Some nurses decide to work in specialized forms of care. Sarah Gagner RN, a nurse that works at the Hoag Orthopedic Institute in southern California chose a career in the orthopedic specialty of nursing. While some may think that working in a doctor’s office could prove overly repetitive, Sarah sees her job in a much different light. Sarah explains to us that while many of the surgical procedures they see are repetitive, each patient is different in their specific needs and care demands.
We asked Sarah to spend some time with us to explore the career of an orthopedic nurse. She was very gracious with her time and helped us to put together this wonderful interview as a result.
How did you find your way into the Orthopedic nursing field?
I found my way in the orthopedic nursing field because I have an interest in physical activity and exercise science. Specifically, I have a background in Kinesiology and transitioning to orthopedic nursing was an extension of my previous training.
What are some of the common cases you see working in the Orthopedic nursing setting?
The most common cases we see working in orthopedics are hip and knee replacements; which are scheduled as elective surgical procedures. As such, the patients’ length of stay is much shorter than that of an unplanned hospital admission.
Can you give us an idea of what your duties are in the Orthopedic setting? A bit of a 9-5 of rehab nurses day?
As with any surgical procedure we are concerned with the patient at as a whole; so while they are there specifically for joint replacement we also focus on helping the patient return to an optimal state of health. We encourage patients and their families to think of their hospitalization as their temporary home. The day starts off with breakfast, with patients assisted to a chair to eat their meals sitting up, rather than in bed. We focus on early ambulation and mobilization; working closely with our physical therapists to increase the physical activity of our patients. During breakfast the patients will be given pain medication which helps to improve their involvement with physical therapy. Patients that are medicated appropriately have better participation in physical therapy and have an increase their range of motion. After physical therapy patients are allowed to rest, some are placed with assistive equipment that will continue their exercise in bed. Lunch is served mid-day, and then after lunch physical therapy will see the patient for a second session. Throughout the day, the nurse is assessing the patient for their level of pain, educating the patient regarding their post-operative care and assisting the families in caring for their loved ones.
What specialty skills are often utilized in Orthopedic nursing that you don’t use as much in other nursing departments?
In contrast to other nursing departments, the majority of our cases are elective; the patients and their families have had time to plan and make arrangements for their hospitalization. Orthopedic departments tend to use more equipment than in other nursing units. For example, a typical knee replacement patient will have an overhead trapeze frame attached to the bed and a continuous passive motion machine (CPM). A knee brace will be utilized when they ambulate, and all patients use a walker. In addition to the equipment there are also specialized intravenous lines and surgical drains. Continuous femoral nerve blocks (CFNB) are used to assist with pain control. A surgeon may place an Orthopat device (a specialized drain that allows for autologous blood reinfusion) or a hemovac drain; each of which are maintained by the nurse in the post-operative unit.
Is it difficult to get your foot in the door as an Orthopedic nurse? How did you do it?
As with any other nursing departments; the demand for orthopedic nurses fluctuates. It is not any more difficult to get your foot in the door than other nursing units. A typical orthopedic unit is classified as medical-surgical units, and medical-surgical units offer a strong foundation for those just starting their nursing career. I started on a medical-surgical unit that specialized in neurological/orthopedics; I was there for three years and built a strong base of knowledge regarding different types of patients. I then transferred to a department that was strictly orthopedics; because I found that I really like orthopedic patients.
What it is about working with Orthopedic cases that challenges you and fulfills you?
The challenge of working in orthopedics is that while we see the same type of surgeries, each patient is different. In a typical day, I may have three patients that have all had their knee replaced; the same surgery and yet they are all different. They all have different struggles, conditions and will progress at different speeds. It is very fulfilling working in a unit with such tangible problems and results. By this I mean; a patient comes in with a severely arthritic knee and has it replaced. Now that the problem is “fixed” we can focus on returning the patient to their usual state of health.
Do you have a heart warming story you can share that has been one of your favorite cases you have had thus far?
There is always something memorable about helping people increase their functional mobility and improve their quality of life; the smile on their face when they walk without debilitating pain for the first time in years or their kind words of heartfelt thanks. One case in particular stands out. I took care of a patient who had her hip replaced, stayed for about three days and then was discharged home. She had had many years of chronic and activity restricting pain. Previously very active, with a healthy social life, she had been unable to participate in things she used to enjoy. After a couple of weeks I called her at home, with some routine follow up questions regarding her recovery. Her husband answered when I called, asking to speak with her I became slightly concerned when he replied “I don’t think that will be possible.” I questioned whether everything was ok; he laughed and stated that she was too busy and, was out with her friends! He went on to say that she had been at her bridge game earlier that morning and was currently out to lunch with some friends, and later that night had planned an evening out at her local church. It was wonderful to hear that her recovery had gone so well; stories like these make me feel like I have helped to make a difference in someone’s life.
Any final words of wisdom for nurses looking to transition into Orthopedics?
If you are looking to transition into orthopedics, be prepared to make a big impact in a short period of time. It is also a very physically demanding unit; you will be moving patients, lifting patients, moving equipment and assisting patients with ambulation. Best of luck to those of you pursuing a career in orthopedic nursing!