Calling all ortho nurses!!! I need some tips!

ONP-C · Jul 19, 2015

There are only few orthopedic emergencies to be concerned with once your patient gets to the floor and they are a lot easier to deal with in comparison to the issues your local internal medicine service manages. Remember, when you see bleeding, "pressure and patience".

I would suggest;

1. Join the NAON

2. Work toward your ONC

3. Netter's Concise Orthopedic Anatomy (Textbook)

4. Know PE, FES, Compartment Syndrome (5-P's). Once you see each, you will NEVER forget...

5. Ask to scrub in during Ortho cases (probably on your own time...), most/all Orthopods like the enthusiasm. Most likely, you will stand in the corner at first but this is your "foot in the door" to becoming a First Assist (more on this latter). You just cannot appreciate the musculoskeletal system until you see it dissected...

6. Never stop learning...

v/r

ONP-C

mmc51264, BSN, MSN, RN · Jul 23, 2015

what PP said!

Wonderlost · Jul 24, 2015

Hey there!

Congrats on the job :) I'm not a RN yet, but I worked in an orthopaedic hospital for a year as a CNA, mainly on the total joint replacement unit, but I also had to go to the spine unit as well. I can offer a few tips from my perspective as a CNA, I hope it helps you out!

Watching a surgery is a great idea, I got to watch a total knee replacement and it really puts into perspective the kind of pain these patients are in. In my opinion, it is not an easy unit to work on bc the patients are always calling out to be turned and get pain meds, and just seeing the surgery helped me to understand that they weren't always being a little dramatic.

A lot of patients will get confused after the surgery just because of the drugs, which I guess is true for all surgeries, but it's worse on the ortho unit since they have really limited mobility and are high fall risks. Make sure you learn how to use the alarms on the beds, picking up a several hundred pound knee replacement patient off the ground is no fun. I once had a guy leap out of the bed and try to strangle me because he thought I was robbing his apartment, and he moved so fast that you wouldn't be able to tell he had surgery a day before but he was so unsteady he would of fallen over had he not grabbed onto me, lol.

Carrying on with the confusion thing, I don't know what it was about this particular hospital, but we would have a ton of people withdrawing from alcohol. I guess they were embarrassed to admit it to the admitting nurse before their surgery, and they'd end up withdrawing. A little trick I learned from my house supervisor was to ask them what they wanted to drink, and often times they would say things like Pabst Blue Ribbon or wine. Personally I think it's helpful, you can be kind of preemptive and get them started on CIWAS or whatever protocol the hospital uses for alcohol withdrawals.

A lot of times the patients will have drains in their sites (we called them hemovacs) and I noticed that the tubing can get pulled out from the actual vacuum container really easily, so putting some tape around it is a huge help so you don't find a bed full of blood on a 2 hour round. Also, and this is something I didn't know until recently, but the tubing can get clogged and you may think they are done draining but when you go to pull them out (I did not do this as a CNA, it was the RN's duty) it will end up shooting blood across the bed and floor so always be wary.

Spine patients were my least favorite, they complained way more and seemed to have the most post op issues. They can never get comfortable and seem to call out more for meds, and we usually had to reinsert catheters on them more often than the joint replacement patients. Just be prepared to be turning these people all night long, and definitely utilize ice packs with them.

Probably the best advice I can give is to be friendly to your CNA's and be prepared for a lot of physical work. Orthopedics is very physically demanding for the RN's and CNA's and they are very needy patients. A typical night for me was taking Q4 vital signs on 8-12 patients a night, walking people to the bathroom all night long, turning people, placing and removing catheters, emptying drains as needed, I was constantly moving for 12 hours. The nurses were doing full body assessments changing dressings and removing drains, constantly giving medicines (esp pain meds), sometimes they would have to report to dr's how the patients were doing depending on which doc did the surgery, and always be prepared for an admit from the ED. You will get a lot of little old ladies with fractured hips, esp from nursing homes.

The night was always so much smoother when the nurse and the CNA support each other. Don't be scared to delegate to your CNA's. In my state, I am able to place and remove catheters, remove IV's, do some wound care if the wound is over 48 hours old, and a few other nursing procedures. It will make your load easier and it is good experience for a CNA going to nursing school. In exchange, just help out with taking patients to the bathroom and taking vital signs, and other things that the CNA normally does. If you're busy, walk them to the bedside commode and tell the CNA you put them there and we can take them off.

I hope this helps you some! Let me know if you have any other questions and I will answer them as best I can. There are a lot of precautions you will need to know for the different types of hip replacements and knee replacements, as well as precautions for spine patients, but I think it is best to learn those on the unit so you can actually see what needs to be done. The physical therapists should be able to show and explain all of them to you, and PT will give you a ton of tips on how to move patients around and ways you can kinda "test" to see if they have the strength to get out of bed before moving them. Good luck!

guest08/02 · Aug 1, 2015

I work on the same type of unit. We became a level 2 trauma unit 2 years ago, and since we were the surgical/ortho floor they became apart of us. I would suggest you joining NAON. They will be a great resource for you as you learn ortho and it will not only help you with total joints but with trauma also. If you are like us, most of the traumas have some type of orthopaedic injury too. The NAON Core Curriculum will be a great resource for you on all things orthopaedic nursing. NAON currently offers members 6 free webinars a year, there was one not long ago on hand trauma. Even if you join know you can go back and watch all the webinars that we have had this year. NAON also has a new committee that focuses on new nurses, and they would be a great resource. Unlike you I was a little intimidated by the trauma side, but I posted questions on our members forums, read about trauma in our Core and networked with ortho nurses who dealt with trauma. You can too, but you have to join first, Good luck and let me know if we can help.

rob

mmc51264, BSN, MSN, RN · Aug 2, 2015

I looked up the executives of NAON and if you are the president, whose name is indeed Rob, I find your aggressiveness a little off-putting. It is fine to let people know about the association, but you have answered the top 5 post with an advertisement to join NAON and/or purchase something from them. I am a member and there are a lot of kinks to work out with ONCB and the testing service of AMP before you solicit more members. Not too mention the pricey materials as well.

It is kind of embarrassing as an ortho certified nurse to see such behavior from the president of the organization behaving in a seemingly desperate attempt to get members. Maybe more effort at the local chapter level would boost membership.

springchick1, ADN, RN · Aug 2, 2015

I looked up the executives of NAON and if you are the president, whose name is indeed Rob, I find your aggressiveness a little off-putting. It is fine to let people know about the association, but you have answered the top 5 post with an advertisement to join NAON and/or purchase something from them. I am a member and there are a lot of kinks to work out with ONCB and the testing service of AMP before you solicit more members. Not too mention the pricey materials as well.
It is kind of embarrassing as an ortho certified nurse to see such behavior from the president of the organization behaving in a seemingly desperate attempt to get members. Maybe more effort at the local chapter level would boost membership.

I didn't find his response aggressive or off-putting in the least. I actually found your response a little rude. You asked for "tips, advice, books, organizations I can join to learn more, and any all knowledge". That's exactly what he offered. The organization he is talking about has everything you are asking for, including access to old webinars.

I don't think it's embarrassing at all for him to share this information. What I do find embarrassing is someone acting the way you are acting to someone who is trying to help them.

mmc51264, BSN, MSN, RN · Aug 2, 2015

I was not OP. If you look at the other posts PP posted in this forum, all are solicitations to join or purchase NAON products, which I believe violates TOS. If I am wrong, then I apologize, but I stand by my opinion that this is not the place for soliciting membership.

I am ortho certified and an active member of NAON and I have the right to have an opinion on how the organization is portrayed.

springchick1, ADN, RN · Aug 2, 2015

Sorry about that. That's my fault. I still don't think there was anything wrong with the post. To me, it sounds like he's just giving information about the organization. I don't feel like he was pushing membership. And yes, you do have the right to have an opinion on how an organization is portrayed. It's just my opinion that he was passing info to the OP.

BonerRN · Aug 3, 2015

This is a great site, I'm glad I found it. I am kind of new to ortho, just over two years and did not know about NAON to reading some of the treads here. I was glad for the information and did go to their site to see what it was about and how to join. In school they talked about joining a professional association but to me ANA and my State one's cost were high and I did not see what I really got for it. But I can see some of the benefits of being in the orthopaedic nursing one, I would like to be certified one day, any advise on studying for the test, how long should I study.

thanks

mmc51264, BSN, MSN, RN · Aug 3, 2015

I studied about 3 weeks, 3-4 hours a day. I did NOT buy the Core curriculum for $150.00. I did buy the CD-ROM practice questions and I did them over and over until I got them right. I also looked anything I did not know until I understood it. I did attend a review course that just happened to be hosted by my hospital which gave me a review PP.

If you have been working on an ortho floor for 2 years and did not know about NAON, then where is your clinical lead team? Are none of your nurses ortho certified? Being certified is one the requirements for our clinical ladder.

soulshine101 · Aug 13, 2015

I studied about 3 weeks, 3-4 hours a day. I did NOT buy the Core curriculum for $150.00. I did buy the CD-ROM practice questions and I did them over and over until I got them right. I also looked anything I did not know until I understood it. I did attend a review course that just happened to be hosted by my hospital which gave me a review PP.
If you have been working on an ortho floor for 2 years and did not know about NAON, then where is your clinical lead team? Are none of your nurses ortho certified? Being certified is one the requirements for our clinical ladder.

To become certified, is it just ortho certified or ortho trauma certified. Sorry if this seems like a stupid question. Just trying to learn the ins and outs. Thanks everyone for all the information!!!