Nursing staff factors influencing pain management in the emergency department: Both quantity and quality matter

Abstract

BackgroundAbdominal pain is one of the most common symptoms for presentation to the emergency department (ED). However, administration of analgesics is often delayed and pain reassessment is often missed. We investigated the effect of several nursing staff factors on the time to administer analgesics and pain reassessment in ED. MethodThis retrospective descriptive study was conducted in a tertiary hospital in Korea. The subjects were adult patients who visited the ED for abdominal pain and received analgesics in 2019. Nursing staff factors were defined as the nurse-to-patient ratio and the nurse’s experience in the ED. Reassessment was classified into three groups: non-reassessment, reassessment in ≤ 1 h, and reassessment in ≥ 1 h. Patient characteristics and the analgesics’ name were collected. The effect of nursing staff factors on the administration time was analyzed using a linear mixture model, and the differences in the nurse, and patient characteristics in the three reassessment groups were evaluated using generalized estimating equations. ResultsA total of 1428 cases were included, 54.1% of which received opioids. The median time from prescription to administration (TTA) was 16 min, and pain reassessment was conducted in 55.0%. TTA tended to increase as the nurse-to-patient ratio increased. Nurses in the two reassessment groups had more experience than those in the non-assessment group. ConclusionBoth the nurse-to-patient ratio and experience in the ED had a significant impact on pain management. Therefore, appropriate ED nurse staffing levels considering the unpredictable and fluctuating number of patients, and nurse retention strategies are needed.