House Bill 1780 amends existing Washington statutes to regulate professional titles and supervision for nurses and physician assistants. The bill amends RCW 18.79.030 to specify permissible titles and abbreviations for registered nurses, advanced registered nurse practitioners / advanced practice registered nurses (nurse practitioners), and licensed practical nurses, requires licensure or a valid multistate license to use those titles, allows a person listed as a Christian Science nurse in the Christian Science Journal to use that title only if they do not hold themselves out as a licensed nurse, and designates it unprofessional conduct for advanced practice nurses and physician assistants to refer to themselves as "doctor" when providing clinical care. These changes are enforceable under the discipline provisions of chapter 18.130 RCW. The bill also amends RCW 18.71A.030 to set practice, supervision, and scope rules for physician assistants. It requires PAs with fewer than 4,000 postgraduate clinical hours to work under supervision of a participating physician, allows PAs with 4,000 or more hours to work in collaboration if they have completed at least 2,000 supervised hours in the chosen specialty, requires the first 2,000 postgraduate hours in a new specialty to be supervised for PAs who change specialties, clarifies that supervision does not necessarily require the physician’s personal presence, and allows experienced PAs (at least 10 years or 20,000 hours in a specialty) to provide that specialty’s services outside the participating physician’s specialty in specified rural or HRSA-designated underserved areas if employed in such settings and after completing related continuing education. The bill also requires evidence of appropriate training where a PA works with an anesthesiologist to deliver certain types of anesthesia. This is a modification of existing law (amendments to RCW 18.79.030 and RCW 18.71A.030) that creates new professional title limits and supervision rules and designates certain title usage as unprofessional conduct under existing disciplinary law. Section 2 of the act expires June 30, 2027, and Section 3 takes effect June 30, 2027. The extracted text does not include definitions for terms such as "participating physician," "collaboration agreement," or "the commission," nor does it include enforcement procedures from chapter 18.130 RCW beyond the reference to discipline; the relationship between the two separate amendments to RCW 18.79.030 using different terminology (A.R.N.P. vs A.P.R.N.) is also not explained in the provided facts.

If passed, nurses and physician assistants will have clearer limits on what titles they can use in clinical care: advanced practice nurses and physician assistants could no longer present themselves to patients as "doctor," and specific short-form titles will be spelled out for registered nurses, advanced/practice nurse practitioners, and licensed practical nurses. Physician assistants will face concrete experience and supervision thresholds before they can work with more independence (fewer than 4,000 postgraduate hours require direct supervision; 4,000+ hours allow collaboration if certain supervised specialty hours are met), and very experienced PAs could practice certain specialties outside their supervising physician’s specialty in designated rural or federally underserved areas if they meet extra experience and continuing education requirements. There is also a requirement for PAs who assist with anesthesia to document adequate training. Violation of these title or practice rules can lead to professional discipline. Those most affected are licensed nurses, advanced/practice nurse practitioners, physician assistants, their participating physicians, and employers (especially rural clinics). Nurses and PAs may need to update how they identify themselves to patients, maintain and document postgraduate hours and continuing education, and adjust collaboration agreements; employers may need to change supervision arrangements and verify clinicians’ experience before expanding duties. Rural and underserved clinics could gain access to more autonomous PA services if staffing meets the experience and location rules, but the bill does not allocate funding for oversight or training and leaves some implementation details unclear (including how two separate amendments to the same nursing statute interact, and the precise definitions of terms like "participating physician" and "the commission"), which could create uncertainty for enforcement and operational planning. Section timing is staggered: one provision expires June 30, 2027, and another takes effect June 30, 2027.