What it takes to become a licensed nursing home administrator in Washington: the Administrator-in-Training (AIT) program, now called the Administrator Residency, the NAB exams, the required Washington law course, fees, continuing education, renewal and endorsement.
| Who licenses | The Washington State Department of Health (DOH) issues the license (RCW 18.52.071); the Board of Nursing Home Administrators (RCW 18.52.040), housed in DOH, sets the licensing rules |
|---|---|
| Eligibility | Age 21 or older, an accredited bachelor’s degree in any field, the AIT or an exemption, the NAB exam (WAC 246-843-071), and a background check (RCW 18.130.064) |
| AIT requirement | 1,500 hours as standard; 1,000 or 500 with qualifying experience or education, or none with an exemption (WAC 246-843-091, -093). DOH now calls it the Administrator Residency (AR) |
| National exams | NAB Core of Knowledge + NHA Line of Service, at a scale score of 113 in the Washington rule (WAC 246-843-070); $480 for the two, paid to NAB |
| State exam | None, and no jurisprudence exam. WAC 246-843-070 sets the NAB exam as the licensing exam and adds no state exam, and NAB’s Washington page lists “State: No” under its examination requirements |
| Washington law course | Required within 180 days after you are licensed: at least 6 hours on Washington nursing home law, offered free and online by DSHS; AITs can take it early (WAC 246-843-130(7)) Details ↓ |
| Continuing education | 36 hours every two years, plus 2 hours of health equity every four years, which may count toward the 36 (WAC 246-843-130) |
| License renewal | Every year by your birthday, $975 (WAC 246-843-990) |
| DOH fees | $805 application and $285 for the AIT (WAC 246-843-990); NAB’s exam fee is separate |
| Official sources | doh.wa.gov (DOH) · WAC 246-843 · RCW 18.52 · nabweb.org (national exams) |
Verified against the sources above, September 2026. Requirements change; the current rules, as the board and the Department of Health apply them, govern, so confirm with DOH before you apply.
The Board of Nursing Home Administrators, created by RCW 18.52.040, sets the licensing rules, and the Washington State Department of Health (DOH) issues the license (RCW 18.52.071). The board is housed in DOH, whose staff handle applications. The board has 11 members under the statute: six licensed administrators, three health professionals or educators, and two public members.
| Website | DOH nursing home administrator pages · the board’s page |
|---|---|
| PO Box 47852, Olympia, WA 98504-7852 | |
| Applications | NHAapplication@doh.wa.gov |
| Phone | 360-236-4723 |
The statute, RCW 18.52.071, and the board’s rule, WAC 246-843-071, set the base:
If you hold NAB’s Health Services Executive (HSE) credential, NAB can send the board verification of your exam and education directly (071(3)), and the HSE also exempts you from the AIT.
Washington’s rule still says Administrator-in-Training (AIT), and DOH now says Administrator Residency (AR). A 2025 interpretive statement (WSR 25-15-025, effective 15 July 2025) says the two terms mean the same thing, so both terms appear on DOH pages and forms.
The standard length is 1,500 hours: “An applicant shall complete a one thousand five hundred hour AIT program” (WAC 246-843-091). That is the standard, not a floor: experience or education can bring it down to 1,000 or 500 hours, and some applicants need no AIT at all:
| Hours | Who qualifies | WAC |
|---|---|---|
| 1,500 hours | The standard program. DOH describes it as nine months. | 246-843-091 |
| 1,000 hours | Any one of: 2 years as a department manager in a state-licensed nursing home or hospital, with supervisory and budget responsibility; 5 years working in a nursing home; a 4-year degree in health administration or nursing; or 500 to 999 AIT hours completed in another state. | 246-843-091(1) |
| 500 hours | 2 of the last 5 years with supervisory and budget responsibility in one of eight listed roles, such as hospital administrator, assistant administrator of a nursing home or hospital, or director of nursing services in a nursing home; or 1,000 or more AIT hours completed in another state. | 246-843-091(2) |
| 500 hours | A master’s degree in health administration or nursing. | 246-843-091(3) |
| Reduced | Veterans with equivalent military experience, at the board’s discretion. | 246-843-091(4) |
| None | Any one of: 5 of the last 7 years with extensive supervisory and budget responsibility in listed roles; equivalent military experience; work as a licensed nursing home administrator for 2 of the last 5 years; a long-term care administration degree from a NAB-accredited program; a degree with a 1,000-hour nursing home practicum; or NAB’s HSE. | 246-843-093 |
If you already hold a license in a substantially equivalent state, DOH says you “do not require an AR”; see endorsement below.
WSR 26-01-031 changed the residency rules from 8 January 2026:
Under WAC 246-843-095, your preceptor must:
The preceptor sends the board a statement of qualifications and an agreement to perform the duties, which include “at least a weekly face-to-face conference with the AIT” and the monthly reports. A preceptor supervises one AIT at a time unless the board approves more in advance (095(2), (3)), and can earn 2 CE hours a month for the work (WAC 246-843-130(5)).
Other states: AIT Hours by State.
The free AIT Planner turns your residency hours into a plan across facility departments. The department split is our planning aid, not a Washington rule, so agree it with your preceptor. No account needed.
Open the free AIT PlannerWAC 246-843-070 requires the NAB nursing home administrator examination “with a scale score of one hundred thirteen.” NAB, the National Association of Long Term Care Administrator Boards, lists two exams for Washington: the Core of Knowledge exam and the NHA Line of Service exam.
| Core of Knowledge | 125 questions (100 scored, 25 pretest); 130 minutes to answer, within 150 minutes of seat time |
|---|---|
| NHA Line of Service | 75 questions (60 scored, 15 pretest); 70 minutes to answer, within 90 minutes of seat time |
| Delivery | Pearson VUE |
| Fee | $480 for the Core and NHA together, paid to NAB, from 1 February 2026 |
| Attempts | Since 1 January 2026, NAB allows up to 4 attempts per exam in each 1 July to 30 June cycle, while RCW 18.52.160 says there “shall not be a limit” on retakes, so ask DOH how the two apply to you |
An HSE holder can have NAB verify the exam directly (WAC 246-843-071(3)), and an endorsement applicant certified by the American College of Health Care Administrators (ACHCA) is exempt from the NAB exam (WAC 246-843-230(2)). More in NAB Exam Format and The Core Domains Explained.
Washington has no state exam and no jurisprudence exam. DOH’s requirements page says “Pass national exam (NAB)” and mentions no state exam, and NAB’s Washington page lists “State: No” under examination requirements. Washington law is covered instead by a required course.
WAC 246-843-130(7) says that “Within 180 days after becoming licensed” you complete “a minimum of a six-hour program” on Washington nursing home law, approved by the board. The deadline falls after licensure, so it is easy to miss, but you can take the course during your residency and the board gives you credit for it. It is a course, not an exam.
| Deadline | Within 180 days after you become licensed |
|---|---|
| Who runs it | DSHS Residential Care Services, with DOH |
| Cost and format | Free and virtual, one full day, 8:30 to 5:00 |
| Dates | DSHS posts the schedule on its course page; the next session listed is 27 October 2026 |
| Who can attend | “ONLY licensed nursing home administrators or those currently participating in the DOH AIT program” |
| Topics (WAC 246-843-130(7)) | RCW 18.52 and the DSHS nursing home rules (WAC 388-97), including resident services, medical and social; resident rights, including decision making, informed consent, advance directives and notices; enforcement; criminal history inquiries; and differences between federal and state law |
Pick a date on the DSHS course page, during your residency or as soon as your license is issued. If your license is expired a year or more and you never took the course, you show proof of it to return (WAC 246-843-180(2)). The rule does not say whether these hours also count toward your 36 CE hours, so ask DOH if you plan to use them that way.
The law course covers “differences between federal and state law,” and the NAB exams are national exams, not Washington exams. Four differences you will meet on the job, each with the Washington section:
| Topic | Federal rule (42 CFR 483) | Washington rule | Section |
|---|---|---|---|
| Direct care staffing | No numeric hours-per-resident-day minimum; the facility must have “sufficient nursing staff” (483.35). CMS’s 2024 minimums (3.48 hours per resident day and a 24/7 RN, 89 FR 40876) were repealed before their compliance dates, effective 2 February 2026 (90 FR 55687) | At least 3.4 hours of direct care per resident day, since 1 July 2016, checked quarterly from CMS Payroll-Based Journal data. The director of nursing counts only in homes of 60 or fewer beds. Fines are 1.5 times the cost of the missing CNA hours, then 2 times for later violations | RCW 74.42.360(2); WAC 388-97-1090(1), (2), (8) |
| Registered nurse coverage | A registered nurse “for at least 8 consecutive hours a day, 7 days a week” (483.35(b)(1)) and a full-time RN director of nursing (483.35(b)(2)). Both can be waived, subject to annual State review or annual renewal by the HHS Secretary (483.35(e), (f)) | Large nonessential community providers: an RN on duty directly supervising care 24 hours a day, 7 days a week. Essential and small nonessential community providers: 16 hours of RN plus 8 hours of RN or LPN. Large nonessential providers may get a one-year exception for the last 8 hours, renewable for up to three consecutive years, but never below 16 RN hours a day | RCW 74.42.360(3), (4); WAC 388-97-1080 |
| The administrator’s time on site | An administrator “Licensed by the State, where licensing is required”; no on-site hours set (483.70(d)(2)(i)) | “An on-site full-time administrator” of “only one nursing home” (or collocated facilities): at least 4 days and an average of 40 hours a week at 50 or more beds; 4 days and an average of 30 hours at 31 to 49 beds; 4 days and an average of 20 hours at 1 to 30 beds. Up to 4 continuous weeks under a designee, with a written agreement with a Washington-licensed administrator who is readily available to consult | RCW 18.52.030; WAC 388-97-1620(3)(e), (4); WAC 246-843-010(8) |
| Reporting suspected abuse and neglect | The facility reports alleged abuse, neglect, exploitation or mistreatment, including injuries of unknown source, “immediately, but not later than 2 hours” if it involves abuse or serious bodily injury, and within 24 hours otherwise, to the administrator and to officials including the State Survey Agency and adult protective services where state law gives it jurisdiction (483.12(c)(1)). Each covered individual also reports a reasonable suspicion of a crime against a resident to the State Agency and law enforcement, within 2 hours if there is serious bodily injury, otherwise within 24 hours (483.12(b)(5); section 1150B of the Social Security Act) | Every employee is a mandated reporter who must “immediately report to the department” (DSHS) any suspected abandonment, abuse, financial exploitation or neglect, not only a suspected crime. A death suspected to be caused by abuse, neglect or abandonment must also be reported to the medical examiner or coroner, as well as DSHS and local law enforcement | RCW 74.34.020; RCW 74.34.035(1), (5) |
Washington: RCW and WAC as published at app.leg.wa.gov, September 2026. Federal: 42 CFR Part 483 in the eCFR, current as of 24 September 2026. Effective 9 April 2026, WSR 26-07-022 removed expired exception and waiver language from the 3.4-hour rule; the 3.4-hour standard did not change.
Set in WAC 246-843-990 (effective 23 February 2024) and nonrefundable, DOH says:
| Application, original license | $805 |
|---|---|
| Administrator-in-training | $285 |
| Application, endorsement | $805 |
| License renewal, every year | $975 |
| Late renewal penalty | $300 |
| Expired license reissuance | $285 |
| Inactive license renewal | $315 |
| Retired active license | $150 |
| Temporary permit | $325 |
If you do the residency, DOH’s fees for a first license are $805 plus $285, and the NAB exams are $480 more, paid to NAB. NAB’s Washington page shows different figures; the amounts above are the ones in the rule.
You need 36 hours every two years (WAC 246-843-130(1)). Your license renews every year, but CE is counted over two years, so keep a running total across two renewals.
Suicide prevention counts as an allowed subject, but administrators are not among the professions RCW 43.70.442 lists as needing suicide prevention training.
Administrators “must renew their license every year on or before their birthday” (DOH; WAC 246-12-030). Renewal is $975, and the late penalty is $300.
Endorsement. If you hold a current license from a state with substantially equivalent standards, you can be licensed by endorsement (RCW 18.52.130; WAC 246-843-230). You send the application, the $805 fee, and verification from every state where you have ever been licensed. DOH’s review of 24 January 2025 lists these as substantially equivalent: California, Connecticut, the District of Columbia, Florida, Hawaii, Kentucky, Louisiana, Maine, Massachusetts, Minnesota, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Texas, Vermont and West Virginia, with Iowa and Kansas reviewed case by case. All other states are listed as not equivalent. DOH’s list page adds that you must have held the credential there for at least two years with no discipline. Check DOH’s list before you apply.
A second path from another state. Since 23 July 2023 (2SHB 1724), RCW 18.130.077 adds a route for applicants who have held their credential in a substantially equivalent state for at least two years immediately before applying, with no gap of more than 90 days and no discipline in the prior two years.
Temporary permits (WAC 246-843-231):
Military families. A military spouse or state-registered domestic partner of a service member can get a temporary practice permit (WAC 246-843-325; RCW 18.340.020; WAC 246-12-051).
Washington keeps no roster of AIT programs: you find a qualified preceptor, the full-time administrator of a Washington-licensed nursing home, and the board approves your own prospectus. “The Department of Health does not have a list of preceptors,” so DOH points you to nursing homes and the state associations.
Nursing homes. Start with administrators you know, or the administrator of the nursing home where you work. DOH also holds a quarterly support meeting on Teams for residents and preceptors.
A NAB-accredited degree. Eastern Washington University says its BA in Health Services Administration, Long-Term Care Option, is accredited by NAB. DOH has a separate checklist for EWU graduates, who apply under the AIT exemption, because “Your preceptorship is different.” See EWU’s program page.
State associations: Washington Health Care Association (WHCA) and LeadingAge Washington. DOH suggests contacting them about residency opportunities.
For approaching facilities and preceptors step by step, see How to Find an AIT Preceptor and an Approved Program.
The legal sources for nursing home administrator licensure in Washington, and the facility rules cited above. Washington has no state exam; the law course covers RCW 18.52 and WAC 388-97, and these are the rules you work under.
Citations verified against official sources, September 2026. Provided for reference, not legal advice; the current official text governs.
1,500 hours is the standard (WAC 246-843-091). Experience or education can cut it to 1,000 or 500 hours, and some applicants, such as NAB HSE holders, are exempt (WAC 246-843-093). DOH now calls it the Administrator Residency.
No state or jurisprudence exam (WAC 246-843-070; NAB’s Washington page: “State: No”). Instead, within 180 days after you are licensed, you complete a 6-hour course on Washington nursing home law, which you can also take as an AIT (WAC 246-843-130(7)). DSHS offers it free and online.
36 hours every two years, plus 2 hours of health equity every four years, which may count toward the 36 (WAC 246-843-130). The license renews every year by your birthday, for $975 (WAC 246-843-990).
There is no list: DOH says it “does not have a list of preceptors.” You find a qualified preceptor, the full-time administrator of a Washington-licensed nursing home, and the board approves your own program before you start (WAC 246-843-090, -095).
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