One of the more difficult scenarios you’ll face as a nurse is patient pain management. 

The patients you encounter may experience pain in very different ways and to very different degrees. Patients also respond differently to pain management medications and techniques. 

While it’s ultimately up to the attending physician to prescribe and manage a patient’s pain, it falls within your role to closely monitor your patients, act as a liaison between them and the doctors you work with and ensure that levels are acceptable and well maintained. 

How can you best fulfill your role in inpatient pain management? Start by checking out this expert advice from nurses with extensive experience in pain management.

Understanding Your Role In Patient Pain Management

When you see a patient in pain, especially if it’s extreme or debilitating pain, your first instinct as a nurse will be to try to alleviate that pain in the soonest possible timeframe so that your patient is comfortable. 

While you can certainly begin working with a patient on pain management techniques and recommend to their attending physician the medication orders that may be necessary, this may not be the first place you want to jump in.

First and foremost, your role in inpatient pain management will be to work toward a goal of patient comfort while recognizing that the pain they are experiencing is a symptom of a deeper root cause. 

If that pain is muted before the root cause is discovered, it may make detection and diagnosis more difficult for the attending provider. 

Cathy Turner, BSN, MBA, RN-BC, the Associate Vice President at MEDITECH, says that the top role in pain management is documenting and managing patient discomfort using pain assessments.

While you work to assess the severity and location of the pain, as well as the events or experiences that may have led to the pain, you build the medical case the attending physician needs to study to determine the eventual diagnosis and how to treat the illness instead of the just the symptom of pain. 

This doesn’t mean that you should delay treating pain while waiting for a diagnosis, but that you will need to remember not to treat just the pain to the exclusion of determining why the patient is suffering.

Find Ways To Alleviate Pain Using Alternatives To Narcotics

Strong narcotic pain medications can be very effective in quickly taking away patient pain. However, narcotics can be habit-forming and lead to dangerous long-term addictions — a severe epidemic currently plaguing the United States and leading the U.S. Department of Health and Human Services to declare a public health emergency over opioid usage in 2017. 

This doesn’t mean that you shouldn’t use certain medications to manage patient pain; rather, it means that all other alternatives should be explored so that opioid use is limited.

In addition to finding effective pain management alternatives, Turner says nurses are responsible for working with their cohorts to implement Nurse Navigator Programs and limit narcotic ordering in emergency departments so that patients who need medications will still have access. Still, drug seekers are not able to take advantage of physician prescribing habits. 

For additional pain management advice for nurses, see Turner’s blog on 5 ways nurses can use EHRs to help with pain management.

Remain In Constant Observation Mode

You will likely work with many patients over the course of a workday. That can make remembering what symptoms you observe difficult to distinguish unless you thoroughly document all of your patient interactions. 

Suzanne Maxley, RN, a retired hospice nurse with many years of patient pain management experience, says, “We saw the patient face-to-face, which the doctor usually does not, and was able to share our observations with the doctor.”

Observations you make should include:

• What the patient’s current pain level is at
• How the patient’s pain level has increased or decreased over time
• Where the patient’s pain is primarily located and how that location may have changed over time
• How the patient has responded to pain medication
• What pain management alternatives have been employed with the patient
• How the patient is specifically describing their pain

By consistently documenting these observations, reporting them to attend providers, and following up regularly to note changes, you can help ensure the patient is appropriately treated and remains as comfortable as possible while undergoing diagnosis and treatment.

Work As A Patient Advocate To Manage Pain

You are a trusted advisor and advocate for the patient while they’re under your care, particularly when they are experiencing significant pain. 

How pain occurs and how it impacts the patient can sometimes be difficult for them to put into words. 

Additionally, patients may not know what questions to ask or what treatments or medications to ask for or accept upon a doctor’s recommendation. This means that one of your most important roles in pain management is as an advocate.

Jeannie Boyle, MSN, RN, reminds in training developed for the U.S. government Indian Health Services agency of the importance of patient advocacy during pain management. Specifically, her training covers advocating for the patient’s right to be treated adequately for the pain they are experiencing, regardless of the cause of that pain. 

This gives you the tasks of ensuring that doctors and other providers are truly hearing the patient’s pleas for help and working to develop an action plan appropriate for each patient’s needs. 

Patients whose pain isn’t adequately treated may end up right back in the emergency department hours or days later or may resort to dangerous self-treatment alternatives. You can work to ensure their needs are heard and met while they are under your care.