PURPOSE: To explore barriers that NICU nurses face when attempting to optimally manage newborn pain.

SUBJECTS: Ninety California NICU nurses with current membership in the National Association of Neonatal Nurses (NANN) voluntarily participated.

METHOD: A researcher-developed survey consisting of 37 questions was mailed to 300 NICU nurses; 102 were returned, and 90 were useable. Probability sampling from a current listing of California registered nurses with current membership in NANN was used to obtain the study's sampling frame. The survey consisted of 35 questions in a Likert-type response rated 1-5 and 2 questions that allowed a written response.

PRINCIPAL RESULTS: Less than half of the nurses (45%) felt newborn pain is well managed within the NICUs where they are employed. Barriers identified related to physicians' pain management practices, lack of evidence-based pain management protocols, nurses' and physicians' resistance to change practice, infant pain assessment tools, and inadequate staff training regarding pain assessment and management.

CONCLUSION: A knowledge-practice gap still exists within newborn pain management. Increased caregiver education remains a necessity, but strategies that address resistance to change practice within healthcare settings must also be considered.