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Based on interview and record review, the Registered Nurse (LN 1) failed to provide appropriate clinical supervision to a Licensed Vocational Nurse (LN 2) during an insertion of a suprapubic catheter (a catheter tube surgically inserted through the anterior abdominal wall into the bladder to establish drainage of urine) for one resident (1). The Registered Nurse and the Licensed Vocational Nurse had no documented training and competency to change suprapubic catheters. This failure resulted in trauma to Resident 1's urethra.

Findings:

During a review of the clinical record for Resident 1, the Emergency Room Note dated 6/4/13, at 5:37 PM indicated Resident 1 had complaints of bleeding from a suprapubic catheter with frank blood from the genital area. He has a history of prostate cancer. Resident 1 was transported to the Emergency Room (ER) for assessment of genital area bleeding on 6/4/13. Resident 1 had a suprapubic catheter change approximately 48 hours before the transport to the ER. Laboratory tests and CT scan (Computed Tomography- a radiographic picture that uses narrow beam of light that passes thru a cross section of the body which allows visualization of tissues, bones, organs and blood flow inside the body) were done and revealed evidence of placement, the distal end of the suprapubic Foley catheter in the distal urethra. Resident 1's diagnosis indicated urethral injury and misplaced suprapubic catheter which has resolved.

During an interview with the Chief Nursing Officer (CNO), on 8/15/13, at 4:35 PM, she stated a Licensed Vocational Nurse (LN 2) from the night shift inserted the suprapubic catheter for Resident 1 on 6/2/13.

During an interview with LN 2, on 8/16/13, at 9:35 AM, she stated she inserted the suprapubic catheter according to the physician's order. LN 2 also stated she has been inserting suprapubic catheter since she started working as a nurse 6 years ago and has encountered no problems. She said, "I was being observed by the Registered Nurse (LN 1) because she wants to watch how I do it because she has not done one before." The catheter was draining clear yellow urine when LN 2 left Resident 1's room. She said it was the oncoming shift nurse (AM shift 7 AM-7 PM) who discovered the bleeding from the catheter site on 6/4/13.

The Job Description titled "Licensed Vocational Nurse, Med-Surg (Medical-Surgical) Unit" dated 5/20/13, read in part..."The LVN is able to perform general nursing duties in all departments with adequate supervision. Coordinates and supervises patient care under direct supervision of a Registered Nurse. Meets current documentation standards and policies."

The Clinical Practice Advisories titled "LPN scope of practice to change suprapubic catheter" dated 1/19/13, read in part... "Board (opined) that it is within LPN scope of practice to change suprapubic catheters with documented training and competency. Education on sterile technique should be included in training."

During an interview with CNO, on 9/24/13, at 10:47 AM, she stated she could not locate in the file, LN1 and LN 2 were competent in suprapubic catheterization. CNO verified there was no competency skill check done for LN 1 and LN 2.