HB 1369

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

As Reported by House Committee On:

Health Care & Wellness

Title: An act relating to enabling student volunteers to provide health care services.

Brief Description: Enabling student volunteers to provide health care services.

Sponsors: Representatives Riccelli, Schmick, Robinson, Parker, Holy, Haler, Tharinger, Cody and Ormsby.

Brief History:

Committee Activity:

Health Care & Wellness: 1/28/15, 1/30/15, 2/3/15 [DPS].

Brief Summary of Substitute Bill

  • Permits pharmacy students, allopathic and osteopathic medical students, and nursing students to perform tasks under the supervision of a licensed pharmacist, licensed allopathic or osteopathic physician, registered nurse, or advanced registered nurse practitioner, so long as those tasks fall within the scope of practice of both the student and the supervisor and certain other conditions are met.


Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. Signed by 15 members: Representatives Cody, Chair; Riccelli, Vice Chair; Schmick, Ranking Minority Member; Harris, Assistant Ranking Minority Member; Caldier, Clibborn, DeBolt, Jinkins, Johnson, Moeller, Robinson, Rodne, Short, Tharinger and Van De Wege.

Staff: Alexa Silver (786-7190).


Scopes of Practice.

Pharmacists are licensed by the Pharmacy Quality Assurance Commission. The practice of pharmacy includes: interpreting prescriptions; compounding, dispensing, labeling, administering, distributing, and storing drugs and devices; monitoring drug therapy; initiating or modifying drug therapy in accordance with written guidelines; participating in drug utilization reviews and product selection; and providing information on legend drugs.

Physicians are licensed by the Medical Quality Assurance Commission (Medical Commission). The practice of medicine is defined as: offering or undertaking to diagnose, cure, advise, or prescribe for any human disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real or imaginary, by any means or instrumentality; administering or prescribing drugs or medicinal preparations; and severing or penetrating the tissues of human beings.

Osteopathic physicians are licensed by the Board of Osteopathic Medicine and Surgery (Osteopathic Board). The practice of osteopathic medicine and surgery is defined as using any method in the treatment of disease, injuries, deformities, and other physical and mental conditions of human beings.

Registered nurses and advanced registered nurse practitioners are licensed by the Nursing Quality Assurance Commission (Nursing Commission). The practice of advanced registered nursing means performing the acts of a registered nurse and performing an expanded role in providing health care services, as defined by the Nursing Commission, including prescribing legend drugs and controlled substances contained in Schedules II through V.

The practice of registered nursing is defined as performing acts requiring substantial specialized knowledge, judgment, and skill based on the principles of the biological, physiological, behavioral, and sociological sciences in, among other things: observing, assessing, diagnosing, caring or counseling, and health teaching of individuals with illnesses, injuries, or disabilities, or in the maintenance of health or prevention of illness; administering, supervising, delegating, and evaluating nursing practice; and executing a prescribed medical regimen. An unlicensed person may provide nursing care to the sick if he or she is uncompensated and does not hold himself or herself out to be a registered nurse.

Practice of Medicine, Nursing, and Pharmacy by Students.

Students enrolled in a school of medicine that is approved and accredited by the Medical Commission may practice medicine pursuant to their coursework or under the supervision and control of a licensed physician. Students enrolled in a school of osteopathic medicine and surgery that is accredited and approved by the Osteopathic Board may practice pursuant to their coursework and under the supervision of a licensed osteopathic physician. Nursing students enrolled in approved schools may practice registered nursing or advanced registered nursing so long as it is incidental to their course of study. Pharmacy students must apply for registration as a pharmacy intern to obtain pharmacy internship experience.


Summary of Substitute Bill:

A pharmacy student registered as a pharmacy intern may practice pharmacy, a nursing student may practice registered nursing or advanced registered nursing, an allopathic medical student may practice medicine, and an osteopathic medical student may practice osteopathic medicine if:

  1. the student is enrolled in an education program approved by the Pharmacy Commission, the Nursing Commission, the Medical Commission, or the Osteopathic Board respectively;

  2. the student performs the services without compensation or expectation of compensation as part of a volunteer activity;

  3. the student is under the direct supervision and control of a licensed pharmacist, licensed allopathic or osteopathic physician, registered nurse, or advanced registered nurse practitioner;

  4. the services are within the scope of practice of both the person supervising the student and the profession for which the student is receiving training;

  5. the student, supervisor, and organization for which the student is volunteering enter into a written agreement defining the time frame for the volunteer activity and the specific tasks the student may perform; and

  6. the student's school verifies in writing that he or she has demonstrated competency through his or her education and training to perform the tasks defined in the written agreement.

The Pharmacy Commission, Medical Commission, Osteopathic Board, and Nursing Commission may adopt rules to implement these requirements.

Substitute Bill Compared to Original Bill:

The substitute bill adds requirements that: the student perform the services as part of a volunteer activity; the student be under direct supervision; the student, supervisor, and organization enter into a written agreement; and the school verify the student's competency in writing. It also adds osteopathic physicians and students to the list of providers who may provide and be subject to interdisciplinary supervision. For pharmacy students, it requires that they be registered as pharmacy interns.


Appropriation: None.

Fiscal Note: Available.

Effective Date of Substitute Bill: The bill takes effect 90 days after adjournment of the session in which the bill is passed.

Staff Summary of Public Testimony:

(In support) This is a simple change that will make it easier for health-related educational programs to offer volunteer services in the community. Students across several professions are trained in basic practices such as taking vital signs, doing cholesterol screenings, providing immunizations, and providing patient education, but the law requires them to be supervised by their own profession. It can be difficult to find enough people from each profession to volunteer. This bill allows these students to be supervised by another profession as long as it is within their scope of practice. Students have repeatedly lost opportunities to volunteer because of an inability to find enough preceptors to supervise students in volunteer opportunities. There is a missed opportunity to do immunizations. Collaborative practice is the future, and inter-credential education is required. In the classroom, there are opportunities for students to learn and work together to be workforce ready, but actual practice opportunities are nearly non-existent. The bill should be amended to include medical schools where students are pursuing a doctorate of osteopathy.

(Opposed) The goal of interdisciplinary training is supported, but there should be sharper language about the scope in which the student performs. For example, while nurses regularly work with pharmacists, nurses do not know how pharmacists do their work. When a nurse is trying to supervise a student, he or she will want to know the portions of the scope of practice on which they are giving guidance. There are also specific rules around performing tasks for which the student has received education.

Persons Testifying: (In support) Representative Riccelli, prime sponsor; Barbara Richardson and Julie Akers, Washington State University Spokane; and Dave Knutson, Pacific Northwest University of Health Sciences.

(Opposed) Sofia Aragon, Washington State Nurses Association and ARNPs United of Washington.

Persons Signed In To Testify But Not Testifying: None.