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CMS Releases Toolkit To Navigate State Workforce Flexibility

April 22, 2020

The Centers for Medicare & Medicaid Services (CMS) and the Assistant Secretary of Preparedness and Response (ASPR) released a new toolkit to help state and local healthcare decision makers maximize workforce flexibilities when confronting 2019 Novel Coronavirus (COVID-19) in their communities. This toolkit includes a full suite of available resources to maximize responsiveness based on state and local needs, building on President Trump’s commitment to a COVID-19 response that is locally executed, state managed, and federally supported. This work was developed by the Healthcare Resilience Task Force as part of the unified government’s response to COVID-19.

COVID-19 Workforce Virtual Toolkit: Resources for Healthcare Decision-Makers Responding to COVID-19 Workforce Concerns


Governor Polis Updates April 21, 2020 COVID-19 

Quick Links to Stay Up to Date

Topline Update

We currently have 10,106 cases, 449 deaths, and 1,880 hospitalizations (1096 are currently hospitalized; 215 were discharged in the last 24 hours) out of 47,466 completed tests. We are thinking of these families and communities during these trying times.

This case data is broken down by various categories, is updated daily and can be found here. 

Hospitalization Rate Leveling Off

The Governor began yesterday’s presentation with a piece of good news: hospitalizations in the state have been stable since the beginning of April and are starting to level off and even decline.

This is a testament to the importance of the stay-at-home order and other restrictions that the Governor has put into place during this state of emergency.

From “Stay-At-Home” to “Safer-At-Home”

The administration also presented yesterday some modeling and analysis on the impact of these distancing measures and how we can move forward.

Here are some key conclusions:

  • We need to maintain sustainable, high levels of social distancing 

  • Seniors and vulnerable populations need to maintain even higher levels of social distancing. 

  • Each intervention (testing, containment, wearing masks, sustainable social distancing, strong precautions for seniors and vulnerable populations) alone does not keep us below hospital capacity. 

  • A successful strategy is a combination of all of these interventions. 

  • Based on the modeling and the trajectory of infections and hospitalizations in Colorado, the state will not renew the statewide “Stay-at-Home” order on April 27; rather, the state will shift to a new phase of the coronavirus response, called “Safer-At-Home”

Currently, the “Stay-at-Home” order has limited our interactions by 75-80%, which has allowed us to slow down the growth of this deadly virus, and has bought us more time to build hospital capacity, obtain equipment and ramp up testing. This new “Safer-at-Home” phase will relax some of these restrictions while maintaining a new level of social distancing: around a 60-65% reduction of normal interactions.

This is a marathon -- not a sprint. These distancing measures need to be sustainable, because we’re going to have to learn to live with coronavirus for a while. There will likely be some level of social distancing happening until we get a vaccine, an effective anti-viral therapy, or so many people have been infected that we develop herd immunity,  but that’s the worst-case scenario.

What does “Safer-At-Home” Mean?

The Governor has proposed a number of policy changes that will allow for 60-65% social distancing, which is much more sustainable for our lives and our economy than the current 75-80% under the stay-at-home order.

These policies are still a work in process, and will continue to evolve based on the recommendations of scientists and public health experts.

The Governor will publish more guidance in the coming week, including details on appropriate precautions and distancing standards for various establishments and facilities. But here’s a preview of what things might look like (subject to change):

  • The general population will no longer be ordered to stay at home; folks will be encouraged to stay at home except when absolutely necessary.

    • Folks are still strongly advised to wear face coverings in public

    • Gatherings over 10 people will still be banned

    • Sick people should still avoid going to work

    • Everyone should still avoid unnecessary travel

    • And most importantly, older Coloradans and vulnerable populations still need to stay at home unless absolutely necessary.

  • Other changes: 

    • Retail will be able to open for curbside delivery at first, with phased-in public openings with strict distancing precautions.

    • Non-critical offices will be able to re-open at 50% capacity with strict social distancing precautions (more shifts, etc.)

      • Large workplaces are advised to have symptoms and temperature checks.

      • Telecommuting should be maximized

      • Accommodations will be needed for seniors and vulnerable populations 

    • Elective Surgeries will once again be available with strict precautions to ensure adequate PPE and the ability to meet critical care needs.

    • Child Care facilities can reopen but with strict precautions

    • Personal services like hair and nail salons, tattoo parlors, dog grooming, personal training, etc. can reopen but with strict precautions

    • House showings can begin in person, but open houses will still be prohibited.

Local Government

We did a good job staying at home as a state and as a result, we no longer need a state-wide stay-at-home order. But that doesn’t mean that every city or community is ready to lift their restrictions. Many local governments, especially those with large populations or in areas where there are hotspots, may continue to have more restrictive rules in place. There will be a process for local governments to work with the administration and modify these new regulations based on local conditions.


Governor Polis April 18, 2020 Updates

April 18, 2020

Quick Links to Stay Up to Date

Topline Update

As of yesterday, we have 9,047 cases, 391 deaths, and 1,755 hospitalizations (858 are currently hospitalized; 203 were discharged in the last 24 hours) out of 43,307 completed tests. Our thoughts and our hearts go out to the impacted families and communities during these trying times.

UPDATE to Public Health Order for Long Term Care Facilities

We know that facilities that serve seniors are particularly vulnerable vectors for infection. That’s why in the first week of this crisis, we issued a public health order to prevent outbreaks that required that facilities restrict visitation and require screening for staff and visitors for symptoms of COVID-19 before they come to the facility, among other things like ensuring social distancing, taking isolation precautions for residents that need to be quarantined, increase effective communication between staff, residents and their families to ensure compliance, ensure adequate supply needs are met, ensure proper sanitation to prevent to spread of infection, notifying public health officials when a case is confirmed and requiring that all wear masks.

Yesterday, the Governor announced that we are updating this public health order to require these long-term care facilities to develop a detailed isolation plan and submit that plan to our Colorado Department of Public Health and Environment (CDPHE) by May 1st. With so many vulnerable individuals and frontline health care staff in close contact, we need to have better planning and better protections to stop the spread of the virus within these facilities. The Governor has also deployed the National Guard to conduct testing at three of the largest nursing homes in the state to prevent outbreaks, and we will be deploying additional testing resources and personnel to other facilities as needed.

In early May, we expect there will be 200 beds in supplemental facilities that will be available for isolation of seniors if their facilities can not provide these beds with a proper level of isolation. The first beds identified for seniors are at St Anthony's North in Westminster.

Furthermore, the administration will be more focused on education, training, and compliance in order to keep these vulnerable communities safe. Below is a video that our Colorado Department of Public Safety put together to illustrate what you can be doing to enact these protocols to ensure protection at facilities.

Click here to view Video:

NEW Executive Order that Requires Masks for Essential Workers

In an effort to further protect workers and residents in senior living facilities, as well as workers in other essential occupations and the public at large, the Governor has issued a new executive order that will require workers in critical businesses and critical government functions where workers interact in close proximity with other employees or with the public. These include grocery store workers, staff at congregate care facilities, and the folks who are still going to work each day to protect our food supply, roads, public health, etc. 

Workers must wear a mask or non-medical cloth face covering that covers the nose and mouth while working, except when doing so would inhibit that individual’s health and wear gloves when in contact with customers or goods. Most employers and workers are already doing this and we salute them for their proactive steps to help us defeat this virus. But the more people wear masks at their critical workplaces, and the more people wear masks when going about their necessary errands, the more lives will be saved and the sooner we can get the economy growing again.

COVID-19 Relief Fund

Yesterday, the Governor announced that we are disbursing $4.8 million in our first round of grants from the COVID-19 Relief Fund. We’re funding 206 organizations across the state, going to organizations around the state working to serve:

  • Families impacted by school or childcare closures

  • Health care, hospitality, service industry, and gig economy workers

  • Workers displaced by business closures

  • Workers without access to paid sick leave

  • Older Coloradans living on a fixed or low income

  • Those experiencing homelessness

  • People with disabilities

  • People without health insurance

  • Immigrant and refugee communities

  • Tribal governments

  • And victims of domestic violence or child abuse

Today the fund is at $12.2 million including $1.3 M from almost 7,000 donors. This includes a very generous gift of $1 million from Pinnacol Assurance. This week, CO Health Foundation stepped up to help with a $2 million dollar match challenge to kickoff the next phase of fundraising.  The challenge is meant to inspire corporations, philanthropies and individual donors who can give a minimum gift of $10,000 to the fund.

We are so grateful for their continued partnership and leadership to encourage other foundations, corporations and individuals to give for the first time or contribute an additional gift to support the important work of grantees across our state. Furthermore, Colorado Gives Day is coming up on May 5 which is a wonderful opportunity to give at Thank you all for stepping up to do your part and keep Colorado strong.

Unemployment Assistance Update
The Governor announced yesterday that gig workers and independent contractors who have seen decreased revenue due to COVID-19 can begin applying for unemployment insurance on Monday. We had been waiting on federal guidance for how to administer benefits to gig workers through the new Pandemic Unemployment Assistance program passed in the CARES Act. Thank you Colorado Department of Labor and Employment (CDLE) for working to get this up and running. Furthermore, the $600 per week in extra federal unemployment insurance from the CARES Act will start to show up in unemployment checks this week. This is crucial to helping families make ends meet as we continue to deal with this public health crisis. Please visit for more details.

COVID Health Equity Response Team

On Monday we released racial data regarding positive COVID cases and deaths. The data showed that some communities of color are more likely to suffer from COVID. The Governor said that this was likely a proxy for other societal inequities because we know that people of color are statistically more likely to work jobs considered “essential” and are therefore at a higher risk of exposure, statistically less likely to have access to benefits like health insurance and paid sick leave and as a result, are statistically more likely to suffer from underlying health conditions that may worsen the symptoms of COVID-19.

That is why the Governor announced that he is establishing the COVID Health Equity Response Team to address these inequities and ensure that all Coloradans, regardless of race or ethnicity, has access to the resources that they need to keep themselves healthy and safe. This team will be headed by Web Brown, the Director of the Office of Health Equity at CDPHE.

The task force will work to:

  • Ensure equity as a factor in decision-making around logistics and resources,

  • Increase access to testing and care services,

  • Ensure racial and ethnicity COVID-19 data are accessible, transparent and used in decision-making,

  • And share time-sensitive information about how Colorado communities are experiencing particular challenges related to the COVID-19 response.

REMINDER: Recreate in Your Own Area
Finally, with the weekend coming up we wanted to reiterate our guidelines for outdoor recreation. Do not drive outside of your local area. Use your local parks. Denver residents shouldn’t be driving even to the foothills. Summit County residents shouldn’t be driving three hours to Mesa to use bike trails, etc. Keep at least 6 feet distance on trails and don’t congregate on the trailhead. The mountains and trails and rivers will be there when COVID-19 is past us so please be patient as we work to stop the spread and bring back normalcy.

Impact on Rural Colorado

We know that this crisis presents a unique challenge for our rural areas both from a public health perspective and an economic perspective. Right now this is hitting our urban centers fairly hard and specific mountain communities very hard. But a new report from the Council of State Governments details how this crisis is shaping up in our rural communities where we are likely to see larger numbers of uninsured individuals and families, less access to healthcare and hospitals where there are fewer providers because areas don’t benefit from the same economies of scale, greater at-risk population to COVID-19, poor connectivity, both from a transportation and a broadband perspective and a delayed economic hit that may last longer.

We’re working with counties in every corner of our state to mitigate the impact of this deadly virus in every community. But no matter where you live in our state you must take this seriously and stay at home to stop the spread and save lives. The better we do this, the sooner we can go back to some level of normalcy.


ANA's President Calls Nurses "Warriors Without Armor"- Survey Finds 66% Lack Adequate PPE (

April 17, 2020

This is a message from Ernest J. Grant, Ph.D., RN, FAAN

President, American Nurses Association

As our nation battles an invisible, deadly enemy, we continue to send our frontline warriors into danger without sufficient armor.   

Our military does not send troops into battle without the equipment they need to stay safe. And as a former volunteer firefighter, I would never have been required to respond to a fire without the proper gear. 

Yet this is what we are asking of our nurses, other health care workers, and first responders when they lack the PPE–personal protective equipment–-they need. And this is occurring as the number of COVID-19 cases continues to grow unabated, and the number of N95 respirators and other emergency supplies available through the Strategic National Stockpile is running out.   

ANA’s Survey on Access To PPE

On March 20, the American Nurses Association began a survey of nurses nationwide about their access to PPE and other work environment concerns. According to findings from more than 20,000 respondents: 

  • 76% reported being extremely concerned about PPE, 
  • 66% reported being out or short of N95 respirators, 
  • 62% were out or short of full-face shields, and 61 percent were out or short of surgical masks. 
  • 69% reported concerns about working short-staffed. 

Further, we hear disturbing reports that employers have retaliated against nurses and other health care workers for raising legitimate concerns about their personal safety and the safety of patients.   

Protecting Nurses Safeguards The Public

Protecting the safety and health of nurses and other frontline workers is directly related to safeguarding the public and stemming the spread and impact of the virus.   

Without the right PPE, nurses are concerned about unintentionally transmitting the virus to patients under their care, or to those in their communities. 

According to our survey, 85% also worry about keeping their families safe from becoming infected. 

There are countless stories from nurses and other health care workers who go to great lengths to prevent potentially contaminating their family members. For example, many have an elaborate system in place to shed their work clothes before stepping into their homes. They also describe isolating themselves as much as possible from their children and other family members – a state of affairs that’s causing great anguish to many.  At this point, we can’t even measure the toll the pandemic will take on the mental health of nurses in the long term.   

There are no definitive numbers on how many health care workers have been infected in the United States, although at least 15 nurses have died. According to an April 3 article in U.S. News and World Report, 

  • 4.4% of health care workers in Pennsylvania had COVID-19,
  • 10.6% of Oklahoma’s coronavirus patients were identified as working in health care, 
  • Alarmingly, about 20% of cases in Ohio are among health care workers. 

In cities such as New York and Boston, we hear about hundreds of health care workers who are COVID positive and in quarantine, depleting the already stretched ranks on the frontlines.  

Looking globally, the International Council of Nurses shared with BBC World News that the infection rate among health care workers in Italy was about 9 percent, and in Spain, reportedly 12 percent, further adding to the staffing crisis in hospitals.  

Nurses are waiting for more protective gear to arrive. 

President Trump signed legislation that allocates funds aimed at bolstering public health efforts and supplies. He has ordered one manufacturer, so far, to ramp up its production of N95 respirators. However, it will take time for that company to retool its shop and begin the production necessary to meet this challenge.  

Although it is encouraging to hear federal officials share details about the procurement and delivery of PPE and other medical equipment, we are still hearing that sufficient supplies of PPE are not getting to those who most desperately need them to take care of patients and themselves. The report from the U.S. Department of Health and Human Services' Office of Inspector General of survey findings from 323 hospitals reinforces what we are hearing about PPE, including the lack of a robust supply chain, problems with the amount and quality of supplies coming from the Strategic National Stockpile, as well as challenges related to changing guidance from the Centers for Disease Control and Prevention and conflicting guidance from federal, state and local authorities. 

As we head into what is predicted to be the most difficult and deadly weeks yet in this country, our plea is urgent. Our courageous nurses are working around the clock under battlefield conditions to care for the sick and dying, putting their own health and safety at risk.  It is both a moral and strategic imperative for our nation’s leaders to do everything possible to arm and protect nurses and other critical responders.  

Ernest J. Grant, PhD, RN, FAAN 

President, American Nurses Association 



Governor Polis Issues Executive Order Providing Needed Flexibility for Health Care Professionals

April 16, 2020

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 [email protected]

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