H-1207              _______________________________________________


                                          SUBSTITUTE HOUSE BILL NO. 1252



                                                                            C 114 L 89



State of Washington                               51st Legislature                              1989 Regular Session


By House Committee on Health Care (originally sponsored by Representatives Prentice, Morris, Wood, Patrick, Braddock, D. Sommers, G. Fisher, Day, Leonard, Ebersole and Wineberry;by request of Department of Licensing)



Read first time 1/25/89.



AN ACT Relating to registered nurses; amending RCW 18.88.030, 18.88.050, 18.88.070, 18.88.130, 18.88.140, 18.88.150, 18.88.280, and 18.88.285; and repealing RCW 18.88.180 and 18.88.185.




        Sec. 1.  Section 4, chapter 202, Laws of 1949 as last amended by section 69, chapter 158, Laws of 1979 and RCW 18.88.030 are each amended to read as follows:

          Whenever used in this chapter, terms defined in this section shall have the meanings herein specified unless the context clearly indicates otherwise.

          The practice of  nursing means the performance of acts requiring substantial specialized knowledge, judgment and skill based upon the principles of the biological, physiological, behavioral and sociological sciences in either:

          (1) The observation, assessment, diagnosis, care or counsel, and health teaching of the ill, injured or infirm, or in the maintenance of health or prevention of illness of others.

          (2) The performance of such additional acts requiring education and training and which are recognized jointly by the medical and nursing professions as proper to be performed by nurses licensed under this chapter and which shall be authorized by the board of nursing through its rules and regulations.

          (3) The administration, supervision, delegation and evaluation of nursing practice:  PROVIDED, HOWEVER, That nothing herein shall affect the authority of any hospital, hospital district, medical clinic or office, concerning its administration and supervision.

          (4) The teaching of nursing.

          (5) The executing of medical regimen as prescribed by a licensed physician, osteopathic physician, dentist, or ((chiropodist)) podiatrist.

          Nothing in this chapter shall be construed as prohibiting any person from practicing any profession for which a license shall have been issued under the laws of this state or specifically authorized by any other law of the state of Washington.

          This chapter shall not be construed as prohibiting the nursing care of the sick, without compensation, by any unlicensed person who does not hold herself or himself out to be a registered nurse, and further, this chapter shall not be construed as prohibiting the practice of practical nursing by any practical nurse, with or without compensation in either homes or hospitals.

          The word "board" means the Washington state board of nursing.

          The term "department" means the department of licensing.

          The word "diagnosis", in the context of nursing practice, means the identification of, and discrimination between, the person's physical and psycho-social signs and symptoms which are essential to effective execution and management of the nursing care regimen.

          The term "diploma" means written official verification of completion of an approved nursing education program.

          The term "director" means the director of licensing or the director's designee.

          The terms "nurse" or "nursing" wherever they occur in this chapter, unless otherwise specified, for the purposes of this chapter shall mean a  registered nurse or registered nursing.


        Sec. 2.  Section 5, chapter 202, Laws of 1949 as amended by section 4, chapter 133, Laws of 1973 and RCW 18.88.050 are each amended to read as follows:

          The state board of nursing((, after July 1, 1973,)) shall consist of seven members((,)) to be appointed by the governor((, two of whom shall be appointed for a term of two years, two for a term of four years, and three for a term of five years.  Thereafter)).  All appointments shall be for terms of five years.  ((The terms of board members in office at the time of the effective date of this 1973 amendatory act shall end June 30, 1973.))  No person shall serve as a member of the board for more than two consecutive terms.

          The governor may remove any member from the board for neglect of any duty required by law,  or for incompetency or unprofessional ((or dishonorable)) conduct as defined in chapter 18.130 RCW.  Vacancies in the membership of the board shall be filled for the unexpired term by appointment by the governor as herein provided.


        Sec. 3.  Section 7, chapter 202, Laws of 1949 as amended by section 6, chapter 133, Laws of 1973 and RCW 18.88.070 are each amended to read as follows:

          The board shall ((meet)) annually ((and at its annual meeting shall)) elect from among its members a ((chairman)) chairperson and a ((secretary)) vice-chairperson.  The board shall meet at least quarterly at times and places it designates.  It shall hold such other meetings during the year as may be deemed necessary to transact its business.  A majority of the board((, including one officer,)) shall constitute a quorum at any meeting.  All meetings of the board shall be open and public except the board may hold executive sessions to the extent permitted by chapter 42.30 RCW.


        Sec. 4.  Section 13, chapter 202, Laws of 1949 as last amended by section 12, chapter 133, Laws of 1973 and RCW 18.88.130 are each amended to read as follows:

          An applicant for a license to practice as a registered nurse shall submit to the board (1) an attested written application on department form; (2) written official evidence of diploma from an approved school of nursing; and (3) any other official records specified by the board.  The applicant at the time of such submission shall not be in violation of ((RCW 18.88.230 as now or hereafter amended)) chapter 18.130 RCW  or any ((other)) provision of this chapter.

          The board, by regulation, shall establish criteria for evaluating the education of all applicants.


        Sec. 5.  Section 14, chapter 202, Laws of 1949 as last amended by section 13, chapter 133, Laws of 1973 and RCW 18.88.140 are each amended to read as follows:

          The applicant shall be required to pass a written examination in such subjects as the board shall determine.   Each written examination may be supplemented by an oral or practical examination.   The board shall establish the standards for passing.

          Upon approval by the board, the department shall issue an interim permit authorizing the applicant to practice nursing pending notification of the results of the first licensing examination following verification of diploma from an approved school of nursing.  Upon the applicant passing the examination, the department shall issue to the applicant a license to practice as a registered nurse.  If the applicant fails the examination, the interim permit expires upon notification and is not renewable.  ((Those applicants who fail the first examination shall be allowed to submit themselves for one subsequent examination without payment of any additional fee if such examination is to be held within one year of the first failure.))   The board shall establish, by rule and regulation, the requirements necessary to qualify for reexamination of applicants who have failed.


        Sec. 6.  Section 15, chapter 202, Laws of 1949 as last amended by section 5, chapter 211, Laws of 1988 and RCW 18.88.150 are each amended to read as follows:

          Upon board approval of the application, the department shall issue a license by endorsement to practice nursing as a registered nurse without examination to an applicant who is duly licensed as a registered nurse by examination under the laws of another state, territory or possession of the United States and who meets all other qualifications for licensure.

          An applicant graduated from a school of nursing outside the United States and licensed by a country outside the United States shall meet all qualifications required by this chapter and by the board and shall pass examinations as determined by the board.


        Sec. 7.  Section 28, chapter 202, Laws of 1949 as last amended by section 1, chapter 37, Laws of 1988 and RCW 18.88.280 are each amended to read as follows:

          This chapter shall not be construed as (1) prohibiting the incidental care of the sick by domestic servants or persons primarily employed as housekeepers, so long as they do not practice professional nursing within the meaning of this chapter, (2) or preventing any person from the domestic administration of family remedies or the furnishing of nursing assistance in case of emergency;  (3) nor shall it be construed as prohibiting such practice of nursing by students enrolled in approved schools as may be incidental to their course of study nor shall it prohibit such students working as nursing aides;  (4) nor shall it be construed as prohibiting auxiliary services provided by persons carrying out duties necessary for the support of nursing service including those duties which involve minor nursing services for persons performed in hospitals, nursing homes  or elsewhere under the direction of licensed physicians or the supervision of licensed, registered nurses;  (5) nor shall it be construed as prohibiting or preventing the practice of nursing in this state by any legally qualified nurse of another state or territory whose engagement requires him or her to accompany and care for a patient temporarily residing in this state during the period of one such engagement, not to exceed six months in length, if such person does not represent or hold himself or herself out as a nurse licensed to practice in this state;  (6) nor shall it be construed as prohibiting nursing or care of the sick, with or without compensation, when done in connection with the practice of the religious tenets of any church by adherents thereof so long as they do not engage in the practice of nursing as defined in this chapter;  (7) nor shall it be construed as prohibiting the practice of any legally qualified nurse of another state who is employed by the United States government or any bureau, division or agency thereof, while in the discharge of his or her official duties;  (8) permitting the measurement of the powers or range of human vision, or the determination of the accommodation and refractive state of the human eye or the scope of its functions in general, or the fitting or adaptation of lenses or frames for the aid thereof;  (9) permitting the prescribing or directing the use of, or using, any optical device in connection with ocular exercises, visual training, vision training or orthoptics;  (10) permitting the prescribing of contact lenses for, or the fitting or adaptation of contact lenses to, the human eye;  (11) prohibiting the performance of routine visual screening;  (12) permitting the practice of dentistry or dental hygiene as defined in chapters 18.32 and 18.29 RCW respectively;  (13) permitting the practice of chiropractic as defined in chapter 18.25 RCW including the adjustment or manipulation of the articulations of the spine;  (14) permitting the practice of ((chiropody)) podiatry as defined in chapter 18.22 RCW;  (15) permitting the performance of major surgery, except such minor surgery as the board may have specifically authorized by rule or regulation duly adopted in accordance with the provisions of chapter ((34.04)) 34.05 RCW;  (16) permitting the prescribing of controlled substances as defined in schedules I through IV of the Uniform Controlled Substances Act, chapter 69.50 RCW; (17)  prohibiting the determination and pronouncement of death.


        Sec. 8.  Section 14, chapter 288, Laws of 1961 as last amended by section 28, chapter 133, Laws of 1973 and RCW 18.88.285 are each amended to read as follows:

          A registered nurse under her or his license may perform for compensation nursing care (as that term is usually understood) of the ill, injured or infirm, and in the course thereof, she or he is authorized to do the following things which shall not be done by any person not so licensed, except as provided in RCW 18.78.182:

          (1) At or under the general direction of a licensed physician, dentist, osteopath or ((chiropodist)) podiatrist (acting within the scope of his or her license) to administer medications, treatments, tests and innoculations, whether or not the severing or penetrating of tissues is involved and whether or not a degree of independent judgment and skill is required.

          (2) To delegate to other persons engaged in nursing, the functions outlined in the preceding paragraph.

          (3) To perform specialized and advanced levels of nursing as defined by the board.

          (4) To instruct students of nursing in technical subjects pertaining to nursing.

          (5) To hold herself or himself out to the public or designate herself or himself as a registered nurse or nurse.


          NEW SECTION.  Sec. 9.  The following acts or parts of acts are each repealed:

                   (1) Section 18, chapter 202, Laws of 1949, section 17, chapter 133, Laws of 1973 and RCW 18.88.180; and

          (2) Section 16, chapter 288, Laws of 1961 and RCW 18.88.185.

                                                                                                                      Passed the House February 27, 1989.


                                                                                                                                         Speaker of the House.


                                                                                                                             Passed the Senate April 7, 1989.


                                                                                                                                       President of the Senate.