Optimizing the role of the nurse practitioner to improve pain management in long-term care.

The purpose of this study was to examine the role of the nurse practitioner (NP) within an interdisciplinary model of pain management in long-term care (LTC). In a cross-sectional survey, 16 NPs in the Canadian province of Ontario (89%) indicated whether they currently performed and whether they should be performing 33 activities related to pain management and identified barriers to the fulfilment of their pain-management role. Most NPs (81.3%) reported use of pain-assessment tools, but less than half reported use of pain-management clinical practice guidelines. NPs were less involved in activities related to (a) prescribing and adjusting pain medications, (b) providing leadership in pain management, and (c) engaging in pain-related research initiatives. However, most felt that they should be more involved in these activities. Barriers to NP management of pain included time constraints; prescribing restrictions; lack of knowledge; difficulties with assessing pain; MD, staff, resident, and family reservations about use of opioids; and poor collaboration with physicians. The results indicate that NPs are not being used to their full potential in managing pain among elderly LTC residents.