The Evolution of the Role of the Registered Nurse in the Management of Analgesia by Catheter Techniques

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Early in 1991 shortly after the American Society for Pain Management Nursing (ASPMN) was founded, Barbara Reed and I represented the ASPMN at a meeting that was facilitated by the American Nurses Association (ANA) and attended by representatives from numerous professional nursing specialty organizations. The meeting was called in response to the rapidly expanding field of pain management and an increase in the use of catheter techniques to manage pain in a wide variety of patients and settings. With advances in research and technology, as well as more clinical experience with these new pain management methods, came the need to describe the involvement of nurses in the monitoring and management of them. The expressed purpose of the meeting was to finalize a position statement that would help to define the emerging role of the registered nurse (RN) in the management of analgesia by catheter techniques (epidural, intrathecal, interpleural, and peripheral nerve catheters) and establish a safe standard of patient care. Another primary objective was to present state boards of nursing with a statement that would provide direction for their decision making with regard to RN practice related to this aspect of pain management. The underlying assumption of everyone who attended that 1991 meeting was that the provision of analgesia was a fundamental nursing obligation and had long been within the scope of nursing practice. The position statement developed by that group of nurses reaffirmed this assumption and was released in September of 1991 and endorsed by state boards of nursing and numerous professional nursing specialty organizations (ANA, 1991).

The RN’s role in pain management has continued to emerge and expand by leaps and bounds since the release of the 1991 ANA-facilitated position statement. Such dramatic growth has produced wide variability in practice with regard to pain management and the need for constant definition of the RN’s role. This seems to be most apparent when the administration of analgesics is involved. As a pain management educator and consultant, I am repeatedly asked for clarification of the RN’s role, particularly with regard to catheter techniques and the use of local anesthetics for analgesia. Nurses often mention discrepancies in institutional policies and procedures resulting in their ability to treat patients in one care area but not in another. For example, RNs within the same institution may be able to increase an epidural analgesic infusion rate in a neonate but not in a laboring patient. In 2004 I took my concerns regarding this lack of uniformity in practices related to RN management of catheter techniques to the members of the ASPMN Board of Directors, and they approved the formation of a task force to look into the issue.

With the help of several reviewers and consultants, the ASPMN task force members, Charlene Cowley, Nancy Eksterowicz, and I, led by Chairperson, Maggie Primeau, produced the position statement, “Registered Nurse Management and Monitoring of Analgesia by Catheter Techniques” presented in this issue of Pain Management Nursing. You will find that this position statement builds on the durable foundation laid by the 1991 ANA-facilitated position statement and reinforces the basic philosophy that the provision of analgesia is within the scope of RN practice and an essential nursing responsibility in the care of patients of all ages and in all settings.

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Reference 

1. American Nurses Association (ANA). Endorsement of position statement on the role of the registered nurse (RN) in the management of analgesia by catheter techniques (epidural, intrathecal, intrapleural, or peripheral nerve catheters). 1991;Retrieved February 1, 2007 from http://www.nursingworld.org/readroom/position/joint/jtcathet.htm
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