End of session report

The Washington State Legislature passed its 2023-25 operating budget on April 23, and the final budget includes nearly $70 billion in state spending. The legislature approved major increases in spending for public schools, housing, and environmental and mental health programs. The budget also includes a major investment in funding for salaries and benefits of state workers. Additionally, the legislature increased state spending on mental and behavioral health programs by $603 million. Most of that funding goes towards new treatment facilities and more community-based housing to support people with developmental and chronic mental illness. The legislature also made the largest increase in funding to public education since addressing funding in compliance to the McCleary decision in 2018.

Nearly $11 million dollars of the budget was allocated for the implementation of the Safe Staffing Bill. Most of that funding goes to the Department of Health and Department of Labor & Industries who are responsible for enforcing the law. An additional $2.7 million was allocated to the Department of Health to investigate the backlog of staffing complaints that accumulated during the public health emergency.

The legislature invested more than $10 million in public university nursing programs: $4.9 million for Eastern Washington University to launch a Bachelor of Science in Nursing Program for the 2023-24 academic year; $3.6 million for community and technical college nursing programs; more than $6 million to four public agencies to help increase the nurse workforce supply.

WSNA budget priorities

All dollars reflect General Fund – State operating funds unless otherwise noted.

Other nursing budget items of interest

All dollars reflect General Fund – State operating funds unless otherwise noted.

Labor budget items of interest

Safe Staffing — PASSED

E2SSB 5236 strengthens accountability to hospital staffing plans. If hospitals fall below 80% compliance with their staffing plans, they are required to report noncompliance to the Department of Health and the Department of Labor & Industries (L&I). Noncompliant hospitals will be assigned a corrective action plan by the departments. These corrective actions may include safe staffing standards set by the state that the hospital will have to follow. The bill also expands meal and rest break laws to include all frontline staff. It closes loopholes to mandatory overtime laws, which are fully enforceable, and the bill ensures hospitals follow the law. If more than 20% of breaks are missed in a month, L&I will issue escalating penalties. The bill is an agreed compromise between the healthcare unions and the Washington State Hospital Association. SB 5236 passed the Senate 35-13 and passed the House 92-6. The bill was signed by the governor on April 20. There is a rolling timeline for when different components of the bill take effect.

Expand Workers Comp for Nurses Suffering from PTSD — PASSED

2SSB 5454 changes the workers compensation standard for nurses suffering from PTSD from an occupational injury to an occupational disease. As an occupational disease, nurses can now qualify for workers compensation for their on-the-job PTSD based on an accumulation of events. (The previous law required that nurses tie their PTSD to a specific event.) The bill includes a presumption that if a nurse contracts PTSD, that nurse got it on the job, and it is on the employer to prove otherwise. The final version of the bill passed the House 57-40 and passed the Senate 30-18. The bill takes effect Jan. 1, 2024.

ARNP Reimbursement Parity — DEAD

SB 5373 would have required health carriers to reimburse advanced registered nurse practitioners (ARNP) and physician assistants at the same rate as physicians for providing the same service in the same service area. The bill passed out of the Senate Health Care Committee and received a hearing in the Senate Ways & Means Committee, but the bill did not make it out of Ways & Means by the fiscal cutoff deadline.

Standing Order for Medication for School Nurses — DEAD

HB 1608 would have created statewide standing orders allowing school nurses to administer emergency medications like epinephrine, and funding for schools to purchase these medications. The bill builds on existing law that provides standing orders for Narcan in school settings. The bill was introduced but did not receive a hearing in the House Education Committee prior to the policy committee cutoff. School Nurse Organization of Washington (SNOW) members plan to work over the interim to educate their legislators about the importance of ensuring every student statewide has immediate access to life-saving medications. The bill is eligible to be considered in the 2024 legislative session.

Multistate Nurse Licensure Compact — PASSED

SSB 5499 enters Washington state into the Nurse Licensure Compact (NLC). Under the NLC, nurses in Washington state can obtain a multistate license allowing them to practice in other compact states without having to be licensed in those states. Nurses from other compact states may do the same when practicing in Washington state. Additional “trailer” language was added to the bill that created several requirements to improve state control over nurses practicing in Washington state. As a condition of employment, compact licensees must complete a one-time suicide assessment, treatment, and management training and any demographic data surveys required by Washington’s Nursing Commission. . Healthcare entities must report to the Nursing Commission every 30 days of employment all nurses who hold a multistate license issued by a state other than Washington and an attestation that those nurses have completed the tasks required as a condition of employment. The bill passed the Senate 40-8 and the House 94-4. The governor signed the bill on April 20. The bill has several effective dates.

Postretirement Employment for Nurses at State Agencies — PASSED

SB 5538 allows PERS and PSERS nurse retirees to return to their jobs without being financially penalized. Until July 1, 2026, PERS and PSERS retirees may work for a state agency for up to 1,040 hours per year in a non-administrative position as a licensed nurse while continuing to receive pension benefits. The bill passed the Senate 41-7 and passed the House 87-11. The bill was signed by the governor on April 14 and goes into effect immediately.

Keep Our Care Act — DEAD

SB 5241 would have modified reporting requirements for mergers and acquisitions between hospitals, hospital systems, or provider organizations. The bill requires the attorney general to determine, through a public process, if the transaction would detrimentally affect the continued existence of accessible, affordable healthcare in the state for at least 10 years after the transaction occurs. The bill also required healthcare entities to submit additional documentation related to charity care. The bill made it all the way to the Senate second reading calendar but did not get a vote on the Senate floor. The bill was returned to Senate Rules for the next legislative session.

Expanding the Supply of Nurses in Washington — PASSED

E2SSB 5582 helps increases resources to support the nurse workforce pipeline in underserved communities. The bill tasks the State Board for Community and Technical Colleges (SBTC) with creating a plan to train more nurses over the next four years. The plan is required to include RNs, LPNs, and CNAs. A report to the legislature is due Dec. 1, 2024. SBTC must select two colleges to develop an online LPN curriculum. SBTC must also conduct a salary survey on nurse educator compensation. The bill permits the Nursing Care Quality Assurance Commission (NCQAC) to grant approval to bachelor’s degrees in nursing programs where nurse administrators hold a graduate degree in nursing as sufficient experience. The bill also creates a Home Care Aid to LPN Apprenticeship Pathway Program and creates a grant to allow schools to expand health science program offerings. Additionally, NCQAC may now count one hour of simulation lab experience in place of two hours of clinical placement learning up to a max of 50% of the required clinical hours for nurse licensure. The bill passed the Senate and the House unanimously. The bill was signed by the governor on April 20. The bill is effective 90 days after legislative adjournment.

Hospital Student Loan — DEAD

SB 5498 would have established the Nurse Loan Repayment Assistance Program under the Washington Health Corps for nurses at participating employers. The Office of Financial Assistance must establish award amounts and other requirements for participation. There would also be an employer matching funds account. This bill died in the Senate Ways & Means committee before being voted on.

Clinical Hours — DEAD

SB 5503 would have required the Nursing Commission to limit the number of clinical or direct patient experience hours required for RNs and LPNs. Currently the Nursing Commission has a floor for clinical hour requirements but does not have a ceiling. The bill died in the Senate Rules Committee before getting a vote on the Senate floor.

Concerning Military Spouse Employment — PASSED

2SHB 1009 establishes requirements for state agencies and licensing authorities, including the Nursing Commission, related to the professional licensing of military spouses. The bill allows a military spouse to terminate an employment contract without penalty after the person’s service member spouse receives orders for a permanent change of station. The bill passed the House and the Senate unanimously.

Privileged Communication between employees and their union — PASSED

ESHB 1187 creates a privilege (from examination and disclosure) concerning any communication between a union representative or union employee made during union representation. There are exceptions to this privilege. The bill passed the House unanimously and passed the Senate 34-14. The bill goes into effect on July 22, 2023.

Compelled Medical Exams for Workers — PASSED

SHB 1068 allows an injured worker in a workers’ compensation claim to record the audio, video, or both of an independent medical examination, and to have a person of the worker’s choice present during the examination. The bill passed the Senate 31-16 and passed the House 67-29.

Requiring Public Employers to Provide Information to Union Reps — PASSED

SHB 1200 requires certain public employers to provide exclusive bargaining representatives’ employee information (contact information, date of hire, salary, and jobsite location) of employees in bargaining units if the employer has that information in its records. The bill allows an exclusive bargaining representative to bring a court action if a public employer fails to comply with the requirement to provide information. The bill passed the Senate 29-20 and passed the House 57-39. The bill takes effect 90 days after the legislative session adjourns.

State’s Ability to Regulate for Musculoskeletal Diseases — PASSED

ESSB 5217 repeals the law prohibiting the Department of Labor & Industries (L&I) from adopting rules related to ergonomics or musculoskeletal disorders. The bill creates limitations on adoption of the new rules. The bill requires L&I to identify industries and risk classifications most likely to be selected for rulemaking, review and report certain claims data, and consider certain factors in rulemaking. The bill allows L&I to provide funding to certain employers to purchase additional equipment and requires up to three additional ergonomists to provide consultation to certain employers. The bill passed the Senate 27-21 and passed the House 51-46. The bill was signed by the governor on April 20 and goes into effect 90 days after the legislature adjourns.

Incentivizing Health Care Professionals to attend Substance Abuse Programs — PASSED

SHB 1255 prohibits DOH and the Nursing Commission from posting information on a public website regarding enforcement action taken against an individual licensed by the Nursing Commission if the individual has successfully completed the terms of an agreement or order requiring the individual to contact and/or participate in an approved substance use disorder monitoring program. The bill passed the House 50-35 and passed the Senate 40-7. The bill was signed into law by the governor on April 20 and goes into effect July 22, 2023.

Health Professions Disciplining Authority — PASSED

ESHB 1340 establishes that participation in reproductive healthcare services or gender-affirming treatment by healthcare providers does not constitute unprofessional conduct under the Uniform Disciplinary Act (UDA) and may not serve as the basis for professional discipline. The bill also establishes that a conviction or disciplinary action based on a healthcare provider’s violation of another state’s laws prohibiting participation in these services does not constitute unprofessional conduct under the UDA and may not serve as the basis for professional discipline. The bill details a few exceptions to the rule. The bill passed out of the House 57-40 and passed the Senate 38 – 19. The House concurred with the Senate amendments with a vote of 57-39.

Providing Free School Meals for All — PASSED

E2SHB 1238 provides free school breakfast and lunch to K-4 students at certain public schools. The bill phases in the provision of free school meals, beginning in schools with 40% or more of their students eligible for free or reduced-price meals in the 2023-24 school year, and then including schools with 30% or more of their students eligible in the 2024-25 school year. The bill passed out of the House 93-3 and passed the Senate 44-5. The House concurred with the Senate amendments with a vote of 92-4.

Restraint and Isolation of Students in Public Schools and Educational Programs — DEAD

E2SHB 1479 would have prohibited certain isolation and restraint of students, including chemical and medical restraint. It would also phase out the use of isolation and isolation rooms by Jan. 1, 2026. The bill would also add training and professional development requirements and would direct the Office of the Superintendent of Public Instruction to provide technical assistance, monitoring, and compliance of the new requirements. SNOW joined with partner organizations, including the Washington Education Association, in advocating for professional development funding to support implementation of the new policies and procedures. The bill passed out of the House 63-31 and received a hearing, but not a vote, in the Senate Early Learning & K-12 Committee. It is eligible to be considered in the 2024 legislative session.

Ensuring Elementary School Students Receive Sufficient Daily Recess — PASSED

ESSB 5237 requires public schools to provide a minimum of 30 minutes of daily recess each school day that exceeds five hours for all elementary school students, beginning in the 2024-25 school year. The bill includes a waiver option for those schools unable to comply. The bill also specifies that before and after school time does not count toward the 30-minute requirement (nor does the time spent changing clothes) and that the recess must be supervised, held outside whenever possible, and student led. The bill passed out of the Senate 28-21 and passed the House 81-15. The Senate concurred with the House amendments with a vote of 27-18.