RN Career Pathway in Washington State

Washington State leaders are concerned that Washington meet its nursing workforce needs — concerned in more ways than one! One concern is that there will be enough professional nurses. The Washington Center for Nursing has worked to showcase the profession to students as young as middle school. A second concern: that nurses will be prepared to function in many roles and to do more than just meet the status quo in a world of increasing healthcare complexity.

RNs have roles far beyond the assistive. Relatively higher levels of preparation are needed for acute and critical care and, on the opposite end of the spectrum, for high level roles in population health. Nursing leaders in Washington State have come out in strong support of preparing nurses across settings and roles to positively impact health on a population level.

Work Settings

The most common setting nationwide is the inpatient hospital ward. In a sense, this is many different settings because of the degree of specialization possible (for example, cardiovascular intensive care, oncology, neurology, pediatric psychiatric). RNs work in other areas of the hospital including the emergency department.

Hospitals are often part of systems with multi-specialty physician’s practices or outpatient care facilities. These, too, may include many specialized clinics.

Skilled nursing facilities and community settings are also common. An RN can carry out roles beyond those of other nursing staff. An RN license allows for more independence and thus the authority to perform certain technical acts in a wider variety of settings. An LPN can administer blood products, for example, only under direct supervision.

RNs are needed for some roles in home health. They carry out technical duties as well as assess patients and manage caseloads. Home health agencies operate under various organizational structures. They may be part of larger healthcare systems.

Becoming an RN and Achieving Proficiency

Future RNs may pursue their initial professional nursing curriculum at the associate’s, bachelor’s, or master’s level. All approved RN programs in Washington state prepare students for the NCLEX RN and licensure. Students learn to practice safely, go through the stages of the nursing process, and carry out duties such as discharge planning and supervision. Bachelor’s and entry-level master’s programs must include additional content in areas like care coordination, quality assurance, and use of research and statistics. At this level, Washington administrative code mandates instruction and clinical experience in community and public health nursing. ADN coursework can later be credited toward a BSN.

While ADNs and BSNs both work under RN licensing, they can expect some role differentiation at the employment level. Washington gives the nod to professional organizations in determining the role of the associate and bachelor’s level nurse.

While initial education and clinical experience provides the legal foundation for practice, expertise comes at a later stage; it is often developed in more narrow areas of nursing. In a recent Washington survey, 71% of acute care hospitals reported having transition to practice programs. Some were designed only for new graduates (http://www.wcnursing.org/data-resources/washington-reports/). Others included some other nurses (for example, those who were new to acute care or were switching practice areas). Preceptorship was the universal element. Some included a separate mentoring element.

In the perioperative sphere, requirements are more formal. The Nursing Care Quality Assurance Commission, Washington’s regulatory body, issued an advisory opinion that Registered Nurse First Assistants (nurses with relatively high level roles assisting in the surgical process) should complete programs meeting standards of the Association of periOperative Registered Nurses and achieve CNOR certification.

Washington Hospitals and Medical Centers

The hospital experience can be very varied depending on the unit and the size of the hospital. Washington has 39 critical access hospitals, each with 25 or fewer beds. It also includes some very large facilities; two hospitals that operate under the Swedish banner are more than 600 beds. Large urban hospitals hire for specialized positions. Critical care hospitals need generalists, but very adept ones. One nurse is going to see patients with many presenting conditions.

Becker’s Hospital Review lists fully three Washington employers on its list of top hospitals and health systems to work for: Confluence Health in Wenatchee, EvergreenHealth in Kirkland, and Seattle Cancer Care Alliance.

Washington boasts three magnet hospitals, recognized for nursing excellence: Providence St. Peter in Olympia, Seattle Children’s Hospital, and the University of Washington Medical Center, also in Seattle.

Some large facilities are nationally ranked in multiple areas of medical practice. They rack up honors in other areas including their use of technology – “most wired”.

Smaller hospitals have their own honors. Olympic Medical Center in Port Angeles is on the 2017 list for top rural and community hospitals. Providence Mount Carmel Hospital is on the list of top critical access hospitals.

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Transport Nurses and Flight Nurses

Sometimes patients are transferred to facilities that can provide a higher level of care (for example, the next higher level of trauma care). Critical care nurses have an important role in ensuring that health status is as good as possible during transfer. Often transfers are by air. Some nurses pursue third party certification as flight nurses.

Public Health Nursing in Washington

The Washington Center for Nursing has spotlighted two public health nurses in a post about nursing roles outside the hospital (http://www.wcnursing.org/nursing-practice/Nursing_Roles_Outside_the_Hospital/). One works in the field of prevention; she runs programs that help people lower their risk factors for chronic disease. The other is in maternal-child health; duties include everything from doing health/ safety checks at day cares to visiting pregnant women at home to support behaviors that will help them have healthy children.

The Nurse-Family Partnership is active in 15 Washington counties (https://www.nursefamilypartnership.org/locations/washington/). This very successful program allows low-income first-time mothers to receive home visits from nurses beginning in the prenatal phase.

The Robert Wood Johnson Foundation blog includes a post from an official at Clark County Public Health in Vancouver about the myriad reasons a person might opt for public health nursing as a career (https://www.rwjf.org/en/culture-of-health/2013/08/are_you_considering.html).

Deans and directors of Washington State BSN and MSN programs have together issued a statement of commitment about ensuring that their students receive a population-focused education.

Career Outlook and Average Nursing Salary in Washington

Washington registered nursing has been projected to experience 19.6% occupational growth over the course of the 2014 to 2024 decade.

Washington State registered nurses averaged $38.52 an hour in 2016. The Bureau of Labor Statistics has figured this at $80,120, based on 52 40-hour work weeks.

Related Articles:

LPN Requirements in Washington State

CNA Requirements in Washington State

Medical Assistant Certification Requirements in Washington State

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