Missouri Nurse Practice Act: Facility Guide

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Written by Katherine Zheng, PhD, BSN Content Writer, IntelyCare
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Reviewed by Aldo Zilli, Esq. Senior Manager, B2B Content, IntelyCare
Nurses meet with their supervising physician in the hallway of a hospital.

Nursing is a highly dynamic profession, with new roles and duties constantly being established to meet the shifting demands of patient care. Over the last century, this has warranted the establishment of state laws that more strictly regulate and govern nursing practice. In Missouri, Nurse Practice Act (NPA) provisions serve as important guidelines for what nursing professionals can and cannot do in their roles.

As a facility leader, it’s important to understand ways to apply the NPA to enforce accurate care protocols for your staff. To help keep you informed, here’s an overview of the Missouri Nursing Practice Act followed by compliance tips to promote better patient safety.

The Nursing Practice Act: Missouri Laws at a Glance

Missouri’s NPA outlines a set of provisions that define nursing education, set professional standards, and provide guidance on the nursing scope of practice. The main purpose of these provisions is to protect the public from unsafe or unlicensed nursing care. The table below summarizes key components of the Missouri NPA that may be most relevant to your facility’s practice policies.

State of Missouri Nurse Practice Act

Legal Authorities Missouri Code of State Regulations – Division 2200:

Revised Statutes of Missouri – Chapter 335:

Nursing Licensure Requirements To obtain a registered nurse (RN) license in Missouri, applicants must either pass the NCLEX examination or receive licensure through endorsement.

Steps to Receive Licensure by Examination:

  1. Complete an accredited nursing program.
  2. Submit all application forms and fees to the Board of Nursing.
  3. Send proof of citizenship and school transcripts.
  4. Complete a background check.
  5. Register for and pass the NCLEX exam.

Steps to Receive Licensure by Endorsement:

  1. Sign up for and verify licensure through NURSYS.
  2. Submit all application forms and fees to the Board of Nursing.
  3. Submit proof of citizenship and complete a background check.
  4. Send official transcripts to nursing@pr.mo.gov.

More information about licensure renewal can be found on the Missouri Board of Nursing’s website.

Missouri Nurse Scope of Practice Guidelines According to the Nurse Practice Act, Missouri facilities and nursing professionals must follow these general “scope of practice guidelines“:

  • Registered Nurses (RNs) can engage in acts or actions which require substantial specialized education, judgment, and skill based on knowledge and application of principles derived from nursing sciences.
  • Licensed Practical Nurses (LPNs) can engage in select actions to promote health or care for people who are ill, injured, or experiencing other health alterations. These actions must be conducted under the direction of a person licensed by a state regulatory board to prescribe medications and treatments or an RN. Additional authorized LPN actions are listed in section 335.099.
  • Advanced Practice Registered Nurses (APRNs) can engage in activities and services consistent with the required education, training, certification, demonstrated competencies, and experiences of an APRN.
Missouri Nurse Practice ActDelegation Rules The Nursing Practice Act authorizes RNs to delegate tasks to licensed or unlicensed healthcare personnel. RNs are expected to follow a standard delegation decision-making process known as the five rights of delegation:

  1. Right task: One that is delegable for a specific client.
  2. Right circumstance: Appropriate patient setting, available resources, and other relevant factors considered.
  3. Right person: Right person is delegating the right tasks to the right person to be performed on the right person.
  4. Right direction: Clear, concise description of the task, including its objective, limits, and expectations.
  5. Right supervision: Appropriate monitoring, evaluation, intervention (as needed), and feedback.
Penalties Under section 335.096, any person who violates the provisions of the NPA may be charged with a class E felony, which could result in up to 4 years in prison and/or a fine of up to $10,000.

Pursuant to Section 335.066, the Board of Nursing may also impose other disciplinary actions as deemed appropriate. This can include license suspension or revocation.

Nurse Licensure Compact (NLC) State? Missouri is part of the NLC, meaning that nurses within the state can practice according to rules and guidelines established by the NLC.

Improving NPA Compliance: 3 Tips for Facilities

Understanding how to enforce the Missouri Nurse Practice Act can help you build a better culture of safety at your facility. Follow these tips to keep your nursing staff informed and enable them to meet the highest standards of care.

1. Provide Regular Staff Training

Under the Missouri Nurse Practice Act, RNs are expected to know their scope of practice and delegate tasks accordingly. As a facility leader, you’re also responsible for establishing institutional policies that help your nurses meet these expectations. Provide regular staff training that reflects delegation and duties under the NPA as well as any policies that are specific to your facility.

2. Report Misconduct to the Board of Nursing

To protect your staff and patients, it’s important to report violations of the NPA to the Board of Nursing in a timely manner. The Board of Nursing receives and addresses complaints from any concerned parties who have reason to suspect professional misconduct. Some examples of why you may want to file a complaint include:

  • You have reason to believe that a nurse or applicant has forged their credentials.
  • You suspect that a nurse has shown up to work under the influence of drugs or alcohol.
  • You witness a nurse purposely delegating duties outside their scope of practice.

3. Stay Informed About Updates From the Board of Nursing

Regulations around nursing practice are constantly changing to meet evolving care standards and patient care demands. It’s important to stay updated about any amendments to the NPA by keeping in touch with your state’s Board of Nursing. You can sign up for email updates or regularly check the Board of Nursing’s website to ensure you have all of the latest information.

Learn More Ways to Keep Your Staff and Patients Safe

It’s not always easy to keep up with Missouri Nurse Practice Act and other regulatory updates, but we’re here to help. Discover the latest practical tips and expert-written insights on how to deliver safe, high-quality care through IntelyCare’s free newsletter.

Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.


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