How to Start an NP Practice in Washington: Full Practice Authority From Day One

By Jody Mitchell, MD | June 1, 2025

A colleague who had spent three years navigating Texas's prescriptive authority agreements called me the day she got her Washington state ARNP license. She was almost giddy. No collaborating physician. No supervision requirements. No protocol agreements. Full practice authority from day one. Washington is one of the most NP-friendly states in the country -- but even here, there are licensing details, prescriptive authority nuances, and business formation requirements that catch people off guard.

A colleague who had spent three years navigating Texas's prescriptive authority agreements called me the day she got her Washington state ARNP license. She was almost giddy. "No collaborating physician. No supervision requirements. No protocol agreements. I just... practice?"

Yes. Washington is one of the most NP-friendly states in the country when it comes to practice authority. NPs here -- called Advanced Registered Nurse Practitioners (ARNPs) -- have full practice authority from the moment their license is issued. No transition period, no supervised hours requirement, no collaborative agreement. You can evaluate, diagnose, treat, prescribe, and manage patients independently on day one.

But "full practice authority" does not mean "no rules." Washington has its own licensing requirements, prescriptive authority nuances, business formation considerations, and credentialing realities that you need to understand before you open your doors. My Texas colleague was so relieved to be free of collaboration requirements that she nearly overlooked the state-specific details that would have caused problems down the road.

This guide covers everything you need to know about starting an NP practice in Washington state.

Full Practice Authority: What It Actually Means in Washington

Washington has been a full practice authority state for decades -- it was one of the first states to grant NPs independent practice. The regulatory framework is governed by the Revised Code of Washington (RCW) Chapter 18.79 and administered by the Nursing Care Quality Assurance Commission (NCQAC), which functions as Washington's nursing regulatory body within the Department of Health.

Under Washington law, ARNPs can: