3.2 Colorado Scope of Practice and Expanded Scope

3.2 Colorado Scope of Practice and Expanded Scope

Quick Answer: 3 CCR 716-1.10 Section I.2 is the Colorado CNA's basic scope. It matches the Rule 1.11 training curriculum: vital signs, height and weight, environment, intake and output, activities of daily living (ADLs), psychosocial support, care of cognitively impaired clients, restorative services, and clients' rights. Section I.3 is a separate expanded scope. Those extra tasks are lawful only when an RN deems the CNA competent and only for clients with stable conditions who are not high risk.

Why the two-layer rule exists

Every approved Colorado training program must teach the Rule 1.11 list. When you pass the NNAAP and are certified, that list is your everyday legal job. The General Assembly later added a short set of extra tasks in section 12-255-206, C.R.S. The Board put those extras in Rule 1.10 I.3 and wrapped them in competency paperwork so a CNA cannot treat tube feedings or packaged medications as ordinary ADLs.

/practice/co-cnaPractice questions with detailed explanations

Basic scope — 3 CCR 716-1.10 I.2 / Rule 1.11

The rule says the CNA scope includes the tasks required by Rule 1.11, Section (G)(3). Learn the six buckets, not a random chore list.

Basic nursing skills

• Caring for clients when death is imminent
• Taking and recording vital signs
• Measuring and recording height and weight
• Caring for the client's environment
• Measuring and recording intake and output (I&O)
• Recognizing and reporting abnormal signs and symptoms of common conditions related to all body systems, and knowing that those changes go to a supervisor

That last bullet is the exam's favorite basic-scope item. The CNA does not decide what the new crackle in the lung means. The CNA does decide that a new crackle, a new fever, or a new refusal to eat is worth an immediate report.

Personal care skills (ADLs)

Bathing · grooming, including mouth care · dressing · toileting · assisting with eating and hydration · proper feeding techniques · skin care · transferring, positioning, and turning.

These are the skills you will also demonstrate on the Colorado skills evaluation. They stay inside basic scope even when they are hard. A two-person mechanical-lift transfer is still an ADL transfer. Inserting a urinary catheter is not.

Psychosocial and mental-health skills

Modify your own behavior in response to the client · recognize developmental tasks of aging · respond appropriately to client behavior · allow personal choices and reinforce dignity · recognize family and other support resources.

Care of cognitively impaired clients

Techniques for the unique needs and behaviors of people with dementia, including Alzheimer's disease · communicating with cognitively impaired clients · understanding and responding to their behavior · methods of reducing the effects of cognitive impairments.

Basic restorative services

• Training the client in self-care according to the client's abilities
• Using assistive devices for transferring, ambulation, eating, and dressing
• Maintaining range of motion (ROM)
• Proper turning and positioning in bed and chair
• Bowel and bladder training
• Caring for and using prosthetic and orthotic devices
• Promoting the client's physical ability to function independently

Restorative care is still CNA work. You are not the physical therapist. You are the person who practices the PT's and nurse's plan at the bedside so the client does not lose what function remains.

Clients' rights

Privacy and confidentiality · personal choices · help with grievances · help getting to client and family groups and activities · security of possessions · freedom from abuse, mistreatment, and neglect · reporting any suspicion of abuse, mistreatment, and neglect immediately · interventions that minimize the need for physical and chemical restraints.

Immediate reporting of suspected abuse is both a rights skill and a legal duty. Later chapters cover the Colorado 24-hour law-enforcement report for at-risk elders and at-risk adults with intellectual and developmental disabilities. For this section, remember that I.2.f.(7) already says immediately.

Expanded scope — 3 CCR 716-1.10 I.3

Expanded-scope tasks are not automatic with a CNA certificate. Two gates must both be open:

1. An RN (I.3 also names an APRN acting in good faith) has deemed the CNA competent for that task.
2. The client has a stable health condition and is not considered high risk.

If either gate is closed, the task is outside this CNA's practice today — even if the CNA did the same task last month on a different person.

Medication mouth-placement rules (I.3.c)

This is the most tested expanded-scope trap because it looks like passing meds.

• The medication must already be presorted and boxed or packaged by an RN, LPN, APRN, or pharmacist. For a minor, a parent or guardian may have sorted it.
• The package must have been stored in a secure manner and must show no signs of tampering.
• The CNA places the package contents in the client's mouth. The CNA does not crush, hide, inject, apply to skin, or decide that a refused dose should go in pudding unless a licensed order and competency cover that method — and ordinary CNA practice does not.
• Any medication not placed in the client's mouth must be reported in a timely manner but not more than two hours after the medication was due.
• Liquid medication sorted by a minor's parent or guardian must be in its original sealed container, and a standard measuring device must be used.
• The first dose of an antibiotic sorted by a minor's parent or guardian must be given under the observation of a professional nurse, physician, podiatrist, or dentist who is present in the same patient care area.

If the box is torn, the pills look different, the client is newly confused, or the client is high risk, stop and get the licensed nurse. Expanded scope is a narrow permission, not a second license.

How an RN deems competence — I.4

The Board does not accept a hallway yes. To deem competence, the RN must complete all of the following:

1. Teach the procedure.
2. Demonstrate the steps.
3. Review the risks of performing the task.
4. Identify what to report to the supervisor.
5. Watch a return demonstration of the clinical performance of the task.
6. Complete a competency document that is signed and dated. The RN who determined competency retains it for at least one year. The CNA who was deemed competent retains it permanently.
7. Within 30 days of being deemed competent, the CNA updates the expanded-scope questions on the Healthcare Professions Profile (HPPP), listing the tasks, the name and license number of the RN, and the date deemed competent.

Skipping the HPPP update is a Board-profile violation, not a paperwork nicety. The profile is how the public and the Board see which expanded tasks you claim.

Continued competence — I.5

Competence is not a lifetime stamp.

• At least annually after the first deeming, the CNA must show continued competence under the direct clinical observation of the RN.
• An updated competence document is signed and dated. The RN keeps it at least one year. The CNA keeps it permanently. Produce it if the Board asks.
• Within 30 days of that updated document, the CNA updates the HPPP expanded-scope questions again with the tasks, the RN's name and license number, and the date.

If the annual observation has lapsed, treat the expanded task as unavailable until the RN rechecks you. Facility policy may require a recheck sooner than one year. Section I.6 lets an employer write stricter procedures as long as these Board minimums are still met.

Colorado scenario

You work in a Colorado group home. An RN deemed you competent six months ago for G-tube feedings and for placing presorted packaged medications in the mouth. Your HPPP lists both tasks. Today's assignment includes 12-year-old Maya, who is stable, and 78-year-old Mr. Diaz, who was just sent back from the emergency department with new shortness of breath and a note that he is high risk for aspiration.

Maya's parent left a sealed liquid antibiotic in the original container with a standard oral syringe. It is Maya's first dose. You may measure and place that dose only if a professional nurse, physician, podiatrist, or dentist is in the same patient care area watching. You do not give a first pediatric antibiotic alone because you have a competency paper.

Mr. Diaz has a scheduled G-tube feeding and an 0800 packaged blood-pressure tablet. He is not a stable, not-high-risk client this morning. Expanded scope I.3 does not apply to him today. You report both the feeding and the packaged tablet to the licensed nurse. You do not run the feeding because you did it yesterday, and you do not tuck the tablet in his mouth to stay on schedule.

If Maya refuses the liquid and the dose is not placed in her mouth, you report that fact within two hours after it was due.

Exam traps

• Treating G-tube feeding, enemas, packaged meds, oxygen, or ostomy-bag changes as automatic CNA skills.
• Using expanded scope on an unstable or high-risk client.
• Calling mouth-placement of a presorted package an independent med pass.
• Forgetting the two-hour unused-medication report, the sealed-container rule for a minor's liquid, or the first-antibiotic observation rule.
• Believing a hallway in-service replaces the signed document, the permanent CNA copy, the 30-day HPPP update, or the annual RN observation.