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The Missouri Board of Nursing (573-751-0681 or [email protected]) recognizes registered nurses with advanced training to work as advanced practice registered nurses (APRN) in the state.
Four APRN roles are recognized in Missouri. They include nurse practitioners (NP), clinical nurse specialists (CNS), certified registered nurse anesthetists (CRNA), and certified nurse midwives (CNM).
The Missouri Board of Nursing will not recognize you as an APRN unless you first hold a Missouri RN license or an RN license in another state within the Nurse Licensure Compact (Missouri, Idaho, Arizona, Utah, Texas, Colorado, New Mexico, Nebraska, South Dakota, North Dakota, Arkansas, Iowa, Mississippi, Tennessee, Kentucky, South Carolina, North Carolina, Virginia, Maryland, Delaware, Rhode Island, New Hampshire, Wisconsin and Maine).
Missouri Job Statistics
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- Are you applying for your first RN license, and have never held one in Missouri or any other state? If so, use the Application for RN License by Examination to obtain your Missouri RN license.
- Do you already hold an RN license in a non-compact state? If so, use the Application for RN License by Endorsement to obtain your Missouri RN license.
- Do you hold an RN license in a compact state? If so, do not apply for Missouri RN licensure unless you plan to declare Missouri as your permanent residence.
- Did you receive your RN training in a country outside the United States? If so, use the Application for RN License by Examination – Educated Outside US to obtain your Missouri RN license. You must also submit a course-by-course evaluation report performed by a Board- approved credentials evaluator:
- Commission on Graduates of Foreign Nursing Schools
- (Credentials Evaluation Service) (215) 349-8767
- Educational Credential Evaluators, Inc. (414) 289-3400
- Educational Records Evaluation Service, Inc. (866) 411-3737 or (866) 411-ERES
- Foundation for International Services, Inc. (425) 248-2258
- International Education Research Foundation, Inc. (310) 258-9451
- Josef Silny & Associates, Inc. (305) 273-1616
- Is your Missouri RN license currently expired? If so, you may reactivate it using the Form to Renew Expired RN License.
With an active RN license, follow these steps to become a recognized APRN in Missouri.
Step 1. Get Your Graduate Degree
Missouri’s Nursing Practice Act states that you must graduate from a regionally accredited college or university with a graduate degree and a concentration in an advanced practice nursing clinical specialty area in order to be recognized as an APRN in the state.
Requirements for advanced practice nursing education programs may be found in the Missouri Nursing Practice Act, 20 CSR 2200-4.1 , (1 )(B).
Qualified Graduate Programs
The college or university that houses your graduate-level advanced practice nursing program must be accredited by a regional accrediting agency recognized by the Council for Higher Education Accreditation (CHEA).
Course Requirements
The Missouri Board of Nursing follows the educational requirements of national certification agencies setting the scope of practice for each APRN role:
- Certified Registered Nurse Anesthetist: to meet the standards of the National Board of Certification & Recertification of Nurse Anesthetists, the certification organization for CRNAs recognized by the Missouri Board of Nursing, courses will include:
- Anesthesia physiology/ pathophysiology
- Physics and chemistry of anesthesia
- Health assessment
- Perioperative technology
- Pharmacology for anesthesia practice
- Practicum/clinical experience (usually at least 500 hours)
- Certified Nurse Midwife: to meet the standards of the American Midwifery Certification Board, the certification organization for CNMs recognized by the Missouri Board of Nursing , courses will include:
- Advanced health assessment
- Risk reduction/health promotion
- Advanced pathophysiology
- Antepartum care in normal women
- Intrapartum, postpartum and newborn care
- High-risk perinatal nursing
- Advanced pharmacotherapeutics
- Well women/gynecological care
- Practicum/clinical experience (usually at least 500 hours)
- Clinical Nurse Specialist and Nurse Practitioner: to meet the standards of your national certification program, your coursework will include the following core APRN courses:
- Advanced pathophysiology/physiology
- Advanced health assessment
- Advanced pharmacology
- Primary care management
- Practicum/clinical experience (usually at least 500 hours)
In addition, your courses will be tailored to your clinical nursing specialty. The Missouri Board of Nursing recognizes the following population specialties:
- Acute care
- Adult health
- Adult psych/mental health
- Child/adolescent psych/mental health
- Family
- Family psych/mental health
- Geriatrics
- Maternal-child
- Neonatal
- Neonatal acute and critical care
- Pediatrics
- Pediatric acute and critical care
- Women’s health
If no national certification exists for your chosen advanced practice clinical specialty, under Missouri’s statutes, your advanced practice graduate education must include courses in the following areas:
- 3 credits of advanced pharmacology within five years of applying for APRN recognition
- 1500 hours of clinical practice in your advanced practice nursing specialty within two years of applying for APRN recognition
Prescriptive Authority
When you become a recognized APRN in Missouri, you will automatically have prescriptive authority for non-controlled substances. If you wish to prescribe controlled substances, an application must be filed. (CRNAs are the only type of APRN who cannot have controlled substance prescriptive authority, as is explained in further detail in Step 3).
In order to gain controlled substance prescriptive authority, you must have documentation of ONE of the following:
- 1000 hours of clinical APRN practice
- 300 hours of APRN preceptorial experience in prescribing drugs, therapeutic devices and medications
- A letter from your advanced nursing education program describing how preceptorial experience was integrated into the program’s curriculum
- 3 hours of advanced pharmacology within the past five years
- 45 continuing education units of pharmacology within the past five years
Specialization
Missouri APRNs may become nationally certified to work with specific patent populations (children, elderly, families, adults, women, etc.).
Additionally, during your graduate-level advanced practice nursing education, you may elect to pursue tracks or concentrations in nursing administration, business administration, nurse leadership, nurse informatics, or nurse education.
Step 2. Earn Your National Certification
If a national certification agency exists for your clinical nursing specialty, you must become nationally certified in that specialty. Each national certification agency has its own requirements and standards that you must meet, including minimum education, experience. Certification is granted upon passing a national certification examination.
The Missouri Board of Nursing recognizes the following APRN roles:
- Nurse practitioner (NP)
- Certified nurse-midwife (CNM)
- Certified registered nurse anesthetist (CRNA)
- Clinical nurse specialist (CNS)
Certification Programs
The Missouri Board of Nursing recognizes the following certifying bodies and APRN clinical nursing specialty certifications:
- ANCC (American Nurses Credentialing Center):
- Acute Care Nurse Practitioner (ACNP)
- Adult Nurse Practitioner (ANP)
- Family Nurse Practitioner (FNP)
- Gerontological Nurse Practitioner (GNP)
- Pediatric Nurse Practitioner (PNP)
- Adult Psychiatric/Mental Health Nurse Practitioner (AP/MHNP)
- Family Psychiatric/Mental Health Nurse Practitioner (F/MHNP)
- Child /Adolescent Psychiatric/ Mental Health Clinical Nurse Specialist (C-AP/MHCNS)
- Family Psychiatric/Mental Health Clinical Nurse Specialist (FP/MHCNS)
- Adult Health Clinical Nurse Specialist (AHCNS)
- Gerontological Clinical Nurse Specialist (GCNS)
- Pediatric Clinical Nurse Specialist (PCNS)
- AANP (American Academy of Nurse Practitioners):
- Adult-Gerontology Primary Care NP
- Adult Nurse Practitioner
- AACN Certification Corporation (American Association of Critical Care Nurses):
- Acute Care Nurse Practitioner (ACNP)
- Adult Acute Critical Care Clinical Nurse Specialist (ACCNS)
- Neonatal Acute Critical Care Clinical Nurse Specialist (NCCNS)
- Pediatric Acute Critical Care Clinical Nurse Specialist (PCCNS)
- NCC (National Certification Corporation):
- Neonatal Nurse Practitioner (NNP)
- Women’s Health Nurse Practitioner (WHNP)
- PNCB (Pediatric Nurse Certification Board):
- Pediatric Nurse Practitioner – Acute Care (ACPNP)
- Pediatric Nurse Practitioner – Primary Care (PCPNP)
- AMCB (American Midwifery Certification Board):
- Certified Nurse Midwife (CNM)
- NBCRNA (National Board of Certification & Recertification of Nurse Anesthetists):
- Certified Registered Nurse Anesthetist (CRNA)
- No national certification exam is currently available for the following Board-recognized clinical specialties, but they are still recognized in Missouri:
- Maternal-Child Clinical Nurse Specialist (M-CCNS)
- Women’s Health Clinical Nurse Specialist (WCNS)
If national certification is available for your specialty, obtain it before proceeding with Missouri’s APRN recognition process. If it is not, make sure that you meet Missouri’s educational requirements for APRN specialties for which no national certification exists (see the education section above).
Step 3. Apply for Your APRN Recognition
Your social security number is a mandatory part of your application for APRN recognition in Missouri. If you do not have a US social security number, contact the Missouri Board of Nursing at 573-751-0681 or [email protected] before moving forward with the application process.
Download the Advanced Practice Registered Nurse Application. Complete it in its entirety, using only black ink. Sign it in the presence of a notary public. Complete and sign the Authorization to Release Confidential Information (part of application packet). Mail this directly to your national certification agency. Along with your completed application, the following items must be sent to the Board:
- $150 application fee via check or money order payable to the Missouri Board of Nursing
- Copy of your current national certification card, showing its expiration date
- Completed Controlled Substance Prescriptive Authority forms and documentation of pharmacology courses, if you are applying for this (see below)
- If no national certification exists for your clinical nursing specialty, have your college or university submit an official transcript to the Board. This should reflect your completion of:
- 3 credits of advanced pharmacology in the past five years
- 1500 hours of clinical practice in your advanced practice nursing specialty in the past two years
Send these documents to the State Board of Nursing, P.O. Box 656, Jefferson City, MO 65102-0656.
When the Missouri Board of Nursing has approved your APRN recognition, you will receive by mail an APRN Document of Recognition. Your RN licensure and APRN recognition status will also be listed on the Missouri Board of Nursing website.
Criminal History Background Check
If you are applying for Missouri APRN recognition and hold an RN license in a compact state, you must complete a criminal history background check. Contact L-1 Enrollment Services at 866-522-7067 to schedule a fingerprinting appointment. Submit your receipt from this fingerprinting service rendered with your APRN application. You must pay a fee to L-1 Enrollment Services as well as provide them with Missouri ORI number MO920100Z.
Graduate Status Recognition
If you have just graduated from your advanced practice nursing education program and wish to practice immediately, you may apply for graduate status recognition. You must have already applied to take your national certification exam, and must still send the Authorization to Release Confidential Information to your national certification agency. You may use the Advanced Practice Registered Nurse Application, and along with it, submit the following documentation:
- Official final transcript sent directly from your school to the Board
- Copy of a letter from your national certification agency stating your eligibility to test
- Signed confirmation statement that states when you are scheduled to take the first available national certification examination in your APRN specialty
- $150 application fee via check or money order payable to the Missouri Board of Nursing
Send the items described above to State Board of Nursing, P.O. Box 656, Jefferson City, MO 65102-0656.
Your graduate status recognition is valid for a maximum length of four months.
No later than five days after you take your national certification exam, send a copy of your results directly to the Board. If you fail the exam, your graduate status recognition ends immediately. If you pass, the Board will notify you of your full APRN recognition.
Collaborative Practice Agreement
Under Missouri statutes, in order to practice as a legally recognized APRN you must have a written collaborative practice agreement with a physician. This agreement must cover the following:
- Complete names, home addresses and business locations of both you and your collaborating physician
- A notice that you will display a disclosure statement at all practice locations informing patients of their right to see the collaborating physician, if desired
- Specialty and/or board certifications of the APRN and collaborating physician
- Guidelines for consultation and referral to your collaborating physician beyond your education, training, competence or scope of practice
- Jointly agreed upon protocols and/or standing orders specific to clinical conditions you will treat
- Identifies the process to review and manage abnormal test results
- Specifies mutual scopes of practice of you and the collaborating physician
- Number of collaborative practice arrangement limitations of the physician
- Physical distance you are from your collaborative physician (maximum of 50 miles)
- Availability of your collaborative physician
- Provisions, process and documentation by which your collaborating physician will review your practice biweekly
- Prescription pad requirements
- Controlled substance limitations (if you have controlled substance authority)
- Dispensing logs and 72 hour dispensing boundaries
- Dispensing of drug samples
- How you will diagnose and treat acute and chronic illness/injury
- Parameters of diagnosis and treatment of well patients and narrowly defined conditions
- Parameters of diagnosis and treatment of other types of health problems
- Population based health services
- Must be signed and dated by both you and your collaborating physician
- How the agreement will be reviewed and revised, as needed
- States that the physician is accountable for all delegated medical acts
- Must be maintained for at least eight years after its termination
You must file the written collaborative practice agreement with the Board and maintain a copy at all locations in which you and /or your collaborating physician see patients.
Controlled Substance Prescriptive Authority
If you are a nurse practitioner, clinical nurse specialist or certified nurse midwife, who meets the following conditions, you may apply for controlled substance prescriptive authority:
- Have at least 1000 hours of clinical practice after graduation from your advanced practice nursing education program
- Have completed 300 hours of preceptorship in the prescription of drugs and therapeutic devices, along with a course in advanced pharmacology
To apply for controlled substance prescriptive authority, submit to the Board one of the following to prove you have completed an advanced pharmacology course and have the requisite preceptorial experience:
- Official, final transcript from your advanced nursing education graduate program
- Letter from your graduate-level advanced nursing education program stating how the preceptorial experience was integrated into the program’s curriculum
- Documentation that you have completed a 3 credit graduate level advanced pharmacology course within the past five years
- Documentation that you have completed 45 continuing education units in pharmacology in the past five years
To prove 300 hours of preceptorial experience, submit the Statement of Preceptorial Experience form. This must be signed by a qualified preceptor (includes a licensed APRN with prescriptive authority, or a licensed practitioner of medicine or osteopathy with unrestricted prescriptive authority)
To prove 1000 hours of clinical practice, submit the Statement of Practice in APRN Category form, completed by you and your supervising APRN. Clinical hours completed during your advanced practice nursing education are not applicable.
Submit the Statement of Controlled Substance Delegation form, completed by you and your collaborating physician.
All items must be mailed to the State Board of Nursing, P.O. Box 656, Jefferson City, MO 65102-0656.
Once the Board has granted you controlled substance prescriptive authority, this will be added to your APRN Document of Recognition as well as to the Missouri Board of Nursing website where your RN licensure and APRN recognition status is listed. This authority does not need to be renewed, nor does it expire, unless your RN license or APRN recognition lapses.
Step 4. Renewing Your APRN Recognition
For Nationally Certified APRNs:
As long as you keep your Missouri RN license active, maintain your national certification, and report any new national certification to the Board, your APRN Document of Recognition will not lapse. No form or fee is necessary to be filed to “renew” it.
You must renew your Missouri RN license, which expires April 30 of odd-numbered years, to keep your APRN Document of Recognition current.
It is your responsibility to send a copy of your new certification card/letter to the Board each time you renew your national certification or earn new national certification. Follow the continuing education (CE) requirements of your national certification agency to maintain certification:
- American Academy of Nurse Practitioners
- Document 75 contact hours of CE within your APRN specialty every five years
- American Nurses Credentialing Center
- Renews every five years:
- Document 75 contact hours of CE in Category I, including 25 contact hours of CE in pharmacology
- Document completion of professional development activities
- For more information see the Certification Renewal Requirements
- Renews every five years:
- National Certification Corporation
- Document 45 hours of CE in your APRN specialty area every three years
- See Certificate Maintenance for more information
- Pediatric Nurse Certification Board
- Document 15 contact hours of CE or equivalent activities each year for a seven-year renewal cycle
- See CPNP Recert for more details
- American Association of Critical Care Nurses
- Every five years, you must complete one of the following options:
- Option 1: 1000 clinical hours and 150 CE renewal points
- Option 2: 1000 clinical hours and pass an exam
- Option 3: 150 CE renewal points and pass an exam
- See Certification Renewal for more information
- Every five years, you must complete one of the following options:
- National Board of Certification & Recertification of Nurse Anesthetists
- Document 40 CE credits every two years
- See the Application for Recertification for more information
- American Midwifery Certification Board
- Meet AMCB continuing competency requirements
- Document 20 hours of continuing education every five years
You must also maintain your Collaborative Practice Agreement and report any changes to the Board.
For Non-Nationally Certified APRNs:
If national certification does not exist for your APRN specialty, you must fulfill Board requirements to keep your APRN recognition active. Contact the Board at 573-751-0073 or [email protected] to request a form to file for continued non-certified APRN recognition. Along with the form, submit the following documentation to the Board:
- Notarized documentation of 800 hours of clinical practice in your APRN specialty in the past two years, which must include the name, address and contact person at each clinical setting and the number of hours performed at each setting
- Documentation of completion of 60 contact hours of continuing education in your APRN specialty area in the past two years
Mail this information to the State Board of Nursing, P.O. Box 656, Jefferson City, MO 65102-0656.
Lapsed APRN Document of Recognition
If you let your APRN Document of Recognition lapse, you must immediately stop practicing as an APRN in Missouri. Contact the Board at 573-751-0073 for further instructions. You may need to re-apply for active APRN recognition with the Board.
Advanced Practice Registered Nurse Associations in Missouri
Consider joining one of the following professional associations that support advanced practice nursing in Missouri:
- St Louis Nurses in Advanced Practice
- Missouri Nurses Association
- Missouri Hospital Association
- Missouri Association of Nurse Anesthetists
- Missouri Organization of Nurse Leaders
- Missouri Midwives Association
Missouri Nurse Practitioner Salary
If you’re looking to earn six figures sometime in your career, becoming an NP will get you there. NPs in Missouri make $106,870 per year, on average. More experienced NPs bring home more: $137,340 or more annually.
Registered Nurse Salary
You can make a good living as an RN in Missouri. RNs in this state report an average annual salary of $65,900. The top-earning RNs in this state make a minimum $91,880 annually.
Nursing Instructors and Teachers Salary
Nursing instructors in Missouri make enough to live comfortably. On average, these professionals bring in $68,420 per year in this state.
Nurse Administrator Salary
(Includes Nurse Managers, Directors, and Chief Nursing Officers)
Fancy becoming a team leader or manager? Nurse administrators in Missouri earn an average of $112,500 annually. Those with more responsibility and experience report an even higher income – more than $170,380 per year.
Nurse Anesthetists Salary
Nurse anesthetists make an extremely good living in Missouri, with their average salary standing at $189,610 per year. Senior anesthetists make more than what the Bureau of Labor Statistics includes in its reports – so, over $208,000 annually.
Nurse Midwives Salary
Midwives in Missouri make a good wage: The average annual pay for these folks is $113,320 per year. The highest-paid midwives make even more: at least $156,780 per year.
2020 US Bureau of Labor Statistics job market trends and salary figures for 1) Nurse Anesthetists, Nurse Practitioners, Nurse Midwives; 2) Medical and Health Services Managers (Nurse Administrators); 3) Registered Nurses; and 4) Postsecondary Nursing Instructors and Teachers reflect state data, not school-specific information. Conditions in your area may vary. 2019 US Census Bureau figures for state median household income provided for comparison. Data Accessed December 2021.