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Pain management practice differs among hospitals in China; however, no studies have examined the association between hospital level and nursing practice of pain management.To evaluate the nursing practice of pain management in orthopedics wards of level 3 and 2 hospitals and compare the differences in pain management regulations, policies, and perceived barriers.This was a cross-sectional descriptive study.This study was conducted during the 10th International Congress of the Chinese Orthopedic Association, November 19-22, 2015.Subjects: The sample included 121 nurses from China.Quantitative research methods were used to assess pain management practice by 121 Chinese nurses as well as barriers to nursing practice.Nurses in level 3 hospitals were more likely to evaluate patients' pain intensity (85.23% vs. 65.38%, p .05) and quality (77.27% vs. 53.85%, p .05) than those in level 2 hospitals. Compared with level 2 hospitals, level 3 hospitals were more likely to participate in the Painless Orthopedics Ward program (53.41% vs. 23.08%, p .01), conduct pain management knowledge training (88.64% vs. 69.23%, p .05), and establish pain management regulations (68.18% vs. 34.62%, p .01). Level 2 hospital nurses reported a higher score for barriers than level 3 hospital nurses (3.27 vs. 2.45, p .05).Nurses from level 2 hospitals received less education on pain management and also paid less attention to and faced more restrictions for pain management than nurses from level 3 hospitals.

Since the 2010s, the Pain Resource Nurse (PRN) program and similar programs have been introduced in Chinese hospitals. However, the status of the PRN program and nurses' experiences in these programs remain unclear.The aim of the study was to identify the factors related to PRN programs and explore PRNs' experiences being part of the program.A combination of descriptive cross-sectional and qualitative methods was used in the study.Thirty-two hospitals in the eastern, central, and western regions of China.Twenty-four PRNs who had been PRNs for 6 months or more.A purposive sample of 32 hospitals from eastern, central, and western regions of China carried out a PRN or similar program for more than 1 year with at least five bedside nurses from different nursing units were enrolled in the descriptive cross-sectional study. The questionnaire was designed by Brown's advanced nursing practice framework theory. A total of 24 PRNs who had been PRNs for 6 months or more participated in the interview by convenience and purposive sampling.The mean number of PRNs in a program was 30.12 ± 17.93 (range 5-74). The role of the PRN was broader compared with that of bedside nurses, and it included pain management, training, and education. The most common reason for hospitals to establish PRN programs was to improve the quality of pain management (n = 28, 87.5%). Administrative support (n = 28, 87.5%) was a major supportive factor for PRN programs and lack of physician support (n = 28, 87.5%) was a barrier. Although all hospitals provided training, those with knowledge assessments after training indicated a significant improvement in the desired PRN functions compared with those that did not (p .05). Personal interviews revealed that the reasons for becoming a PRN varied and included considering PRN as a career opportunity, personal interest, passively accepting the designation, and being a PRN temporarily. The positive professional experiences of being a PRN included an increased sense of self-worth and accomplishment and growth in a specialty, whereas the negative experiences included frustration with the work environment and resignation because of extra workload.The hospital survey results indicated that the PRN program in China is still in the early development stage. The PRN interviews suggest that being a PRN involves both positive and negative experiences.