Beyond the Pain Scale

Provider Communication and Staffing Predictive of Patients' Satisfaction With Pain Control

Judith Shindul-Rothschild, PhD, MSN, RN; Jane Flanagan, PhD, RN, ANP-BC; Kelly D. Stamp, PhD, ANP-C, RN, FAHA; Catherine Y. Read, PhD, RN


Pain Manag Nurs. 2017;18(6):401-409. 

In This Article


This cross-sectional study examined factors associated with patients' self-report that pain was "never" or "sometimes" well controlled. The dependent measure in this study was defined by CMS and measured in the HCAHPS survey that asks patients to self-report on clinical quality measures of their hospital experience. This specific measure is used to assess the percentage of adult inpatients who reported how often ("Never," "Sometimes," "Usually," "Always") their pain was controlled by asking, "During this hospital stay, how often was your pain well controlled?" (CMS HCAHPS, 2011–2012). HCAHPS is administered to a random sample of adults after hospital discharge from medical, surgical, and maternity units (CMS, 2011).

Data Sources

The data sources used in this study included the CMS HCAHPS from September 30, 2011 to October 1, 2012 and the American Hospital Association (AHA) Annual Survey of Hospitals released for 2011. CMS and AHA data sources were merged using the CMS hospital identifier number with the AHA Annual Survey of Hospitals released for 2011. The sample consisted of nonfederal general hospitals in California (n = 295), New York (n = 109), and Massachusetts (n = 60). This study was exempt from an institutional review board approval because the data are available from public and proprietary sources and do not include any identifiable patient data.

Statistical Analysis

Correlations, analysis of variance, independent t tests, and a stepwise linear regression were conducted using IBM SPSS Version 21 (IBM, 2012). Variables were computed in the AHA dataset to permit comparisons across hospitals in the stepwise linear model analysis. Dummy variables were created for city/county hospitals, for-profit hospitals, nonprofit hospitals, teaching hospitals, and Massachusetts, New York, and California hospitals. The proportion of adult intensive care unit beds to total staffed hospital beds, Medicare case mix, and Medicaid days to adjusted patient days were included as proxy measures of intensity of care.

In the AHA Annual Survey of Hospitals (2011), the staffing domain includes full-time, part-time, and full-time equivalent (FTE) staffing for hospital personnel. Full-time employees are defined as working ≥35 hours a week and part-time employees as working <35 hours a week. Full-time equivalents (FTE) are defined as equal to the sum of full-time workers plus .5 of the part-time workers. Employee hours per patient day (HPPD) were calculated by multiplying full-time and full-time equivalent employees by 2,080 (40 hours/week × 52 weeks) and dividing by adjusted patient days. Total nursing staff FTE HPPD was calculated by summing registered nurse, licensed practical nurse, and nursing assistant FTE HPPD.

The data file was examined for random or systematic missing data and marked skewness. No systematic missing data or marked skewness were found in the variables included in the data analysis. Scatterplots of the candidate predictors were examined for applicability of the linear model, outliers, or unusual distributional shapes.