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Renewing a nursing license in Mississippi is an essential process for maintaining professional credentials and ensuring compliance with state regulations. The Mississippi Nurse Renewal form is a comprehensive document that outlines the necessary steps and requirements for registered nurses (RNs) and advanced practice registered nurses (APRNs) to renew their licenses. This form includes important details such as renewal fees—$100 for active RNs, $25 for inactive status, and additional costs for APRNs and controlled substance prescriptive authority. Nurses must submit their payment along with their social security number or nursing license number, as cash payments are not accepted. It’s crucial to remember that failure to renew by the December 31 deadline will result in an invalid license and potential penalties. Additionally, if there’s a name change, proper documentation and a fee are required to update records. The form also addresses multi-state licensure, which allows nurses to practice in other compact states, provided they maintain their primary residence in Mississippi. This article will delve deeper into each aspect of the renewal process, ensuring nurses are well-informed and prepared for a smooth renewal experience.

Mississippi Nurse Renewal Example

MISSISSIPPI BOARD OF NURSING

713 S. Pear Orchard Rd, Suite 300

Ridgeland, MS 39157

(601) 957-6300

2014

REGISTERED NURSE RENEWAL

INSTRUCTIONS

1.Make fee payable to: Mississippi Board of Nursing

2.Renewal Fees: Active $100.00; Inactive $25.00; Advanced Practice Registered Nurse (APRN) $100.00; (additional certification $50.00 each); Controlled Substance Prescriptive Authority (CSPA) $50.00. Include your phone number and social security number and/or nursing license number on your payment. Cash will not be accepted.

3.Your current license becomes INVALID and a PENALTY WILL BE ASSESSED if not renewed by the expiration date of DECEMBER 31, 2014.

4.After the expiration date of current license, the Reinstatement fees are: Active $100.00 (plus additional fee); Inactive $25.00; Advanced Practice Registered Nurse (APRN) $100.00 (additional certification $50.00 each) and Controlled Substance Prescriptive Authority (CSPA) $50.00.

5.Name change requires a fee of $25.00, copy of marriage license, divorce decree or other legal documents indicating name change should be submitted directly to this office.

6.Advanced Practice Certification is only for the State of Mississippi.

7.If you are an APRN, complete both a RN and APRN form in order to renew your APRN certification.

8.Primary state of residence/home – is the state that is the nurse’s “declared fixed permanent and principal home for legal purposes.”

9.Multi-state licensure means you may practice as a RN pursuant to your Mississippi RN license, not in an expanded role, in any Compact state unless you have had an action limiting your privilege to practice in the other Compact state. If you change primary state of residency to another compact state you will need to obtain licensure in your new state within thirty (30) days.

10.If you or your spouse is working in a federal/military facility and Mississippi is your primary state of residence, you should include proof of Mississippi residency.

11.If you do not wish to renew your RN license, please notify the Board office in writing.

NOTE: License wallet cards will no longer be distributed. You or your employer may check licensure status by accessing

the online licensure verification at www.msbn.ms.gov.

DO NOT RETURN THIS INSTRUCTION PAGE TO THE MISSISSIPPI BOARD OF NURSING.

Revised 09/2014

MISSISSIPPI BOARD OF NURSING

713 S. Pear Orchard Rd., Suite 300

Ridgeland, MS 39157

(601) 957-6300

2014 REGISTERED NURSE RENEWAL APPLICATION

NON-REFUNDABLE FEES

Active

$100.00

Inactive

$ 25.00

Any statement made on this application which is false and known to be false by the applicant at the time of making such statement shall be deemed fraudulent and will subject the applicant to disciplinary proceedings.

LICENSE # ______________________ SS # ___________________________ PHONE # ____________________________________

NAME________________________________________________________________________________________________________

First

Middle

 

Maiden

Last

ADDRESS__________________________________________________________ EMAIL ___________________________________

P.O. Box/Street

City

State

Zip

County

My primary state of residence is: _____________________________

PLEASE CIRCLE CORRECT INFORMATION

GENDER

HIGHEST DEGREE HELD

MAJOR CLINICAL AREA

MAJOR FIELD OF EMPLOYMENT

1. Male

5.

Diploma

1.

Gerontology

1.

 

Hospital

2. Female

6.

Associate Degree Non-Nursing

2.

Obstetric/Gynecologic

2.

 

Nursing Home

 

7.

Associate Degree Nursing

3.

Medical/Surgical

3.

 

Private Duty

DATE OF BIRTH

 

8.

Baccalaureate Non-Nursing

4.

Pediatric/Child Health

4.

 

Community/Public Health

 

 

_____-_____-_____

9.

Baccalaureate Nursing

5.

Psychiatric/Mental Health

5.

 

Home Health

10. Masters Non-Nursing

6.

General Practice

6.

 

Office Nurse (Physician/Dentist/NP)

 

 

 

11. Masters Nursing Education

7.

Community/Public Health

7.

 

Federal/Military

MARITAL STATUS

12. Masters Nursing Administration

8.

Critical Care

8.

 

Industry

1. Single

13. Masters Nursing Advanced

9.

Emergency Care

9.

 

Nursing Education Program

2. Married

 

Practice

10. Dialysis

10. School/Student Health Services

 

14. Masters Nursing Other

11. Oncology

11.

Occupational Health

 

15. Doctorate Nursing Science

12. Rehabilitation

12.

Self Employed (Except Private Duty)

 

16. Doctorate Science Nursing

13. OR/RR/Anesthesia

13.

Hemodialysis

 

17. DNP Clinical

14. Quality Assurance

14.

Other(Specify)______________

 

18. DNP Non-Clinical

15. Education

 

 

 

 

19. PhD Non-Nursing

16. Neonatology

 

 

 

 

20. PhD Nursing

17. Home Health

 

 

 

 

EMPLOYMENT STATUS

18. Other(Specify)___________

 

 

 

 

 

 

 

 

 

ETHNIC INFORMATION

1.

Nursing Full-time

 

 

 

 

 

2.

Nursing Part-time

 

 

 

 

 

1. White (not of Hispanic

TYPE OF POSITION

ADVANCED PRACTICE

3.

Other Field Full-time

origin)

1.

Nursing Administrator or

REGISTERED NURSE (APRN)

4.

Other Field Part-time

2. African American

5.

Unemployed (less than

 

Assistant Administrator

ROLE

3. Native American

 

2.

Consultant

 

5 yrs)

1.

CRNA

4. Asian

 

 

3.

Supervisor or Assistant

6.

Unemployed (5 yrs or

2.

CNM

5. Hispanic

 

Supervisor

 

more)

 

3. CNS

6. Other (specify)

 

 

 

4.

Educator/Instructor

7.

Inactive

4.

CNP

____________

5.

Head Nurse/Assistant

 

EMPLOYER

 

 

 

 

 

Head Nurse

 

 

Check here if you wish to only renew

 

Name____________________

6.

General Duty or Staff

 

 

 

as a RN without renewing your

 

 

 

7.

Clinical Specialist

 

_________________________

Mississippi APRN certification.

 

 

(Masters Degree)

 

 

 

 

 

 

City ______________________

8.

Nurse Practitioner

 

 

 

 

9.

RNFA (Registered Nurse First

 

 

 

 

State _____________________

 

Assistant)

 

 

 

 

10. Other (Specify)_________

 

 

 

 

County____________________

 

 

 

 

 

 

 

 

 

 

 

 

 

Since you last held an active Mississippi license, have you been disciplined by any disciplinary licensing board or agency or convicted of a felony or misdemeanor in any court of law (excluding speeding tickets), or are any charges currently pending against

you? YES NO

If the answer to the above question is “YES”, attach a detailed explanation and certified copies of all pertinent records, including

but not limited to, any and all court and/or regulatory agency records from the applicable state or jurisdiction. Allow additional time for “YES” answers to be reviewed.

Please check here if you allow us to disclose your email address to selected third parties. YES

NO

By my signature below, I certify that the above information is correct.

Signature: _________________________________________ Date: _______________

File Breakdown

Fact Name Fact Details
Renewal Fees Active: $100.00; Inactive: $25.00; APRN: $100.00; CSPA: $50.00.
Payment Method Payments must be made to the Mississippi Board of Nursing. Cash is not accepted.
Expiration Date Licenses must be renewed by December 31, 2014, to avoid penalties.
Reinstatement Fees After expiration, fees increase: Active: $100.00 plus additional fees.
Name Change Process A $25.00 fee and legal documentation must be submitted for name changes.
Advanced Practice Certification This certification is valid only in Mississippi.
Multi-State Licensure Practicing in Compact states requires a valid Mississippi RN license.
Residency Proof Federal/military workers must provide proof of Mississippi residency.
Notification of Non-Renewal If not renewing, written notice must be sent to the Board office.

Guide to Using Mississippi Nurse Renewal

Completing the Mississippi Nurse Renewal form is an important step to ensure that your nursing license remains valid. After filling out the form, you will need to submit it along with the required fees and any additional documentation. Below are the steps to guide you through the process of filling out the form.

  1. Obtain the Mississippi Nurse Renewal form from the Mississippi Board of Nursing website or their office.
  2. Fill in your license number and social security number at the top of the form.
  3. Provide your phone number for contact purposes.
  4. Enter your name in the designated fields: first, middle, maiden, and last.
  5. Complete your address, including P.O. Box or street, city, state, zip code, and county.
  6. Include your email address for communication.
  7. Indicate your primary state of residence by writing it in the provided space.
  8. Circle your gender and fill in your date of birth.
  9. Mark your highest degree held and your major clinical area.
  10. Choose your major field of employment from the options given.
  11. Indicate your employment status and type of position held.
  12. If applicable, check the box for advanced practice registered nurse (APRN) and specify your role.
  13. Answer the question regarding any disciplinary actions or convictions. If "YES," attach the necessary documentation.
  14. Sign and date the form at the bottom to certify that the information provided is accurate.
  15. Make the renewal fee payable to the Mississippi Board of Nursing. Ensure that you include your phone number and social security number on the payment.
  16. Submit the completed form, payment, and any additional documents to the Mississippi Board of Nursing at the address provided.

Get Answers on Mississippi Nurse Renewal

What are the renewal fees for the Mississippi Nurse Renewal form?

The renewal fees vary based on the license type. The fees are as follows: Active RN - $100.00, Inactive RN - $25.00, Advanced Practice Registered Nurse (APRN) - $100.00, and an additional certification fee of $50.00 each. For Controlled Substance Prescriptive Authority (CSPA), the fee is $50.00. Payment must be made to the Mississippi Board of Nursing and should include your phone number and social security number or nursing license number. Cash is not accepted.

What happens if I do not renew my license by the expiration date?

If the license is not renewed by the expiration date of December 31, 2014, it becomes invalid. A penalty will be assessed for late renewal. After expiration, the reinstatement fees will apply, which are the same as the renewal fees, plus an additional fee for active status.

What should I do if I have changed my name?

If you have changed your name, you must submit a fee of $25.00 along with a copy of the legal documents that indicate the name change. This may include a marriage license or divorce decree. These documents should be sent directly to the Mississippi Board of Nursing.

What is required for Advanced Practice Certification?

Advanced Practice Certification is specific to the state of Mississippi. If you are an APRN, you must complete both the RN and APRN renewal forms to renew your APRN certification.

What is meant by primary state of residence?

The primary state of residence is defined as the nurse’s declared fixed, permanent, and principal home for legal purposes. This is important for determining licensure and practice rights.

Can I practice in other Compact states with my Mississippi RN license?

Yes, as a nurse with a Mississippi RN license, you may practice in any Compact state, provided you have not had any actions that limit your privilege to practice in those states. If you change your primary state of residence to another Compact state, you must obtain licensure in that new state within 30 days.

What if I do not wish to renew my RN license?

If you decide not to renew your RN license, you should notify the Mississippi Board of Nursing in writing. This will ensure that your records are updated accordingly.

How can I verify my licensure status?

You or your employer can verify licensure status online. The Mississippi Board of Nursing provides an online licensure verification service at www.msbn.ms.gov. Note that license wallet cards will no longer be distributed.

What documentation is needed if I or my spouse works in a federal or military facility?

If you or your spouse is employed in a federal or military facility and Mississippi is your primary state of residence, you must include proof of Mississippi residency with your renewal application.

Common mistakes

Filling out the Mississippi Nurse Renewal form can be a straightforward process, but many applicants make common mistakes that can lead to delays or complications. One frequent error occurs when individuals fail to include the correct fee amount. The form specifies different fees for active, inactive, and advanced practice registered nurses (APRN). If a nurse submits the wrong fee, their application may be rejected, necessitating a resubmission and potentially risking the expiration of their license.

Another mistake involves neglecting to provide essential personal information. The application requires not only the nursing license number but also the social security number and phone number. Omitting any of this information can result in processing delays. Additionally, applicants sometimes forget to sign the form, which is crucial for certifying that the information provided is accurate. Without a signature, the application cannot be processed.

Some applicants misunderstand the residency requirements outlined in the form. The primary state of residence must be accurately declared, as it affects licensure status, especially for those practicing in compact states. Misrepresenting residency can lead to disciplinary actions or complications in maintaining licensure. Furthermore, nurses who work in federal or military facilities must provide proof of Mississippi residency, a detail that is often overlooked.

Lastly, many applicants fail to read the instructions thoroughly, particularly regarding name changes. If a nurse has changed their name, they must submit legal documentation along with a fee. Ignoring this requirement can result in the application being returned or delayed. Each of these mistakes highlights the importance of careful attention to detail when completing the renewal form, ensuring that all requirements are met to maintain active nursing status.

Documents used along the form

When renewing a nursing license in Mississippi, several additional forms and documents may be required alongside the Mississippi Nurse Renewal form. Each of these documents serves a specific purpose in the renewal process, ensuring compliance with state regulations and maintaining the integrity of the nursing profession.

  • Advanced Practice Registered Nurse (APRN) Application: This form is necessary for nurses who wish to renew their APRN certification. It requires completion of both the RN and APRN forms to ensure proper licensing.
  • Name Change Documentation: If a nurse has changed their name, they must submit legal documents such as a marriage license or divorce decree along with a $25 fee. This ensures that the nursing license reflects the nurse's current legal name.
  • Reinstatement Application: For those whose licenses have expired, this application is required to reinstate the license. It involves additional fees and documentation to verify eligibility for reinstatement.
  • Proof of Residency: Nurses who are employed in federal or military facilities must provide proof of Mississippi residency if it is their primary state of residence. This documentation is essential for maintaining licensure under the state's jurisdiction.
  • Disciplinary Action Disclosure: If a nurse has faced any disciplinary action or legal issues since their last renewal, they must submit a detailed explanation along with certified copies of relevant records. This ensures transparency and accountability in the nursing profession.

Submitting the appropriate forms and documents is crucial for a smooth renewal process. Ensuring all requirements are met will help maintain your nursing license and uphold the standards of the profession in Mississippi.

Similar forms

  • Nursing License Application: Like the Nurse Renewal form, this document requires personal information, proof of education, and payment of fees to obtain or renew a nursing license.
  • State Medical License Renewal: Similar to the Nurse Renewal form, this document mandates the payment of fees and submission of personal information to maintain a valid medical license.
  • Pharmacy License Renewal: This document, like the Nurse Renewal form, includes a fee structure and requires proof of continuing education to ensure the pharmacist's qualifications remain current.
  • Real Estate License Renewal: Much like the Nurse Renewal form, this document requires payment of renewal fees and submission of personal details to keep a real estate license active.
  • Teaching License Renewal: This document shares similarities with the Nurse Renewal form in that it requires proof of ongoing education and payment of fees to maintain teaching credentials.
  • Cosmetology License Renewal: Like the Nurse Renewal form, this document necessitates the payment of fees and submission of personal information to keep a cosmetology license valid.
  • Driver's License Renewal: Similar to the Nurse Renewal form, this document requires personal identification and payment of fees to renew a driver's license and maintain legal driving status.

Dos and Don'ts

When filling out the Mississippi Nurse Renewal form, keep these important tips in mind:

  • Do make your payment to the Mississippi Board of Nursing. Include your phone number and social security number or nursing license number on the payment.
  • Don't submit cash. Only checks or money orders are accepted.
  • Do renew your license before the expiration date of December 31, 2014, to avoid penalties.
  • Don't forget to include any necessary documentation if you are changing your name.
  • Do complete both the RN and APRN forms if you are renewing both certifications.
  • Don't ignore the requirement to notify the Board in writing if you do not wish to renew your RN license.
  • Do check your licensure status online, as wallet cards will no longer be distributed.

Misconceptions

Misconceptions about the Mississippi Nurse Renewal form can lead to confusion and delays in the renewal process. Here are five common misunderstandings:

  • Renewal fees are refundable. Many believe that if they change their mind about renewing, they can get their fees back. However, all fees paid are non-refundable.
  • Cash payments are accepted. Some may think that cash is an option for paying renewal fees. In reality, cash will not be accepted; payments must be made via check or money order.
  • License renewal is automatic. It is a common belief that a nursing license will automatically renew if the application is submitted on time. In fact, if the renewal is not completed by the expiration date, the license becomes invalid and penalties may apply.
  • Only one form is needed for APRNs. Advanced Practice Registered Nurses (APRNs) might assume that they only need to fill out the APRN renewal form. However, they must complete both the RN and APRN forms to renew their certification.
  • Proof of residency is not required. Some nurses think that they do not need to provide proof of Mississippi residency if they work in a federal or military facility. In fact, proof of residency is necessary if Mississippi is their primary state of residence.

Key takeaways

When filling out and using the Mississippi Nurse Renewal form, consider these key takeaways:

  • Payment Requirements: Ensure that you make the renewal fee payable to the Mississippi Board of Nursing. Active nurses pay $100.00, while inactive nurses pay $25.00. Additional fees apply for Advanced Practice Registered Nurses (APRN) and other certifications.
  • Renewal Deadline: Be aware that your current license will become invalid if not renewed by December 31, 2014. A penalty will be assessed for late renewals.
  • Name Change Process: If you have changed your name, include a $25.00 fee along with legal documentation, such as a marriage license or divorce decree, when submitting your renewal form.
  • Multi-State Licensure: Understand that if you change your primary state of residence to another compact state, you must obtain licensure in that new state within 30 days.
  • Documentation for Federal Employees: If you or your spouse works in a federal or military facility, include proof of Mississippi residency with your application.