As a level 4 student preparing to begin my journey as a registered nurse, I have been encouraged to reflect on the opportunities available to me in the clinical setting. My work this semester involves providing care to patients on the burn unit at the Hamilton General Hospital. This is a specialized unit with 12 beds, 2 of which remain reserved for critical care patients. Critical areas have always interested me as a student. It is inspiring to see how nurses can evolve into such skilful clinicians, using their critical thinking to produce positive patient outcomes. My current preceptor has been working on same the clinical setting for 30 years and reflects the image of an expert nurse as described by Benner in her article about the different levels of nursing performance. To Benner, an expert nurse is one who does not depend on rigid structures or guidelines to inform practice, but instead relies heavily on intuition to connect their understanding of the situation to the appropriate course of action. In my time there as a student so far, I have seen how nurses specifically use their expertise to predict a patient’s response to pain. Being a novice/advanced beginner can at times be frustrating, especially in more critical areas where you are expected to plan ahead, think quickly and outside the box. Being inspired by their work, however, makes me hopeful for my nursing future and encourages me to take advantage of the extensive learning opportunities available.

Burns are very painful injuries associated with a long recovery process, and the perception of pain among patients is variable. This I have found to be a consistent theme in my professional practice area. On some instances, I have seen patients experience extremely high levels of pain. Be it after a grafting procedure or during a dressing change, once the pain gets ahead of them, chaos is the outcome This may be a disturbing experience both for the patient and for the nurse. The patient may enter a complete state of agony and become unrecognizable. Their screams are piercing and their cries unsettling. In dealing with these situations, novice nurses may be engulfed by feelings of despair. This is a legitimate response. What exactly does one do when a human being becomes absolutely inconsolable? On the other hand, expert nurses often maintain their calm. They are efficient and speedy. They just know what to do. 

As a student observing these situations unfold in real time, one may feel there is just not much to do. You may be able to support the staff by getting supplies, communicating something to another member of the team, or simply by holding the patient's hand and providing emotional support. Thinking back on these experiences I am able to reflect on existing biases I may have had with regards to pain management. Before being placed on this unit I had not often administered high-alert medications. For me, the biggest barrier was having a fear of administering too much medication while also managing the patient's pain appropriately. These events have helped me understand how each person reacts to pain differently especially given their previous health and social history.

Although pain is often interpreted as a physical modality, a patient's needs may go beyond the physical to also encompass the emotional, social, and spiritual. Only by looking at a person holistically may we be able to meet their needs appropriately. The nurses on this unit achieve this with grace and efficacy. They inspire me daily. They are compassionate, kind, attentive, and knowledgeable. Empowered by the knowledge acquired from practicing in this setting, I feel closer to becoming a newly registered nurse.