Washington Department of Health vs Board of Nursing: Who Regulates CNAs?

Two state bodies regulate CNAs in Washington, and they divide the work cleanly. The Washington State Board of Nursing (WABON), formerly the Nursing Care Quality Assurance Commission (NCQAC), writes the rules for nursing assistant training and testing, approves training programs, and sets the standards behind the 108-hour minimum and the two-part exam. The Washington State Department of Health (DOH) issues the Nursing Assistant-Certified (NA-C) and Nursing Assistant-Registered (NAR) credentials, runs background checks, collects fees, handles annual renewals, and maintains the public Provider Credential Search. A third agency, the Department of Social and Health Services (DSHS), regulates Home Care Aide training and long-term care employment but not the CNA credential itself.

If you know which body owns which task, you will send every question and form to the right place the first time.

The division of responsibilities

What the Board of Nursing does for CNAs

The Board is the policy body. It adopts the rules in WAC 246-841A that govern nursing assistant education and practice. Its decisions shape what every CNA student in the state experiences:

• Training minimums. The 108-clock-hour requirement (35 theory, 33 skills lab, 40 clinical) comes from WAC 246-841A-440, adopted by the Board. The federal floor is 75 hours; Washington chose more.
• Program approval. A school cannot enroll students in a nursing assistant program until the Board has approved its curriculum, instructors, facilities, and clinical site agreements. Approved programs are reviewed periodically and can lose approval.
• Instructor qualifications. WAC 246-841A-430 requires licensed nurses with recent direct-care experience as instructors.
• Student protections. The same rule requires programs to allow at least four attempts at the skills competency exam.
• Exam structure. The Board set the current two-part format that took effect October 1, 2023: skills test first, administered by the training program or scheduled through the Board's online system, then the Credentia knowledge test.
• Alternative pathways. The HCA bridge, the medical assistant bridge, and the E1 through E9 eligibility routes are Board-approved routes.

The Board's staff work inside the DOH, which is why correspondence about training and exams can arrive on DOH letterhead. The skills testing contact, nac.exam@doh.wa.gov, is an example: the address is a DOH address, but the function belongs to the Board's nursing assistant program.

What the Department of Health does for CNAs

The DOH is the operating agency. Once you have completed training and passed the exam, every remaining interaction is with the DOH:

• Application and issuance. You apply for the NA-C or NAR through the DOH online portal, answer personal history questions, pay the fee on the DOH nursing assistant fee schedule, and receive the credential from the DOH.
• Background checks. The DOH runs the name-based statewide criminal history check and orders a fingerprint-based check when required, most commonly for applicants who recently lived out of state.
• Renewal. Your NA-C expires on your birthday every year and is renewed through the DOH portal. The DOH sends reminders, processes late renewals with a late fee for lapses under three years, and handles reactivation.
• Records. Name changes, address changes, and duplicate certificates are DOH transactions.
• Endorsement. Out-of-state CNAs apply to the DOH, which verifies the credential with the other state's registry.
• Public registry. The Provider Credential Search, run by the DOH, is Washington's nurse aide registry and shows every NA-C and NAR with status, dates, and disciplinary history.
• Discipline. The DOH receives complaints about nursing assistants, investigates them, and takes action on the credential, from a notice of correction up to suspension or revocation. Actions are published on the credential record.

The Washington CNA registry article walks through the DOH side of the process step by step.

Where DSHS fits

DSHS does not regulate the CNA credential, but it touches CNAs in two ways. First, it approves the 75-hour Home Care Aide training, and an active HCA credential is the entry ticket to the HCA–CNA bridge. Second, DSHS licenses nursing homes, assisted living facilities, and adult family homes, runs the background check required for employment in those settings, and investigates abuse and neglect there. A CNA can hold a clean DOH credential and still be barred from a DSHS-regulated setting, and vice versa. Huduma CNA Programs sits on both sides: it is a Board-approved nursing assistant program and a DSHS-approved HCA training provider and HCA exam site.

Whom to contact for each question

Why the split exists

Washington organizes most health professions this way: a profession-specific board or commission sets standards and decides discipline, while the DOH provides licensing operations, investigators, and the shared credential database for all of them. The arrangement means the same online portal, fee schedule format, and lookup tool serve nurses, nursing assistants, medical assistants, and dozens of other professions, while each profession's board keeps control of its own standards. For nursing assistants, the Board holds the training and exam rulemaking role, and the DOH holds credentialing and enforcement, which is why you will see both names on documents throughout your career.

What the name change from NCQAC means for you

The Nursing Care Quality Assurance Commission was renamed the Washington State Board of Nursing. Older documents, school websites, and forms still say NCQAC. The responsibilities did not change, the rules in WAC 246-841A did not change because of the rename, and any reference to "the Commission" in a training document means the Board. If a form you are handed still uses the old name, it is not out of date on substance.

Common confusions, resolved

• "I sent my renewal to the Board of Nursing." Renewals go to the DOH through the online portal. The Board does not process them.
• "The DOH approved my training program." The Board approves programs. The DOH issues your credential after you finish.
• "DSHS certified me as a CNA." DSHS certifies Home Care Aides' training and runs employer background checks. The CNA credential comes from the DOH.
• "My HCA is with DSHS, so my NAC will be too." The HCA credential itself is issued by the DOH; DSHS approves the training. The NAC is also issued by the DOH.

For the rules the Board wrote, see the plain-English guide to WAC 246-841A. For the exam the Board designed, see the Washington NAC exam guide.

Frequently asked questions

Who issues CNA licenses in Washington? The Washington State Department of Health issues the Nursing Assistant-Certified credential. The Board of Nursing sets the training and exam standards you must meet first.

Is the Washington Board of Nursing the same as NCQAC? Yes. The Nursing Care Quality Assurance Commission was renamed the Washington State Board of Nursing. Same body, same rules.

Does the Board of Nursing approve CNA schools? Yes. Only Board-approved programs can qualify you for the exam. Verify a school's approval before enrolling.

Who handles CNA renewal in Washington? The DOH, through its online portal, every year on your birthday. No continuing education is required for a standard NA-C.

Who do I contact about the skills test? The Board of Nursing's nursing assistant program handles skills testing questions at nac.exam@doh.wa.gov. Your training program handles scheduling if it administers the test on site.

Does DSHS regulate CNAs? Not the credential. DSHS approves Home Care Aide training and runs background checks for employment in long-term care settings, which affects where a CNA can work.

To meet the Board's standards, compare the CNA Traditional and HCA–CNA Bridge programs and check upcoming class dates.