Steps to Becoming an APRN in Missouri

missouri nursing

1Get your Graduate Degree in Missouri
2Earn your National Certification in Missouri
3Apply for Your APRN Recognition in Missouri
4Renewing 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

  • As of May 2020, NPs in Missouri earn $106,870 per year, on average.
  • NPs in Missouri earn about 35% more than the state’s median household income.
  • RNs working in Missouri make $65,900 on average, annually.
  • 2020 NCLEX-RN first-time pass rates for nursing school graduates in Missouri: 90%
  • Approximately 71,560 RNs and 6,200 NPs are licensed in Missouri.
  • 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.

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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:

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.

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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

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.

Area Name
Employment
Annual mean wage
Cape Girardeau
NA
103190
Central Missouri nonmetropolitan area
160
102950
Columbia
200
95620
Jefferson City
110
100590
Joplin
150
105720
Kansas City
2910
110650
North Missouri nonmetropolitan area
180
101250
Southeast Missouri nonmetropolitan area
300
105020
Southwest Missouri nonmetropolitan area
110
96810
Springfield
510
89980
St. Joseph
150
124010
St. Louis
2790
105360

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.

Area Name
Employment
Annual mean wage
Cape Girardeau
1480
62880
Central Missouri nonmetropolitan area
2790
60050
Columbia
3360
65270
Jefferson City
1450
63560
Joplin
2500
48210
Kansas City
24910
70240
North Missouri nonmetropolitan area
1960
59720
Southeast Missouri nonmetropolitan area
3880
59640
Southwest Missouri nonmetropolitan area
1270
58400
Springfield, MO
5500
60210
St. Joseph
1210
64560
St. Louis
35730
68230

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.

Area Name
Employment
Annual median wage
Central Missouri nonmetropolitan area
100
61710
Kansas City
720
65960
North Missouri nonmetropolitan area
30
56120
Springfield
140
62850
St. Louis
550
65160

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.

Area Name
Employment
Annual mean wage
Cape Girardeau
150
132050
Central Missouri nonmetropolitan area
400
95830
Columbia
410
112570
Jefferson City
110
93620
Joplin
230
NA
Kansas City
3030
107100
North Missouri nonmetropolitan area
300
109480
Southeast Missouri nonmetropolitan area
410
96870
Southwest Missouri nonmetropolitan area
110
112520
Springfield
470
107580
St. Joseph
90
107390
St. Louis
4020
110740

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.

Area Name
Employment
Annual mean wage
Cape Girardeau
40
NA
Central Missouri nonmetropolitan area
NA
191430
Columbia
90
194660
Kansas City
520
174490
St. Louis
340
170870

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.

Area Name
Employment
Annual mean wage
St. Louis
60
115200


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.

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