Written Protocol · RN
Washington Standing Order for Registered Nurses
Recognized but not required in every case. The Standing Order is the written instrument Washington law names for a Registered Nurse working with a physician. Below: the board that governs it, what it contains when one is used, and the supervision rules that apply either way.
RNs (general licensure, not an ARNP) are not subject to physician-supervision or collaborative-agreement requirements in Washington; RN practice under RCW 18.79.040 is defined without a physician-oversight condition.
What a voluntary Registered Nurse agreement covers in Washington
Washington requires no written agreement for registered nurses. These are the clauses a practice includes when it chooses to put one in writing. The Washington State Board of Nursing governs registered nurses here.
A standing order involving a medical regimen that Registered Nurse carries out is approved by an authorized health care practitioner acting within scope, and is developed and approved by medical, pharmacy and nursing leadership; facility policy may restrict but not expand nursing scope.
Source: NCQAC Advisory Opinion AO 28.01, Standing Orders (rev. Nov. 17, 2023)
Registered Nurse may follow institutional standing orders or approved statewide standing orders issued by the Department of Health.
Source: NCQAC Advisory Opinion AO 28.01, Standing Orders (rev. Nov. 17, 2023)
- The Standing Order also carries 1 scope clauses, authored in the document itself.
Statutes and rules these clauses cite
- NCQAC Advisory Opinion AO 28.01, Standing Orders (rev. Nov. 17, 2023)board guidance
RNs and LPNs may follow standing orders; standing orders involving a medical regimen are approved by an authorized health care practitioner; nurses may follow approved statewide or institutional standing orders; examples include screening, medication refills, laboratory tests and immunizations.
What Washington does require
The supervision and prescribing rules that apply to registered nurses regardless of any agreement.
Proximity
Not codified
Supervision ratio
Not codified — no cap on file
Chart review
Not codified
Meeting cadence
Not codified
Prescriptive authority
No agreement needed to prescribe · no controlled-substance authority
RNs do not have independent prescriptive authority in Washington; they administer medications only as ordered by an authorized prescriber.
Written agreement
Not required
Unconditional — general RN licensure is never subject to physician supervision or a collaborative agreement, unlike the ARNP/PA categories above.
Practice ownership (corporate practice of medicine)
Non-licensee ownership permitted — General RN licensure does not require a healing-arts PSC under RCW 18.100 — non-clinical businesses an RN might own (staffing agency, home health agency) fall under general corporation/LLC law and carry no ownership restriction.
For medical-aesthetics (med-spa) businesses performing delegated medical procedures, RN ownership of the business entity does not remove the need for physician delegation and oversight of the procedures themselves.
Sources for the supervision rules (1)
About Washington's rules
Washington is a full-independence state for ALL FOUR ARNP roles (NP, CRNA, CNM, CNS) under RCW 18.79, not just NPs — confirmed current via WAC 246-840-300/420 and Board of Nursing guidance. PAs are separate: HB 2041 (eff. Jan. 1, 2025) replaced supervision-only with a 4,000-hour supervision→collaboration tier (RCW 18.71A.120) with no numeric ratio cap.
Other clinicians in Washington: see the state overview.