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

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.