Orthopedics is the segment of medical practice that deals with injury or disease of the musculoskeletal system. Therefore, orthopedic nurse practitioners specialize in the treatment and longterm care of individuals who suffer from musculoskeletal issues.
According to the National Association of Orthopedic Nurses (NAON), "The role of the orthopaedic nurse is to advance musculoskeletal healthcare by promoting excellence in orthopaedic research, education and nursing practice." The orthopedic specialty was first introduced to nursing in the U.S. with the first orthopedic institution, which opened in 1863 in New York City. At that time, people who suffered from musculoskeletal issues, such as those caused by polio and tuberculosis, were often not admitted to hospitals as they were deemed "incurable."
Today, orthopedic nurses can be found in virtually every clinical setting, including emergency rooms, nursing homes, and in home healthcare positions. Working alongside physicians, physical therapists, and other nurses, orthopedic NPs are able to help patients recover from surgery, rehabilitate from injuries, and in the best cases, return to their mobile, pain-free lives after a traumatic event.
Orthopedic patients can be found in many different environments, including hospital emergency departments, dedicated orthopedic units, nursing homes, rehabilitation centers, and oncology departments. However, most orthopedic nurses work in a hospital environment in one way or another.
Obviously, the clinical environment of a nurse who works for a home health agency is much different from one who works in an emergency department, but in the orthopedic specialty, nurses deal with similar situations.
In the hospital, most orthopedic nurses are found in a specialized orthopedic unit, dealing with patients who are preparing for or recovering from orthopedic surgery. In contrast, nurses in rehabilitation clinics or home health positions typically deal with patients who are already in recovery.
Musculoskeletal conditions that require orthopedic treatment can occur at any stage of life, so orthopedic nurse practitioners (NPs) generally work with a very diverse patient population. While older adults are more likely to suffer from falls or need joint replacements, orthopedic units also see plenty of children and even infants who require care for fractures, bone cancers, and other orthopedic needs.
Of course, an orthopedic nurse can certainly seek out a position that focuses on his or her preferred patient population by looking for employment at a children's hospital or specialized nursing facility.
In the hospital environment, orthopedic nurse practitioners have duties that are somewhat similar to NPs in other departments. Nurses in this environment should expect to make regular patient rounds, keep careful records of their patient statuses, and offer clear and compassionate communication to their patients and their families.
Orthopedic NPs may be responsible for a fairly heavy caseload and should therefore be able to manage time well, ensuring that all patients stay comfortable and healthy. It also often falls to the nurse practitioner to be the source of information and education for the family of an injured patient, letting them know what recovery may look like; what kind of follow up care will be necessary; and how to best help the patient return to his or her normal life after a hospital stay.
In any environment, orthopedic nurses work with a care team, typically consisting of physicians (such as orthopedic surgeons), physical therapists, case managers, and/or social workers.
One of the most important and frequently stressful issues that orthopedic nurse practitioners must deal with is pain management. Musculoskeletal conditions can leave patients in extreme pain and both the patient and the patient's family will often look to the nurse practitioner to provide the medications to manage that pain. Orthopedic nurse practitioners should be able to not only know when to provide which medications, but also must be able to say no when it is medically necessary, which can be a challenge. This is particularly important in light of the ongoing opioid addiction crisis.
Orthopedic nurse practitioners may also be tasked with other recovery care responsibilities in the hospital, such as emptying drains, moving immobile patients for hygienic and health purposes, and replacing dressings on wounds. Some orthopedic nurse practitioners may also assist with orthopedic surgeries—before, during, and after.
In the case that surgery is not necessary, an orthopedic nurse practitioner may be responsible for setting a broken bone, applying casts and/or splints, and making arrangements for follow-up care.
While certification is not required to become an orthopedic NP, it can be a good choice for those who wish to further their career opportunities and demonstrate their expertise to prospective employers. The Orthopedic Nurses Certification Board (ONCB) offers one orthopedic NP nursing certification: the Orthopaedic Nurse Practitioner (ONP-C).
To be eligible to sit for the ONP-C exam, a nurse must:
To earn certification, the NP must pass a 150-question exam. Certification stays valid for up to five years as long as the nurse practitioner participates in the requisite number of continuing education (CE) hours.
Until recently, orthopedic nurses were solely able to learn their specialty on the job. However, those nurses who are interested in pursuing this line of work are now able to take courses at Duke University through their orthopedic specialty. Duke offers an eight-credit-hour specialization, which is available to nurse practitioners with an MSN degree or higher from a regionally accredited institution and nurse practitioner students from other regionally accredited colleges or universities. At the end of the program, successful students are awarded a specialty certificate.
Being an orthopedic nurse practitioner can be extremely rewarding for the right person. In many cases, nurses in this specialty are able to care for a patient from a very low point when he or she may be immobile and in a tremendous amount of pain, until a bone is completely healed. Being able to witness this type of transformation and have a hand in a patient's care in this way can be very gratifying for many nurse practitioners.
However, as with virtually every nursing specialty, there can be more difficult instances when full recovery is not possible. Orthopedic nurse practitioners will also have to deal with the aftermath of difficult surgeries and be able to show compassion and hope for patients that may find themselves permanently disabled or with severely limited mobility due to an injury, accident, or infection.