Nurse Practitioners in Missouri

One of the things that nurse practitioners want to do across the county is to practice to the extent of their license. In many states this has become a reality, and in several other states this concept is not yet a reality.

This is not due to lack of evidence – the data is there (see Quality of Nurse Practitioner Practice). It’s also not from lack of support from the Institute of Medicine to the Federal Trade Commission.

Missouri is one of the states that is facing challenges in health outcomes and access to care. It’s also one of the states that currently has one of the most restrictive practice acts…but I understand it was not always this way (See The APRN White Paper for Missouri) and there was a time when both health outcomes and access were better than they are today.

AMNP recently released a fact list about NP practice in Missouri and HB 1866 which seeks to correct these disparities.  The facts and points as well as calls to actions for both NPs and healthcare consumers is well done.

Here are the facts about NP practice in Missouri.

  • Missouri’s Nurse Practitioners undergo rigorous certifications, periodic peer review, clinical outcome evaluations, and adhere to a strong code of ethics.
  • Healthcare costs for both private insurance and Medicaid/Medicare patients can be significantly reduced by utilizing Missouri’s 6,358 nurse practitioners to the fullest extent of their training.
  • Multiple studies suggest patient outcomes are improved when nurse practitioners are involved in or directly responsible for patient care.
  • Nurse practitioners and other APRN’s throughout Missouri are highly educated healthcare providers, with most attaining a Doctorate of Nursing Practice. All nurse practitioners have at minimum a master’s degree, and most receive advanced clinical training in their area of specialty.
  • Insurance Acceptance – 85% accept Medicare, 84% accept Medicaid, 94% accept private insurance, 81% accept uninsured.
  • Current law does not define the scope of practice for Advanced Practice Nurses in Missouri. HB 1866 seeks to provide clarity and describe the parameters under which APRN’s practice.
  • Current law allows physicians and nurse practitioners to enter into collaborative arrangements in the delivery of healthcare services. These arrangements can be unduly restrictive and inhibit early care and intervention at a time when there is a shortage of healthcare professionals in 109 of 114 counties in Missouri.
  • Existing statute requires physicians who collaborate with nurse practitioners to be within 30-50 miles of the nurse practitioner. This arbitrary mileage restriction decreases patient access, as it not only inhibits clinicians from practicing but could prohibit a nurse practitioner from assisting in natural disasters in Missouri where immediate access to healthcare is critical.
  • Healthcare practitioners in Missouri and elsewhere are not permitted to exceed their level of training. Doing so puts their license and livelihood at risk. By defining the scope of practice in HB 1866, the legislation ensures that mechanisms are in place within the Missouri Board of Nursing to evaluate and discipline anyone who improperly exceeds what they have been trained to do.
  • At a time when technologies such as telemedicine are available to increase access and care, unnecessary geographic boundaries take time away from physicians and nurse practitioners that could otherwise be spent on seeing additional patients and improving patient outcomes.
  • Much of the information required by statute in collaborative practice agreements between physicians and nurse practitioners is similar to what is contained within contracts. Specifying this information in statute is unnecessarily redundant and limits flexibility for physicians and nurse practitioners to devise relationships that are best suited to the patient population.

What can you do to support Missouri’s Nurse Practitioners?

  • SUPPORT legislation (HB 1465, HB 1866, et. al) that will provide all patients in Missouri with increased access to nurse practitioners that are genuinely committed  to healthy patient outcomes
  • SUPPORT amendments offered that reduce or eliminate barriers for nurse practitioners to practice to the fullest scope of their advanced education and training
  • ENCOURAGE physicians and other healthcare providers to work in partnership with Missouri’s nurse practitioners to reduce healthcare costs, increase access to care, and improve patient outcomes
  • OPPOSE any efforts to limit the ability of nurse practitioners to help solve the growing problem of healthcare shortages through unnecessary restrictions or limitations
  • OPPOSE any efforts to place advanced practice nurses under the Missouri Board of Healing Arts (BOHA). Missouri’s nurses, including nurse practitioners, are regulated by the Missouri Board of Nursing. Placing nurse practitioners under the Board of Healing Arts is analogous to regulating malpractice attorneys through BOHA. It is not logical, cost effective, or best for patients to have a universal governing body administer licensing and regulation for multiple healthcare disciplines.


For questions or additional information: Contact Derek Leffert at 573.280.8500 or Rich Aubuchon at 573.645.9760

Click here to download the pdf of this fact sheet.

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  1. I am looking at your book on collaboration. I live in Missouri as you do. I am not aware of the law stating an established patient must see a doctor after presenting with a new problem. Is this correct? Thanks! Mary

  2. Mary, I read it in the statues when I first arrived in MO. It’s possible with the changes made last year it was removed. I was told while it was there, few people followed it. I’ll see if I can find out if that’s been removed.

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