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Steps to Becoming an APRN in Missouri

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Get your Graduate Degree in Missouri
Earn your National Certification in Missouri
Apply for Your APRN Recognition in Missouri
Renewing Your APRN Recognition in Missouri

The Missouri Board of Nursing (573-751-0681 or nursing@pr.mo.gov) 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

  • 2015 mean salary for NPs in MO: $90,410
  • 2013 NCLEX-RN pass rate for Missouri: 87.2%
  • RNs listed among Top Jobs in Missouri 2012-22, with 21,004 job openings projected during that period
  • 2016 APRNs licensed in Missouri: 9354
    • NPs: 7037
    • NMs: 128
    • NAs: 1821
    • CNSs: 368
  • 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.

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 nurse 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:

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 nursing@pr.mo.gov 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:

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 nursing@pr.mo.gov 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:


Missouri Nurse Practitioner Salary

Nurse practitioners in the Plains region, including Missouri, earned a total of $124,540 on average, according to a 2011 salary survey conducted by the American Academy of Nurse Practitioners. Advance for NPs & PAs, a peer reviewed journal, reported that in 2011, NPs practicing in St. Louis and Kansas City earned an average of $79,690 and $87,454, respectively. Springfield, Missouri boasted the highest average NP salary in the state at $126,500.

Registered Nurse Salary

Area name
Employment
Annual mean wage
Cape Girardeau-Jackson MO-IL
1770
56630
Columbia MO
3090
58150
Fayetteville-Springdale-Rogers AR-MO
3060
53340
Jefferson City MO
1280
54600
Joplin MO
2050
44470
Kansas City MO-KS
21760
64520
St. Louis MO-IL
35270
60300
Springfield MO
5690
54560
Central Missouri nonmetropolitan area
3020
58420
North Missouri nonmetropolitan area
1730
50180
Southeast Missouri nonmetropolitan area
3110
49610
Southwest Missouri nonmetropolitan area
940
55890

Health Diagnosing and Treating Practitioners Salary

Area name
Employment
Annual mean wage
Kansas City MO-KS
70
96980
St. Louis MO-IL
100
58130
Springfield MO
40
24810

Nursing Instructors and Teachers Salary

Area name
Employment
Annual median wage
Fayetteville-Springdale-Rogers AR-MO
40
Estimate Not Released
Kansas City MO-KS
330
61930
St. Louis MO-IL
460
63460
Springfield MO
40
63080
Central Missouri nonmetropolitan area
100
49760
Southeast Missouri nonmetropolitan area
50
52480

Nurse Administrator Salary
(Includes Nurse Managers, Directors, and Chief Nursing Officers)

Area name
Employment
Annual mean wage
Cape Girardeau-Jackson MO-IL
100
74350
Columbia MO
210
86690
Fayetteville-Springdale-Rogers AR-MO
230
82490
Jefferson City MO
230
65540
Joplin MO
130
68900
Kansas City MO-KS
2020
89220
St. Joseph MO-KS
150
94790
St. Louis MO-IL
not available
84090
Springfield MO
320
75420
Central Missouri nonmetropolitan area
260
74890
North Missouri nonmetropolitan area
170
65720
Southeast Missouri nonmetropolitan area
250
70980
Southwest Missouri nonmetropolitan area
110
64270

These tables provide salary and employment information compiled by the US Department of Labor’s Bureau of Labor Statistics in May 2011. The data contained herein does not include self-employed nurses in independent practice.

When responding to the salary survey, some advanced practice registered nurses identified themselves as RNs while others identified themselves as health diagnosing and treating practitioners. When available, both sets of data were included for comparative purposes.

* These figures represent earnings that are at or above $90.00 per hour or $187,199 per year. The Bureau of Labor Statistics does not publish earnings beyond $90.00 hourly or $187,199 yearly.

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