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Thursday, December 4, 2025
A Missouri nurse practitioner has filed a lawsuit that supporters say could influence longstanding rules governing how advanced practice registered nurses deliver care in rural areas of the state. The case comes amid continuing shortages of primary care and psychiatric providers, especially outside metropolitan regions.
The Association of Missouri Nurse Practitioners reports that 113 of the state’s 114 counties are designated medically underserved. Advocacy groups say nurse practitioners could help fill gaps in access if Missouri loosened its collaborative practice requirements. Under current law, nurse practitioners must maintain a formal agreement with a physician in order to treat patients and prescribe medications, which critics argue restricts care in regions with few available doctors.
Nurse practitioner Marcy Markes, who filed the lawsuit, argues that the regulation prevents clinicians from applying the full scope of their education and training without a physician partnership. She noted that many patients must travel long distances for basic and emergency care. By comparison, neighboring states such as Kansas and Iowa grant full practice authority to nurse practitioners.
Efforts in Missouri’s General Assembly to modify nurse practitioner practice rules have repeatedly failed to reach a floor vote. Derek Leffert, executive director of the Association of Missouri Nurse Practitioners, said supportive lawmakers often face procedural obstacles and organized opposition from professional groups. One recurring issue is the physician fee nurse practitioners must pay to work outside hospital settings, a cost that lacks statewide oversight.
Markes said her collaborating physician supports the lawsuit and hopes the case will eventually allow more nurse practitioners to serve residents in medically short regions. Supporters have praised her willingness to take public action in the interest of expanding access to care.
The debate has also intersected with federal discussion on how nursing degrees are classified. Leffert noted that nurse practitioners commonly hold graduate-level or doctoral training and questioned statements suggesting nursing is not a professional field.
According to the Missouri Nurses Association, the state has 4,720 nurse practitioners. Many advocates argue that regulatory change would strengthen Missouri’s health care workforce and improve timely access to primary and behavioral health services.
