Role of the Nurse in Pain Management
|Guidance regarding the interpretation and application of the Nurse Practices Act (NPA) may be adopted by the ND Board of Nursing (Board) as a means of providing direction to licensees and stakeholders who seek to ensure safe nursing practice and to address issues of concern relevant to public protection. (North Dakota Century Code (NDCC) 43-12.1-08(2)(p).
Board approved practice guidance does not carry the force and effect of the law/rules. Each licensed nurse (nurse) is “responsible and accountable to practice according to the standards of practice prescribed by the board and the profession”; and must “accept responsibility for judgments, individual nursing actions, competence, decisions, and behavior in the course of nursing practice.” (Standards of Practice, North Dakota Administrative Code (NDAC) 54-05-01-07 and 54-05-02-04). “Competence": means the application and integration of knowledge, skills, ability, and judgment necessary to meet standards. (NDAC 54-01-03-01(16)).
The Board seeks to safeguard public health and safety by providing regulation and guidance of the nursing profession. A balanced approach to pain management is required; one that addresses the potential for abuse without preventing clients from receiving the care they require. Therefore, the Board adopts this Practice Statement to assure health care providers, clients, and their families that the policy of this Board supports, encourages, and expects competent comprehensive care for the treatment of pain across the lifespan.
Pain is a common reason clients seek medical attention and is encountered by every health care provider. Health care professionals must be knowledgeable about effective and compassionate pain relief, while clients and their families should be assured such relief will be provided. Communication and collaboration between members of the healthcare team, the client, and the family are essential in achieving adequate pain management. Ideally, the client directs the plan of care and the pain level to be achieved.
The proper management of client’s pain is a nursing function within the role of the nurse who is responsible and accountable for the care provided and for assuring the safety and well-being of the client (NDAC Chapter 54-05-02). When adequate pain management is not achieved under the currently prescribed treatment plan, the nurse is responsible for reporting such findings to the prescriber and documenting this communication.
RANGE DOSE ORDERS:
- Only the licensed health care practitioner with prescriptive authority may change the pharmaceutical management plan.
- The LPN may assist in the pain assessment however the RN has the overall responsibility.
- The RN and LPN must perform a thorough pain assessment to base decisions regarding range dose orders.
Both the RN and LPN must be knowledgeable of the:
- medication to be administered,
- anticipated time of onset of the medication,
- time to peak effect, duration of action of the medication,
- and side effects of the medication to be administered. (Gordon et al 2004)
The RN and LPN are accountable for implementing the pain management plan including pharmacologic, non-pharmacologic and complimentary interventions utilizing their knowledge, skills and abilities and organization policy. (NDAC Section 54-05-01-03 & 54-05-02-03).
The nurse’s scope of practice is determined by their education, experience, knowledge, skills, and abilities. Each licensee is accountable for providing safe
, and effective care, while utilizing ethical principles focused on optimum client care to take appropriate measure to relieve suffering.
NDCC 43-12.1 Nurse Practices Act
NDAC Article 54-05 Standards of Practice
NDCC Chapter 19-03.3 Controlled Substances for Care & Treatment
American Nurses Association (2018). Position statement on ethics of pain management. Retrieved from http://www.ana.org.
U.S. Pain Foundation. (2019). Pain Management Best Practices Inter-Agency Task Force Report. Retrieved from pmtf-final-report-2019-05-23.pdf (hhs.gov)
Federation of State Medical Boards: Guidelines for the Chronic Use of Opioid Analgesics. (2017) Retrieved from http://www.fsmb.org.
Standards for Joint Commission Accreditation of Healthcare Organizations. (2020). Pain Assessment and Management Standards for Join Commission Accredited Health Care Organizations.
Kansas Board of Nursing (2016). Joint Policy Statement of the Kansas Boards of healing Arts, Nursing and Pharmacy on the Use of Controlled Substances for the Treatment of Chronic Pain. Retrieved from http://www.ksbn.kansas.gov.
Minnesota Board of Medical Practice, Nursing and Pharmacy (2015). Joint Statement on Pain Management. Retrieved from http://www.mbn.org
North Carolina Board of Nursing, Pharmacy and Medicine (2019). Joint statement on pain management in end-of-life care. Retrieved from http://www.ncbon.org.
Initially developed by Nurse Practice Committee 2006 with consultation and input from the staff of the following organizations: NDBME, NDBOP, NDDH, NDMA, NDHA, NDLTCA, & NADONA.
The ND Board of Nursing endorses pain management guidelines established by the World Health Organization, the U.S. Department of Health and Human Services – Agency for Health Care Policy and Research, American Nurses Association, and the U.S. Pain Foundation.
Adopted: May 2006; September 2006.
Reviewed/Revised: 10/12, 4/2022
ANA position statement: Ethics of Pain Management
- Nurses have an ethical responsibility to relieve pain and the suffering it causes.
- Nurses should provide individualized nursing interventions.
- The nursing process should guide the nurse’s actions to improve pain management.
- Multimodal and interprofessional approaches are necessary to achieve pain relief.
- Pain management modalities should be informed by evidence.
- Nurses must advocate for policies to assure access to all effective modalities.
- Nurse leadership is necessary for society to appropriately address the opioid epidemic.