What is an Orthopedic Nurse?

orthopedic nurse with patient
orthopedic nurse with patient

Quick Look: Orthopedic Nurse

What you’ll do: Care for patients with musculoskeletal disorders and diseases

Where you’ll work: Hospitals, emergency rooms, specialty medical offices, long-term care centers

Degree you’ll need: Registered nurse (RN) with an Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) degree

Median annual salary: $75,330


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

Nurses looking to explore orthopedics can benefit from experience working in emergency rooms, surgical suites, and critical care departments. But first, you’ll need to complete your education.

woman doing research on laptop

1: 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 with mobility. You’ll want to be sure you’re comfortable working in operating rooms and surgical suites.

students wearing scrubs take notes in classroom

2: 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.

woman taking test on laptop computer

3: 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.

registered nurse talking with patient

4: 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.

orthopedic nurse working with patient

5: 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.

nurse helping patient with paperwork

6: Get certified.

To increase knowledge and demonstrate a commitment to excellence in the field, consider pursuing an optional orthopedic nursing certification, which require 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.”

Certifications

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 involves two full years and 1,000 hours of experience in order to be considered for the exam:

  • Certification: Orthopaedic Nursing Certification (ONC)
  • Agency: Orthopaedic Nurses Certification Board
  • Prerequisites: RN license, two full years as an RN, 1,000 hours of RN work experience in orthopedic nursing within the past three years
  • About the Credential: This certification is the most popular among orthopedic nurses and requires the least schooling and training hours to achieve. This certification is most helpful for an orthopedic nurse in a bedside care provider role.

Two other certifications are available for nurses working as advanced practice registered nurses (APRNs) who hold a master’s or doctoral degree:

  • Certification: Orthopaedic Nurse Practitioner Certification (ONP-C)
  • Agency: Orthopaedic Nurses Certification Board
  • Prerequisites: RN license, Master’s level degree from an advanced nursing practice (APRN) program, minimum of 2,000 hours of APRN work experience in the last three years
  • About the Credential: This certification is helpful for those who wish to work as an orthopedic nurse practitioner (ONP). The certification tests the roles required of ONP’s, along with the knowledge of a variety of musculoskeletal conditions and injuries.
  • Certification: Orthopaedic Nursing Certification – Advanced Certification (ONC-A)
  • Agency: Orthopaedic Nurses Certification Board
  • Prerequisites: RN license, three full years as an RN, Master’s degree or higher in nursing (MSN MN, MNEd) or related discipline with direct involvement in musculoskeletal health (MPH, MBA, MNA, MHA), 2,500 hours of nursing experience in musculoskeletal health since completing the graduate degree, or within the last three years if degree completion was more than three years ago
  • About the Credential: This certification is helpful for those who wish to work as an orthopedic nurse with an advanced 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 impacting:

  • Joints
  • Bones
  • Tendons
  • Ligaments
  • Nerves
  • Muscles

As an orthopedic nurse, you will commonly support patients by:

  • Collecting detailed patient histories
  • Examining and prepping pre-operative patients
  • Assisting orthopedic surgeons during procedures
  • Examining post-operative patients
  • Administering medication
  • Educating patients and families
  • Assisting with continuous passive motion therapy
  • Caring for wounds and changing bandages
  • Setting fractures
  • Casting
  • Monitoring patients’ neurovascular status

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 Staff Nurse:

These staff nurses support patients with pre and post-operative care. They are bedside with patients and are attuned to their immediate needs, identifying and assessing a patient’s potential risk for complications. They may work a day or evening shift and hold a specific caseload based on the needs of their unit.

Orthopedic Surgical/Perioperative Nurse:

These nurses support surgical care teams in the operating room. Unless on an emergency or trauma unit, they will work daytime hours to assist with scheduled surgeries. Some surgical nurses specialize in open-heart surgery or gastric issues, while others assist in general surgical tasks such as monitoring vital signs, circulatory mechanisms, and breathing.

Within an orthopedic surgical unit, you may see a variety of different nurses assisting a surgery, including nurse administrators, scrub nurses, circulator nurses, and nursing assistants. Perioperative orthopedic nurses typically don’t leave the surgical unit for pre or post-op observation, but are tasked with the safety, planning, and monitoring of patients during surgery. Some perioperative orthopedic nurses should consider earning the Certified Perioperative Nurse (CNOR) certification from the Competency and Credentialing Institute.

Orthopedic Post-Anesthesia Care Unit (PACU) Nurse:

These nurses work exclusively in the PACU unit and help monitor patients in the critical pre and post-operative hours. These nurses assess and care for patients recovering from general anesthesia and IV sedation and support the transition onto the recovery floor.

Orthopedic Occupational/Navigator Nurse:

These nurses do not take a caseload of patients like a staff nurse does, but they do support patient education with one-on-one council and classes and help patients move through the continuum of care. These nurses commonly work a day or evening shift to support pre-operative patients prepare for surgery and assist with discharge planning. Pre-operative education often includes informing the patient of post-surgical assessments and behavioral expectations such as alerting the nurse to pain, not using the bathroom alone, and what IV’s and dressings to expect. Thus, navigators serve an imperative role in advocacy, encouragement, and education.

Workplaces

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:

  • Emergency rooms
  • Trauma units
  • Surgical units
  • Orthopedic units or specialty offices
  • Outpatient surgical practices and care clinics
  • Ambulatory infusion centers
  • Long-term care centers
  • Home health care agencies
  • Nursing homes
  • Sports medicine practices
  • Rehabilitation facilities
  • Pediatric units
  • Oncology units

A Day in the Life: Orthopedic Nurse in a Hospital Orthopedic Unit

6:50 a.m.
As an orthopedic staff nurse in a hospital setting, you will typically work three, 12-hour shifts and your patient ratios will be determined at the organizational level. A typical morning might involve coming to work a few minutes early to receive any time-sensitive patient information from the outgoing shift nurses. You might also take this time to say hello to any patients from the previous day who may not be on your caseload today.

7 a.m.
After consulting your staffing matrix and evaluating your assignment and caseload for the day, you participate in interdisciplinary walking rounds during which you huddle at a patient’s bedside or at the nursing station with the incoming and outgoing care team. Most units find it works best when the report is done in the patient’s room with family (if available) so the outgoing nurse can say goodbye and the incoming nurse can more clearly understand the patient and family needs.

8 a.m.
You orient a new patient and their family to the details of their surgery this morning. You know you will care for this patient after surgery and want to make sure they understand what to expect of post-operative care and recovery.  

Noon
Your patient has returned from surgery, so you conduct a neurovascular assessment on your patent’s legs and lower extremities. You start by looking for a pulse on the top of the foot to test blood circulation. You pinch to see how quickly blood returns to the toenails and assess circulation behind the knee. You look for other signs of deep vein thrombosis or blood clots and make a plan for continued daily monitoring.

2 p.m.
Medication administration and assessment is an important part of your job. You administer medication to your patient for pain management, nausea, and post-op urinary retention. You evaluate how your patient is tolerating the medications and consult with your care team.

4 p.m.
As a nurse, you know the longer a patient stays in the hospital the more likely they are to have complications. Since the hospital is not the safest refuge for recovery, you discuss discharge with the post-operative patient and their family. You consult with an orthopedic nurse navigator and others from your care team about resources to aid in recovery and the transition home. 

6 p.m.
You manage surgical drains and change dressings for your patient who had surgery this morning. You consult with a physical therapist and occupational therapist to help support the patient’s aftercare plan. As you assess the patient, you see signs of a potential blood clot and immediately consult the care team.

6:50 p.m.
You say goodbye to all your patients for the day and connect with an incoming orthopedic nurse about your patient with potential blood clotting. You share the care plan, the family’s concerns, and the discharge plan. You head home for a good night’s rest and look forward to connecting with your patient on your shift tomorrow.

Salary

The U.S. Bureau of Labor Statistics reports that the median annual wage in 2020 for registered nurses, including those who work in orthopedics, was $75,330. 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 $81,680, while those who worked for nursing care facilities earned $72,090. 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 $156,160.

“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.

What’s the Difference: Orthopedic Nurse vs Orthopedic Nurse Practitioner


Degree needed:

Orthopedic Nurse:
ADN or BSN

Orthopedic Nurse Practitioner:
ADN or BSN, plus MSN or DNP from an APRN program

License needed:

Orthopedic Nurse:
RN

Orthopedic Nurse Practitioner:
RN and NP

Certifications needed:

Orthopedic Nurse:
ONC through ONCB

Orthopedic Nurse Practitioner:
ONP-C through ONCB

Certification requirements:

Orthopedic Nurse:
Most commonly an orthopedic nurse will have or be working toward an Orthopaedic Nursing Certification (ONC). Requirements include an RN license, two full years as an RN, and 1,000 hours of RN work experience in orthopedic nursing within the past three years.

Orthopedic Nurse Practitioner:
An orthopedic nurse practitioner will have or be working toward an Orthopaedic Nurse Practitioner Certification (ONP-C). Requirements include an RN license, a Master’s level degree from an APRN program, and a minimum of 2,000 hours of APRN work experience in the last three years. Certification must be renewed every five years through the board and each state may require additional fulfillment of continuing education contact hours.

Responsibilities:

Orthopedic Nurse:
Patient assessment through mostly monitoring, assisting doctors, treating injuries, pain management

Orthopedic Nurse Practitioner:
More complex assessment, experience identifying a problem and making a differential diagnosis

Workplaces:

Orthopedic Nurse:
Inpatient and outpatient medical settings, hospitals, surgical units

Orthopedic Nurse Practitioner:
Inpatient and outpatient medical settings, hospitals, surgical units

Career Outlook

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 9% between 2020 and 2030. 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.

Professional Resources

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.


erin draper

Written and reported by:

Erin Baldwin Draper

Contributing Writer

tandy gabbert

With professional insight from:

Tandy Gabbert, MSN, RN, ONC

Director of Education, National Association of Orthopaedic Nurses