1. Roberts, Meghann T. MSN, BSN, RN
  2. Smith, Nancy J. MSN, BSN, RN-BC
  3. Brendlen, Virginia MN, BSN, RN-BC
  4. Madara, Kimberly BSN, RN
  5. Salyer, Jessica BA, RN
  6. Love, Alene MA, BSN, RN-BC, ONC

Article Content


The purpose of this initiative was to develop staff nurses into pain management registered nurses (PMRNs) to provide night coverage for the acute pain service (APS) patients receiving either epidural or regional catheters for postoperative analgesia.



Research has shown that effective pain management promotes earlier mobilization and reduces hospital length of stay, postoperative complications, and costs.



At Duke University Hospital, anesthesiology residents covered the APS patients from 11 pm to 7 am while also being responsible for operating rooms. Consequently, APS patients did not consistently receive prompt and adequate pain management. In recognition of this barrier to effective pain management, administrators, physicians and the APS clinical nurse specialists (CNSs) collaborated to develop the PMRN role.



The initiative involved recruiting and educating staff nurses to deliver care based on the same protocols that the APS CNSs utilize. Four night-shift orthopedic charge nurses participated in the 6-week APS orientation. The orientation consisted of didactic readings and classes, one-to-one clinical experience, case studies, and a skills day to demonstrate and validate clinical competencies. Ongoing competency maintenance and assessment are achieved through quarterly meetings and an annual refresher week with the APS CNSs.



Outcomes measured included (1) quantity and distribution of pain calls throughout the hospital, (2) response time and duration of intervention, (3) impact on staff satisfaction, (4) PMRN satisfaction with orientation, and (5) overall care of the APS patients. These outcomes will be described in the presentation.



Outcomes demonstrated that experienced staff nurses were able to follow CNS pain management protocols after completing an extensive, structured educational program. Within staffing and budget constraints, this program expanded the impact of the CNS role through staff nurse development, resulted in growth opportunities for experienced staff nurses, and improved staff and patient satisfaction.


Implications for Practice:

CNSs can improve pain management through effectively educating staff nurses in complex skills and decision making. By working creatively with both the medical and administrative teams, CNSs can develop alternative staffing models to improve patient and staff satisfaction.


Section Description

The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.


A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.


The conference abstracts are published to share new knowledge with those unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics.


Watch for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.