Missouri Code of State Regulations
Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE
Division 2200 - State Board of Nursing
Chapter 4 - General Rules
Section 20 CSR 2200-4.020 - Requirements for Licensure
Universal Citation: 20 MO Code of State Regs 2200-4.020
Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This amendment updates the rule to current standards.
(1) Examination.
(A) Written examination as used in Chapter
335, RSMo, shall mean the National Council of State Boards of Nursing's
licensure examination.
(B) The
registered professional nurse (RN) candidate shall have successfully completed
the basic prescribed curriculum and received a degree or diploma from a school
with an approved professional nursing program. The practical nurse candidate
shall have successfully completed a basic prescribed curriculum in an approved
school of practical nursing and have earned a practical nursing degree,
diploma, or certificate or completed a comparable period of training as
determined by the board. A comparable period of training as determined by the
board shall mean graduation from an approved professional nursing program with
validation by examination of a personal and vocational concepts course by an
approved practical nursing program or graduation from the Army Practical Nurse
Program.
(C) Pursuant to section
324.007,
RSMo, the education, training, and/or service received and completed through
the Air Force Basic Medical Technician Corpsman Program (BMTCP) - 4N051-5 Skill
Level is an approved program for practical nursing. Any applicant for licensure
for practical nursing who has successfully completed the BMTCP - 4N051-5 Skill
Level, or above, has met the educational qualifications for licensure by
examination.
(D) The candidate must
file a complete application containing data and documents required by the board
and attest that all information contained in, or referenced by, the application
is complete and accurate and is not false or misleading. Any application for
licensure submitted to the board is valid from one (1) year from the date the
application is submitted. After the expiration of one (1) year, an applicant
shall submit a new application.
1. Any
applicant applying for the practical nurse licensing examination who is
deficient in theory, clinical experience, or both, as stated in 20 CSR 2200,
Chapter 3-Practical Nursing, and has not earned a practical nursing degree or
met the requirements for a comparable period of training as determined by the
board pursuant to 20 CSR 2200-4.020(1)(B) or
(C), will not be approved.
(E) The applicant shall
submit to state and federal fingerprint or other biometric criminal background
checks.
(F) An application for
licensure by examination shall include verification of graduation or
eligibility for graduation from an approved nursing program.
(G) The term first licensing examination
scheduled by the board, as used in section
335.081,
RSMo, means the first licensure examination taken by the applicant which must
be taken within ninety (90) days of graduation.
(H) An applicant for licensure by endorsement
or licensure by examination who answers yes to one (1) or more of the questions
on the application or the fingerprint checks reveal charges and/or convictions
which relate to possible grounds for denial of licensure under section
335.066, RSMo, shall submit
copies of appropriate documents, as requested by the board, related to that
answer, evidence of rehabilitation, and/or the fingerprint check before his/her
application will be considered complete. The copies shall be certified if they
are records of a court or administrative government agency. An applicant for
licensure by endorsement or licensure by examination who the executive director
or designee determines may not meet the requirements for licensure or
examination shall be notified that the application will be reviewed by the
members of the board at the board's next regular scheduled meeting following
receipt of all requested documents. The Missouri State Board of Nursing shall
notify any individual who is refused permission to take an examination for
licensure or an individual licensed in another state, territory, or foreign
country that is denied a license by endorsement without examination. At the
time of notification, this individual is to be made aware of his/her avenue of
appeal through the Missouri Administrative Hearing Commission.
(I) A passing designation as determined by
the Missouri State Board of Nursing shall be attained by candidates to qualify
for licensure to practice professional/practical nursing in Missouri. Results
of the licensing examination shall be reported only by pass/fail designation to
candidates and to directors of programs of professional/practical
nursing.
(J) An original
examination report will be forwarded to the examinee. A copy will be retained
in the permanent application on file in the Missouri State Board of Nursing
office. A composite report will be forwarded to the director of each program of
professional/ practical nursing listing the names of the candidates and the
pass/fail designation for each candidate.
(K) An official final transcript. The
transcript must include the degree/designation awarded and date of graduation
and must be received directly from the primary source or directly from an
electronic transcript service approved by the board.
A candidate cannot take the licensure examination until all licensure requirements are met, including providing a transcript.
(L) Proof of United States
citizenship or alien status as specified in
8
U.S.C.A. section 1621 or lawful presence as
specified in section
208.009,
RSMo.
(M) Requests for Examination
Modification.
1. The Missouri State Board of
Nursing and its test service will determine if a candidate will be allowed
modification of the examination if the candidate requests the modification
because of a disability defined by the Americans with Disabilities
Act.
2. The candidate requesting
modification shall submit a request to the Missouri State Board of Nursing. The
request shall contain-
A. A letter from the
candidate's nursing education program indicating what modifications, if any,
were granted by that program;
B.
Appropriate documentation supporting the request for accommodation from a
qualified professional with expertise in the areas of the diagnosed disability.
Documentation must include:
(I) A history of
the disability and any past accommodation granted the candidate and a
description of its impact on the individual's functioning;
(II) Identification of the specific
standardized and professionally recognized tests/assessments given (e.g.,
Woodcock-Johnson, Weschler Adult Intelligence Scale);
(III) Clinical diagnoses of disability (where
applicable, list the DSM Code Number and Title);
(IV) The scores resulting from testing,
interpretation of the scores, and evaluations; and
(V) Recommendations for testing
accommodations with a stated rationale as to why the requested accommodation is
necessary and appropriate for the diagnosed disability; and
C. A letter from the applicant
requesting the modifications detailing the specific modifications and
explaining the rationale for the modifications.
3. When the request is received from the
candidate with the previously listed items, the request will be
reviewed.
4. If approved, a request
for modification of an examination will be submitted to the test
service.
(2) Repeat Examination.
(A) A candidate who does
not achieve the passing designation as determined by the Missouri State Board
of Nursing shall not qualify to receive a license to practice
professional/practical nursing in Missouri. It shall be unlawful for any person
to practice professional/ practical nursing in Missouri as a graduate nurse
after failure of the National Council of State Boards of Nursing, Incorporated,
licensure examination until successfully passing the examination and receiving
a license.
(B) In order to retake
the licensure examination, the candidate must file a repeat examination
application containing data and documents required by the board and attest that
all information contained in, or referenced by, the application is complete and
accurate and is not false or misleading. Any repeat examination application
submitted to the board is valid one (1) year from the date the application is
submitted. After the expiration of one (1) year, an applicant shall submit a
new repeat examination application.
(C) The applicant shall submit to state and
federal fingerprint or other biometric criminal background checks if the
applicant's previous background checks are more than one (1) year
old.
(3) A graduate of a nursing program may practice as a graduate nurse until he/she has received the results of the first licensure examination taken by the nurse or until ninety (90) days after graduation, whichever first occurs. The graduate nurse shall practice with proper supervision. Proper supervision means the general oversight and initial and ongoing direction in any given situation including, but not limited to, orientation, procedural guidance, and periodic inspection and evaluations.
(4) Passing Score.
(A) The standard score of three hundred fifty
(350) in each subject of the State Board Test Pool Examination for Registered
Nurses shall be the Missouri passing score beginning with series nine hundred
forty-nine (949) through series two hundred eighty-two (282). Candidates
writing the licensing examination prior to the date series nine hundred
forty-nine (949) was given shall have no grade below sixty-five percent (65%)
and shall have attained an average score of seventy percent (70%). Beginning
July 1982, the standardized scoring system to be used with the National Council
Licensure Examination for Registered Nurses will have a passing score of
sixteen hundred (1600). Beginning February 1989, to be eligible for licensure,
a candidate must achieve a pass designation on the National Council Licensure
Examination for Registered Nurses.
(B) For the period March 1, 1954 through
February 28, 1958, seventy percent (70%) was required for passing the practical
nurse examination. For the period March 1, 1958 to December 31, 1958, the
standard score of three hundred (300) was the minimum passing score for the
practical nurse examination. As of January 1, 1959, the standard score of three
hundred fifty (350) shall be the minimum passing score in Missouri for the
State Board of Nursing Test Pool Licensing Examination or the National Council
Licensure Examination for Practical Nurses. Beginning October 1988, to be
eligible for licensure, a candidate must achieve a pass designation on the
National Council Licensure Examination for Practical Nurses.
(5) Licensure by Endorsement in Missouri-Registered Nurses (RNs) and Licensed Practical Nurses (LPNs).
(A) A professional/practical nurse licensed
in another state or territory of the United States may be entitled to licensure
provided qualifications are equivalent to the requirements of Missouri at the
time of original licensure. This equivalency is defined as-
1. Evidence of completion and graduation from
an approved program of professional/practical nursing if educated in a state of
the United States (except Puerto Rico); a course-by-course evaluation report
received directly from a credentials evaluation service approved by the board
if the initial nursing education was earned in Puerto Rico, Canada, or another
country;
2. Attainment of a passing
standard score or pass designation as determined by the Missouri State Board of
Nursing on the licensing examination or attainment of an acceptable grade in
areas comparable to those required in Missouri at the time licensure was
secured in the state of original licensure;
3. If the applicant is from a non-English
speaking land, successful passage of an English-language proficiency exam,
approved by the board that includes the components of reading, speaking, and
listening. The English-language proficiency exam results must be received
directly from the testing agency. The English-language proficiency exam must
have been taken and passed within two (2) years of the date the applicant was
initially licensed in another state or territory of the United States by
examination; and
4. If an
individual was licensed by waiver as a practical/ vocational nurse in another
state, territory, or foreign country prior to July 1, 1955, and the individual
meets the requirements for licensure as a practical nurse in Missouri which
were in effect at the time the individual was licensed in the other
jurisdiction, she/he is eligible for licensure in Missouri as an LPN. If an
individual is licensed by waiver in another state after July 1, 1955, she/he
does not qualify for licensure by waiver in Missouri as a practical
nurse.
(B) Procedure for
Application.
1. The applicant must file a
complete application containing data and documents required by the board and
attest that all information contained in, or referenced by, the application is
complete and accurate and not false or misleading. Any application for
licensure submitted to the board is valid for one (1) year from the date the
application is submitted. After the expiration of one (1) year, an applicant
shall submit a new application, along with the required fee.
2. The applicant shall submit to state and
federal fingerprint or other biometric criminal background checks as
administered through the Missouri State Highway Patrol.
3. The applicant shall provide for official
verification of licensure from all states and/or territories.
4. The applicant shall cause an official
nursing transcript to be forwarded directly to the Missouri State Board of
Nursing office from the primary source or received directly from an electronic
transcript service approved by the board if educated in a state of the United
States (except Puerto Rico); or a course-by-course evaluation report received
directly from a credentials evaluation service approved by the board if the
initial nursing education was earned in Puerto Rico, Canada, or another
country.
5. Proof of United States
citizenship or alien status as specified in
8 U.S.C.A. section
1621 or lawful presence as specified in
section 208.009, RSMo.
6. If the applicant is from a non-English
speaking land, successful passage of an English-language proficiency exam,
approved by the board that includes the components of reading, speaking, and
listening. The English-language proficiency exam results must be received
directly from the testing agency. The English-language proficiency exam must
have been taken and passed within two (2) years of the date the applicant was
initially licensed in another state or territory of the United States by
examination.
7. The board will not
review a submitted application for licensure until such time as all required
credentials and any other documents requested by the board are
received.
(6) Temporary Permit.
(A) A single state
temporary permit may be secured for a limited period of time six (6) months if
otherwise eligible pursuant to Chapter 335, RSMo and these regulations until
licensure is granted or denied by the Missouri State Board of Nursing or until
the temporary permit expires, whichever comes first. If the applicant does not
hold a current nursing license in another state, territory, or Canada, a
temporary permit may be issued upon receipt of a completed endorsement
verification of licensure from the applicant's original state of licensure by
examination and transcript, if requested.
(7) Intercountry Licensure by Examination in Missouri-RN and LPN.
(A) Application
Procedure.
1. A professional/practical nurse
educated outside a state of the United States may be entitled to apply to take
the examination for licensure if, in the opinion of the Missouri State Board of
Nursing, current requirements for licensure in Missouri are met.
2. The applicant shall file a complete
application containing data and documents required by the board and attest that
all information contained in, or referenced by, the application is complete and
accurate and is not false or misleading. Any application for licensure
submitted to the board is valid for one (1) year from the date the application
is submitted. After the expiration of one (1) year, an applicant shall submit a
new application, along with the required fee. Credentials in a foreign language
shall be submitted in their original language and also a duplicate set
translated into English, the translation shall be signed by the translator, and
the signature shall be notarized by a notary public. The translation shall be
attached to the credentials in a foreign language when submitted to the
Missouri State Board of Nursing.
3.
The required credentials for professional/practical nurse applicants are-
A. A course-by-course evaluation report and
credentials evaluation report received directly from a credentials evaluation
service approved by the board and education, identity, and, professional
license verification received directly from an agency approved by the
board;
B. A photostatic copy of a
birth certificate (if a copy of birth certificate is not available, copy of
baptismal certificate, passport, or notarized statement from an authorized
agency will be accepted as verification of name, date of birth, and place of
birth);
C. Photostatic copy of
marriage license/certificate (if applicable);
D. Successful passage of an English
proficiency exam, approved by the board that includes the components of
reading, speaking, and listening. The English-language proficiency exam results
must be received directly from the testing agency and must have been taken and
passed within the last two (2) years;
E. Photostatic copy of original license
issued by the licensing agency where original licensure/registration was
secured by examination;
F. Copy of
Passport;
G. Copy of original
education certificate/diploma;
H.
Copy of Transcript/Marksheet;
I.
Copy of nursing education program transcripts and copy of certificate (if
any);
J. Professional/Health
License issued by the regulator of the country last worked in or home country
professional/ health license;
K.
Employment Certificate/Experience Certificate/ Relieving Letter/Last appraisal
letter (if this includes the employment start date)/First and last salary slip
(Recommendation letters are not acceptable documents for employment
verification); and
L. The applicant
shall submit to state and federal fingerprint or other biometric criminal
background checks as administered through the Missouri State Highway
Patrol.
(8) Licensure Renewal.
(A) Renewal periods shall be for one (1), two
(2), or three (3) years as determined by the board. A license will expire when
the lawful presence expires as specified in
8 U.S.C.A. section
1621 or section
208.009, RSMo, if the nurse is
not a United States citizen.
(B)
The required fee and information related to the nurse's practice and
demographics for the purpose of collecting nursing workforce data shall be
submitted prior to the expiration date of the license.
(C) In answer to requests for information
regarding an individual's licensure, the staff of the board will verify status
and other information as deemed appropriate by the executive
director.
(D) The renewal
application, any required documents and the appropriate fee should be received
by the board a minimum of three (3) business days prior to the expiration date
of the nurse's current license in order for the board to process the
application prior to the expiration date. Failure to do so may result in the
license becoming lapsed, which will require the nurse to complete a new
application as set forth in
20 CSR
2200-4.020(10).
(9) Inactive Licenses.
(A) Any nurse possessing a current license to
practice nursing in Missouri may place that license on inactive status by
submitting a request with the board.
(B) Individuals wishing to reactivate
licenses shall file an application for license renewal containing data and
documents required by the board and attest that all information contained in,
or referenced by, the application is complete and accurate and is not false or
misleading. Any application for licensure submitted to the board is valid for
one (1) year from the date the application is submitted. After the expiration
of one (1) year, an applicant shall submit a new application, along with the
required fee.
1. The applicant must submit to
state and federal fingerprint or other biometric criminal background checks as
administered through the Missouri State Highway Patrol.
2. If a nurse did practice nursing while the
license was inactive, the nurse must disclose how long and where the practice
of nursing occurred. If the nurse was practicing nursing in Missouri at the
time his/her license was inactive, he/she also must submit a statement
indicating whether and when he/she ceased working as soon as he/she realized
that the license was inactive. In addition, the nurse must cause his/her
employer to submit a statement on the employer's letterhead stationery
indicating whether and when the nurse ceased working as soon as he/she realized
that the license was inactive and the nurse will not resume practice until duly
licensed.
3. Evidence of United
States citizenship or alien status as specified in
8 U.S.C.A. section
1621 or lawful presence as specified in
section 208.009,
RSMo.
(C) No person shall
practice nursing or hold him/herself out as a nurse in Missouri while his/her
license is inactive.
(D) A nurse
who applies for renewal of an inactive license who answers yes to one (1) or
more of the questions on the application which relate to possible grounds for
denial of renewal under section
335.066, RSMo, shall submit
copies of appropriate documents related to that answer and/ or evidence of
rehabilitation, as requested by the board, before his/her application will be
considered complete. The copies shall be certified if they are records of a
court or administrative government agency. If a nurse requesting reinstatement
of his/her inactive license is denied by the State Board of Nursing based upon
the fact that the nurse is subject to disciplinary action under any provisions
of Chapter 335, RSMo, the nurse will be notified of the statutory right to file
a complaint with the Administrative Hearing Commission.
(E) A nurse whose license is inactive for
three (3) years or more shall file the application, documents, and fees
required in subsection (9)(B). In addition, the nurse may be required to appear
before the board personally and demonstrate evidence of current nursing
knowledge and may be required to successfully complete the National Council of
State Boards of Nursing's licensure examination or to present proof of regular
licensed nursing practice in another state(s) during that time
period.
(10) Lapsed Licenses, When-Procedures for Reinstatement.
(A) Pursuant to sections
335.056 and
335.061, RSMo, a license issued
by the State Board of Nursing to an RN or LPN is lapsed if the nurse fails to
renew that license prior to the expiration date. No person shall practice
nursing or hold him/herself out as a nurse in Missouri while his/her license is
lapsed.
(B) A nurse whose license
has lapsed in Missouri shall file an application for license renewal containing
data and documents required by the board and attest that all information
contained in, or referenced by, the application is complete and accurate and is
not false or misleading. Any application for licensure submitted to the board
is valid for one (1) year from the date the application is submitted. After the
expiration of one (1) year, an applicant shall submit a new application, along
with the required fee.
1. The applicant must
submit to state and federal fingerprint or other biometric criminal background
checks as administered through the Missouri State Highway Patrol;
2. If the nurse was practicing nursing in
Missouri at the time his/her license was lapsed, he/she must submit a statement
indicating that he/she ceased working as soon as he/she realized whether and
when the license was lapsed. In addition, the nurse must cause his/her employer
to submit a statement on the employer's letterhead stationery indicating
whether and when the nurse ceased working as soon as he/she realized that the
license was lapsed and the nurse will not resume practice until duly licensed;
and
3. Evidence of United States
citizenship or alien status as specified in
8 U.S.C.A. section
1621 or lawful presence as specified in
section 208.009,
RSMo.
(C) A nurse whose
license is lapsed for three (3) years or more shall file the same application,
documents, and fees required in subsection (10)(B). In addition, the nurse may
be required to appear before the board personally and demonstrate evidence of
current nursing knowledge, and may be required to successfully complete the
National Council of State Boards of Nursing's licensure examination or by proof
of regular licensed nursing practice in another state(s) during that time
period.
(D) Upon satisfactory
completion of the requirements specified in subsections (10)(B)-(C) which are
pertinent to that nurse, the board reserves the right to refuse to reinstate
the lapsed license of any nurse, including one who is subject to disciplinary
action under any provisions of Chapter 335, RSMo, which includes disciplinary
action for practicing nursing without a license while that license is lapsed. A
nurse who is requesting renewal of a lapsed license who answers yes to one (1)
or more of the questions on the application which relate to possible grounds
for denial of renewal under section
335.066, RSMo, shall submit
copies of appropriate documents, as requested by the board, related to that
answer and/or evidence of rehabilitation before his/her application will be
considered complete. The copies shall be certified if they are records of a
court or administrative government agency. If a lapsed license is not
reinstated, the board will notify the nurse of the fact and the statutory right
to file a complaint with the Administrative Hearing Commission.
(E) If any provision of this rule is
declared invalid by a court or agency of competent jurisdiction, the balance of
this rule shall remain in full force and effect, severable from the invalid
portion.
(11) Change of Name, Address, or Both.
(A) Each Missouri
licensed nurse shall notify the board within thirty (30) days of each name
change.
(B) Each Missouri licensed
nurse shall notify the board within thirty (30) days of each address
change.
(12) Retired License Status.
(A) An applicant for renewal
of a nurse license who is retired from the profession may apply for a retired
license status by completing a form provided by the board.
(B) Retired from the profession means that
the licensee does not intend to practice nursing for monetary compensation for
at least two (2) years; however, such person may provide volunteer services. A
retired license will only be a single-state license.
(C) A licensee may qualify for retired
license status provided the licensee:
1. Is
retired from the profession;
2.
Holds a current, unrestricted, and undisciplined nurse license; and
3. Submits the required form.
(D) Retired license renewal for a
professional nurse is biennial; occurring on odd-numbered years, and the
license will expire on April 30 of each odd-numbered year. Retired license
renewal for a practical nurse is biennial; occurring on even-numbered years,
and the license will expire on May 31 of each even-numbered year.
(E) Individuals wishing to reactivate
licenses after being retired shall file an application for license renewal
containing data and documents required by the board and attest that all
information contained in, or referenced by, the application is complete and
accurate and is not false or misleading. Any application for licensure
submitted to the board is valid for one (1) year from the date the application
is submitted. After the expiration of one (1) year, an applicant shall submit a
new application, along with the required fee.
1. If a nurse did practice nursing for
monetary compensation while the license was retired, the nurse must disclose
how long and where and submit a statement indicating employment dates, employer
names and addresses, and an explanation of why the nurse practiced for
compensation while the license was retired. In addition, the nurse must cause
his/her employer to submit a statement on the employer's letterhead stationery
indicating whether and when the nurse ceased working as soon as he/she realized
that the license was retired and the nurse will not resume practice until duly
licensed.
(F) A nurse who
applies for renewal of a retired license, who answers yes to one (1) or more of
the questions on the application which relate to possible grounds for denial of
renewal under section
335.066, RSMo, shall submit
copies of appropriate documents related to that answer and/or evidence of
rehabilitation, as requested by the board, before his/her application will be
considered complete. The copies shall be certified if they are records of a
court or administrative government agency. If a nurse requesting reinstatement
of his/her retired license is denied by the State Board of Nursing based upon
the fact that the nurse is subject to disciplinary action under any provisions
of Chapter 335, RSMo, the nurse shall be notified of the statutory right to
file a complaint with the Administrative Hearing
Commission.
*Original authority: 335.036, RSMo 1975, amended 1981, 1985, 1993, 1995, 1999, 2007; 335.046, RSMo 1975, amended 1981, 1995, 1999; and 335.051, RSMo 1975, amended 1981, 1999.
Disclaimer: These regulations may not be the most recent version. Missouri may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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