A nurse is caring for a client receiving a new medication that has potential side effects causing discomfort. The client expresses concern about these effects and questions continuing the medication. Applying the ethical principle of nonmaleficence, what is the nurse's best action?

Rationale:
A. Scanning the bar code on the medication administration record (MAR) and the client’s armband is correct practice. This is part of barcode-assisted medication administration (BCMA), which helps ensure the “five rights” of medication administration: right patient, right drug, right dose, right route, and right time.

B. Documenting medication administration prior to giving the medication is incorrect and requires intervention because it can lead to medication errors and falsification of records. Accurate documentation should always occur after the medication is administered to ensure the record reflects what was actually given and to maintain patient safety. Pre-documentation creates a risk of missing errors, skipped doses, or giving the wrong medication.

C. Checking the provider's orders and confirming the dosage in a medication reference guide is correct because it demonstrates due diligence in verifying medication safety and dosage accuracy before administration.

D. Verifying the medication against the prescription and medication label is correct as it ensures accuracy in medication delivery, preventing errors such as administering the wrong drug or incorrect dose.

Rationale:

A. The unit clerk is incorrect because an electronic health record (EHR) password is confidential and linked to the individual nurse’s identity. Allowing a unit clerk to use the nurse’s login would constitute unauthorized access to protected health information (PHI). This violates HIPAA regulations, compromises the accuracy of audit trails, and prevents the facility from identifying who performed specific chart entries or data retrieval. Unit clerks who are allowed to access records must be issued their own usernames and passwords.

B. No one is correct because an EHR password must never be shared with any other person under any circumstance. Each password serves as a digital signature that identifies all actions taken in the medical record, including documentation, medication administration verification, and order review. Sharing this password eliminates accountability, increases the risk of documentation errors, and exposes the facility to legal liability if a breach occurs. HIPAA and facility policies strictly mandate that every user accesses PHI only under their own authorized credentials. Therefore, the nurse must keep her password private at all times.

C. A nursing student completing a preceptorship on the unit is incorrect because students must be granted their own temporary, restricted EHR access if allowed by the facility. Sharing a nurse’s password with a student is a direct violation of confidentiality standards. It also risks improper documentation or access to information beyond the student’s scope of involvement. The facility must maintain clear tracking of who enters or alters data, which is impossible when credentials are shared.

D. The nurse manager is incorrect because having a higher-level position does not justify using another nurse’s credentials. Managers have their own passwords with access permissions appropriate to their role. Sharing passwords, even with supervisors, violates HIPAA, breaks institutional policy, and may result in disciplinary action, termination, or legal consequences. Each user must log in under their own identity to maintain accurate accountability and ensure data security.