Missouri collaborative practice and your NP preceptor

Updated September 25, 2026 · Reviewed by the Graceland Preceptor placement team

In Missouri, a nurse practitioner prescribes and treats under a written collaborative practice arrangement with a physician, governed by RSMo 334.104 and the joint rule 20 CSR 2200-4.200. Neither text mentions students, but the arrangement shapes the clinic your Graceland University practicum happens in: chart review every 14 days, a physician on site at least every two weeks, a cap on how many NPs one physician supports, and proximity limits.

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10%of an APRN's charts reviewed by the collaborating physician every 14 days

6full-time-equivalent APRNs, PAs or assistant physicians per collaborating physician, at most

2024July 30: the current collaborative practice rule took effect

Missouri collaborative practice and your NP preceptor. 10%: of an APRN's charts reviewed by the collaborating physician every 14 days; 6: full-time-equivalent APRNs, PAs or assistant physicians per collaborating physician, at most; 2024: July 30: the current collaborative practice rule took effect. — 10%: of an APRN's charts reviewed by the collaborating physician every 14 days; 6: full-time-equivalent APRNs, PAs or assistant physicians per collaborating physician, at most; 2024: July 30: the current collaborative practice rule took effect.

What the law asks of every collaborating pair

The statute was last amended effective August 28, 2023, and the joint rule of the medical and nursing boards was amended effective July 30, 2024. Together they set the working terms for every NP who prescribes or treats in Missouri.

In writing. The arrangement must be written, and it is what lets the physician delegate prescribing and treatment authority to an advanced practice registered nurse (RSMo 334.104.2).
Chart review. The APRN sends at least a tenth of the charts documenting care to the physician every fourteen days, and the physician reviews at least a fifth of the charts involving controlled-substance prescriptions on the same cycle (334.104.3; 20 CSR 2200-4.200(3)(E)).
Presence. Where the APRN diagnoses and starts treatment, the physician must be on site at least once every two weeks for chart review and direction, barring documented extraordinary circumstances (334.104.3(11); rule (3)(F)).
Availability. The physician must be reachable for consultation at all times, in person or by telecommunications (rule (3)(A)).
Ratio. One physician may collaborate with no more than six full-time equivalents of APRNs, physician assistants and assistant physicians combined (334.104.8).
New pairings. Before practicing where the physician is not continuously present, the APRN completes at least a month working with the physician continuously on site, with some exceptions (334.104.9).
Records. The arrangement is signed before use, reviewed at least yearly and kept eight years after it ends. APRNs do not have to file a copy with the Board of Nursing.

Geographic proximity and the old 75-mile figure

The statute requires each arrangement to explain how the pair maintains geographic proximity, then allows waivers: up to 28 days a year for rural health clinics, arrangements that rely on telehealth, and a waiver application for other reasons.

Older versions of the rule spelled out a distance: the physician and APRN had to practice within 75 miles by road of each other. The rule text in force since July 30, 2024 no longer contains a mileage figure, and whether any numeric distance still applies has not been confirmed. The Missouri State Board of Nursing is the place to ask.

For your practicum, proximity affects your preceptor's arrangement, not your approval. Graceland approves you by site and address, so what matters is that the office where you train has an affiliation agreement and an approved preceptor.

What collaborative practice means inside your practicum

Your preceptor is the NP or a physician, never the arrangement itself. Graceland accepts NP preceptors with at least an MSN and a year of experience (the handbook elsewhere says one to three years), and physicians who are board-certified or board-eligible in a primary care area of practice. Physician assistants collaborate under the same Missouri statute, yet Graceland does not allow a PA to precept any practicum hours; the page on who cannot precept you lists the other exclusions.

The collaborating physician can be a strong second preceptor. Under Graceland's two-preceptor rule, you need at least two different preceptors across your three practicums, and a single practicum may have two, each with an approved Appendix B. Graceland also recommends at least 120 hours with an APRN or NP across the three practicums, so keep the NP as your primary preceptor where you can.

Missouri's review cycle also touches your charting. Graceland asks you to get the preceptor's signature on all patient documentation, prescriptions included, and in Missouri those same charts feed the physician's 14-day review.

If your NP preceptor has just started with a new collaborating physician, ask whether the one-month continuously-present period limits which days or offices they can host you.

Telehealth, multiple offices and the Missouri clinic week

Missouri lets collaborating pairs waive proximity through telehealth, but Graceland's track rules decide your hours. FNP students need instructor approval for any telehealth hours, AGACNP students may log none, and PMHNP students may count up to two terms or 450 hours, licensed where each patient is located; see PMHNP telehealth hours.

NPs in collaborative arrangements sometimes cover more than one office. Graceland counts each address separately: a preceptor with three offices means three Appendix A requests, three site contracts and three approval emails, but only one Appendix B. List every office you might work at before paperwork goes in, since added sites and preceptors need approval first.

Your license and Graceland's standing in Missouri

Missouri has been in the Nurse Licensure Compact since January 19, 2018. Graceland requires an unencumbered RN license in every approved state where you log practicum hours, verified by the board, and a Missouri practicum counts like any other. Missouri law separately allows supervised practice by students of approved nursing schools, but Graceland's RN license rule is the one you plan around.

No Missouri board rule was found that requires programs based elsewhere to seek approval before placing students in the state. Graceland is rooted here anyway: the Missouri Department of Higher Education approves it to operate, and its June 2020 MSN chart says the program keeps an annual report on file with Missouri. The Missouri state guide and the Kansas City preceptor page cover the rest of the picture.

Why Missouri students choose us

We know how a Missouri clinic runs before we call it. Your placement advisor finds NP preceptors who meet Graceland's experience standard, confirms which offices they cover so every address reaches Appendix A, and, when it helps, lines up the collaborating physician as the second preceptor Graceland's rule calls for.

Every package is aimed at Graceland's June 15, October 15 or February 15 deadline, and your advisor stays reachable through the term in case a preceptor's schedule changes. Start with the form below.

Questions Graceland students ask

Does Missouri law require anything special to precept a nursing student?

Neither RSMo 334.104 nor 20 CSR 2200-4.200 mentions students or precepting. Your requirements come from Graceland: the preceptor completes Appendix B, you submit Appendix A for each site, and the practice signs an affiliation agreement with Graceland before any clinical activity begins.

Is there still a 75-mile rule for Missouri NPs?

The 75-mile-by-road figure appeared in older versions of the collaborative practice rule. The version effective July 30, 2024 contains no mileage, while the statute still requires geographic proximity with waivers for rural health clinics, telehealth and other approved reasons. Ask the Missouri State Board of Nursing if a distance matters to your preceptor.

Can my preceptor's collaborating physician also precept me?

Yes, if the physician meets Graceland's standard of board certification or eligibility in a primary care area and completes an approved Appendix B. Graceland allows two preceptors per practicum and requires two different ones across the three practicums, so the collaborating physician is a natural second preceptor.

Can a Missouri physician assistant precept my practicum hours?

No. Although Missouri PAs collaborate with physicians under the same statute as NPs, Graceland's Graduate Student Handbook does not allow physician assistants to precept any practicum hours. Choose an NP, a qualifying physician or, for PMHNP, a psychiatrist or certified PMHNP.

Does my Missouri NP preceptor need to send Graceland the collaborative agreement?

Graceland's handbook does not list it among the practicum paperwork, and Missouri does not require APRNs to file a copy with the Board of Nursing either. What Graceland reviews is the preceptor's license, credentials and experience on Appendix B and the site details on your Appendix A.

Home stateMissouriGraceland's Missouri chart row, the Independence campus, collaborative practice as it affects your search, Kansas City to St. Louis sites and your RN license.Kansas CityKansas City NP preceptorsFinding NP preceptors across Kansas City on both sides of the state line: KU Health System and Children's Mercy processes, state rules and lead times.PreceptorsPreceptor requirementsWho can precept a Graceland University NP student: NP and physician credentials, years in practice, a license where the site is, and each track's own rules.PreceptorsTwo-preceptor ruleGraceland needs two or more different preceptors across three NP practicums, no more than two per practicum and none for all three terms. How to plan it well.PreceptorsWho cannot precept youGraceland rules out physician assistants, relatives and partners, supervisors and subordinates, and your own unit as preceptors. Here is where each line falls.AccreditationAccreditation and approvalsCCNE, the Iowa Board of Nursing, Missouri approval, HLC and NC-SARA: what each Graceland credential covers and what it means for practicums and certification.

Last checked 2026-09-25

We check these pages against Graceland's own catalog, program pages and Graduate Student Handbook. Your handbook, your track coordinator and the contract coordinators have the final word.

Graceland's practicums are arranged by you, with Graceland's help. We do the searching.

Tell us your Graceland track, your city and your next practicum. We find preceptors who fit the course, line up what Appendix A and Appendix B ask for, and aim everything at Graceland's paperwork deadline for your term.

Preceptors matched to the course: primary care for FNP, hospital and ICU clinicians for AGACNP, psychiatrists and PMHNPs for PMHNP
Site address, contract contact and preceptor details ready before the June 15, October 15 or February 15 deadline
Close to home in your approved state, with a second preceptor planned for Graceland's two-preceptor rule

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