Physician duties · CNS · Missouri
Signing for a Clinical Nurse Specialist in Missouri: what the physician takes on
The agreement is mandatory for the clinician, which makes its duties mandatory for you. Missouri does not name a specific instrument.
CNS is not a distinct licensure category — Missouri's unified APRN statute (§ 335.016) lists 'Certified Clinical Nurse Specialist' as one of four national-certification sub-types under the single APRN license. No CNS-specific supervision statute was found; treated identically to general NP under § 334.104.
What you take on as the physician
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
Available remotely (no on-site requirement)
Same undefined 'geographic proximity' standard as general NP (§ 334.104).
Supervision ratio
Up to 6 at a time (combined across provider types)
Same 6-FTE combined cap as general NP/PA.
Chart review
10% of charts · As needed (every 14 days)
Same 10%/20% structure as general NP.
Meeting cadence
As needed
Same biweekly-presence standard as general NP.
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Same Schedule III-V/hydrocodone framework, 120-hour cap, ≥1,000-hour threshold for the controlled-substance certificate as general NP.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Same as the general `np` entry — no CNS-specific ownership rule found.
Legal sources for these rules (2)
What physicians charge for this role
Typical monthly compensation in Missouri
$500 – $650
Estimate for one Clinical Nurse Specialist. This state's rules add a restrictive-tier premium.
About Missouri's rules
PA/APRN collaboration is governed by nearly-identical §§ 334.104/334.735: a 6-FTE combined ratio cap, 10%/20% chart-review every 14 days, biweekly physician presence, and a 120-hour controlled-substance Rx cap. A pre-2024 numeric 75-mile proximity rule was reportedly rescinded by both boards — current text uses an undefined 'geographic proximity' standard; verify with counsel before relying on any specific mileage figure.
Other clinicians in Missouri: see the state overview.