Executive Order aids student nurses, CNAs; expands workforce during crisis

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Temporary Regulatory Changes Smooth Nurse, CNA Pathways
to Graduation; Expand Available Healthcare Workforce Pool

Governor Jared Polis issued Executive Order D 2020 038 on April 15, 2020, removing regulatory barriers that will provide nursing and nurse aide students in educational programs throughout Colorado avenues towards spring and summer graduation, while bolstering the ability of nurses and Certified Nurse Aides to enter or remain in the workforce.

Nursing student externs are also granted the ability to continue in paid positions as the state continues to prioritize essential healthcare services in lockstep with state agencies during the ongoing Novel Coronavirus (COVID-19) emergency. 

The Executive Order, effective for at least 30 days, simultaneously authorizes the temporary expansion of scope of practice for healthcare professionals providing services for patients presenting to, or admitted to, hospitals or inpatient medical facilities - including emergency departments - during the pandemic as delegated by a physician, physician assistant, advanced practice nurse, certified nurse anesthetist, registered nurse, or respiratory therapist.

The expansion of the scope of regulated professionals will create necessary flexibility and an opportunity to fill critical inpatient gaps with regulated healthcare personnel, while providing a structured, well-supervised setting to ensure patient safety.

Healthcare professionals are statutorily required to work within a defined scope of practice, so inpatient facilities have previously been unable to use readily available personnel while Colorado is experiencing an unprecedented number of hospital admissions. Temporarily relaxing these restrictions via the Executive Order will allow for the cross-training of healthcare professionals and alleviate workforce shortages at hospitals and inpatient facilities, particularly in respiratory therapy and amongst critical care staff.

This Order does not expand scope of practice for healthcare professionals working outside of these healthcare settings.

Professionals allowed to fill these voids may now include: surgical assistants, surgical technologists, certified nurse aides (CNAs), physical therapists/assistants, occupational therapists/assistants, speech-language pathologists, podiatrists, optometrists, chiropractors, retired volunteer nurses, and dentists. 

Anesthesiologist assistants, certified nurse anesthetists, advanced practice nurses, respiratory therapists, medical assistants, and physician assistants have increased authority under the Order as delegated by appropriate medical professionals. National speciality-practice certification requirements also may be waived for physicians and physicians assistants, widening their treatment capabilities.

Nursing students would have forfeited tuition, and in many cases been unable to enter the workforce in May, without a temporary suspension of Board of Nursing statutes and rules within the next week. Nurse aide students would have either lost their long-term care training positions, or completed their school-based program but would have been unable to enter the workforce.

Here is how the regulatory changes for nursing students will work in practice:

  • The Board of Nursing requires 750 clinical hours for Registered Nursing programs; 400 for Licensed Practical Nurses. Nursing student policy allowed students in a nursing education program to practice in a clinical setting while enrolled. But students were unable to get these clinical hours because facilities – such as hospitals, nursing homes, home health settings, and rehabilitation centers – were closed to students because of dwindling resources, health-related concerns, etc. Graduation is now possible through the Executive Order, which allows for several options. Nurses falling under these exceptions still must pass the written exam to be fully licensed in Colorado.
  1. a)    An expansion past the normal allowance of 50 percent clinical simulation accepted towards clinical hours.b)    Faculty or administrators at academic institutions may deem students competent to graduate with reduced clinical hours, based on a demonstrable skill set established over the course of their nursing education.c)    Students volunteering their time and skills during the pandemic can count these hours towards clinical hours without faculty supervision, allowing them to complete courses which would result in them meeting the requirements for graduation.d)    The Board of Nursing student extern policy allows students that are enrolled in a nursing education program to practice in a clinical setting while enrolled in a paid position for four months. These students may continue working, when normally they would be prohibited once they graduate.
  • First-year students excelling in their clinical work to date can progress to the second year without delay, as these provisions allow them to postpone half of their clinical hours until the fall, or by completing all clinical hours this semester through clinical simulation.
  • Board rules had prohibited the employment of an uncertified graduate of a nurse aide program for longer than four months until passage of the CNA test. Unavailability of the test due to test site closures prompted the Center for Medicare and Medicaid Services (CMS) to recently issue a waiver allowing nurse aides, once graduated, to work beyond 120 days, as long as they were in line to take the test for certification. The suspension of statutes in Colorado makes that possible.
  • Nurse aides may enter the workforce with a temporary certification from the State. The written and skills-based exam must be completed prior to full certification, but will allow these students to enter the workforce.
  • Clinical hours for CNAs may be completed through simulation instead of a face-to-face setting.
  • Nursing students currently in their last semester are authorized to provide volunteer services delegated and supervised by a healthcare professional.

The Order also temporarily transferred exclusive emergency rulemaking authority over the medical, nursing, dental, chiropractic, podiatry, optometry, and physical therapy boards to the Director of the Division of Professions and Occupations, which should further assist students within additional professions who have been unable to test due to the indefinite postponement of exams.

Additionally, the Order helps ensure hospital pharmacies are able to meet expanding patient needs during the crisis by reducing restrictions on hospital satellite locations.

Please see the Executive Order Question and Answer document for more details. For further inquiries or clarification on the emergency suspension of statutes and rules, please email dpo@state.co.us.


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