Orthopedics

I am a junior in nursing school and I'm more than halfway done. I love nursing, and i still do, however after 3 years of physical therapy and 2 ACL surgeries, I have just discovered that I have a huge interest in orthopedics. Physical Therapy interests me, orthopedic surgieries interest me, fractures and muscle and ligament injuries fascinate me as well. Is there any type of advanced practice degree, most nursing practioner but even clinical specialist, that would allow me to work in a sort of sports medicine field or assessing/diagnosing/treating orthopedic injuries? Before I finish out this degree I want to have an idea of where I'm going with this, and I'm realizing that my interest in orthopedics is something I can't ignore.

Go to the dark side;).

David Carpenter, PA-C

Dare we think to consider PA school? Not out of the question, but depends on school availability and the particular state as usual. I have been interested to see the changes / advances that PAs have made for their practices legislatively, and NPs continue to plug away as well. I do not see any advantage to clinical specialist. Can someone clarify that for me?

Clinical specialist is a wild card. You can get more information on the CNS page, but in some states they have the same scope as a NP, in some states they have a primary educational role (both staff and patient) and in some states they are not recognized as ANPs.

As far as ortho its kind of like CNM for deliveries. There are PAs that deliver babies but there are many many more CNM. Ortho is the same way. There are some NPs (and CNS in some cases) that work in orthopedic surgery but the great majority are PAs. 10% of all PAs work in orthopedic surgery. You might get a job in orthopedics as an NP but it will be much easier as a PA.

David Carpenter, PA-C

I hate to push people towards PA school when I'm pro-nursing! However, in the orthopedics offices that serve our hospital (rounding, surgery, etc...) they typically employ PAs.

But wait! Before you make any decisions... take the time to talk to the MDs of these practices. I'm leaning towards a Pulmonary group who only employs PAs. When I indicated my interest in fulfilling some clinical hours with them, the MDs all tell me that they aren't opposed to hiring NPs, but that none have ever applied to the practice! As a FNP I can offer more than the basic pulmonary care... I can serve as their primary care provider with a focus on respiratory issues.

Our "attending" Neurosurgery MDs in my ICU utilize a NP. The other groups use PAs. They're all good! Just be sure your license allows you to practice within that scope.

Best of luck to you!!! Keep us posted on your decision!

Its really not about being pro-nursing, its about realistically assessing the situation. Ortho physicians train with PAs, almost every practice has PAs. They are going to hire the product they are familiar with which is usually not NPs.

I've told more than a few RNs here wondering about PA school that NP would be a better choice. I've even told a few PA want-to-bes on the other forum that they would be better served in NP school. Surgery is one area that your chances are going to be better as a PA than an NP if you want to work in the OR. The statistics pretty much show that. You can argue whether its scope, or other barriers to practice but bottom line there are 35 PAs working in surgery for every NP (depending on whose numbers you like).

On the other hand even if someone is sure that they are going into ortho they may very well end up somewhere else. After all I was sure I was going into neurosurgery and ended up in Peds GI in my first job;).

David Carpenter, PA-C

discombobulated86,

i am currently a nurse for a very busy orthopaedic surgeon who specializes in total joint replacements. i assist him with seeing patients pre-operatively, assisting him in the o.r., and seeing the patients post-operatively. he does, however, do many other surgeries like acl reconstructions, etc. i started off on an ortho/neuro floor, and then came to work for this doctor. i was interested in becoming a first assist in order to bill for surgery, but my boss just hired a pa!

i will say that i love my job, and i love orthopaedics! but, now i feel ready to move on and am interested in becoming an acnp. this could also be a position created to work in a doctor's office if you are interested. hope this helps!

the real problem with the rnfa is billing. while you may be able to get credentialled with private insurances, you can't bill medicare or medicaid. if you are doing sports medicine with lots of private insurance that may not be as much of a problem, but typically total joint practices have a lot of medicare which would make this less than ideal. also, depending on the state seeing patients for follow up care without the surgeon being present can be problematic. a combination acnp and rnfa will solve most of these problems. the only program that i am aware of is the uab program:

http://www.uab.edu/images/sonimg/academic/msn/acute_care_adult_np_rnfa_12.07.pdf

david carpenter, pa-c