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Despite advances in the science of sedation and pain assessment, few studies have examined the impact of various assessment tools on nursing confidence. This study examines how bispectral index monitoring impacts nursing confidence in the assessment and comfort in medication administration based on that assessment. In this prospective observational Quality Improvement project, nurses using bispectral index (BIS) and the Richmond Agitation Sedation Scale (RASS) were randomly selected to complete a self-assessment survey intended to measure their personal confidence and comfort regarding care they were providing for a specific patient on the day the survey was completed. From 110 nurse surveys, nurses had higher confidence assessing pain and sedation when BIS monitor was used in concert with RASS assessments for patients with neuromuscular blockade agents. There was no different in confidence in- nor comfort with- sedation and pain assessments for patients not receiving neuromuscular blockade agents.