A nurse suspects a client is developing opioid use disorder and reduces the client's dosage of pain medication by 50% without a prescription from the provider. The nurse checks on the client 1 hr later and sees the client sitting up in a chair. The client tells the nurse, "I am in too much pain to reach the nurse call button." The nurse is liable for which of the following legal violations?

Rationale for Correct Answers

• Termination of employment: The nurse was already counseled three months ago regarding HIPAA and workstation security. This new incident is a repeat violation of privacy standards, which is usually grounds for immediate dismissal in most healthcare facilities.
• Reprimand from the state board of nursing: State boards oversee professional licenses. Posting client information or derogatory comments about patients on social media violates the Nurse Practice Act and professional boundaries, leading to disciplinary action against their license.
• Criminal penalties: HIPAA violations (especially those involving the disclosure of Protected Health Information on social media) can lead to federal criminal charges, including fines and potential jail time, depending on the severity and intent.

Rationale for Incorrect Choices

• Deletion of social media account: While the nurse might choose to do this, it is not a formal legal or professional disciplinary action imposed by the employer or the state.
• Review by the ethics committee: Ethics committees generally consult on clinical dilemmas (like end-of-life care); disciplinary actions for privacy breaches are handled by Human Resources and Legal departments.

Rationale:

A. This option is incorrect because allowing a client with cognitive impairment to sit at the nurses’ station during the day without supervision can increase risks for wandering, agitation, or injury. Clients with cognitive deficits often have difficulty understanding their environment and may inadvertently interfere with clinical operations or put themselves at risk. Safe, structured, and familiar environments are preferable.

B. This option is correct because placing the client’s room near the nurses’ station allows for closer monitoring and timely intervention if the client becomes confused, attempts to wander, or exhibits behavioral changes. This proximity supports patient safety while still promoting a sense of autonomy and privacy. Nurses can quickly respond to needs or emergencies, which is especially important for clients with cognitive impairment who may not recognize hazards or communicate effectively.

C. This option is incorrect because using full-length bed rails for clients with cognitive impairment is associated with increased risk of entrapment, injury, or falls if the client attempts to climb over them. Safer alternatives include half rails, low beds, or motion-sensor alarms, which protect the client while reducing risk.

D. This option is incorrect because a red wristband indicating fall risk is only a visual cue for staff and does not actively prevent falls. Comprehensive fall prevention requires environmental modifications, frequent monitoring, use of assistive devices, and individualized care plans rather than relying solely on identification bands.