How the Missouri Nurse Practice Act Impacts Everyday Nursing Decisions
Understanding Your Legal Duties at the BedsideAs a licensed nurse in Missouri, your daily decisions are shaped not only by patient needs and clinical protocols but also by the legal standards set forth in the Missouri Nurse Practice Act. This law governs every aspect of nursing practice in the state—from scope of duties to documentation expectations—and even one unintentional mistake could result in disciplinary action from the Missouri State Board of Nursing.To protect your license and your career, it’s critical to understand how the Missouri Nurse Practice Act affects your everyday work and what responsibilities it imposes on you each time you provide care.
What Is the Missouri Nurse Practice Act?The Missouri Nurse Practice Act, found in Chapter 335 of the Missouri Revised Statutes, is the primary law that defines what nurses can and cannot do in the state. It governs:
Scope of practice for RNs, LPNs, and APRNsStandards of professional conductDelegation authorityDisciplinary groundsLicensing and renewal procedures
Daily Decisions Shaped by the Nurse Practice ActEvery shift, Missouri nurses make dozens of decisions that must align with legal expectations under the Nurse Practice Act. Let’s explore a few high-risk areas:1. Delegation of TasksAccording to RSMo § 335.016, nurses may delegate certain tasks to unlicensed assistive personnel—but only within specific guidelines. You are legally responsible for ensuring that the person to whom you delegate is competent and qualified, and that the task is within the allowed scope.Improper delegation, such as assigning a task that requires clinical judgment to a CNA, can trigger allegations of negligence or unprofessional conduct.2. Patient Assessment and JudgmentThe Act defines nursing as requiring “substantial specialized judgment and skill.” That means nurses must assess changes in patient conditions, report concerns promptly, and apply clinical reasoning before taking action.Failing to notice or report a critical change in vitals, for example, could lead to accusations of failure to monitor—a violation that the Board treats seriously.3. Medication AdministrationThe Act authorizes nurses to administer medications—but only in accordance with accepted standards, physician orders, and facility protocols.Errors like incorrect dosing, improper timing, or failing to record administration not only risk patient harm but may violate RSMo § 335.066, which outlines grounds for discipline, including negligence and misconduct.4. Documentation and RecordkeepingAccurate documentation is a legal requirement, not just a best practice. The Board routinely disciplines nurses for:
Incomplete chartingFalsifying recordsDocumenting care not provided
When Does a Nursing Mistake Become a Legal Problem?Not every mistake results in Board action. However, a nurse may face discipline when the error reflects:
Gross negligenceHabitual incompetenceUnethical behaviorSubstance abuseImproper delegation or supervisionCriminal activity
Consequences of Violating the Nurse Practice ActDisciplinary actions for violating the Missouri Nurse Practice Act include:
ReprimandProbationSuspensionRevocationFines or civil penaltiesMandatory education or treatment