HB 1792

Requiring all nursing assistant applicants—including those with prior training or experience—to pass a competency exam may create barriers to entry for experienced workers, especially those from low-income backgrounds or non-English speakers, potentially increasing staffing shortages in long-term care facilities at a time of acute workforce scarcity. The bill eliminates the waiver of examination that previously allowed experienced workers to bypass testing, which could delay or prevent certification for qualified individuals who struggle with standardized exams despite demonstrated competence.

While the bill adds two certified nursing assistant (CNA) members and one training program educator to the Board of Nursing, the board remains overwhelmingly dominated by RNs, APRNs, and LPNs (12 of 17 members), limiting the influence of frontline direct-care workers on regulatory decisions affecting their own scope of practice and working conditions. This structure may result in regulatory priorities that reflect professional self-interest over frontline worker input, especially on issues like delegation, supervision, and scope-of-practice boundaries.

The bill removes the Department of Health’s authority to hire administrative and investigative staff for nursing assistant regulation and transfers all disciplinary functions—including denial of certification, renewal, and discipline—to the Board of Nursing, which is not structured as an operational agency. This could lead to delays in complaint processing, inconsistent enforcement, and reduced oversight capacity, especially if the board lacks dedicated staff resources, potentially weakening consumer protection in long-term care settings.

The bill creates a tiered regulatory system where CNAs working in nursing homes face stricter oversight (e.g., direct supervision, on-site RN assessment), while those in community-based or in-home settings operate under less stringent delegation rules—despite performing similar tasks—potentially increasing variability in care quality and safety across settings. This fragmentation may compromise patient safety, especially for vulnerable populations receiving care at home, where oversight is more diffuse and monitoring is limited.

The bill requires home- and community-based nursing assistants to complete separate training certifications (e.g., “basic core nurse delegation training” and “specialized diabetes training”) issued by DSHS—not the Board of Nursing—creating administrative duplication and confusion. Employers (e.g., home care agencies) must now navigate two sets of training standards for overlapping roles, increasing compliance costs and potentially discouraging hiring or retention of qualified staff, especially in rural or under-resourced areas.