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The Mississippi Nurse Renewal form is an essential document for registered nurses (RNs) and advanced practice registered nurses (APRNs) wishing to maintain their licenses and continue practicing in the state. The renewal process requires nurses to submit a payment alongside their application, with fees varying based on their license status—$100 for active RNs and APRNs, and $25 for inactive licenses. It is critical for applicants to note that failure to renew by the December 31 deadline results in invalidation of the license and potential penalties. In the case of name changes, applicants must provide documentation such as a marriage license or divorce decree, along with a fee of $25. For APRNs, dual completion of both RN and APRN renewal forms is necessary, ensuring the proper certification is honored. Nurses should also be aware of residency requirements related to multi-state practice and must declare their primary living state. If you choose not to renew, informing the Board in writing is essential. Remember, license wallet cards will no longer be issued, but verification of licensure remains accessible online at the Mississippi Board of Nursing website.

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: _______________

Form Characteristics

Fact Name Description
Renewal Fees Active license renewal costs $100, while inactive renewal is $25. For APRN, it costs $100 and additional certifications are $50 each.
License Validity If not renewed by December 31, 2014, the current license becomes invalid and penalties will apply.
Reinstatement Fees After expiration, the fees to reinstate are similar to renewal fees plus an additional charge for active licenses.
Name Change Procedure To change your name, submit a $25 fee along with legal documents confirming the change.
Advanced Practice State Requirement Advanced Practice Certification is specific to Mississippi and requires completion of both RN and APRN forms if applicable.
Multi-State Licensure Nurses can practice in Compact states under their Mississippi RN license, except in expanded roles.
Federal/Military Proof Evidencing residency in Mississippi is required if you or your spouse works in a federal or military facility.
Notification of Non-Renewal If choosing not to renew, a written notification must be sent to the Board office.
Online Licensure Status License status can be verified online at www.msbn.ms.gov. No wallet cards will be distributed.

Guidelines on Utilizing Mississippi Nurse Renewal

Completing the Mississippi Nurse Renewal form is an important step to maintain your nursing license. This renewal process requires careful attention to detail and timely submission. Following the instructions outlined here will help ensure that your application is processed smoothly and without delays.

  1. Gather the required information: Collect your nursing license number, Social Security number, and contact information to have them on hand while filling out the form.
  2. Choose your renewal fee: Determine whether you are renewing as an Active nurse ($100.00), an Inactive nurse ($25.00), or as an Advanced Practice Registered Nurse (APRN) ($100.00), as well as any additional certification fees, if applicable.
  3. Make the payment: Write a check for the appropriate fee made payable to the Mississippi Board of Nursing. Include your phone number and Social Security number or nursing license number on the payment. Note that cash is not accepted.
  4. Complete the application form: Fill in all required fields such as your license number, Social Security number, and contact details. Provide your full name using your first, middle, maiden, and last names.
  5. Specify your primary state of residence: Indicate your primary state as required. This is crucial for determining licensure eligibility.
  6. Select the correct information: Circle your gender, highest degree held, major clinical area, and major field of employment from the provided options.
  7. Indicate employment status: Choose whether you work full-time or part-time in nursing or another field, or if you are unemployed.
  8. Provide your employer's information: If applicable, include the name and address of your current employer.
  9. Answer the disciplinary history question: Carefully indicate if you have faced any disciplinary actions or convictions that apply. If yes, attach a detailed explanation and relevant documents.
  10. Review your application: Double-check all information for accuracy, ensuring that nothing is left blank and that your contact information is correct.
  11. Sign and date the form: Your signature certifies that the information you provided is true and accurate. Don’t forget to include the date.
  12. Submit your application: Send the completed form, along with your payment, to the Mississippi Board of Nursing at the address provided on the form.

Once your form is submitted, it will be reviewed for completeness and verification. Be mindful of deadlines to avoid any lapse in your nursing license. If you have any questions during this process, consider contacting the Board of Nursing directly for assistance.

What You Should Know About This Form

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

The renewal fees vary depending on your status. If you are an active nurse, the fee is $100. An inactive status incurs a fee of $25. For Advanced Practice Registered Nurses (APRN), the renewal is also $100, while each additional certification costs $50. If you have Controlled Substance Prescriptive Authority (CSPA), that renewal is $50 as well. Remember that payments must be made via check or money order, as cash will not be accepted.

When is the deadline for renewing my nurse license?

It is crucial to renew your license by December 31, 2014. If not renewed by this date, your current license will become invalid. Additionally, a penalty will be assessed. If your license expires, you will need to pay reinstatement fees, which are the same as regular renewal fees, with possible additional charges.

What should I do if I have a name change?

If you have changed your name, you must submit a fee of $25 along with a copy of the legal document that verifies the change. This might include a marriage license, divorce decree, or other legal documents. Be sure to send these directly to the Mississippi Board of Nursing for proper processing.

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

Yes, if you are licensed in Mississippi, you can practice as a Registered Nurse (RN) in other Compact states, except in an expanded role. However, if you move your primary residence to another Compact state, you must obtain a new license within 30 days of the move. Remember to check your licensing status in any state where you intend to practice.

Do I still need to renew my APRN certification if I renew my RN license?

If you are an APRN, you must complete both the RN and APRN renewal forms. It is essential to renew both certifications simultaneously to ensure that you remain compliant with state regulations. Failing to renew one may affect your ability to practice effectively.

How can I check my licensure status?

You can check your licensure status online at the Mississippi Board of Nursing’s official website. Simply go to www.msbn.ms.gov, and look for the licensure verification section. Note that license wallet cards will no longer be distributed, so online verification is the best way to ensure your status is current.

Common mistakes

Filling out the Mississippi Nurse Renewal form can be straightforward, but many applicants make common mistakes that can delay the renewal process. Understanding these pitfalls can save time and prevent complications.

One frequent mistake occurs when applicants forget to include the correct fee. The renewal fees differ based on the type of license held, such as Active or Inactive. Failing to send the appropriate payment can lead to delays or rejection of the application.

Another issue is neglecting to provide essential contact information. Applicants must include their phone number and social security number or nursing license number. Missing this information can lead to challenges in processing the renewal.

Many individuals also overlook the importance of completing both sections of the form if they are renewing as an Advanced Practice Registered Nurse (APRN). This requirement is crucial for maintaining APRN certification and must not be ignored.

Additionally, applicants often forget to address name changes adequately. If a nurse has changed their name, they must submit a name change fee along with legal documentation like a marriage license or divorce decree. Neglecting this step can result in their application being incomplete.

A significant mistake relates to misunderstandings about primary residency. Nurses need to identify their primary state of residence accurately, as this impacts their licensure status, particularly if they have moved to a Compact state.

Not checking for disciplinary actions can also be problematic. If a nurse has faced disciplinary actions or has been convicted of certain crimes, failing to disclose this information can lead to serious consequences, including denial of the renewal.

Finally, some applicants forget to sign the renewal form. A signature certifies that the information provided is correct and can be a necessary step for validating the application. Without it, the renewal may not be processed at all.

Documents used along the form

The Mississippi Nurse Renewal form is a vital document for registered nurses in Mississippi, allowing them to maintain their licensure. However, several other forms and documents are often used alongside it during the renewal process. Below is a list of these related documents.

  • Name Change Form: This form is necessary if a nurse needs to update their name on their license due to marriage, divorce, or other legal reasons. It must be accompanied by a fee and supporting legal documents.
  • Advanced Practice Registered Nurse (APRN) Application: Nurses who are seeking to renew their APRN certification must complete this application in addition to the standard renewal form. This ensures that both their RN and APRN credentials are current.
  • License Reinstatement Application: In cases where a nurse has failed to renew their license by the expiration date, this application is required to reinstate their license. It includes associated fees that differ from the standard renewal costs.
  • Continuing Education Proof: This document verifies that the nurse has completed the necessary continuing education hours required for renewal. Some license types require specific continuing education credits.
  • Employment Verification Letter: This is a letter from the nurse’s employer confirming their employment status and role within the organization. It may be required, especially for APRN renewals or for verifying hours worked in nursing.

Each of these documents plays a critical role in the renewal and maintenance of a nursing license in Mississippi. Nurses should ensure they have all the necessary paperwork ready and accurate to facilitate a smooth renewal process.

Similar forms

The Mississippi Nurse Renewal form shares similarities with several other documents related to professional licensing and application processes. Here is a list detailing nine documents that have comparable features:

  • Registered Nurse Application Form: Similar to the renewal form, this application requires personal information, educational background, and verification of existing licenses. It serves as the primary step for newly qualified individuals seeking licensure.
  • Advanced Practice Registered Nurse (APRN) Application: Like the Nurse Renewal form, this application mandates submission of fees, proof of qualifications, and specific details related to nursing practice updates. It allows APRNs to maintain compliance with state requirements.
  • Nursing License Reinstatement Form: When a nurse's license has expired, this document outlines the process for reinstatement, including fees and any necessary documentation, mirroring the renewal process.
  • Continuing Education Verification Form: This form also necessitates proof of completed continuing education hours, ensuring that nurses stay currently informed about best practices and advancements in their field, akin to what is required in the renewal form.
  • Board of Nursing Complaint Form: Both documents require detailed personal information and may ask for narrative accounts from the applicant or complainant, dealing with compliance and professional conduct matters.
  • Nurse Practitioner (NP) Certification Application: Similar to the renewal form, NP certification applications demand proof of education, clinical competency, and payment of associated fees. This ensures that nurse practitioners meet state standards for practice.
  • License Verification Request: This document also requests vital information, including license numbers and personal details, to confirm the status of a nurse's license. It is essential for compliance and may be necessary for potential employers.
  • Name Change Application: In the same vein as the Nurse Renewal form, this application similarly requires submission of legal documents to support any name changes, ensuring accuracy in the practice records.
  • Employment Verification Form: This form necessitates thorough documentation regarding work history and qualifications, paralleling the renewal form's requirement for employment details and professional status verification.

Dos and Don'ts

When filling out the Mississippi Nurse Renewal form, consider the following:

  • Double-check that all information is accurate, including your nursing license number and social security number.
  • Make the payment to the Mississippi Board of Nursing using a check or money order; cash is not accepted.
  • If your name has changed, provide the necessary legal documentation along with the name change fee.
  • Complete both the RN and APRN forms if renewing both licenses.

There are also actions to avoid:

  • Do not forget to submit your renewal application before the expiration date to avoid penalties.
  • Avoid leaving out important information, as incomplete applications can lead to delays or applications being rejected.
  • Do not send cash as a method of payment for your renewal fees.
  • Do not assume your license is valid after the expiration date without renewing; it will become invalid.

Misconceptions

Misunderstandings about the Mississippi Nurse Renewal form exist. These misconceptions can lead to confusion and potentially impact a nurse’s ability to practice. Below are ten common misconceptions and clarifications regarding the renewal process.

  1. Renewal fees change each year. Many believe the fees vary yearly. In reality, the fees for renewal are set and remain constant unless explicitly stated by the Mississippi Board of Nursing.
  2. Cash payments are accepted. Some may think cash is a viable option for payment. However, cash payments are not accepted; a check or money order must be used instead.
  3. Late renewals incur only a flat fee. It is a common belief that only a single late fee applies. Additional costs may be incurred for reinstatement, which can vary depending on your status.
  4. A name change can be reported orally. Some assume that informing the Board verbally suffices for a name change. A formal request with proper documentation is required to process this change.
  5. Renewal is unnecessary if practicing out of state. A common misconception is that if nurses are not practicing in Mississippi, they do not need to renew. Failure to maintain a current license can lead to penalties, regardless of practice location.
  6. The renewal application can be returned via email. Many think they can submit the renewal application through email. Applications must be mailed to the Board office and cannot be submitted online.
  7. All licenses expire on the same date. There’s a belief that all nursing licenses share the same expiration date. In fact, renewal dates may vary based on individual licensing terms.
  8. Proof of residency is optional. Some may think that proof of residency is not essential. If the nurse is employed in a federal or military facility and claims Mississippi as their primary residence, residency proof must be included.
  9. Renewal applications can be submitted anytime. Many believe they can submit the application whenever they wish. Licenses must be renewed by a specified expiration date, or penalties will apply.
  10. Email addresses can be disclosed freely. Some may think any email address provided can be shared. The nurse must consent to the disclosure of their email address to third parties.

Understanding these points can ensure a smoother renewal process for Mississippi nurses.

Key takeaways

Here are key takeaways for filling out and using the Mississippi Nurse Renewal form:

  • Payment is Required: The renewal fee must be paid to the Mississippi Board of Nursing. Do not send cash.
  • Fee Structure: Active renewals cost $100.00, while inactive renewals are $25.00. Additional fees apply for APRN certifications.
  • Expiration Consequences: If the license is not renewed by December 31, 2014, it becomes invalid, resulting in penalties.
  • Reinstatement Fees: Fees can increase significantly after expiration, so it’s wise to renew promptly.
  • Name Changes: A fee of $25.00 and documentation supporting your name change must be submitted for any name updates.
  • APRN Dual Forms: APRNs need to complete both RN and APRN forms to maintain certification.
  • Primary Residence: Clarify your primary state of residence; this is essential for maintaining your license status.
  • Multi-State Licensure: Remember that your Mississippi RN license allows practice in other Compact states under specific conditions.
  • Military Considerations: Proof of residency is important if working in a federal/military facility while maintaining Mississippi as your primary state.
  • Non-Renewal Notification: If you choose not to renew your license, notify the Board office in writing to avoid unnecessary complications.

For further information, the licensure status can be verified online on the Board's website. Do not return the instruction page with your application.