orthopedic advanced practice role in hospital/ED?

[FNP grrl]

howdy! new here, just checking it out.

i am an fnp, working in a level 2 trauma ctr/ regional referral facility in western NC- new position for this hospital x6 months. i (and 3 PAs) cover the hosp 24/7, essentially on-call, but always nearby, and we respond to orthopedic ED calls- kind of like "orthopedic first responders" if you will. we are employed by the hospital, not individual orthopedists; our primary supervising MD is also employed by the hospital. we do inpatient rounding on his patients, but not for all of the other attending orthopods.

we see any ED ortho pt. (regardless of who is the attending on call) that needs immediate consult, intervention, admission, or surgery- the ED still sees all the basic ortho patients that just need routine follow up. we contact the attending on call & work collaboratively. primarily we do admission & pre-op H&Ps (ho-hum...), & put on lots & lots of splints, with some occasional procedual stuff (the night shift folks get to do that more b/c the orthopod is obviously less likely to want to come in). the idea was to expedite & standardize ortho pt care- the patients had horrible ED wait times before we came on board & i believe we have made a big difference that way. also, our H&Ps are MUCH more thorough, and i believe we often do more thorough physical assessment as well. i can also tell that multi-trauma patients get much better ortho care in the ED now.

i am a bit disappointed though, as i thought we'd be getting more hands-on training- i've only done a few minor procedures. supposedly, we were to learn hematoma blocks & simple reductions, putting in tibial traction pins, etc. i also thought we were going to get surgical experience, but so far that hasn't materialized. so it's a mixed bag so far, though i have learned a lot about ortho in general, serious traumatic ortho in particular (my background is ER nursing, so a lot of the ortho stuff was/is new to me). and- the patient load is VERY hot & cold- sometimes there are long periods of time w/ nothing to do, punctuated by 5 admits in the last 2 hours of a shift. that can be pretty frustrating.

so just wondering if any of you work in a position like this or have heard of one? i'd be curious to know what your scope of practice is, how you get procedural training, etc. i know there are other hospital-based advanced nursing practice roles, but so far i haven't found anyone else specifically doing ortho.