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Health Equity CE required in Washington State

The Washington Department of Health has implemented ESSB 5229, requiring all health care professionals credentialed under Title 18 RCW, to complete health equity continuing education (CE) training.

By January 1, 2024, licensees will be required to complete 2 hours of health equity CE at least once every four years. The rule-making authority for each health profession licensed under Title 18 RCW has to adopt rules by 1/1/2024 to require health equity training.

As of Dec. 22, 2023, there are new health equity continuing education for nurses in Washington. All licensed registered nurses (RNs) and licensed practical nurses (LPNs) have until their 2026 renewal date to complete 2 hrs of health equity CE. After the 2026 renewal, nurses must complete 2 hours of health equity CE every renewal period.

The 2-hour course linked below satisfies the Washington requirement for all health care professionals credentialed under Title 18 RCW to complete health equity continuing education training. Addressing the wide range of issues clinicians should understand in helping move the healthcare system to a more equitable state, this course includes all standards outlined in ESSB 5229 to satisfy the requirement. This course provides continuing education credits for ADA CERP, ACCME, ANCC, CDR, ASWB, ACPE, AAPA, and APA.

In 2023, the health department in consultation with the boards and commissions adopted the minimum standards for the CE programs covering health equity.

According the the Washington State Legislature (link), the minimum standards must include instruction on skills to address the structural factors, such as bias, racism, and poverty, that manifest as health inequities. These skills include individual-level and system-level intervention, and self-reflection to assess how the licensee’s social position can influence their relationship with patients and their communities. These skills enable a health care professional to care effectively for patients from diverse cultures, groups, and communities, varying in race, ethnicity, gender identity, sexuality, religion, age, ability, socioeconomic status, and other categories of identity. The courses must assess the licensee’s ability to apply health equity concepts into practice. Course topics may include, but are not limited to:

(i) Strategies for recognizing patterns of health care disparities on an individual, institutional, and structural level and eliminating factors that influence them;

(ii) Intercultural communication skills training, including how to work effectively with an interpreter and how communication styles differ across cultures;

(iii) Implicit bias training to identify strategies to reduce bias during assessment and diagnosis;

(iv) Methods for addressing the emotional well-being of children and youth of diverse backgrounds;

(v) Ensuring equity and antiracism in care delivery pertaining to medical developments and emerging therapies;

(vi) Structural competency training addressing five core competencies:

(A) Recognizing the structures that shape clinical interactions;

(B) Developing an extraclinical language of structure;

(C) Rearticulating “cultural” formulations in structural terms;

(D) Observing and imagining structural interventions; and

(E) Developing structural humility; and

(vii) Cultural safety training.

(4) The rule-making authority may adopt rules to implement and administer this section, including rules to establish a process to determine if a continuing education course meets the health equity continuing education requirement established in this section.

(5) For purposes of this section the following definitions apply:

(a) “Rule-making authority” means the regulatory entities identified in RCW  18.130.040 and authorized to establish continuing education requirements for the health care professions governed by those regulatory entities.

(b) “Structural competency” means a shift in medical education away from pedagogic approaches to stigma and inequalities that emphasize cross-cultural understandings of individual patients, toward attention to forces that influence health outcomes at levels above individual interactions. Structural competency reviews existing structural approaches to stigma and health inequities developed outside of medicine and proposes changes to United States medical education that will infuse clinical training with a structural focus.

(c) “Cultural safety” means an examination by health care professionals of themselves and the potential impact of their own culture on clinical interactions and health care service delivery. This requires individual health care professionals and health care organizations to acknowledge and address their own biases, attitudes, assumptions, stereotypes, prejudices, structures, and characteristics that may affect the quality of care provided. In doing so, cultural safety encompasses a critical consciousness where health care professionals and health care organizations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities, and as measured through progress towards achieving health equity. Cultural safety requires health care professionals and their associated health care organizations to influence health care to reduce bias and achieve equity within the workforce and working environment.