Date of Conferral



Doctor of Nursing Practice (DNP)




Dr. Janice Long


Overcrowded emergency rooms (ERs) decrease the flow of nursing care creating a delay in nurse-administered pain management leaving patients in pain. The project-focused question asked if ER nurses felt that overcrowding in the ER led to inadequate pain management and if a clinical practice guideline (CPG) could be developed to promote effective pain management in the setting. Callista Roy's theory of human adaptation was used to guide the project. To prepare for CPG development, data from a simple random selection of 10 nurses who had worked in the ER for a minimum of 6 months was obtained from the practice site. The 12-item questionnaire was validated by a panel of experts from the site prior to use. Data were analyzed for frequencies and a t-test was used to determine whether overcrowding significantly influenced pain management. Results indicated that overcrowding, overflow to hallways, and work demands on nurses in the ER significantly (p < .01) affected timely pain management for patients. In response to the staff feedback and using the same expert panel for review, a clinical practice guideline was developed and presented to the site administration for implementation. In addition to implementation of the CPG, recommendations from the panel included having a committee review the overflow situation and improve patient-to-nurse ratios in the ER. While the clinical practice guideline was not implemented during this project timeline, the site administration accepted the document and planned for future implementation. Positive social change will result as pain management is addressed in a timely manner and patients are satisfied with care.