What is an Orthopedic Nurse?
In the last few decades, orthopedic nursing (more formally known as orthopaedic nursing) has become one of the fastest growing careers in healthcare. The nursing specialty focuses on musculoskeletal disorders and diseases, including arthritis, osteoporosis, fractures, broken bones, joint replacements, and genetic malformations.
“The demand for orthopedic nursing has grown and patient population growth is one of the reasons,” says Tandy Gabbert, MSN, RN, ONC, director of education for the National Association of Orthopaedic Nurses. “Life expectancy is longer than it used to be, but health expectancy is not, so people who live to be 90 can still be fraught with musculoskeletal conditions. We do one and a half million total joint arthroplasties (joint augmentations or replacements) a year in this country. We’re going to do more than that in future years.”
Steps to Become an Orthopedic Nurse
Make sure this job is right for you.
As an orthopedic nurse, you’ll often be working with patients before, during, and after invasive surgeries. They may be afraid, in pain, and in need of help moving. You’ll want to be sure you’re comfortable working in operating rooms and surgical suites.
Earn your nursing degree.
Enter either a two-year Associate Degree in Nursing (ADN) or four-year Bachelor of Science in Nursing (BSN) program. You’ll want to be sure you attend an accredited school and program. If you don’t, your credits may not be recognized should you want to transfer schools, and you won’t be eligible to take the exam required to become an RN.
Take and pass the NCLEX.
The NCLEX, or National Council Licensure Examination, is the test nursing school graduates must pass in order to earn their RN license. The test covers a variety of nursing-related topics and is a computerized exam that includes mostly multiple-choice questions.
Get licensed as an RN.
Once you’ve passed the NCLEX, you’ll work with your state’s nursing board to fulfill any other requirements and get licensed.
Gain real-world experience in the field.
As an RN looking to work in orthopedics, you’ll typically want to gain experience in a department or facility that focuses on orthopedics such as a surgical unit, emergency department, or long-term care facility. Some orthopedic employers prefer to hire nurses with experience. Don’t let that deter you: Many will hire new nurses who wish to gain experience in the field and become certified.
To increase knowledge and demonstrate a commitment to excellence in the field, consider pursuing an optional orthopedic nursing certification, which requires nurses to fulfill a certain number of hours of work experience. The more experience you have, the quicker you will fulfill your certification hours.
“How long it takes to become an orthopedic nurse really depends on the organization that hires and the nursing school that trains—both have a lot of responsibility for the growth of that new nurse,” says Gabbert. “It’s important for a nurse who is getting ready to graduate to ask about the process. It could be as little as three months, and it could be less if someone has experience and worked in a hospital setting before they graduated.”
While earning a certification as an orthopedic nurse will help demonstrate your skills and commitment to the specialty, it is not required for a new orthopedic nurse in most settings. According to Gabbert, since certification requirements include a set number of practice hours, hospital and clinical settings expect to hire many new nurses without certification.
Still, many new nurses do pursue certification.
“Certification is the gold standard,” Gabbert says. “There’s a lot to be said for a nursing unit where 80% of nurses are certified. It adds to that ability to promote the magnet status of the hospital and keeps staff up on current practice. It promotes the nurse, promotes the profession, and actually improves care. There are many programs that have done research to identify an improvement in patient outcomes.”
Orthopedic nurses working as RNs may pursue the Orthopaedic Nursing Certification (ONC), which requires two full years and 1,000 hours of experience to be considered for the exam:
Two other certifications are available for nurses working as advanced practice registered nurses (APRNs), who hold a master’s or doctoral degree:
What Do Orthopedic Nurses Do?
Trained in pain management, casting, traction, and mobility devices, orthopedic nurses support physicians and patients with pre and postoperative care and even assist in the operating room. Unlike more traditional nursing roles like home health and rehabilitation that only support patients in recovery, orthopedic nurses are more typically found in acute settings and help patients before, during, and after surgery.
Orthopedic nurses commonly support conditions that affect:
As an orthopedic nurse, you will commonly support patients by:
For an orthopedic nurse, caring for patients with musculoskeletal conditions, traumas, and injuries requires a good memory, skillful hands, empathy, and calm, compassionate communication.
“A patient who just had surgery and has taken narcotics has a limited threshold in terms of what kind of medicine is going to make them feel better, so that ability to communicate well, to be able to explain things, and also to have that calming influence is essential,” says Gabbert. “People in the hospital are vulnerable, and recognizing that is essential to the orthopedic nurse.”
Within a hospital setting, you will typically find many subtypes of orthopedic nurses, including supervisors, researchers, and nurse managers. Other orthopedic nursing positions include:
Orthopedic nurses serve patients of all ages. Depending on the type of nursing required, orthopedic nurses work in a variety of specialized and fast-paced environments. Orthopedic nurses in a clinic or outpatient setting more commonly work during the day, while those in a hospital setting may work a day, evening, or night shift. Workplaces may include:
A Day in the Life: Orthopedic Nurse in a Hospital Orthopedic Unit
The U.S. Bureau of Labor Statistics reports that the median annual wage in 2021 for registered nurses, including those who work in orthopedics, was $77,600. Here are median annual salaries for RNs by state.
Median Salary: $77,600
Projected job growth: 6.2%
10th Percentile: $59,450
25th Percentile: $61,790
75th Percentile: $97,580
90th Percentile: $120,250
Projected job growth: 6.2%
|State||Median Salary||Bottom 10%||Top 10%|
|District of Columbia||$95,220||$62,700||$129,670|
Source: U.S. Bureau of Labor Statistics (BLS) 2021 median salary; projected job growth through 2031. Actual salaries vary depending on location, level of education, years of experience, work environment, and other factors. Salaries may differ even more for those who are self-employed or work part time.
Although income will vary based on practice setting, experience, licensure, location, certification, and specialized skills, the BLS noted that RNs who worked in general medical and surgical hospitals earned an average of $85,020, while those who worked for nursing care facilities earned $72,260. In contrast, orthopedic nurse practitioners, who are advanced practice registered nurses with either a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) degree, earn an average of $120,680.
“Stark pay differences come when there are educational differences,” says Gabbert. “An orthopedic nurse practitioner’s salary is (considerably higher than) an orthopedic staff nurse’s salary based on the level of advanced skills. Their experience can be considered halfway between the staff nurse and physician.”
Gabbert adds that an RN or nurse practitioner specializing in orthopedics may make more than a non-specialized nurse because of the advanced skills and experience required, which is comparable to other specialties such as telemetry or med-surg.
The demand for orthopedic nurses is expected to continue to grow as the population ages and requires specialized orthopedic surgery and care for issues such as hip replacements and arthritis. According to Gabbert, health can vary greatly even amongst individuals of the same age due to poor health equity and socio-economic issues. These social determinants of health will be increasingly important in promoting equity and inclusivity in healthcare and have the potential to influence, improve, and increase care for aging populations.
“There are more orthopedic procedures all the time, increasing the demand for nurses,” Gabbert says. “Orthopedic departments don’t mind starting with someone who is fresh out of school,” she adds.
According to the BLS, job growth of all registered nurses is expected to increase by 6 percent through 2031. This is good news for those looking to enter the field, especially when considering more than one million nurses will reach retirement age over the next 10 to 15 years, according to the Federal Health Resources and Services Administration.
To stay up-to-date with the latest resources and evidence-based practices in the field, Gabbert recommends connecting with your local nursing chapter. Other resources include:
National Association of Orthopedic Nurses: Professional tools, resources, collaboration, and education for current and prospective nurses. Helps students better understand the profession through live education courses, certification prep, and education to prepare nurses to grow into management, talk collaboratively with colleagues of different professions, improve patient outcomes, and improve evidence-based practice.
Orthopaedic Nurses Certification Board: The professional organization responsible for certification of all orthopedic nurses. Learn more about ONC, ONP-C, and ONC-A exams and certification.
National Student Nurses Association: A membership organization fostering professional development of student nurses of all disciplines.
Orthopaedic Nursing: This peer-reviewed journal is a helpful reference for those in the field. It can be printed or accessed online.
American Academy of Orthopedic Surgeons (AAOS): A helpful resource for orthopedic patients and professionals to learn about the most up-to-date surgical information and evidence-based best practices.