I work in LTC. I am also a 6 months in new nurse.

We have many residents that are self-responsible (perhaps some need that reassessed, but they still are their own person). My question is that if someone is self responsible and obtains a bruise/skin tear/etc, is it a HIPAA violation to notified their family. I know who most of my "selfs" are so I ask if they want me to call. I was informed that our policy says that we are always to call family...but again, HIPAA violation???

What about bigger occurrences? Where do you draw the line, at a fall without injury? Medication change?

Your scenario is not a privacy violation. This is specifically provided for under HIPAA, is often also mentioned in the medical privacy laws of a given state, and is usually good clinical practice to do so, unless the patient has specifically directed you to not share this information.

488-Does HIPAA permit a doctor to discuss a patient’s health with the patient’s family and friends | HHS.gov

Thank you! That is exactly what I was looking for. I had been ill-informed and there was not clear policy regarding this in the facility.

I always called the doctor and the family, unless the patient was A&O x 3 and asked me not to, in which case I documented the heck out of the incident, including (as much as possible) their exact words requesting no notification. That way I covered my rear while respecting the patient's choice.