Growing a nursing career in Critical Care at Canada's largest burn unit

Charmaine Bertrame has worked as a nurse in Sunnybrook Health Sciences Centre’s Ross Tilley Burn Centre (RTBC) for 35 years. Her journey there began when she was still in college, studying to become a registered nurse. Her last placement was in the burn unit, and she was apprehensive—mostly because it was a Critical Care unit.

“But it did not take long as a nursing student for me to realize how special this unit was. The passion and commitment were something I had not experienced before,” she says. “That made a huge impact on me.”

The RTBC is the first burn centre in Canada and the second outside the United States to be verified by the American Burn Association. This verification provides a true mark of distinction, indicating that the centre provides high quality patient care to burn patients from time of injury through rehabilitation. Sunnybrook is also a teaching hospital affiliated with the University of Toronto, attracting medical trainees from around the world. Adult patients with major burns are admitted to RTBC, where they receive unique resuscitation and specialized wound care. The unit is comprised of 10 ICU beds and four acute care beds.

Bertrame takes care of patients from their most critical stages in the ICU to when they’re ready for rehabilitation. “You not only get to know your patients, but their families too, because they are in the unit for a length of time,” she says.

The role also requires special skills. “The complexity of the wound care that we do is unique to our unit, as it is the only place in the province that this patient population is cared for. Our patients come to us locally, but also province wide.”

Sunnybrook employs a sponsorship approach to facilitate recruitment and training of critical care nurses. “This approach involves hiring nurses into critical care positions, contingent on successful completion of an accredited critical care certificate, with their time and tuition being paid for by the organization,” says Jennifer Lovering, project manager of the Critical Care Sponsorship program.

Myron Nagendran, who started his career at Sunnybrook as a nurse in trauma and acute care, is another one of the nurses who has benefitted from this approach.

“I was given the opportunity to shadow the burn unit for a day; I was impressed by the compassionate care this small team of nurses was able to provide to such critically ill patients. Medically the care required by each patient is unique and challenging, and requires inter-professional collaboration,” he says.

Nagendran applied for the Critical Care program and was selected for sponsorship, successfully completing the courses required to work in the burn unit.

“In Ontario, there are probably about 40 to 50 nurses specialized to provide this kind of care in the adult population. I find it professionally challenging and personally rewarding to care for patients through all phases of their recuperation, from burn injury to rehabilitation.”

It also allows nurses to use a wide range of skillsets.

“I was drawn towards the burn unit because it’s essentially a blend of all my nursing interests: critical care, wounds, advanced life support and rehabilitation,” says Emily Gomes, who started working as a full-time RN in RTBC in March 2022. “I knew that the work would be emotionally and physically demanding, but I felt I was up to the challenge, and I’m so glad I made the decision to join the burn team.”

Gomes began her nursing career in 2016, working in a medical unit at a small community hospital. In 2020, she completed her Critical Care Certificate and transitioned into the ICU, where she worked for about two years before joining the burn unit.

“The skillsets and knowledge you gain in the burn unit is incredibly vast—every day I feel like I’m learning something new and exciting,” she says. “There are RNs who have worked in the burn unit for decades, and they have been amazing teachers. Among RTBC staff there is a strong sense of collaboration, safety and respect. We are the only program of its kind in the province, and so we all depend on each other to uphold a high standard of care.”