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Washington Nursing Home Administrator — Requirements & Free Practice

US-WA · License preparation

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Licenses, application pathways and examination requirements

Each license and applicant pathway has its own requirements and exemptions. Choosing practice questions does not determine your eligibility.

Nursing Home Administrator License

Washington nursing home administrator license issued by the Department of Health under Board standards.

Licensing authority: Washington State Board of Nursing Home Administrators · Application information

Licensure by endorsement from a substantially equivalent jurisdiction
Achca waiver
Current American College of Health Care Administrators certification excuses the current NAB national examination under WAC 246-843-230(2).
Fees
Submit the endorsement application and applicable fee.
Historical score
Applicants licensed before 1986 may submit proof of the discontinued PES examination in place of the NAB examination.
Prior license
Hold an out-of-state nursing home administrator license in good standing from a jurisdiction with substantially equivalent qualifications.
Verification
Submit verification from all jurisdictions in which currently or previously licensed.
Interstate recognition after two years of equivalent licensure
No examination is required for this applicant pathway.
Application
Apply for Washington credential under the Department of Health endorsement process.
Prior license
Credentialed for at least two years immediately before applying in one or more states with substantially equivalent standards, without a licensure interruption longer than 90 days.
Standing
Meet RCW 18.130.077(3) restrictions on denial, discipline, investigation, and pending charges.

Official no-examination sources

Effective from 2026-09-22.

Return expired license after five years through current licensing examination
Application
Submit the expired-license activation application and satisfy WAC 246-12-040.
Course
Show completion of the Washington nursing-home law course if not completed before expiration.
Rule reference
WAC 246-843-180(3)(c) points to WAC 246-843-170, which is not a current section; WAC 246-843-070 defines the current nursing home administrator licensing examination.
Return expired license after five years with equivalent license or active out of state practice
No examination is required for this applicant pathway.
Application
Submit the expired-license activation application and satisfy WAC 246-12-040.
Course
Show completion of the Washington nursing-home law course if not completed before expiration.
Experience
Provide an active substantially equivalent out-of-state administrator license or proof of active licensed administrator practice in another jurisdiction during the lapse.

Official no-examination sources

Effective from 2026-09-22.

Return expired license to active status before five years
No examination is required for this applicant pathway.
Application
Submit the expired-license activation application and satisfy WAC 246-12-040.
Course
If expired for at least one year, show completion of the Washington nursing-home law course if not completed before expiration.

Official no-examination sources

Effective from 2026-09-22.

Initial licensure after administrator residency
Age
At least 21 years old.
Degree
Baccalaureate degree from a recognized institution of higher learning.
Hse
NAB HSE designation may verify degree and examination requirements under WAC 246-843-071(3).
Residency
Complete the Board-approved administrator residency or AIT program, normally 1,500 hours over nine months.
Score
Submit NAB passing scores; the current rule specifies a scale score of 113 for the nursing home administrator examination.
Standing
Meet the statutory character and safe-practice standards; submit the application and fee.
Initial licensure with administrator training exemption
Age
At least 21 years old.
Degree
Baccalaureate degree or accepted HSE verification.
Score
Submit NAB examination scores or accepted HSE verification.
Standing
Meet statutory character and safe-practice standards; submit the application and fee.
Training exemption
Qualify under one of the experience, veteran, prior administrator practice, accredited degree, practicum, or NAB HSE categories in WAC 246-843-093.
Annual renewal
No examination is required for this applicant pathway.
Continuing education
Complete 36 hours of continuing education every two years and applicable statutory continuing competency.
Renewal
Renew annually on or before the birthday with the required fee and declaration.

Official no-examination sources

Effective from 2026-09-22.

Inactive Nursing Home Administrator License

Inactive credential status; practice in Washington is not allowed while inactive.

Licensing authority: Washington State Board of Nursing Home Administrators · Application information

Place active license on inactive status
No examination is required for this applicant pathway.
Notice
Notify the Department of Health in writing.
Practice
Do not practice in Washington while inactive.
Prior license
Hold an active Washington nursing home administrator license in good standing.

Official no-examination sources

Effective from 2026-09-22.

Return to active status after five inactive years without active practice elsewhere
Reactivation
Meet WAC 246-12-110 and pass the current licensing examination.
Return to active status after five inactive years with active practice elsewhere
No examination is required for this applicant pathway.
Reactivation
Meet WAC 246-12 Part 4 requirements and provide proof of active licensed nursing home administrator practice in another jurisdiction.

Official no-examination sources

Effective from 2026-09-22.

Return to active status after less than five inactive years
No examination is required for this applicant pathway.
Reactivation
Meet WAC 246-12 Part 4 conditions, including written notice, active renewal fee, declarations, and current competency requirements.

Official no-examination sources

Effective from 2026-09-22.

Renew inactive credential
No examination is required for this applicant pathway.
Renewal
Pay inactive credential renewal fee by the birthday expiration date and any required surcharge.

Official no-examination sources

Effective from 2026-09-22.

Limited Nursing Home Administrator License

Limited authority for institutions relying on prayer or spiritual means.

Licensing authority: Washington State Board of Nursing Home Administrators · Application information

Initial limited licensure for a prayer or spiritual healing institution
Exam
The general applicant examination rule applies to nursing home administrator licensure; the limited-license statute does not expressly waive it.
Medical qualification exception
An applicant employed by such an institution need not demonstrate medical techniques or medical education or standards inconsistent with its remedial care.
Membership
Demonstrate membership in a recognized church or denomination operating an institution relying on prayer or spiritual means.
Scope
Authority is limited to administering that kind of institution.
Annual renewal of limited license
No examination is required for this applicant pathway.
Continuing education
Fulfill applicable continuing competency requirements.
Renewal
Renew the nursing home administrator license under RCW 18.52.110.

Official no-examination sources

Effective from 2026-09-22.

Nursing Home Administrator Temporary Practice Permit

Temporary full-scope practice permit under the profession-specific rules.

Licensing authority: Washington State Board of Nursing Home Administrators · Application information

Temporary permit while national fingerprint background check is pending
Duration
Permit ends on permanent-license decision or after 180 days and is not renewed or reissued.
Eligibility
Satisfy all permanent-license qualifications except the fingerprint-based national background check; hold an unrestricted active license from a substantially equivalent state.
Temporary permit for interim placement at a specific facility
No examination is required for this applicant pathway.
Consultation
Provide a written consultation agreement with a Washington licensed nursing home administrator.
Duration
Permit expires after 180 days and may not be renewed, reissued, or extended.
Eligibility
Pass Washington criminal background check and hold an unrestricted active out-of-state license or meet a WAC 246-843-093 AIT exemption.

Official no-examination sources

Effective from 2026-09-22.

Temporary permit for military spouse or domestic partner
No examination is required for this applicant pathway.
Duration
Permit ends upon license decision or after 180 days.
Military
Applicant is a military spouse or registered domestic partner moving to Washington on military orders.
Prior license
Hold an unrestricted active equivalent out-of-state license without pending investigation, charges, or disciplinary action.
Requirements
Meet training, education, and practice standards while completing other Washington requirements.

Official no-examination sources

Effective from 2026-09-22.

NAB National Core Knowledge Exam for Long-Term Care Administrators (CORE)

Provider
Pearson VUE
Format
Objective multiple-choice items with four response options, one correct; delivered by Pearson VUE
Exam questions
125 (100 scored, 25 non-scored pretest)
Time limit
150 minutes seat time; 2 hours 10 minutes to answer questions
Passing score
Scaled score of 113 on a 50-150 scale
Exam fee
CORE only $320; CORE and NHA combo $480 (effective 2/1/2026)
Examination outline
  • Care, Services, and Supports (39%)
    • Quality of Care: Medical and Nursing Care Practices
    • Quality of Care: Medication Management and Administration
    • Quality of Care: Disease Management (e.g., acute vs. chronic conditions)
    • Quality of Care: Nutrition and Hydration (e.g., specialized diets)
    • Quality of Care: Activities of Daily Living (ADLs) and Independent Activities of Daily Living (IADLs)
    • Quality of Care: Rehabilitation and Restorative Programs
    • Quality of Care: Care Recipient Assessment and Interdisciplinary Care Planning
    • Quality of Care: Clinical and Medical Records and Documentation Requirements (e.g., storage, retention, destruction)
    • Quality of Care: Medical Director
    • Quality of Care: Emergency Medical Services (e.g., CPR, first aid, Heimlich maneuver, AED)
    • Quality of Care: Transition of Care (e.g., admission, move-in, transfer, discharge, and move-out)
    • Quality of Care: Basic Healthcare Terminology
    • Quality of Life: Psychosocial Needs (e.g., social, spiritual, community, cultural)
    • Quality of Life: Person-Centered Care and Comprehensive Care Planning
    • Quality of Life: Care Recipient Bill of Rights and Responsibilities
    • Quality of Life: Care Recipient Safety (e.g., fall prevention, elopement prevention, adverse events)
    • Quality of Life: Care Recipient (and Representative) Grievance, Conflict, and Dispute Resolution
    • Quality of Life: Care Recipient Advocacy (e.g., Ombudsman, resident and family council)
    • Quality of Life: Care Recipient Decision-Making (e.g., capacity, power of attorney, guardianship, conservatorship, code status, advance directives, ethical decision-making)
    • Quality of Life: Care Recipient (and Representative) Satisfaction
    • Quality of Life: Recognition of Maltreatment (e.g., abuse, neglect, exploitation)
    • Quality of Life: Mental and Behavioral Health (e.g., cognitive impairment, depression, social support systems)
    • Quality of Life: Trauma-Informed Care (e.g., PTSD)
    • Quality of Life: Pain Management
    • Quality of Life: Death, Dying, and Grief
    • Quality of Life: Restraint Usage and Reduction
    • Quality of Life: Foodservice (e.g., choice and menu planning, dietary management, food storage and handling, dining services)
    • Quality of Life: Social Services Programs
    • Quality of Life: Therapeutic Recreation and Activity Programs
    • Quality of Life: Community Resources, Programs, and Agencies (e.g., meals on wheels, housing vouchers, Area Agencies on Aging, Veterans Affairs)
    • Ancillary Services: Hospice and Palliative Care
    • Ancillary Services: Specialized Medical Equipment (e.g., oxygen, durable medical equipment)
    • Ancillary Services: Transportation for Care Recipients
    • Ancillary Services: Telemedicine (e.g., e-health)
    • Ancillary Services: Diagnostic Services (e.g., radiology, lab services)
    • Ancillary Services: Dental and Oral Care Services
    • Ancillary Services: Healthcare Partners and Clinical Providers (e.g., MD/DO, Nurse Practitioner, Psychiatrist, Podiatrist, Dentist)
    • Ancillary Services: Volunteer Programs
  • Operations (37%)
    • Financial Management: Budgeting and Forecasting
    • Financial Management: Financial Analysis (e.g., ratios, profitability, debt, revenue mix, depreciation, operating margin, cash flow)
    • Financial Management: Revenue Cycle Management (e.g., billing, accounts receivable, accounts payable, collections)
    • Financial Management: Financial Statements (e.g., income/revenue statement, balance sheet, statement of cash flows, cost reporting)
    • Financial Management: Revenue and Reimbursement (e.g., PDPM, PDGM, ACOs, HMOs, Medicaid, private payors)
    • Financial Management: Financial Reporting Requirements (e.g., requirements for not-for-profit, for-profit, and governmental providers)
    • Financial Management: Integration of Clinical and Financial Systems (e.g., EMR/HER, MDS)
    • Financial Management: Internal Financial Management Controls (e.g., segregation of duties, access)
    • Financial Management: Supply-Chain Management (e.g., inventory control)
    • Financial Management: Resident Trust Accounts for Personal Funds
    • Risk Management: OSHA Rules and Regulations
    • Risk Management: Workers’ Compensation
    • Risk Management: Ethical Conduct and Standards of Practice
    • Risk Management: Compliance Programs
    • Risk Management: Risk Management Process and Programs
    • Risk Management: Quality Improvement Processes (e.g., root cause analysis, PDCA/PDSA)
    • Risk Management: Scope of Practice and Legal Liability
    • Risk Management: Internal Investigation Protocols and Techniques (e.g., incidents, adverse events)
    • Risk Management: Mandatory Reporting Requirements (e.g., incidents, adverse events, abuse, neglect, financial exploitation, fraud)
    • Risk Management: Insurance Coverage (e.g., liability, property)
    • Risk Management: Healthcare Record Requirements (e.g., confidentiality, disclosure, safeguarding, HIPAA, HITECH)
    • Risk Management: Security (e.g., cameras, monitoring systems, locks, staff location reporting)
    • Risk Management: Contracted Services (e.g., roles, responsibilities, oversight, background checks)
    • Human Resources: Federal Human Resources Laws, Rules, and Regulations (e.g., ADA, FMLA, Wage and Hour, FLSA)
    • Human Resources: Selection and Hiring Practices (e.g., EEOC, interviewing, adverse impact, protected classes, occupational qualifications)
    • Human Resources: Compensation and Benefits Programs (e.g., time off, healthcare insurance, employee pay and payroll)
    • Human Resources: Organizational Staffing Requirements and Reporting (e.g., PBJ)
    • Human Resources: Staff Certification and Licensure Requirements
    • Human Resources: Professional Development (e.g., maintenance of credentials, continuing education)
    • Human Resources: Employee Training and Orientation
    • Human Resources: Performance Evaluation
    • Human Resources: Human Resource Policies (e.g., drug-free workplace, discipline, job classification, photography and video, social media usage, mobile phone usage)
    • Human Resources: Employee Record-Keeping Requirements
    • Human Resources: Employee Grievance, Conflict, and Dispute Resolution
    • Human Resources: Employee Satisfaction, Engagement, and Retention
    • Human Resources: Cultural Competence and Diversity Awareness
    • Human Resources: Labor Relations (e.g., union, collective bargaining [CBA], contract/pool staff)
  • Environment and Quality (13%)
    • Care Setting: Federal Codes and Regulations for Building, Equipment, Maintenance, and Grounds
    • Care Setting: Person-Centered Environment (e.g., home-like environment)
    • Care Setting: Safety and Accessibility (e.g., ADA, safety data sheets)
    • Care Setting: Facility Management and Environmental Services
    • Care Setting: Information Systems Infrastructure (e.g., configurations, data security, technical controls)
    • Care Setting: Preventative and Routine Maintenance Programs (e.g., pest control, equipment, mechanical systems)
    • Care Setting: Infection Control and Sanitation (e.g., linens, kitchen, hand washing, healthcare-acquired infections, hazardous materials)
    • Care Setting: Disaster and Emergency Planning, Preparedness, Response, and Recovery (e.g., Appendix Z)
    • Regulatory Compliance: Federal Healthcare Laws, Rules, and Regulations
    • Regulatory Compliance: Government Programs and Entities (e.g., Medicare, Medicaid, waivers)
    • Regulatory Compliance: Certification and Licensure Requirements for the Organization
  • Leadership and Strategy (11%)
    • Leadership: Organizational Structures (e.g., departments, functions, systemic processes)
    • Leadership: Organizational Change Management
    • Leadership: Organizational Behavior (e.g., organizational culture, team building, group dynamics)
    • Leadership: Leadership Principles (e.g., communication, styles, mentoring, coaching, personal professional development)
    • Leadership: Governance (e.g., board of directors, governing bodies, corporate entities, advisory boards)
    • Leadership: Professional Advocacy and Governmental Relations
    • Organizational Strategy: Mission, Vision, and Value Statements
    • Organizational Strategy: Strategic Business Planning (e.g., new lines of service, succession management, staffing pipeline)
    • Organizational Strategy: Business Analytics (e.g., evidence-based practice, data analytics)
    • Organizational Strategy: Business Development (e.g., sales, marketing, partnerships, ACOs, contracts and agreements, negotiations)
    • Organizational Strategy: Public Relations and External Stakeholders (e.g., hospitals, referrals sources, local community, donors)
Examination sources

NAB National Nursing Home Administrators Line of Service Exam (NHA)

Provider
Pearson VUE
Format
Objective multiple-choice items with four response options, one correct; delivered by Pearson VUE
Exam questions
75 (60 scored, 15 non-scored pretest)
Time limit
90 minutes seat time; 1 hour and 10 minutes to answer questions
Passing score
Scaled score of 113 on a 50-150 scale
Exam fee
NHA only $190; CORE and NHA combo $480 (effective 2/1/2026)
Examination outline
  • Care, Services, and Supports (45%)
    • Quality of Care: Medical and Nursing Care Practices
    • Quality of Care: Medication Management and Administration
    • Quality of Care: Nutrition and Hydration (e.g., specialized diets)
    • Quality of Care: Rehabilitation and Restorative Programs
    • Quality of Care: Care Recipient Assessment and Interdisciplinary Care Planning
    • Quality of Care: Clinical and Medical Records and Documentation Requirements (e.g., storage, retention, destruction)
    • Quality of Care: Medical Director
    • Quality of Care: Emergency Medical Services (e.g., CPR, first aid, Heimlich maneuver, AED)
    • Quality of Care: Transition of Care (e.g., admission, move-in, transfer, discharge, and move-out)
    • Quality of Life: Psychosocial Needs (e.g., social, spiritual, community, cultural)
    • Quality of Life: Person-Centered Care and Comprehensive Care Planning
    • Quality of Life: Care Recipient Bill of Rights and Responsibilities
    • Quality of Life: Care Recipient Safety (e.g., fall prevention, elopement prevention, adverse events)
    • Quality of Life: Care Recipient (and Representative) Grievance, Conflict, and Dispute Resolution
    • Quality of Life: Care Recipient Advocacy (e.g., Ombudsman, resident and family council)
    • Quality of Life: Care Recipient Decision-Making (e.g., capacity, power of attorney, guardianship, conservatorship, code status, advance directives, ethical decision-making)
    • Quality of Life: Recognition of Maltreatment (e.g., abuse, neglect, exploitation)
    • Quality of Life: Mental and Behavioral Health (e.g., cognitive impairment, depression, social support systems)
    • Quality of Life: Trauma-Informed Care (e.g., PTSD)
    • Quality of Life: Pain Management
    • Quality of Life: Death, Dying, and Grief
    • Quality of Life: Restraint Usage and Reduction
    • Quality of Life: Foodservice (e.g., choice and menu planning, dietary management, food storage and handling, dining services)
    • Quality of Life: Social Services Programs
    • Quality of Life: Therapeutic Recreation and Activity Programs
    • Ancillary Services: Hospice and Palliative Care
    • Ancillary Services: Transportation for Care Recipients
    • Ancillary Services: Diagnostic Services (e.g., radiology, lab services)
    • Ancillary Services: Dental and Oral Care Services
    • Ancillary Services: Healthcare Partners and Clinical Providers (e.g., MD/DO, Nurse Practitioner, Psychiatrist, Podiatrist, Dentist)
    • Ancillary Services: Volunteer Programs
  • Operations (28%)
    • Financial Management: Revenue and Reimbursement (e.g., PDPM, PDGM, ACOs, HMOs, Medicaid, private payors)
    • Financial Management: Financial Reporting Requirements (e.g., requirements for not-for-profit, for-profit, and governmental providers)
    • Financial Management: Integration of Clinical and Financial Systems (e.g., EMR/EHR, MDS)
    • Financial Management: Resident Trust Accounts for Personal Funds
    • Risk Management: OSHA Rules and Regulations
    • Risk Management: Compliance Programs
    • Risk Management: Scope of Practice and Legal Liability
    • Risk Management: Internal Investigation Protocols and Techniques (e.g., incidents, adverse events)
    • Risk Management: Mandatory Reporting Requirements (e.g., incidents, adverse events, abuse, neglect, financial exploitation, fraud)
    • Risk Management: Healthcare Record Requirements (e.g., confidentiality, disclosure, safeguarding, HIPAA, HITECH)
    • Risk Management: Security (e.g., cameras, monitoring systems, locks, staff location reporting)
    • Risk Management: Contracted Services (e.g., roles, responsibilities, oversight, background checks)
    • Human Resources: Organizational Staffing Requirements and Reporting (e.g., PBJ)
    • Human Resources: Staff Certification and Licensure Requirements
    • Human Resources: Professional Development (e.g., maintenance of credentials, continuing education)
    • Human Resources: Employee Training and Orientation
    • Human Resources: Performance Evaluation
    • Human Resources: Employee Record-Keeping Requirements
    • Human Resources: Cultural Competence and Diversity Awareness
  • Environment and Quality (27%)
    • Care Setting: Federal Codes and Regulations for Building, Equipment, Maintenance, and Grounds
    • Care Setting: Person-Centered Environment (e.g., home-like environment)
    • Care Setting: Safety and Accessibility (e.g., ADA, safety data sheets)
    • Care Setting: Facility Management and Environmental Services
    • Care Setting: Preventative and Routine Maintenance Programs (e.g., pest control, equipment, mechanical systems)
    • Care Setting: Infection Control and Sanitation (e.g., linens, kitchen, hand washing, healthcare-acquired infections, hazardous materials)
    • Care Setting: Disaster and Emergency Planning, Preparedness, Response, and Recovery (e.g., Appendix Z)
    • Regulatory Compliance: Federal Healthcare Laws, Rules, and Regulations
    • Regulatory Compliance: Government Programs and Entities (e.g., Medicare, Medicaid, waivers)
    • Regulatory Compliance: Certification and Licensure Requirements for the Organization
    • Regulatory Compliance: Regulatory Survey and Inspection Process
    • Regulatory Compliance: Procedures for Informal Dispute Resolution (IDR)
    • Regulatory Compliance: Centers for Medicare and Medicaid Services (CMS) Quality Measures
    • Regulatory Compliance: Quality Assurance and Performance Improvement (QAPI)
    • Regulatory Compliance: Bed-Hold Requirements
    • Regulatory Compliance: Pre-Admission Screening Annual Review (PASRR)
    • Regulatory Compliance: Facility Assessment
Examination sources