Careful and regular assessment of pain improves the perception of nurses concerning the impact of pain on their patients' lives to enhance the quality of its management. Monitoring pain as the fifth vital sign is currently practiced in many developed countries. Therefore, the present study aimed to apply of a proposed graphic chart for pain as fifth vital sign in nursing practice in Assiut University Hospitals- Egypt. An exploratory descriptive research design was carried out in five units including (medical, surgical, burn, trauma & orthopedic units). The study subjects consisted of 60 nurses available at the time of the study. An interview questionnaire, nurses’ opinionnaire scale, nurses’ audit and proposed five vital signs graphic chart were used for data collection. Results revealed that nurse’s mean age ± SD was (27.85±7.82) years, years of experience mean ± SD was (7.40±3.94) years. The majority of nurses agreed upon chart feasibility (81.7%) & quality of pain care (83.3%). Overall 83.3% of the nurses agreed upon the proposed graphic chart. Auditing of patients files revealed full application of the new change by 93.3%, 63.3% of nurses for graphic part &70 % for pain assessment part. It is concluded that the majority of the nurses had full application of the proposed change & it is recommended to be implemented in nursing practice in different health settings. Nurses need to be accountable to improve their knowledge and skills in assessing pain, which necessitates implementing educational programs through in-service training and continuing nursing education. It is also necessary for hospitals to require nurses’ notes on their charts for pain assessment and management.