Interested in specializing in orthopedic nursing

GypsyRN16 · Oct 2, 2013

Hi Turner76! Congrats on starting your nursing studies, its a hot field right now so you're already ahead of the pack!

I am a relatively new nurse on an ortho floor and I love it. I am unsure of the type of hospital you are looking at but if you're in a hospital with sought after surgical service, expect a faced-paced environment with a lot of turn over. If patients are stable, they generally do not stay on the unit for more than 3 days, some even are discharged POD2. Much of postoperative work is also pain management, but many patients are coming out of the OR with PCA pumps which is helpful, but you still need to monitor pain and respirations. A fair amount of heavy lifting, assisting patients to the bathroom/bedside commode, placing patients on CPMs (which are passive motion devices and are quite heavy). Similar to what you learn in school, patients who are bed bound are more suseptible to bone degeneration, so we get patients up same day of surgery or POD1 to make sure their are actively promoting bone regeneration. Many hospitals now are being very strict with following the Joint Commission's standards for patient outcomes, so you are following strict protocol follow MDs orders in regards to giving anticoagulants, antibiotics and betablockers at the appropriate times, so if you're a "type A personality" and like structure this is a good area for you. Also, you get to work closely with the surgeons, its a good experience for professional reasons.

Overall, it is a positive experience. My negative experiences on the unit are sometimes medical issues become secondary to ortho issues, but I make it a prerogative to not. Always be aware of a patient with an underlying CHF, COPD, DM or any other issues that may affect their postoperative status. Also, ortho floors keep a close eye on H&H, PT/INR but I think its important to recognize other labs that are abnormal to be alert of any electrolyte imbalances to be the MD aware of.

I think ortho is a good specialty as a new grad. And it gives you experience into the surgical services which is great for professional trajectory (PACU, OR, trauma ICU, ED).

Good luck! Feel free to ask anymore questions!

DaddyO · Oct 8, 2013

Gypsy seems to have covered it. Good reply...

only thing I can add is that we follow protocols...like the timing of removing Foley Catheter and Drains (Hemovac, JP and Stryker) and dressing changes. Foley removal is usually POD 1(6-8hrs to void, if not scan bladder and possibily straight cath,), Fluids are usually discontinued once the Pt is back to eating...but keep fluids running until the first void.

Dressing changes on knees POD #2, Hips POD #1,

Drains usually POD#1 unless there is a lot of draining. the stryker drain is a reinfusing system...so you may find yourself reinfusing if there is a lot of blood draining as well (keep an eye on H/H).

Another big thing is the Antibiotics postop...which is usually 2 doses postop. With revisions.....Pts are on a cocktail of three antibiotics around the clock until cultures are in.

we are a Postop ortho floor. Other than jonts (knee and hip), we see Back, and upper limbs procedures. No anticoags for Back surgeries.....and the pain seems to be more challenging to manage than the joints. In many cases this can be due to Pt's being on pain meds for a long period of time prior to having their procedure.

Motorcycle and car accidents, people jumping off of buildings, falling off ladders crushed on the trains...etc....are all on our floor. so you may see some challenging cases....not just those elective procedures.

We work closely with PT and OT prior to discharge. when Pt's are off the PCA or PCEA pumps......you may need to call the MD or Pain mgmt. residents.....if the ordered meds are not adequate or for a 1x break thru order.

Older Pt's are more likely to have Ultram ordered....but Percocet and Roxicodone is what is mostly used after the pumps are removed and making the transition to PO meds.

Most Pt's have pre-existing medical issues....diabetic, hypertension...etc....so this is when your other skills outside of Ortho will come into play. unfortunately with cardiac meds....MDs do not always put parameters in. I deal with Pt's that have dementia/Alzheimer, and there are certain meds that should not be given, not to mention may need to have a sitter ordered for their safety.

Lastly, I am a male nurse......and like Gyspy stated....we do a LOT of pulling and lifting on the floor. So definitely watch your back and how you lift.

turner76 · Oct 24, 2013

Thank you both so much for all the information! There is so much for me to learn still, but ortho seems to be a good fit for me from what you two are telling me. I definitely enjoy structure like Gyspy said it would be. I still have time to really figure out what I want to do. I am just so fascinated by it and have been since I had knee surgery. I had a great experience with my doctor and all of the nurses that were around. I am really looking forward to growing as a nurse and excited to see what this adventure will bring.