242649 Nursing Pain Practices: The Need to Improve Policy Governing Prescriptive Authority

Tuesday, November 1, 2011

Jennifer Kowalkowski, RN, MS, MPH , School of Nursing, University of Wisconsin-Madison, Madison, WI
Aaron Gilson, MS, MSSW, PhD , Pain & Policy Stuides Group, University of Wisconsin - Madison, Madsion, WI
Background: Nurses are essential partners in the management of pain. Several states have adopted laws and policies promoting pain management as an integral part of nursing practice, including prescriptive authority for Advanced Practice Nurses (APNs). Legislation and regulations underscore the legal role of APNs in treating severe pain, particularly related to prescribing controlled substances. To date, no studies have evaluated nursing policies to determine whether they promote effective pain treatment or contain recommendations or requirements that could adversely affect care. Methods: A nation-wide criteria-based content analysis was used to identify positive and negative language in statutes and regulatory policies governing nursing practice related to pain relief. Results: Substantial variation was found among states regarding nurses' authority to prescribe medications or recommendations for practice, revealing potentials for systematic inequities in pain care. Nine states grant no authority to nurse prescribers to manage chronic severe pain. Conversely, nursing boards in 18 states have issued a specific policy encouraging effective pain treatment, although the messages vary considerably. Conclusions: Understanding policy content can inform local and national efforts to improve nurses' capacities for treating chronic severe pain. This project emphasizes the expectation that APNs perform to the full extent of their training, and engage as equal partners with other members of the healthcare team in transforming patient care and promoting pain management as a requisite component of professional nursing practice. This project has the potential to improve the policy environment governing APNs' pain practice, promoting safe and effective treatment for all patients experiencing pain.

Learning Areas:
Chronic disease management and prevention
Public health or related laws, regulations, standards, or guidelines
Public health or related nursing
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Learning Objectives: 1. Attendees will be able to describe three types of nursing policies that have been adopted to encourage the safe and effective use of medications for the treatment of chronic severe pain. 2. Attendees will be able to describe how the variation in state legislation and regulatory policies governing nursesí prescriptive authority, including for the treatment of chronic severe pain, can affect patient outcomes. 3. Attendees will be able to describe how the nurses are positioned to serve as leaders in promoting policy change that will facilitate safe and effective treatment of chronic severe pain.

Keywords: Nurses, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I completed the evaluation of state policies for this project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.