE: timing/frequency should be noted because the state may have requirements for initial filing and/or filing for updates, terminations, etc.
        • At the end of the supervision period, if applicable, the supervisor will submit a written evaluation to the commission. (Evaluation must be on company letterhead). More than one supervisor is acceptable as long as successful evaluations are completed by each supervisor.
      • What are the prescription requirements? (identifying collaborator on rxs, restrictions on certain categories of drugs that may or may not be scheduled [one area of concern right now is abortion-inducing medications], etc.)
        • An NP must have prescriptive authority from the board of nursing. 
        • Prescriptions for drugs, medical equipment and therapies must comply with all applicable state and federal laws and be within the NP's scope of practice.
        • The NP must sign all prescriptions and include the initials ARNP or NP.
      • What are the requirements for controlled substance prescribing?
        • An NP may not…prescribe controlled substances in Schedule I.
        • Any NP with prescriptive authority who prescribes controlled substances must be registered with the drug enforcement administration.

      Sources for Reference