If you hold a Missouri Nurse Practitioner's license you know how hard you had to work to earn this prestigious credential. It took years of initiative and determination to obtain your license. That's why you need to defend yourself if you are, or maybe, accused of misconduct. If a patient, another healthcare practitioner, or a member of the public files a written complaint about you with the state, your NP license may be at risk. A complaint can cause the state to investigate and start disciplinary action. In Missouri, the disciplinary process can lead to a loss of licensure, so always take an accusation seriously. You should never ignore an allegation of wrongdoing with the hope that it will go away, even if the claim seems trivial. There is too much at risk. You must fight for your NP license with an experienced law firm at your side.
If you are named in a complaint or are worried you could be, the Lento Law Firm's Professional License Defense Team can help. The team has a great deal of experience with disciplinary cases involving nurses, doctors, and other licensed professionals. An attorney with the Professional License Defense Team is ready to hear what you have to say and answer your questions. The Lento Law Firm's attorney will explain what will happen as your case moves through Missouri's disciplinary process. The attorney will also discuss your options and endeavor to reach the best outcome possible. Skills and knowledge are crucial, and the Lento Law Firm's attorneys have the tools you need. They will help you navigate the nerve-wracking disciplinary process, regardless of your location in Missouri. The firm can help if you are in Branson, Joplin, Kansas City, St. Louis, or any other area of the state, as well as nationwide. The Lento Law Firm and its Professional License Defense Team are ready to go to bat for you. Reach out to us by calling 888-535-3686 or use this online form to contact us.
The Nurse Practitioner Licensing Process in Missouri
The Missouri Board of Nursinghandles the licensing process for nurses within the state. The board issues licenses for Licensed Practical Nurses, Registered Professional Nurses (RNs), and Advanced Practice Registered Nurses (APRNs). Nurses in advanced practice include Certified Nurse Practitioners. Missouri is also part of the Nurse Licensure Compact and, as a member, allows nurses who hold a license from another state to practice within the state.
To become an APRN, such as an NP in Missouri, an individual must first obtain an RN's license. An RN who holds an unencumbered license can pursue an APRN license, which is also called a document of recognition (DOR). To obtain a DOR, an individual must fulfill certain educational requirements and pass an exam administered by one of the board-approved certifying organizations. An RN who is a new graduate NP and wants to begin advanced practice before taking the exam can pursue a temporary DOR. This credential will allow a graduate to practice as an NP for no more than four months, without the authority to write prescriptions. The graduate must submit a recognition application to the board and provide proof ofcompletion of an advanced nursing education program. The applicant must have a graduate degree from an accredited college or university with a concentration in an advanced practice nursing specialty. In addition, the education program must provide a minimum of 500 faculty-supervised clinical hours. The applicant must register to take the first available exam and agree to notify the board and their employer of their results within five working days of receipt. (If the applicant does not pass the exam, they must stop advanced practice immediately.) The applicant cannot pursue a temporary DOR if they have ever been denied certification or had any certification suspended, revoked, or canceled by one of the board-approved organizations.
An RN with an unencumbered license who has passed the exam and received NP certification can apply for a DOR to begin advanced practice. The individual must provide proof of their advanced nursing education and of certification in their advanced practice specialty, such as family or pediatric care, for example. The applicant must also undergo a criminal background check and submit a set of fingerprints to the Missouri State Highway Patrol. The DOR applicant must disclose whether they have ever been denied any nursing license or other professional license and explain the reasons for the denial. The applicant must also state whether they have ever been subject to disciplinary action, been on license probation, or had a license revoked or suspended. The individual also must reveal whether they are under investigation or subject to any pending discipline. Lastly, an applicant must disclose whether they:
- Have ever voluntarily surrendered any professional license or certification during or following an investigation;
- Have been convicted, pled guilty, or pled no contest to any crime;
- Have been convicted, pled guilty, or pled no contest to any traffic offense related to the use of drugs or alcohol;
- Had a judgment rendered against them relating to the practice of healthcare and based on fraud, misrepresentation, deception, or malpractice;
- Have any condition or impairment, including a history of alcohol or substance use, that is not being treated and interferes with the ability to practice in a competent and professional manner;
- Are listed on any sexual offender registry; and
- Have ever been on an employee disqualification list or other restriction within a health-related profession.
To keep a DOR, an NP must maintain their current RN's license. If that license becomes inactive or lapses, the individual's DOR automatically expires. An NP must also obtain periodic recertification, since APRN certification expires on a date set by the certifying organization.
Standards of Practice for Nurse Practitioners in Missouri
As Missouri has an interest in protecting the public, the state regulates nursing at all levels. APRNs, such as NPs, must have a written collaborative practice arrangement with a physician before they can practice their specialty. These arrangements generally delegate, to the NP, a physician's authority to dispense some drugs and provide treatment to patients. However, the services administered must be within the NP's scope of practice and consistent with the individual's skill, training, and competence. The physician must always be available for consultations with the NP to ensure patient safety. Further, an NP who wishes to prescribe controlled substances must apply to the board for authorization. An NP who holds authorization must comply with all requirements of the Missouri Board of Narcotics and Dangerous Drugs and the federal Drug Enforcement Administration.
NPs must abide by the Missouri Nursing Practice Act and practice within their specialty's professional scope and standards. No one can use the titles APRN or NP, or any other title, abbreviation, sign, or card to indicate they are a nurse in advanced practice unless they hold the appropriate license. In addition, no one can practice or offer to practice advanced practice nursing unless duly licensed.
In Missouri, it is also illegal to:
- Sell or fraudulently obtain any nursing diploma, license, or license renewal;
- Practice nursing under a fraudulently obtained diploma or license; and
- Practice nursing while a license is under suspension or revocation.
Lastly, all NPs must comply with all state and federal laws, just like everyone else.
Discipline of Nurse Practitioners in Missouri
The board can bring disciplinary action against an NP's license when the health and safety of patients and the public are in jeopardy. Discipline may consist of censure (public reprimand), the placement of a licensee on probationary status, the suspension or revocation of licensure, or the denial of licensure. The board may act against an NP in the following situations, for example:
- Use or unlawful possession of any controlled substance, regardless of impairment, or of an alcoholic beverage to an extent that impairs the ability to perform professional work;
- Having been found guilty, pled guilty, or pled no contest to any offense related to the qualifications or duties of the profession, or to any offense involving fraud, dishonesty, or violence, or to any offense of moral turpitude;
- Use of fraud, deception, or bribery in securing any nursing certificate or license;
- Incompetency, gross negligence, or repeated negligence in the performance of professional duties;
- Violation of any provision of state nursing law;
- Disciplinary action by another state or a federal agency;
- Being declared insane or incompetent by a court;
- Violation of professional trust or confidence;
- Failing to successfully complete the state's program for a substance use disorder;
- Failure to guard against contagious or infectious diseases;
- Physical or mental illness or disability that impairs the ability to practice with reasonable judgment, skill, or safety; and
- Any behavior constituting a danger to the health and safety of a patient or the public.
Further, Missouri can discipline an NP for misconduct, fraud, misrepresentation, dishonesty, unethical conduct, or unprofessional conduct in the performance of professional duties. This behavior includes, for example:
- Overcharging or overtreating patients, or charging for visits or services that did not take place;
- Attempting, through intimidation or deception, to obtain or retain a patient, or discourage a second opinion;
- Performing inappropriate or unnecessary treatment, tests, or services;
- Delegating responsibilities to an unqualified person;
- Performing services beyond the authorized scope of licensed practice;
- Exercising influence to engage a patient in sexual activity;
- Being listed on a sexual offender registry;
- Failing to cooperate with the board during any investigation;
- Failing to comply with any board subpoena or order;
- Violating a board agreement, order, or settlement;
- Unethical or unprofessional conduct involving a minor;
- Failing to conform to nursing standards;
- Failing to maintain professional boundaries with a patient;
- Violating a patient's privacy rights;
- Failing to assess, accurately document, or report a patient's status, or falsely assessing, documenting, or reporting the status;
- Causing physical or emotional harm to a patient; and
- Failing to provide details of a patient's needs to other nurses who will provide continuing services.
Anyone can file a complaint about an NP with the board. The complaining party must identify themselves, explain their allegations, and attach any supporting documents. The board will review the complaint and begin an investigation if it determines that a possible violation of Missouri nursing law occurred. If the board finds insufficient evidence, or that no violation occurred, it will not take any action. If the board finds a violation but decides not to pursue formal discipline, it may issue a letter of concern to the NP. The board may decide instead to file a formal complaint seeking disciplinary action against the NP. In this situation, Missouri will have its own attorney, so the NP should have one, too. The Lento Law Firm and its Professional License Defense Team know what to do when a complaint is filed against an NP. The firm can start to defend you as soon as you become aware that a complaint has been, or maybe, filed.
If an NP is facing possible discipline, they may negotiate a settlement with the board. The settlement will outline the facts of the case and the agreed-upon penalty. If the case moves to the administrative hearing stage, both the state and the NP can present their evidence and testimony. If the hearing officer finds that a violation of law occurred, the board can impose a penalty either on its own or in combination with another penalty. The board may censure the NP, place the nurse on probation for no more than five years, suspend the nurse for no more than three years, or revoke licensure. Note that in some emergency situations, the board can pursue an immediate suspension or restriction of a license. These situations usually involve sexual misconduct, drugs, or alcohol.
An NP can appeal disciplinary action to the Missouri civil court system, but it is crucial to have an attorney who will make sure that deadlines and rules are observed. An NP should have legal representation throughout the disciplinary process and during the appeals process as well.
Retain the Lento Law Firm to Protect Your Missouri Nurse Practitioner's License
As an NP, you take great pride in your accomplishments, so do not let an accusation of misconduct derail your career. If your license is at risk, you must be proactive and fight for your livelihood. The Lento Law Firm and its Professional Defense Team can help you before and after a complaint is filed, and they can assist you even if the disciplinary process has already started. The best thing you can do is to consult with an attorney who understands Missouri's laws on nursing and the state's disciplinary process. From Independence to Republic to Springfield, the Lento Law Firm is your top choice for legal assistance. The Lento Law Firm can help no matter where you are in Missouri, or anywhere else in the country. Call 888-535-3686 to tell us about your case, or use this online form to set up a consultation.
