Becoming An Orthopedic Nurse: Everything You Want to Know

Orthopedic nursing is a popular subspecialty in acute care/hospital-based nursing. If you’ve been thinking about becoming an orthopedic nurse, I’m going to answer some of your burning questions, like…

Alright, let’s talk ortho!

What is an orthopedic nurse?

Orthopedic nursing specializes in musculoskeletal conditions such as arthritic joints, injuries to bones and ligaments, tumors, and other diseases. Orthopedic surgery is used to correct spine deformities and repair different types of bone and ligament injuries. Many of the procedures are elective, but some occur emergently as a response to a traumatic injury.

An orthopedic nurse (often called an “ortho nurse”) is a nurse who cares for patients after they have had orthopedic surgeries and/or procedures. 

Types of Orthopedic Surgeries

Orthopedic nurses take care of patients after different surgical procedures. Here are some of the various types of procedures performed by orthopedic surgeons. Let’s discuss some!

Total Joint Replacements

This surgery involves replacing an arthritic, painful joint with new metal components to reduce pain and increase mobility. This can also stabilize a joint after removing bone cancer. Common examples include total knee, total hip, and total shoulder replacements.

Sports Surgeries

Arthroscopy is a type of surgery that allows a surgical team to look inside a joint with a small camera and make repairs to damaged tissues through tiny incisions. Examples include repairing an ACL, meniscus, rotator cuff, and labrum.

Spinal Fusion

Spine surgery is performed on the vertebrae of the spine to increase stability and reduce pain by fusing the bones together with screws and rods. This surgery can be performed for the cervical, thoracic, or lumbar spine. Examples include laminectomies, fusion, and removal of spinal cord tumors.

Trauma

Orthopedic trauma surgery repairs any broken bones (except the face) with open reduction and internal fixation (ORIF). The bones are realigned and metal implants are inserted to hold the bones in the correct position for healing. 

These procedures are typically unplanned and result from traumatic injuries due to car accidents, falls, violence, and other incidents. Some examples include ORIF of the pelvis, femur, and humerus fractures.

Planned Elective Versus Emergency Procedures

Patients with traumatic orthopedic injuries often arrive at the emergency room by ambulance, where they are medically stabilized and assessed to determine how quickly they will need surgery to repair their bones. 

Patients follow a different process for having a planned elective surgery. In these cases, patients schedule a date for surgery with the orthopedic surgeon’s scheduler. The patient will complete pre-admission testing prior to the day of surgery. During this appointment, the patient will have their vital signs reviewed and lab values drawn, complete a cardiac assessment, and receive directions for surgery (ex. no food after midnight).

Patients undergoing planned surgeries typically receive instructions prior to the day of surgery. When patients have emergency surgery, there is more emotional support needed to help patients recover from the traumatic event, adjust to new limitations, and provide education for post-operative needs.

General Flow of Patient Experience in the Orthopedic Nurse Operating Room

Whether patients arrive with an orthopedic injury as an elective or an emergency procedure, patients follow a similar path to the operating room. Let’s discuss the patient experience from pre-op to ortho hospital floor. 

Day of Surgery

On the day of surgery, the patient will be assessed in a preoperative holding area. The pre-op nurse will:

• Verify an updated patient history and physical, surgical consent, and site mark placement on the operative area
• Manage placement of the IV
• Assess patient allergies
• Remove clothing and jewelry
• Determine COVID-19 status
• Confirm a negative pregnancy result if applicable

An anesthesia team also assesses the patient to determine additional needs, such as a nerve block or the placement of arterial blood pressure monitoring or central lines. Anesthesia providers determine an appropriate plan for surgery and explain the benefits and associated risks to the patient.

The operating room (OR) nurse and surgical team will also interview the patient to verify his or her identity. Afterward, the patient has the  opportunity to ask any remaining questions they may have. The team then confirms the documentation and assessments to move forward with the surgery.

In the Operating Room

The patient will be transferred from the preoperative area to the OR, where he or she will be moved to the OR bed. The anesthesia provider will then connect the patient to monitors. Once the patient is anesthetized, the surgical team and OR nurse will position the patient appropriately for surgery. 

Responsibilities of the Operating Room Nurse

The OR nurse is the advocate for patient safety and manages the care of the patient during surgery. They have many responsibilities, which include:

• Confirming the correct patient for the correct surgery on the correct body site
• Verifying surgical consent
• Positioning the patient safely to prevent injury
• Performing surgical counts to prevent items left in a patient
• Maintaining the knowledge and ability to use surgical equipment 

The Orthopedic Nurse’s Responsibilities on the Floor

After the surgery is completed, the patient will be transferred from the OR to the recovery area. If the patient is admitted to the hospital, the patient will typically go to an orthopedic nursing unit.

The orthopedic floor nurse has various responsibilities while providing care to the patient. This includes:

• Giving the ordered medications for post-operative pain control
• Managing surgical drains and changing dressings
• Working with physical therapy and occupational therapy staff to assist the patient with ambulation and returning to daily activities 
• Providing discharge education regarding dressings, level of activity, home medications, and necessary follow-up appointments 

Why Nurses Love Orthopedics

Orthopedic nursing is a specialty that many nurses are passionate about. There is a feeling of instant gratification when a patient comes to the OR with a fractured bone and leaves with a repaired injury and the promising chance of a full recovery.

Many nurses love orthopedics because the patients are typically healthier with fewer morbidities, which makes it easier to provide care for the patients. There is also a sense of truly seeing patients improve, as they were previously struggling with an injury or disease and are now on their way to recovery with much less pain. Overall, it is a rewarding experience for both the nurses and their patients.

About the Author

Blyss Splane BSN RN CNOR is a certified operating room nurse with years of experience scrubbing and circulating. She was an orthopedic surgical specialty coordinator for the OR at a level 1 trauma hospital. Now she travels as an OR nurse in the southeast. She is the owner of Nurse Splane Writes, creating content for healthcare websites and blogs. Blyss is an avid reader and spends her time pursuing a healthy lifestyle. She can be found at NurseSplaneWrites.com or email her at NurseSplaneWrites@gmail.com.