This national mail survey assessed pain-related knowledge and subjective competence of a random sample of home care nurses across the United States. Other study objectives were to examine the relationship between nurse characteristics, knowledge and perceived competence, and assess continuing education practices. On average, the 1236 nurses scored only 56% of the items correctly, demonstrating stronger knowledge in pain assessment than treatment. Respondents reported most confidence in patient and family communication, discussion of advance directives and pain assessment. The lowest competence was reported in sophisticated pain treatment techniques. The relationship between knowledge and subjective competence was found to be highly significant. Sixty-three percent of the sample displayed a realistic assessment of their pain management knowledge, while 37% under- or overestimated what they knew. It is challenging to engage the latter group who overestimate their competence but score low on pain management knowledge. Educational strategies need to differentiate these two groups and target the audience appropriately.
