What's Ortho Nursing Like?

proudnurseRN · Jan 25, 2010

Ortho nursing.... mainly "older" pts. I wouldn't compare it to physical therapy... although PT and nursing have to work together. Typically our PT gets the patient up the first time and then gives us the heads up on whether the pt can make it to the BSC or BR, with or without a walker, with assist of 1 or 2...light assist or strong assist.

Lots of pain control. Lots of PCA and pain med pushes.

Have to keep up on the vitals and labs.

Several other health issues that the elderly usually have. Many pts with COPD, heart hx, etc.

I like ortho. Particularly the replacements. Typically clean surgeries that you see the person have a great deal of improvement in a few days. Don't care for the fx hips that come in... particularly when you see and elderly person lose their independence right in front of your eyes. Being told they have to go to a nursing home, even if just for extended therapy, does something to people. Sometimes you can just see the will to live leave right there.

NJNursing, ASN, RN · Jan 26, 2010

I didn't really choose it, I kind of got plunked into it, but I've stuck with it for over 2 years. It's busy with high turnover. People seldom stay more than 3-4 days for elective hips and knees. Hips are generally over 73 and knees are generally over 50. They can be needy depending on their pain tolerance, they can be resistant to therapy, they can get lazy and not do their incentive spirometers or their in bed PT's or be compliant with their anticoag therapy and end up with DVT's. It's a LOT of education and teaching and reinforcement. The anesthesia/pain meds can make them confused or crazy, especially in the elderly. Back patients are the worst and they're usually younger and needier. Then you'll get an occasional person with "intractable pain" or some BS like that which is apparently drug seeking because they're allergic to motrin, tylenol, morphine, percocet, vicoden and darvocet. And they need Benadryl with their Dilaudid, thank you very much. It can be aggravating, but when people come and they tell you that the surgical pain is far less than the pain that they were living with their degenrated hips/knees day to day, it's rewarding to give them that mobility back. To see the hope in their faces that they'll be able to walk their child down the aisle or attend their grandchild's christening or even just be able to function with family again is great.

I agree the hip fractures are tough, especially when they just fix them and not replace them. They often have a lot of extensive histories and you're treating a lot of stuff. It's a lot of pain management and keeping on top of hemoglobins, bun/creatinines. However, I know our floor is very esteemed amongst other med-surg floors because unlike the other floors, our pts are generally there by choice and not necessity. Joint replacements are elective surgery and it's not like the person who's in with cellulitis or appendicitis or clogged A-V fistulas or anything else like that. We work hard for our Joint Certification and are the bread and butter of med-surg. Not to toot our own horns.

Huseyin Kaleci · Nov 25, 2013

hi, i'm writing an orthopedic clinic ı working here. patients comes here and doctors are examing them if need an operation ı take their blood for pre- operative test after ı give an apointment for operation ı talk operation theater an decide operation time. they comes on morning operation day ı takes them and goes to inpatient services. when comes operation time ı goes operation theater ı calling sevices for patient. after ı talk to doctor and anesthesiologist to start operation. ı preparing operation room and orthopedic sets (drill,plate,screw etc.) after we operated patient if doctor ordered cast or splint ı do that. when patient going to services ı go with patient and checking bandages casts bleeding sutures usually post op 1st day patient walking and ı help and give education about how to do. ı havent good ver well english but ı hope ı can help you about this subject:)

mmc51264, BSN, MSN, RN · Nov 27, 2013

I am finishing my first year as an ortho nurse, I love it. You do have to have an understanding of what PT/OT do to help, but like proudnurseRN said, PT will tell you what you should be able to do. You have to know your anterior/posterior hip precautions and knee precautions. We get a lot of vascular pts that are candidates for amputations, osteomyelitis, and of course trauma (including GSW).

I find the biggest challenge is the older patient that cannot tolerate narcotic pain meds and have a tough time with pain. We use a lot of regionals for a short time post-op, but they have to come down at some point.

chinotto_21 · Nov 28, 2013

I've been working on an ortho floor for 9 months now and I've decided to leave. It's extremely demanding, both physically and mentally. We have a 36 bed unit and do hips, knees, fractures, ankles and spinal surgeries. We also get "off service pts" from geri, general surgery, internal medicine and oncology. Our typical assignment is 6 pts (with atleast one of them being an immediate post-op). On day shift, there are Physios and NA's but on evening and night shift, there is no additional help, the nurse is responsible for doing everything, from head to toe. I often work evenings and most days I barely have enough time to eat supper. I do not take a coffee break and often leave 30-40 mins after my shift (unpaid). It is by far the worst working conditions I have seen so far. In my 9 months being there I have seen atleast a dozen new nurses getting trained and quitting within their training period.

Anyways, this is my experience with ortho, and I realize that your own working conditions may vary greatly depending on your floor's budget and management. My only suggestion is that if you find that it's not for you, say it at the beginning. The longer you stay, the harder it will be for you to transfer to another unit/department

mmc51264, BSN, MSN, RN · Nov 29, 2013

6 is too many on an ortho floor. Our sister floor is a uro/gyn/ent and I volunteered to go there for 3 months to help out and to learn. It was invaluable for the many off service pts we get.

I hate that you are burned out because you are overworked.

DoeRN · Nov 29, 2013

I'm a float nurse and from my experience Ortho is extremely physically demanding and busy. It's my least favorite area to be floated too. Lots of PCA's, blocks, pain meds, patients who don't want to do anything for themselves. Lots of education (which I don't mind) but constant reinforcement. I'm always super tired and run down after being floated to Ortho. Thank goodness I can set my own schedule because I usually don't work the next day after being floated to the Ortho floor. Some people love working there. Last time I worked Ortho I had 6 of the neediest patients ever and the charge nurse was trying to give me a 7th patient. Um yeah I'm surprised I didn't get a call from my boss because I flat out refused the 7th patient that day.

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chinotto_21 · Nov 29, 2013

Actually 6 pts is our normal assignment. If a nurse calls in sick and they are unable to replace the sick call, we get 7 pts.

amandaRN411 · Dec 9, 2013

ORTHO nursing is physically demanding. And like one post earlier said, it's a lot of pain meds, pca's and pt usually works with the patient first. They will tell you how to move the patient and if they are a 1 person assist and so on. It's not so much that these patients are walkie talkies. It's the high acuity of the patients. On our floor, we only have 4-5 patients. And if we're desperately short we take 6. The usual length of stay is 3-4 days. Most of them are elderly patients. I haven't had a patient younger than 40. Usually these patients are very needy and sort of lose their will to live because of a loss of independence. But that's where ORTHO nurses come in to play. We must encourage them to heal and believe in themselves that they can do it. And we have to be a supporter. I have learned since working on ORTHO that you have to be am advocate for your patient more than usual.

julesjameson3333 · Sep 6, 2016

Thanks for posting this topic. I'm considering ortho as well given my background working for a chiropractor as a massage therapist and rehabilitative yoga instructor.

Knee replacements have come a long way!

Not to high jack this thread, but as far as master's degrees are concerned, do doc's utilize PA's or NP's more???

RainMom · Sep 16, 2016

Thanks for posting this topic. I'm considering ortho as well given my background working for a chiropractor as a massage therapist and rehabilitative yoga instructor.
Knee replacements have come a long way!
Not to high jack this thread, but as far as master's degrees are concerned, do doc's utilize PA's or NP's more???

Our primary ortho group uses PA's. I also came from working in a chiro office to ortho & love it (for the most part). I have since moved on to PACU but still do prn shifts.