Ortho/Neuro

[ymaudy]

So, I suppose I'm one of the lucky ones. I passed nursing school this past May, after having gotten a PCT job at a local hospital during my last semester. As just about every new grad, I was hoping for a Med/Surg RN position. Unfortunately, despite my Med/Surg floor manager raving about me, she suggested that the Ortho/Neuro floor take me. I am more than ecstatic about actually having a job, especially in this market. However, my questions are "will this count towards those first one or two years of med/surg" everyone says I should have? Also, what can I expect from an Ortho/Neuro floor? I hear this floor gets some of the traumas too (up to level 2.) Ortho/Neuro wasn't anything I had considered let alone thought about. I'm interested in hearing about this area of nursing. Any Ortho nurses out there?

[Roy Fokker, BSN, RN]

Ortho is one part of the "meat and potatoes" so to speak of surg nursing (IMO).

Post-ops ... lots and lots of old ladies and old dudes with hip/knee replacements, lumbar laminectomies et al. Occassionaly (i.e. frequently) you'll see medical/gen-surg overflows: everything from run of the mill pneumonias to belly surgeries to anything under the sun.

The neuros are slightly different - depends on what kind of unit you have. Mine was a step-down neuro unit: lots of craniotomies, ICPs, we also did lots of CVA/TIAs.

You'll get a decent mix of med/surg nursing. Sure :)

cheers,

[nurseprnRN, BSN, RN]

i used to tell my students that it's perfectly ok to have more than one thing wrong with you.

on neuro/ortho you will see a lot of fracture /trauma and joint replacements, and a bunch of those people will have classic medical problems like coronary artery disease, renal disease, and copd. you'll see amputations-- diabetics, mostly.

you'll see strokes-- diabetics, high blood pressure, and unsuspected cardiac defects. you'll see intracranial masses with weird presentations.

you'll see younger people with sports injuries worried about getting back on the team, and injured workers who are terrified about losing their livelihoods.

you'll get good at assessing, preventing, and treating pain in a lot of different ways-- po, iv, epidural, local infusion, ice, massage... you'll get good at activity assessment and management. you'll see a lot of post-ops, so you can see how they recover from anesthesia over the next day or two.

you'll interact with acute rehab and vna, since your joint replacement and cva patients will need them. find out what they do.

you'll see seizure disorders-- young and old people with intracranial lesions or metabolic derangements. and you'll get great experience in post-surgical care of drains, dressings, mobility, chest/deep breathing/cough/pneumonia prevention, neuro and peripheral vascular exams, and gadgetry.

you'll have great opportunities to assess and manage patient health teaching for discharge and inpatient care. you'll get to play with pt, ot, and speech therapy, and they love teaching new nurses. use them!

you'll have a lot of diagnostic imaging and testing to check out-- mri, ct, bone scans, and labs, pathology reports, and things like swallowing exams and evoked potentials.

you'll probably even get to deal with hospice some, for the cvas that will not be waking up or the folks with metastases that don't want any more chemo and just want to live their last weeks or months in peace.

in short, you will get terrific experience in a broad range of cool stuff, and it will be great background for whatever you want to do later. i think it could be about the best place in the house for a new grad.

have fun! let us know how it works out!

[blue heeler]

you will be an expert at blood transfusions, managing pain, and use of all things ortho including: traction, immobilizers, braces, slings, casts, trapezes, polar care, hemovacs, stryker drains, jp drains, pca pumps, nerve blocks, cpm machines, walkers, gait belts, lifts, and anything else needed pre and post op.

also, i make it standard practice to bed alarm all joint patients, alert and oriented or not. too many times people think they can get up by themselves when they should only be up with pt or nursing.

i think the biggest challenge is managing pain. whenever i float to another unit, it is kind of a nice break from pain pain pain.

you will learn a ton on that unit and will be a neuro check pro!

[Tait, MSN, RN]

You will be fine. Patients might be divided into specialties, but believe me they always have more wrong with them than that!

Best of luck and congratulations!

[RNperdiem, RN]

You will develop skills involved with delegating to CNAs.

Especially in ortho, you will be very dependent on a good working relationship with your aides.

I used to be a CNA in orthopedics, and patients are unable to get around unassisted. Much of my shift was spent getting patients to the bathroom, up to the chair and back to bed.

[colnurse]

I started as a new grad on an ortho floor and have learned more than I could have expected. we also have tele, so we get that mix too. you do pain managment, pressure ulcer sore management since many an elderly falls breaks a hip and may come in with a sore. you have your elective surgery core, which is nice because those patients want to be at the hospital at least a few days and they are motivated to get moving. you get very good at getting your patients up and my hospital the docs like the ortho floor getting the fractured hips because we get those folks up and moving. you will gain a good working relationship with multiple disciplines in the hospital, pt, ot, st. these people are med/surg patients because most have other medical needs than their elective surgery or fracture that they have. you will have trauma patients, you will give all sorts of blood products, deal with all the hypotension.hypertension, lyte imbalances, possible dvts/pes and preventing them is key. you are going to learn so much, so don't worry it is not called med/surg because you are going to come out if you ever do with an amazing foundation that you learned and will be able to apply to so many other areas of nursing and that is just the ortho side

[noyesno, MSN, APRN, NP]

I started on an ortho/neuro/trauma floor 15 weeks and 3 days ago and I think it's a good floor to start out on. It's really busy and the patient turn around is really quick (lots of admissions and discharges a day) but it'll give you a good nursing foundation.

Skills you'll get good at:

-Wound care

-PAIN MANAGEMENT

-Ambulating patients

-Catheterizing post-op patients who can't pee

-Neuro checks

-Setting up trapezes, traction

-Stalking the PT/INRs for coumadin orders

-Heparin drips

-IV's

You'll also probably see some general/random surgery patients, things like: cholecystectomies, appendectomies, hysterectomies, bowel resections, TURP, skin grafts.

You'll get to have some fun with NG's and colostomies here and there.

GOOD LUCK TO YOU! :)

[Roy Fokker, BSN, RN]

also, i make it standard practice to bed alarm all joint patients, alert and oriented or not. too many times people think they can get up by themselves when they should only be up with pt or nursing.

Why didn't I ever think of that?!!

Thanks! I'll keep this filed away the next time I work a floor! :)

cheers,

[ymaudy]

thanks for all the tips guys. I better brush up on my neuro assessment skills =)