When assessing a patient for possible side effects related to acetaminophen, the pain management nurse asks the patient about the use of: alcohol, marijuana, opioids, tobacco.

And your answer is --. This question is similar to those on the Pain Management Certification examination.

Nurses who are interested in becoming certified are urged to develop a study plan about six months before you take the exam.

All four of Cancer Treatment Centers of America - Tulsa hospital’s pain management nurses are now board certified by the American Society for Pain Management Nursing.

Rhonda Franklin, RN, BC, Nancy Johnson, R, BC, OCN, and Susan Mitchell, BSN, RN - BC, join Tammy Johnson, BSN, RN-BC, who earned the certification earlier. Certification is good for five years.

In late 2005, the American Society for Pain Management Nursing and the American Nurses Credentialing Center joined together to offer the first national pain management certification exam.

"[This] certification means that you possess sufficient knowledge of pain physiology, pathophysiology and how to apply the nursing process to produce effective outcomes for pain management," states ASPMN on its website.

Hiring nurses who can think, and having policies that allows those nurses to go outside the treatment box, can result in additional benefits, both to the patient and to the facility.

Tammy Johnson, RN, BSN, BC, who joined Cancer Treatment Centers of America in Tulsa in October 2008, recognized an unmet patient need and acted to address the need.

"After joining the CTCA team last October, Tammy very quickly saw the need to achieve pain management certification in order to become more knowledgeable in caring for our patients’ pain," said CTCA Clinic Supervisor Laura Stickney, RN.

"Being certified," explains Tammy, "is a great service to the hospital and to the patient. It’s not only good nursing care, but takes it to a higher level." She explained that it is most important to determine what kind of pain a patient may be experiencing, the quality and characteristics.

"It’s more than just putting a number to the pain ... is this bone pain, is this neuropathic pain ... and what is the best medicine to treat it."

"Pain Management physicians rely heavily on the pain nurses, to adequately assess our patients in terms of analgesic effectiveness, side effects and overall impact upon the patients," explains Mark Axness, MD, director of Anesthesiology at CTCA. He also describes the pain nurses as a tremendous asset who figure out solutions to pain, even beyond medications.

"Our patients tend to have a very high acuity and treatment level, and for this reason," he adds. "Our nurses are working in a very specialized and critical care area, all of which require a tremendous fund of knowledge and clinical insight. The pain certification is a very difficult exam and completion of this goal is a great achievement.

Mitchell, who has been a nurse for years, said she found the exam mostly clinical with Franklin, a 20-year veteran, added that it covers all types of pain, not just oncology.

Tammy Johnson said becoming certified in pain management is a good investment in the knowledge of a nurse’s skills.

She said nurses in other facilities which do not have a pain management department need the ability to assess pain issues.

Mitchell said certification "gives me more confidence in what I am doing here. It encourages others to seek higher levels of certification."

Franklin said certification means that "you are better at your job."

Nancy Johnson, with 21 years in nursing, said "because we are a cancer facility and most of the places where our patients come from did not have adequate pain management, so when they arrive here usually they are very discouraged because they are so uncomfortable."

"We are always able to make their pain much better," she said. "Better pain management enables them to have a higher quality of life."

Nancy emphasized that "when you have a pain problem, you need to see a pain specialist."

She believes patients at the Tulsa facility get a lot better care simply because all four nurses are certified in pain management. "We do make a difference."

Preparing to take the examination is overwhelming, according to one nurse. "And it’s a relief when you pass it," another said. After months and months of study and worry, your pass-fail status is known five minutes after the test ends.

To take the exam, a person must hold a current, active RN license in a state or territory of the United States or the professional, legally recognized equivalent in another country; have practiced the equivalent of two years full-time as a registered nurse; have practiced in a nursing role which involves aspects of pain management; e.g. pain assessment and management, pain management education, research, etc.) at least 2,000 hours in the three years prior to applying to take the examination; have completed 30 hours of continuing education in the three years prior to taking the exam, of which a minimum of 15 hours must be related to pain management.