3.1 Role of the Colorado CNA and Required Supervision
Key Takeaways
- A Colorado CNA gives basic nursing and personal care only under supervision — never as an independent practitioner (3 CCR 716-1.10 I.1; DPO Nursing FAQ).
- Lawful supervisors are a dentist, physician, podiatrist, professional nurse, LPN, or other licensed or certified healthcare professional acting inside that person's own scope.
- The CNA observes and reports; the licensed nurse assesses, diagnoses, and writes the care plan.
- Report a change in condition to the licensed nurse first — that is the start of the chain of command.
- Member of the Health Care Team is 6% of the NNAAP written exam, typically 4 of the 60 scored items.
3.1 Role of the Colorado CNA and Required Supervision
Quick Answer: A Colorado certified nurse aide (CNA) gives basic nursing and personal care under supervision. 3 CCR 716-1.10 Section I.1 and the Colorado Division of Professions and Occupations (DPO) Nursing FAQ both say CNA practice is not independent. The CNA observes and reports. The licensed nurse assesses, diagnoses, and writes the care plan. On the 2024 National Nurse Aide Assessment Program (NNAAP) written outline used in Colorado, Member of the Health Care Team is 6% of the scored exam — typically 4 of the 60 scored items.
Why this section is on the exam
The Colorado written NNAAP has 70 multiple-choice items. Sixty are scored; ten are unmarked pretest items. Domain III, Role of the Nurse Aide, is 26% of those 60 scored items (16 items). The fourth leaf topic in that domain — Member of the Health Care Team — is 6%, which is about four scored questions. Those four items almost always test the same three ideas: who may supervise you, what you may do versus what the licensed nurse does, and who you tell first when something changes.
What the Colorado CNA does
A certified nurse aide (CNA) — the title on the Colorado Nurse Aide Registry — provides basic nursing skills and personal care for clients (residents or patients) who need help with daily living. The work is hands-on: baths, dressing, toileting, feeding, turning, vital signs, intake and output, and restorative support so the person stays as independent as possible.
The CNA is a member of the health-care team, not a solo practitioner. Every assigned task sits under a licensed professional who remains responsible for the nursing process. That is why the exam keeps asking who assesses, who plans, and who the CNA reports to.
Colorado law and the DPO FAQ use the word supervision on purpose. The DPO Nursing FAQ states that supervision is required for licensed practical nurse (LPN) and CNA practice, and that a nurse aide practices under a physician, podiatrist, professional nurse, licensed practical nurse, or other licensed or certified healthcare professional acting within the scope of that person's practice. Rule 1.10 I.1 adds dentist to that same list and requires the supervisor to be an actively licensed healthcare professional acting within the scope of the license or certificate.
Supervision does not mean the dentist, physician, or nurse must stand in the doorway for every bed bath. It does mean the CNA works from an assignment and a care plan created by licensed staff, and that the CNA cannot invent treatments, change orders, or decide that a new problem is not worth bothering the nurse about.
Who may supervise a Colorado CNA
| Supervisor named in 3 CCR 716-1.10 I.1 / DPO FAQ | Typical setting | What this person does that the CNA does not |
|---|---|---|
| Dentist | Dental office or oral-surgery suite | Diagnoses oral disease; writes dental orders |
| Physician (MD/DO) | Hospital, clinic, nursing facility | Diagnoses; prescribes; directs medical care |
| Podiatrist | Clinic or long-term care foot-care visit | Diagnoses and treats conditions of the foot |
| Professional nurse (RN) | Every care setting | Assesses; creates and updates the nursing care plan; delegates and evaluates |
| Licensed practical nurse (LPN) | Long-term care charge nurse; clinic | Provides licensed nursing care under an authorized supervisor; commonly receives the CNA's report |
| Other licensed or certified healthcare professional acting in scope | Setting-specific | Only tasks inside that person's own license — never a blank check |
Two exam traps sit in this table. First, an experienced CNA is not a lawful supervisor of CNA practice. Second, the doctor is in the building does not replace telling the licensed nurse who has the assignment. Day to day, the CNA's first report is almost always to the RN or LPN running the unit.
The health-care team
NNAAP items name team members and ask what each one does. Memorize the function, not just the title.
| Team member | Role next to the CNA |
|---|---|
| Client / resident | The center of the team. Care exists for this person's goals, safety, and rights. |
| Family or legal decision-maker | Partner in care; may hold decision-making authority |
| Registered nurse (RN) | Assesses, plans, delegates, evaluates, gives many medications, coordinates the team |
| Licensed practical nurse (LPN) | Licensed nursing care and medications under authorized supervision; often the charge nurse who takes the CNA report |
| Certified nurse aide (CNA) | Basic nursing and personal care; observes and reports; does not assess, diagnose, or write the care plan |
| Physician / advanced practice provider | Diagnoses and prescribes |
| Physical therapist (PT) | Mobility, gait, transfers, strength |
| Occupational therapist (OT) | Activities of daily living, adaptive equipment, fine-motor function |
| Speech-language pathologist (ST / SLP) | Speech, communication, and swallowing / diet texture |
| Social worker | Psychosocial support, discharge planning, family conflict, resources |
| Dietary / registered dietitian | Therapeutic diets, supplements, nutrition problems |
| Activities staff | Recreation, engagement, quality of life |
The CNA follows the care plan the licensed nurse and the interdisciplinary team write. If the plan says a two-person transfer and a mechanical lift, the CNA does not just walk the resident this once because the hall is busy. Changing the plan is a licensed-nurse decision.
Observe and report — do not assess or diagnose
The exam loves the verbs.
- Observe means use your senses: what you see, hear, smell, and touch, plus what the client tells you. Left heel is red and warm. Resident refused lunch and is holding the right side of the chest.
- Report means tell the licensed nurse promptly, then document what you observed according to facility policy.
- Assess means interpret those facts, decide what they mean, and choose a nursing response. That is the RN's job (and, within LPN scope, licensed nursing judgment — still not the CNA's).
- Diagnose means name a medical or nursing diagnosis. The CNA does not diagnose pneumonia, stroke, or depression.
- Create the care plan means write goals and interventions. The CNA contributes observations. The CNA does not author the plan.
If a written item asks What should the nurse aide do first? and the stem is a change in condition, the first action is report to the licensed nurse. Measuring another set of vitals can be part of the assignment, but it does not replace the report.
Chain of command
Chain of command is the order you use when you need a licensed decision or when the first person does not respond.
- Stay with the client if the person is unsafe, and call for help.
- Report to the licensed nurse who has the assignment (RN or LPN) — this is the first and usual step.
- If that nurse does not respond and the client is at risk, go to the charge nurse or nursing supervisor.
- Next is the Director of Nursing (DON) or the on-call nursing leader.
- Facility administration sits above nursing leadership for operational issues, not for a bedside assessment shortcut.
- You do not jump to the physician, the family, or social media instead of telling the nurse.
Skipping the nurse to be helpful is a scope error and a communication error. The physician's order still has to be received and transcribed by licensed staff. The CNA does not take verbal orders.
Colorado scenario
You are the day-shift CNA on a Denver skilled-nursing unit. At 10:15 a.m. Mr. Ortega, who is usually talkative, does not answer when you greet him. His speech is slurred. The right side of his mouth droops. His assigned LPN is in another room starting a dressing change. A second CNA says, Just document it and tell the doctor at lunch — the nurse hates to be interrupted.
The correct action is to stay with Mr. Ortega, call for help, and report the change to the licensed nurse immediately. Slurred speech and facial droop are observations, not a CNA diagnosis of stroke, but they are exactly the kind of change Rule 1.10 I.2 requires you to recognize and report to a supervisor. You do not write a new care-plan intervention, give aspirin, or wait for lunch. If the assigned LPN cannot come, you escalate to the charge nurse. That is Member of the Health Care Team in one picture: know your role, know the team, and use the chain of command.
Exam traps
- Treating an experienced CNA as a supervisor of CNA practice.
- Believing an LPN cannot supervise a CNA (the rule and the FAQ both name the LPN).
- Calling assessment, diagnosis, or care-plan writing CNA judgment.
- Skipping the licensed nurse because the doctor is nicer or the nurse is busy.
- Forgetting that Member of the Health Care Team is a scored written topic — about four items — not only a skills-test attitude.
Under 3 CCR 716-1.10 I.1 and the DPO Nursing FAQ, who may supervise Colorado CNA practice?
A resident's blood pressure is 188/104 and the resident says, I feel like my head is going to explode. What is the CNA's first required action as a member of the health-care team?
On the official 2024 NNAAP written outline used for Colorado, Member of the Health Care Team is worth about what share of the scored written exam?