What Is Orthopedic Nursing: A Look Beyond the Bare Bones
By Kirsten Slyter on 03/22/2021
At some point in their lifetime, most people will break a bone. Others will deal with orthopedic conditions like osteoporosis, arthritis or injuries related to the body’s many ligaments or tendons. Because of this, the odds of crossing paths with an orthopedic nurse at some point in your life are fairly strong.
Orthopedic nurses have the opportunity to help patients who are in extreme pain from trauma, injuries or long-term conditions. They are able to connect with patients quickly and encourage them while providing pain relief and managing dressings, casts and drains as well. In this article, we’ll walk through the various duties of an orthopedic nurse in a wide range of settings. We’ve also received insights from orthopedic nurses to help you understand what to expect if you’re interested in orthopedic nursing.
What does an orthopedic nurse do?
Orthopedic nurses, also referred to as simply “ortho nurses,” are registered nurses (RNs) who specialize in the skeletal and muscular system. They work with patients who have suffered broken bones, undergone orthopedic surgery or are dealing with longer-term orthopedic conditions by monitoring patient progress, administering medications, assisting with devices like crutches or canes and arranging physical and occupational therapy sessions to help patients heal.
The specific duties of an orthopedic nurse can vary quite a bit depending on where they work. An ortho nurse working with patients right out of a joint-replacement surgery has different responsibilities than an ortho nurse in an outpatient, pediatric orthopedic clinic. The nurse in the hospital will likely spend more time administering IV pain medications than educating patients on how to use assistive devices like crutches or how to put on an ankle support brace, like the one in the clinic might.
In every setting, orthopedic nurses have the opportunity to support patients in severe pain with a variety of conditions. “No two days are ever the same,” says Alaina Ross, orthopedic RN and contributor for Test Prep Insight.
Where do orthopedic nurses work?
Orthopedic nurses can work in a variety of settings that come with different schedules, patients and duties. Keep in mind, the majority of registered nurses (60 percent) works in hospitals, according the U.S Bureau of Labor Statistics, with physicians’ offices and outpatient care centers ranking as the second most common location.1 Let’s walk through a few of the more specific settings you’ll find orthopedic nurses in.
Orthopedic surgery centers
Nurses are a vital part to getting patients into, through and recovering from orthopedic surgery. They can work in preoperative (before surgery), perioperative (during surgery) and postoperative (after surgery) care.
Preoperative care includes getting the patient prepped for surgery once they arrive to the hospital or surgery center. This means taking vitals, reviewing the patient’s chart, cleaning the operative area and starting fluids.
Perioperative nurses can work in the operating room (OR) on a specific orthopedic surgical team. In the OR, they’ll prepare the room according to the surgeon’s preferences and needs, which includes detailed info about equipment, instruments and supplies. They also collaborate with the anesthesia team to ensure the patient’s safety during surgery. They’ll see the same type of surgery many times. However, each patient has unique risks and needs. The most common orthopedic surgeries include:
- Total joints replacements: Procedure where a damaged joint is replaced by a device made to replicate the same movements.
- Arthroscopy: Procedure where the surgeon places a tiny camera in an incision to visualize a joint. This can include AC, meniscus or rotator cuff repairs.
- Spinal fusion: Surgery where vertebrae are fused to together to increase stability and reduce the patient’s day-to-day pain.
- Trauma: Surgeries that usually include repairing broken bones injured during an accident. These can include open reduction and internal fixation (ORIF), which is used to stabilize a bone and begin the healing process.
Hospital orthopedic unit
After a patient undergoes an orthopedic surgery, they are usually transferred to a floor in the hospital dedicated to patients with orthopedic problems. Nurses on the ortho floor usually work three 12-hour shifts per week and care for four to six patients at a time. They stay very busy giving medications for pain, managing surgical drains and changing dressings. They also work with physical and occupational therapists to get the patients back on their feet and returning to their normal day-to-day activities. These nurses play a huge role in getting the patient to take their first steps post-surgery.
At the end of the patient’s stay, nurses in orthopedic units are in charge of educating and discharging the patient so they can go home or head to a rehabilitation facility. Patients often move in and out of an orthopedic unit quickly. They can be admitted for just an overnight stay or up to three days. Amber Kujath, PhD, RN, ONC, director for the National Association of Orthopedic Nurses, recalls ending some shifts on the orthopedic unit with four different patients than the four she started with—simply because they had all been discharged. “The ability to make connections and gain your patients’ trust quickly is important,” she says.
Orthopedic outpatient clinic
Patients come to orthopedic clinics for a variety of reasons. Some may have just suffered an injury. Others may be coming in for follow-up care on a condition, like osteoporosis, or preparation for an orthopedic surgery.
A large portion of an orthopedic nurse’s job in a clinic is dedicated to education. They teach patients how to use assistive devices, like crutches, canes or braces. They also prepare patients for what to expect after orthopedic surgery. They may also apply splints, casts, slings and wound dressings.
In a clinic setting, nurses usually get to see patients more than once. It can be rewarding to form long-term relationships with these patients and help them improve over time.
What you should know about orthopedic nursing
If you can envision yourself as an orthopedic nurse, there’s a few things you should know about what it’s actually like to work as an orthopedic nurse. We asked nurses in the field what they think future nurses should know.
You can have a long-term impact in a short amount of time
No matter the setting, orthopedic nurses have the opportunity to help patients heal from injury, surgery or disease. Since orthopedic patients are typically healthier with fewer morbidities, they often improve more quickly than other patients. Though they may be in a lot of pain initially, witnessing their recovery is often a high point of the job. “It’s so rewarding to watch them recover and do physical activates they have not been able to do for months or even years,” says Ross.
Additionally, ortho nurses have the opportunity to educate patients on lifestyle changes that can improve their bone health, which in turn, can improve their quality of life for years to come.
You’ll get to care for patients in all stages of life
While some areas of nursing have a limited range of patients like pediatrics, geriatrics or obstetrics, orthopedic nurses get to care for all types of patients in every stage of life. “Everybody’s bones break,” says Kujath. Ortho nurses can work with children, older adults, athletes—anyone!
Not only does this diversity give nurses the opportunity to care for a wide variety of patients, but it also allows ortho nurses to subspecialize within orthopedics. They can work in clinics or departments that focus on a particular subspecialty, like:
- Pediatric orthopedics
- Hand surgery
- Sports medicine
- Spine surgery
- Joint replacement
- Podiatry (foot and ankle orthopedics)
- Trauma surgery
- Bone health
- Orthopedic oncology
No matter what area of orthopedics draws your interest, remember that nurses often have quite a bit of lateral mobility in their careers and can pursue different specialties throughout their career, so you’ll always have options.
Orthopedic nursing skills and characteristics
The best orthopedic nurses are extremely compassionate and sensitive to their patients’ pain. They pay attention to details when noticing changes in a patients’ vitals and administering pain medication.
Ortho nurses also need to be able to form strong connections with their patients even if they’re only in their care for a short time. After an orthopedic surgery, patients only stay in the hospital a day or two, and the orthopedic nurse is often by their side when they take their first steps after surgery. Orthopedic nurses provide substantial encouragement for the patient to start their recovery despite post-surgical pain.
When applying and interviewing for orthopedic nursing positions, candidates should be sure to highlight their compassion, patience and attention to detail.
How to become an orthopedic nurse
The first step on the road to becoming an orthopedic nurse is to first become a registered nurse (RN). To become an RN, you’ll need a degree—either an Associate’s Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN) and to obtain state licensure. Then you’ll be qualified to apply to a variety of nursing positions, including orthopedic nursing positions.
Some orthopedic nursing employers may prefer ortho nurses with a certain amount of experience. Even nurses fresh out of nursing school can gain more experience in a few different ways. Ross recommends volunteering on an orthopedic unit to get more familiar with the rhythms of an ortho unit. New nursing grads can also look for programs for new grads on ortho units to help them make the transition.
Orthopedic nursing certifications
As in many other nursing specialties, earning additional certifications can increase a nurse’s confidence, give them access to more resources and even help newer nurses find a job in the field. Nursing students and registered nurses alike can join the National Association of Orthopedic Nurses and pursue the Orthopedic Nurse Certified (ONC) credential.
In order to earn the ONC credential, orthopedic nurses must have two years of practicing as an RN under their belt, 1,000 hours of orthopedic nursing in the past three years and a current RN certification. They must also pass the certification exam that includes questions about everything ortho—from osteoporosis to how to fit crutches.
Though you can get an orthopedic job without certification, it can help. “If you want to be mobile and marketable, it helps to be certified,” says Kujath. “But really, certification is more about personal pride and becoming an expert.” Becoming certified can allow nurses to become valuable sources in their units while increasing their confidence.
Do you have a future in orthopedic nursing?
Orthopedic nursing is unique in the intense pain patients face but also the dramatic recovery that ortho nurses get to witness and the healing they play a big role in. If you’re up for those extremes, orthopedic nursing might be right for you.
If you’re ready to start down your path of becoming a registered nurse, begin with our article “How to Become a Registered Nurse: Your 4-Step Guide.”
Though you certainly don’t have to choose a specialty before becoming an RN (or even after), if you’re intrigued by the variety of specialties RNs can work in and want to discover more, check out our article “Top 25 Types of Nurses Employers Are Looking to Hire.”
1Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, [accessed March 2021] www.bls.gov/ooh/. Information represents national, averaged data for the occupations listed and includes workers at all levels of education and experience. This data does not represent starting salaries. Employment conditions in your area may vary.