Objective We examined the effects of nurse, infant and organisational factors on the delivery of higher pain care by neonatal intensive care nurses.

Methods We included 93 nurses from two neonatal intensive care units who had performed 170 pain-producing procedures. Nurse use of evidence-based protocols to manage procedure-related pain using a scorecard of nurses’ assessment, management and documentation were examined in the context of infant acuity, nurse physician collaboration and nurse workload. Nurse knowledge of pain care was measured using a newly developed pain knowledge and use instrument with good psychometric properties.

Results Procedural pain care was more likely to meet evidence-based criteria when nurses rated nurse–doctor collaboration more highly (odds ratio (OR) 1.44; 95% CI 1.05 to 1.98), when infants required higher intensity care (OR 1.21; 95% CI 1.06 to 1.39) and when treating nurses experienced unexpected increases in their work assignments (OR 1.55; 95% CI 1.04 to 2.30). Nurses’ knowledge levels about the protocols, educational preparation and their experience were not significant predictors of implementation of evidence-based care.

Conclusion Organisational factors such as nurse–physician collaboration and work assignments were more predictive of evidence-based care than nurse factors. Nurses’ knowledge levels regarding evidence-based care were not a predictor of the implementation of protocols. In the final modelling, collaboration with physicians, a variable amenable to intervention and further study, emerged as a strong predictor. The results highlight the complex issue of translating knowledge to practice; however, specific findings related to pain assessment and collaboration provide some direction for future practice and research initiatives.