For nurses looking to kick off a career, Missouri is a great option. The Show Me State has plenty of opportunities and a low cost of living. But a low cost of living also means pay for registered nurses and licensed practical nurses is lower than you'll find in other states.

Missouri's nursing board investigates complaints against nurses and disciplines where necessary. If you're facing an investigation in Missouri, the Lento Law Firm Professional License Defense Team can help. Contact us at 888-535-3686 or fill out this online form.

Nursing in Missouri

The nursing board in Missouri operates under the Missouri Division of Professional Registration, located in Jefferson City. The governor appoints the board members, five of whom must be RNs. The other four must be made up of at least one LPN, one advanced practice registered nurse (APRN), and a voting member of the public.

In addition to the Nurse Practice Act, the board uses state statutes to oversee nurse licensing in the state. The goal is to protect public health and safety both in issuing licenses and investigating complaints against Missouri's nursing licensees.

Missouri Scope of Practice Requirements

As with other states, Missouri takes a strict stance on using nursing credentials without holding those licenses. As a nurse in Missouri, you'll also need to stay within the scope of your licensed credentials. Practicing outside that scope can lead to disciplinary action.

• RN: RNs in Missouri have a wide range of responsibilities, including direct patient care and medication administration. They operate under less supervision than LPNs but lack the advanced education and supervisory responsibility that APRNs have.
• LPN: An LPN focuses on providing direct patient care and carrying out care plans developed by RNs and APNRs. They practice under direct supervision.
• APRN: APRNs tend to be educated and trained in specific nursing areas. They create patient care plans and also supervise other nurses.

In addition to practicing outside of your scope, you can also get in trouble for practicing without a license. This includes having a suspended, revoked, or lapsed license. Nurses should renew three business days before the renewal date.

Continuing Education Requirements

One of the best things about being a licensed nurse in Missouri is that there are no continuing education (CE) requirements. That means you'll be able to renew every two years without having to take a dozen or so credit hours of coursework. You can, however, voluntarily take classes to stay on top of changes in your industry.

APRNs with prescribing authority need to comply with any CE mandates issued by the Drug Enforcement Administration and the Missouri Bureau of Narcotics and Dangerous Drugs. You'll also have to maintain your national certification to keep your prescribing authority.

Drug and Alcohol Issues

Substance abuse is one of the top reasons a nurse faces disciplinary action in Missouri. A nurse found in possession of an illegal substance, as defined by state or federal government, can be disciplined even if that nurse isn't impaired.

Nurses can also face disciplinary action for substance abuse if it affects their ability to serve as a nurse. This includes taking prescription medications if a pattern of abuse is present. Nurses who practice while impaired can face disciplinary action even if the nurse doesn't have a history of impairment while on duty.

Criminal Activity

A criminal past won't stop you from getting a nursing license in Missouri unless the activity directly relates to your duties as a nurse. If you've pleaded to or been found guilty of any of the following, you might be denied a license or face revocation if you already hold one:

• Murder in the first degree or dangerous felonies.
• Rape, sodomy, child molestation, or serious sexual misconduct.
• Incest, child abandonment, or child endangerment.
• Promoting or possession of child pornography.

If you are arrested while you hold a license, you may be concerned that the board will take that license. It's important to be upfront about any convictions you face. The board monitors for criminal violations and takes action against nurses who are practicing after a conviction.

Fraud and Misrepresentation

When you apply for a nursing license in Missouri, it's expected that you'll be honest about your credentials. Failure to be 100 percent forthright on your application can result in disciplinary action. This includes attempting to use bribery to secure a Missouri nursing license.

This prohibition of fraudulent activity includes using or selling fake credentials that allow someone to practice nursing without a valid license. Using someone else's license or allowing someone to use yours to practice nursing can also lead to disciplinary action.

Incompetence in Nursing

The board expects every licensee to have the education and experience necessary to carry out the tasks assigned to that role. Failure to meet those expectations can lead to complaints from patients or coworkers, and those complaints can launch an investigation and potential disciplinary action.

Even if you rise to those expectations, though, errors can happen. A small mistake could lead to a complaint and investigation. It's important to check and double check everything, especially when it comes to administering medication and charting. All that paperwork can be used as part of a hearing against you, so do your best to avoid mistakes.

Patient Abuse and Neglect

The board takes reports of harm against patients seriously. Abuse can be physical, sexual, or emotional and can apply to patients of all ages, although elder abuse is often the focus of conversation when it comes to these offenses.

Missouri defines patient abuse as:

• Inflicting physical, sexual, or emotional injury on a patient.
• Financially exploiting patients.
• Neglecting a patient by failing to provide promised services when that failure can harm the patient's health, safety, or welfare.
• Bullying or otherwise intimidating a patient in a way that reasonably causes that person to fear for his or her safety.

The nursing board accepts complaints of abuse and neglect from members of the public and other licensed professionals. Past misbehaviors can also land nurses on the Employee Disqualification List (EDL). Licensed facilities aren't allowed to knowingly hire employees who are on the EDL.

Patient Confidentiality

Nursing professionals have access to sensitive information on the patients they treat, and those patients trust healthcare professionals to protect their privacy. That trust is written in the law, both federally, with the Health Insurance Portability and Accountability Act, and locally, with Missouri's confidentiality laws.

If you're a licensed nurse, you need to be careful with patient records. A patient should give approval in writing before information is released to anyone else, including spouses, parents, and children. At the same time, patients have the right to access their own records, so you should do what you can to safely provide them.

Unpaid Government Debts

Missouri is one of many states that suspends nursing licenses for government-mandated payments. This starts with child support. If you've been ordered by the courts to pay child support, three months without paying or $2,500 in arrears will get your license suspended.

You'll also need to have your state income taxes in good standing. In order to qualify for a new license or a renewal, you'll have to have filed state income taxes for the past three years and paid all taxes due.

Other Professional Misconduct Issues

Missouri has pinpointed a few other issues that can result in a license revocation in the state:

• A nurse can lose a license for committing fraud during the application process. But it's also a violation to fraudulently gain a promotion or other job benefits.
• Violating the nurse practice act yourself can result in disciplinary action, but you can also be disciplined for helping someone else violate the act.
• If you're judged either mentally ill or incompetent in a court of law, the board can revoke your license.
• Nurses who use false or misleading advertising to earn business can face disciplinary action.

Duty to Report

In Missouri, reporting instances of misconduct starts in the workplace. Every employer should have a process in place that makes it easy for nurses to speak up when they see something. This should be a safe place where employees feel free to report what they witness without fear of retribution.

Examples of misconduct you should report include:

• Abuse or neglect of an adult or child.
• Incompetence that jeopardizes the health and/or safety of a patient.
• Visible intoxication while on the job.
• Fraud or misrepresentation in securing licensing credentials or in obtaining promotions or benefits.
• Fraud or misrepresentation in the course of performing duties.
• Gross negligence or incompetence.
• Violations of the nurse-patient boundaries.
• Violence or threats of violence in the workplace.

This is by no means a thorough list. If a nurse suspects an activity might be in violation of regulations, it's important to reach out to a supervisor or the board as soon as possible.

All complaints against Missouri nursing professionals should be put in writing and either mailed or hand delivered to the executive director of the Missouri State Board of Nursing at 3605 Missouri Boulevard, P.O. Box 656, Jefferson City, MO 65109. You can also request a complaint form.

Multistate Nursing in Missouri

Your Missouri nursing license allows you to practice across state borders, thanks to the multistate nurse licensure compact (NLC). More than 40 states are part of the compact, which means that once you're licensed in Missouri, you can practice nursing in any of those states. If a state isn't part of the NCL, your license will still transfer as long as the state offers reciprocity.

But that also means that if you do something that puts your license at risk in any state, your Missouri license could be in jeopardy. You'll need to familiarize yourself with the laws in each state where you practice to keep your license safe.

How to Protect Your Missouri Nursing License

Once you've secured your Missouri nursing license, you'll want to do what you can to protect it. Here are some steps you can take to safeguard your Missouri nursing license:

• Your first move, once you have your license number, should be to go to Nursys e-Notify and enroll in notifications. This will ensure you're alerted when it's time to renew, if you have disciplinary action against you, or if any other change occurs to your license status.
• Know the limitations of your license. Avoid practicing outside the scope of your assigned credentials. Even if you're understaffed, it's important to stop and ask for help from the appropriate professional if an issue comes up that's outside the limitations of your license.
• Remain polite and professional in all your patient interactions. Some reports come from disgruntled patients wanting retribution for what they see as an unpleasant interaction.
• Document meticulously. Check and double check every entry when you're charting, and if you have an incident you think could lead to issues later, stop and make notes so that you'll be able to recall all the facts later.
• Stay current on your child support and tax payments. Failure to pay either of those can result in a loss of your nursing license.
• Report any violations you witness. Loyalty to coworkers is admirable, but not when it comes at the risk of your own career.
• Avoid drinking if there's any possibility you can be called into work. If you have a substance abuse issue, seek help before it affects your ability to do your job.
• If you're notified of an investigation, take extra effort to gather as much evidence as possible. Reach out to the Lento Law Firm Professional License Defense Team with any questions you have or if you need help building your case.

Defending your Missouri Nursing License

Getting a notice of disciplinary action from the Missouri Nursing Board can be stress inducing, but you don't have to go through it alone. The Lento Law Firm Professional License Defense Team can review your situation and help you respond to all board communications. We'll work with you to prepare a defense so that when you do appear in front of the board, you have the best chance possible of retaining your license.

If you need help with your Missouri nursing license defense, give us a call at 888-535-3686. You can also fill out our confidential online form to get a call back from one of our attorneys.