Barbara A. Kahn, BSN, ONC, took the orthopedic nurse certification exam in 1994 and has since seen big changes in the roles orthopedic nurses play and skill sets they need for optimal patient care.
“Orthopedic nursing has really evolved over the last 10 years because patients used to stay in the hospital two or three days,” said Kahn, a Clinical Nurse in the OR at the Hospital for Special Surgery, New York, N.Y. “They would have a catheter in, and things progressed slowly. Now joint replacement, spine surgery, and fractures are being done as ambulatory procedures.”
Since many common orthopedic surgeries have moved from acute care to the ambulatory setting, today’s orthopedic nurses focus more on teaching. They’re also building patient confidence that they can safely go home the day of surgery and following through to make sure patients are taking their medications, taking care of their wounds, and elevating their extremities — whatever they need to do at home to avoid a complication, according to Kahn.
Kahn, a speaker for Nurse.com’s Orthopedic Nursing Certification Review Course, said orthopedic nurses play a greater role in patient care than in the past.
The emphasis on patient education allows orthopedic nurses to develop relationships with patients, whereas rounding physicians, residents, or physician assistants might have spent more time with orthopedic hospitalized patients in the past.
“Now it is the nurse who is going to do the preop, the intra-op, the hospitalization (if patients are hospitalized), and the postop,” Kahn said.
A Good Fit for Orthopedic Nursing
Nurses with a keen interest in how the body works — such as how bones and muscles interact, posture, and how people move — will likely enjoy this nursing specialty.
“I walk down the city streets and watch everybody walk,” Kahn said. “If somebody is limping, I diagnose them. I watch football because I want to get the injury before it’s announced. I think it’s very important that you have that kind of desire.”
Orthopedic nursing is less about educating patients about things like diet and nutrition and more about helping them understand the art of movement. It is about getting people back to being able to be active, Kahn said.
While many nurses in the hospital setting care for the elderly and patients with serious illnesses, especially during the pandemic, orthopedic nurses often care for younger patients.
“We’re having younger patients with joint replacements,” she said. “We are having younger patients with spine surgery. They all want to get back to the activity they did previously, and the nurse is a big part of that.”
It is also important for orthopedic nurses to collaborate with other disciplines, including social workers, physical therapists, neurologists, and others, according to Kahn.
“You really need to network,” she said.
Deep Wells of Knowledge
The Nurse.com orthopedic nurse certification review course includes reviews on the anatomy, orthopedic assessments, medical complications, metabolic bone conditions, tumor disorders, and pediatric orthopedics. There is a lot to know for the certification exam, according to Kahn, and learning must go past orthopedics.
“You need to know the medicine behind it, as well,” she said.
Orthopedic conditions can lead to blood clots or can be more complex due to rheumatoid arthritis and some autoimmune diseases, for example. “That gives you a whole different array of medications that you need to know about that can compromise the immune system or raise blood pressure. You really need to have a good medical background,” Kahn said.
Elective procedures such as total joint replacements were down in 2020, according to Kahn. It also has become more cumbersome to get patients prepared for surgery because they have to have a negative COVID-19 test for elective procedures to go forward, she said.
But, in general, demand in the U.S. for orthopedic care is great and was increasing pre-COVID-19. More than one in two people in the U.S., 18 years and older (nearly three out of four ages 65 and older) are affected by musculoskeletal diseases, according to data by the U.S. Bone and Joint Initiative.
The number of hip and knee arthroplasty procedures in the U.S. grew to nearly 1.9 million in 2019, a 24.4% increase from the previous year, according to the American Joint Replacement Registry 2020 Annual Report.
Nurses are needed to care for these patients, even though many of these patients are treated in ambulatory surgery centers, according to Kahn.
“You need preop and you need follow-up more than ever,” Kahn said. “Nurses are advocates. They’re teachers. They’re liaisons. They’re becoming community based. Orthopedics is wonderful. If you like to be in a fast-paced situation where people are normally relatively healthy and they usually go home … this is a great profession.”