Barriers and enablers to emergency department nurses' management of patients' pain

Pain Manag Nurs. 2015 Jun;16(3):372-9. doi: 10.1016/j.pmn.2014.08.015. Epub 2014 Oct 31.


Pain is the most common reason for presentation to the emergency department (ED). On presentation patients expect rapid pain relief, yet this is often not met. Despite extensive improvements in analgesia medication there are still barriers to nurses' assessment, management, documentation, and reassessment of pain. The aim of this study is to identify barriers, enablers, and current nursing knowledge regarding pain management. Using an anonymous quantitative web-based survey, members of the College of Emergency Nurses New Zealand were invited to complete a questionnaire on pain assessment and management. The questionnaires were analyzed using descriptive statistics. Enablers to ED nurses' improved management of pain were the provision of nurse-initiated analgesic protocols and pain management champions. Common barriers perceived by the respondents were the responsibility of caring for acutely ill patients as well as a patient with pain. Similar barriers to previous research were identified and included lack of time, workload, reluctance of clinicians to prescribe analgesia, and the lack of nursing knowledge regarding opioid administration. Raising awareness that oligoanalgesia exists in the ED is essential. This research suggested that nurses would benefit from ongoing education on the usage of opioids. Nurses' attitude regarding patients' right to expect total pain relief as a consequence of treatment was also an issue. ED nurses, by virtue of their role, are in a unique position to be leaders in pain assessment and pain management.

MeSH terms

  • Adult
  • Aged
  • Analgesics, Opioid / therapeutic use
  • Clinical Competence / standards*
  • Clinical Protocols / standards
  • Educational Status
  • Emergency Nursing / standards*
  • Emergency Service, Hospital
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Medication Adherence
  • Middle Aged
  • New Zealand
  • Nursing Staff, Hospital / standards
  • Pain / nursing
  • Pain / prevention & control*
  • Pain Management / nursing*
  • Surveys and Questionnaires
  • Workload
  • Young Adult


  • Analgesics, Opioid