The Board of Nursing (Board) regulates the nursing profession in Washington and establishes, monitors, and enforces licensing, standards of practice, and discipline. The Board currently is operating the Washington State Student Nurse Preceptor Grant Program to address the nursing workforce demands. The grant program is currently funded at $3 million annually and funds nurses who precept nursing students in healthcare settings including advanced registered nurse practitioner (ARNP), registered nurse, and licensed practical nurse programs.

A certified registered nurse anesthetist (CRNA) is a ARNP who administers anesthesia and other medications. They can practice independently and they also take care of and monitor people who receive or are recovering from anesthesia.

Center for Health Workforce Studies. University of Washington's Center for Health Workforce Studies (UW CHWS) is a part of University of Washington School of Medicine. UW CHWS conducts health workforce research to inform health workforce planning and policy and develops and refines analytical methods to support health workforce planning. Also, UW CHWS provides consultation to local, state, regional and national policy makers on health workforce issues. The specific aspect of the health workforce that UW CHWS addresses are the allied health workforce and the health equity and health workforce diversity. 

Preceptor Grant Program. The Board must develop and manage a grant process for the purpose of providing incentives to CRNAs to precept nurse anesthesia residents in health care settings. The Board must ensure the grant process funds are distributed equally among the total qualified applicant preceptors that dedicate at least 80 hours per year to precepting any nurse anesthesia residents.

Workforce Study. UW CHWS, in collaboration with the Board, Washington Medical Commission, and the Department of Health, must study the workforce shortages in each facility providing anesthesia services in Washington State. An initial report must be submitted to the Legislature beginning June 30, 2025, and an update report must be submitted annually thereafter.

The initial report and each subsequent report must include, but is not limited to: identifying the factors and barriers to entry into the profession of nurse anesthesiology; evaluating and assessing the current training and pipeline for CRNAs; developing recommendations that reduce barriers for individuals who want to become CRNAs and increasing the available clinical training slots for nurse anesthesia residents; creating and maintaining an implementation plan to improve the pipeline for CRNAs in the state; identifying the number of qualified anesthesia providers, including, at a minimum, physician anesthesiologists and CRNAs, who may practice independently in the state of Washington at each facility providing anesthesia services; and providing policy recommendations to expand the nurse anesthesia workforce and optimize the cost of providing anesthesia services, including initiatives for all practicing independent anesthesia providers to practice at the top of their license.

UW CHWS shall submit a final report due June 30, 2029, detailing the progress made in the previous five years and any findings and policy recommendations to further address the workforce shortages and barriers to further expanding education of CRNAs.

PRO: All work to build anesthesiology in the state and the country is important. This bill comes from stakeholder discussions and attempts to address stakeholder concern that there needs to be more done to build training spots and increase the CRNA workforce.  The state values CRNAs and there is hope that the Preceptor Grant Program and the study will both work together to build more opportunities for CRNAs. There are those who don't believe a study is necessary to determine whether an anesthesia provider shortage exists because there are anecdotes of hospitals having available hospitals rooms that cannot be in use due to a lack of anesthesia providers and ample evidence of a workforce shortage in anesthesia care. The state should adopt any and all provisions to help address this workforce shortage. There is an amendment request to change "residents" to "students."
 
OTHER: CRNAs in Washington face barriers in the education and training pipeline and this prevents expansion of the providers who actually delivered the largest majority of the anesthetics in Washington State. Although CRNAs have been lawfully permitted to practice independently in Washington for over two decades, there are still areas of the state where nurse anesthetists are kept from practicing at the top of their training and are reduced to a supervised model, which sometimes means CRNAs are excluded all together. This is an inefficient use of anesthesia resources and access to care is decreased. It also limits surgical and procedural capabilities and why there is a need for a workforce study. This bill attempts to address many concerns some stakeholders had with another bill that was before the committee but there is a request for an amendment to include language that links the bills and for there to be negotiations for agreed-upon amendments.

The committee recommended a different version of the bill than what was heard. PRO: We are looking at anything we can to expand the workforce. This will allow us to address concerns while also getting more data. Investing in student nurse anesthetists is one way to address the current shortage and this bill complements other current legislation being considered by the Senate to expand capacity in the profession. This would improve the training pipeline. We would like to refine and clarify the focus of the study. Maximizing the number of anesthesia providers is unavoidable. We need to make sure there are enough providers so that services and surgeries can be provided. This is important for patient care. This bill demonstrates that the legislature understands the current anesthesia workforce shortage and workforce constraints. Nursing anesthetists are independent anesthesia providers but are not always able to practice independently depending on the practice model used at each facility.