WSR 10-17-107



(Nursing Care Quality Assurance Commission)

[ Filed August 17, 2010, 2:08 p.m. , effective September 17, 2010 ]

Effective Date of Rule: Thirty-one days after filing.

Purpose: WAC 246-840-581, 246-840-582 and 246-840-583, the rules allow and define the nursing care quality assurance commission's ability to resolve complaints of a less serious nature through an early remediation program. The nurse and employer can agree to an action plan involving training and monitoring. The investigation is abbreviated.

Statutory Authority for Adoption: RCW 18.79.110 and 18.130.050.

Adopted under notice filed as WSR 10-08-091 on April 6, 2010.

Changes Other than Editing from Proposed to Adopted Version: Words were changed to future tense for sentences that referred to empowerment and authorization to be consistent with statutory construction. Unnecessary modifers were stricken. The word "complaint" was changed to "allegation" in WAC 246-840-581. All other changes were editing.

A final cost-benefit analysis is available by contacting Terry J. West, Department of Health, P.O. Box 47864, Olympia, WA 98504-7864, phone (360) 236-4712, fax (360) 236-4738, e-mail

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 3, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 3, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 3, Amended 0, Repealed 0.

Date Adopted: May 14, 2010.

Paula R. Meyer, MSN, RN

Executive Director


WAC 246-840-581   Early remediation program purpose.   WAC 246-840-582 and 246-840-583 establish the early remediation program and its eligibility criteria and procedures. The intent of this program is to effectively and efficiently protect patients by resolving allegations of practice deficiencies of a less serious nature through a plan of remedial education, training, and supervision. Such allegations may not include substance abuse or drug diversions. The nursing care quality assurance commission may resolve allegations of practice deficiencies through early remediation during an investigation.


WAC 246-840-582   Early remediation program definitions.   The definitions in this section apply throughout WAC 246-840-581 and 246-840-583 unless the context clearly requires otherwise.

(1) "Action plan" means a documented agreement between the nurse named in the complaint(s) and the commission listing remedial steps to be taken by the nurse to resolve the identified practice deficiencies. Action plans may require remedial education, on-the-job training, and follow-up monitoring of the nurse's clinical practice by the current employer or other practice monitor.

(2) "Commission" means the Washington state nursing care quality assurance commission.

(3) "Complaint" means a documented report of a possible violation of the Uniform Disciplinary Act which the commission shall assess and may subsequently authorize an investigation.

(4) "Early remediation program" means a process in which a complaint alleging practice deficiencies is resolved through an action plan without initiating disciplinary procedures.

(5) "Practice deficiencies" include, but are not limited to:

(a) Substandard nursing practice;

(b) Failure to properly conduct a patient assessment, document treatment, or administer medications; and

(c) Failure to comply with scope of practice requirements or delegation laws and regulations.

(d) Practice deficiencies do not include drug diversion, patient abuse, fraud, theft, deceit or other willful misconduct, or conduct resulting in more than minor patient harm.


WAC 246-840-583   Early remediation program criteria.   (1) In any complaint where the commission identifies practice deficiencies, the commission may resolve the matter through the early remediation program.

(2) The commission shall use the following criteria to determine eligibility for early remediation:

(a) The identified practice deficiencies could be corrected by remedial education, on-the-job training and practice monitoring within six months or less, and patient protection does not require significant long-term practice limits;

(b) The nurse is willing and able to participate in the early remediation program;

(c) The nurse's current employer agrees to participate in the action plan;

(d) The nurse has no current charges or disciplinary history of unprofessional conduct and has not previously participated in an action plan; and

(e) The degree of patient harm suffered as a result of the nurse's substandard practice is minor, if any.

(3) The commission shall use the following process to implement the early remediation program:

(a) After a preliminary investigation identifies the practice deficiencies the commission will apply criteria in subsection (2)(a) through (e) of this section to determine eligibility for early remediation;

(b) If all of the criteria are met, and if the commission determines the nurse is eligible for participation in the early remediation program the commission shall propose an action plan to the nurse and employer.

(c) If the nurse complies with the agreed action plan, the commission may consider the nurse's completion of the action plan as grounds to close the matter without further action.

(d) The commission shall evaluate whether the practice deficiencies have been corrected and are unlikely to recur; and

(e) The commission may decide to conduct a full investigation and consider disciplinary action if additional facts become known or circumstances change such that the nurse is no longer eligible based on the criteria in subsection (2)(a) through (e) of this section.


Washington State Code Reviser's Office