Examination Prep
Manual and Regulatory
Guide for Washington
State Nursing Home
Administrators
The practice of long-term care administration in the state of Washington requires a sophisticated
integration of clinical expertise, financial stewardship, environmental safety, and administrative
law. To successfully navigate the credentialing examination and maintain licensure, candidates
must possess a detailed understanding of both the Washington Administrative Code (WAC) and
the Revised Code of Washington (RCW). This guide provides a comprehensive analysis of the
state's regulatory, operational, and clinical frameworks, followed by a formal practice
examination designed to reflect the technical depth of the licensing board's standards.
Professional Licensure, Educational Standards, and
the AIT Pathway
Licensure as a nursing home administrator in Washington State is governed by academic and
experiential benchmarks designed to protect vulnerable residents. Under the jurisdiction of the
Board of Nursing Home Administrators, candidates must possess a baccalaureate degree from
an accredited institution, meet practical experience requirements, and pass the national
examination administered by the National Association of Long Term Care Administrator Boards
(NAB). The standard experiential pathway is the board-approved Administrator-in-Training (AIT)
program.
Regulatory Domain Licensing and Training Compliance Criteria
Standards
Academic Foundation Baccalaureate or higher degree Verification via official
from an accredited institution transcripts sent directly to the
Department of Health
Standard AIT Program Standard 1,500-hour rotational Preceptor must submit monthly
program under an approved reports and a final report 10
preceptor days before completion
AIT Facility Standards Sponsoring facility must have at Smaller facilities require a
least 50 licensed beds board-approved plan to expand
, Regulatory Domain Licensing and Training Compliance Criteria
Standards
rotational experience
Rotational Allocation Minimum 90% of hours spent Conducted in a licensed
rotating through each clinical nursing home or Washington
and operational department veterans home
AIT Written Project At least one problem-solving Project description must be
project to improve facility approved by the board before
operations the AIT program start date
Biennial Continuing 36 hours of approved Tracked biennially on or before
Education continuing education every two the administrator's birthday;
years max 12 hours per day
Health Equity Training Minimum 2 hours of health Included within the existing
equity education every four 36-hour continuing education
years requirement
Specific exemptions to the standard AIT program are available for hospital administrators,
regional directors of rehabilitation, and assistant administrators who demonstrate a minimum of
five years of experience within the last seven years, with extensive supervisory and budgetary
responsibility. Additionally, individuals who have worked as a licensed nursing home
administrator for at least two years in the past five years are exempt from the standard AIT
requirement.
Once licensed, administrators must manage their personal credentials diligently. Licenses must
be renewed annually on or before the administrator’s birthday. If a credential is not renewed on
time, the Department of Health immediately places it in an "expired" status, rendering the
administrator unauthorized to practice. Any practice during expired status is a violation of state
law and subjects the individual to disciplinary action.
Administrators are also required to attend a board-approved, minimum six-hour course on
Washington state laws relating to nursing homes within 180 days of initial licensure. This course
covers Chapter 18.52 RCW and Chapter 388-97 WAC to ensure that the licensee understands
state-specific standards regarding resident rights, enforcement, and criminal history inquiries.
Clinical Staffing Metrics and Direct Care Quotas
Maintaining adequate staffing levels is a critical operational standard. Under WAC 388-97-1090,
nursing facilities must align their daily schedules with mandatory direct care hours and direct
nursing supervision requirements.
Clinical Staffing Parameter Statutory Threshold and Compliance Auditing
Calculation Rules Mechanism
Minimum Direct Care 3.4 hours of direct care per Measured quarterly using
Standard resident day (HRD) electronic CMS Payroll-Based
Journal (PBJ) data
Director of Nursing Services Excluded from the HRD Included in the HRD calculation
calculation in facilities with \ge only for facilities with \le 60
61 beds beds
Behavioral Health Integration Geriatric behavioral health Tracked under appropriate PBJ
worker hours are permitted to job codes as defined by RCW
satisfy the HRD quota 74.42.010
Manual and Regulatory
Guide for Washington
State Nursing Home
Administrators
The practice of long-term care administration in the state of Washington requires a sophisticated
integration of clinical expertise, financial stewardship, environmental safety, and administrative
law. To successfully navigate the credentialing examination and maintain licensure, candidates
must possess a detailed understanding of both the Washington Administrative Code (WAC) and
the Revised Code of Washington (RCW). This guide provides a comprehensive analysis of the
state's regulatory, operational, and clinical frameworks, followed by a formal practice
examination designed to reflect the technical depth of the licensing board's standards.
Professional Licensure, Educational Standards, and
the AIT Pathway
Licensure as a nursing home administrator in Washington State is governed by academic and
experiential benchmarks designed to protect vulnerable residents. Under the jurisdiction of the
Board of Nursing Home Administrators, candidates must possess a baccalaureate degree from
an accredited institution, meet practical experience requirements, and pass the national
examination administered by the National Association of Long Term Care Administrator Boards
(NAB). The standard experiential pathway is the board-approved Administrator-in-Training (AIT)
program.
Regulatory Domain Licensing and Training Compliance Criteria
Standards
Academic Foundation Baccalaureate or higher degree Verification via official
from an accredited institution transcripts sent directly to the
Department of Health
Standard AIT Program Standard 1,500-hour rotational Preceptor must submit monthly
program under an approved reports and a final report 10
preceptor days before completion
AIT Facility Standards Sponsoring facility must have at Smaller facilities require a
least 50 licensed beds board-approved plan to expand
, Regulatory Domain Licensing and Training Compliance Criteria
Standards
rotational experience
Rotational Allocation Minimum 90% of hours spent Conducted in a licensed
rotating through each clinical nursing home or Washington
and operational department veterans home
AIT Written Project At least one problem-solving Project description must be
project to improve facility approved by the board before
operations the AIT program start date
Biennial Continuing 36 hours of approved Tracked biennially on or before
Education continuing education every two the administrator's birthday;
years max 12 hours per day
Health Equity Training Minimum 2 hours of health Included within the existing
equity education every four 36-hour continuing education
years requirement
Specific exemptions to the standard AIT program are available for hospital administrators,
regional directors of rehabilitation, and assistant administrators who demonstrate a minimum of
five years of experience within the last seven years, with extensive supervisory and budgetary
responsibility. Additionally, individuals who have worked as a licensed nursing home
administrator for at least two years in the past five years are exempt from the standard AIT
requirement.
Once licensed, administrators must manage their personal credentials diligently. Licenses must
be renewed annually on or before the administrator’s birthday. If a credential is not renewed on
time, the Department of Health immediately places it in an "expired" status, rendering the
administrator unauthorized to practice. Any practice during expired status is a violation of state
law and subjects the individual to disciplinary action.
Administrators are also required to attend a board-approved, minimum six-hour course on
Washington state laws relating to nursing homes within 180 days of initial licensure. This course
covers Chapter 18.52 RCW and Chapter 388-97 WAC to ensure that the licensee understands
state-specific standards regarding resident rights, enforcement, and criminal history inquiries.
Clinical Staffing Metrics and Direct Care Quotas
Maintaining adequate staffing levels is a critical operational standard. Under WAC 388-97-1090,
nursing facilities must align their daily schedules with mandatory direct care hours and direct
nursing supervision requirements.
Clinical Staffing Parameter Statutory Threshold and Compliance Auditing
Calculation Rules Mechanism
Minimum Direct Care 3.4 hours of direct care per Measured quarterly using
Standard resident day (HRD) electronic CMS Payroll-Based
Journal (PBJ) data
Director of Nursing Services Excluded from the HRD Included in the HRD calculation
calculation in facilities with \ge only for facilities with \le 60
61 beds beds
Behavioral Health Integration Geriatric behavioral health Tracked under appropriate PBJ
worker hours are permitted to job codes as defined by RCW
satisfy the HRD quota 74.42.010
