Aim: To identify neonatal nurses’ self-reported practices, knowledge and attitudes toward premature infant pain assessment and management. Method: An exploratory cross sectional mixed methods survey. Findings: Of the 127 surveys distributed, 86 were returned (68% response rate). Those with postgraduate education had higher knowledge and reported more positive attitudes. Comfort measures and analgesia for painful procedures were reported as used more often in term infants. Analgesia was not used for endotracheal intubation. This was attributed to non-prescribing of analgesia by doctors. Conclusion: Nurses reported a positive attitude toward infant pain assessment and management but a low level of knowledge about premature infants’ response to pain. The non-use of analgesia for painful procedures presents a formidable challenge to changing practice. Evidenced based strategies may overcome barriers.