Requirements for Licensure

PURPOSE: This rule sets out requirements for licensure in Missouri of registered professional nurses and licensed practical nurses by examination, endorsement, and renewal. (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 AND INSURANCE 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-bycourse 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 courseby-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 of 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 AND INSURANCE 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. AND INSURANCE AUTHORITY: sections 335.036, 335.046, 335.051, and 335.066, RSMo Supp. 2023.* This rule originally filed as 4 CSR 200-4.020. Original rule filed Oct. 14, 1981, effective Jan. 14, 1982. Amended: Filed May 13, 1982, effective Aug. 12, 1982. Amended: Filed Oct. 13, 1982, effective Jan. 13, 1983. Amended: Filed March 15, 1983, effective June 11, 1983. Amended: Filed Sept. 13, 1983, effective Dec. 11, 1983. Amended: Filed May 24, 1985, effective Nov. 11, 1985. Amended: Filed Sept. 13, 1985, effective Dec. 28, 1985. Amended: Filed Aug. 5, 1987, effective Nov. 12, 1987. Rescinded and readopted: Filed Aug. 11, 1989, effective Dec. 11, 1989. Amended: Filed Dec. 13, 1989, effective Feb. 25, 1990. Amended: Filed Oct. 17, 1991, effective April 9, 1992. Amended: Filed March 5, 1992, effective Aug. 6, 1992. Emergency amendment filed May 14, 1993, effective May 24, 1993, expired Sept. 20, 1993. Amended: Filed May 14, 1993, effective Nov. 8, 1993. Amended: Filed June 29, 1993, effective Jan. 13, 1994. Amended: Filed Sept. 7, 1993, effective May 9, 1994. Amended: Filed Feb. 2, 1994, effective July 30, 1994. Amended: Filed Dec. 15, 1995, effective June 30, 1996. Amended: Filed Jan. 29, 1996, effective July 30, 1996. Amended: Filed July 27, 1998, effective Jan. 30, 1999. Amended: Filed May 12, 2000, effective Nov. 30, 2000. Amended: Filed June 28, 2002, effective Dec. 30, 2002. Amended: Filed March 15, 2004, effective Sept. 30, 2004. Amended: Filed July 29, 2005, effective March 30, 2006. Moved to 20 CSR 2200-4.020, effective Aug. 28, 2006. Amended: Filed May 14, 2007, effective Nov. 30, 2007. Amended: Filed Feb. 29, 2008, effective Aug. 30, 2008. Amended: Filed June 2, 2008, effective Dec. 30, 2008. Amended: Filed Aug. 27, 2009, effective Feb. 28, 2010. Amended: Filed Sept. 5, 2013, effective Feb. 28, 2014. Emergency amendment filed April 27, 2017, effective May 9, 2017, expired Feb. 15, 2018. Amended: Filed April 27, 2017, effective Oct. 30, 2017. Amended: Filed June 22, 2018, effective Dec. 30, 2018. Amended: Filed June 21, 2019, effective Dec. 30, 2019. ** Amended: Filed Nov. 20, 2023, effective May 30, 2024. *Original authority: 335.036, RSMo 1975, amended 1981, 1985, 1993, 1995, 1999, 2007, 2008, 2011, 2018; 335.046, RSMo 1975, amended 1981, 1995, 1999; 335.051, RSMo 1975, amended 1981, 1999; and 335.066, RSMo 1975, amended 1981, 1995, 1999, 2007, 2013, 2018. **Pursuant to Executive Order 21-09, 20 CSR 2200-4.020, subsection (1)(G) and sections (3) and (6) was suspended from March 23, 2020 through December 31, 2021.