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What is an Orthopedic Nurse Practitioner? (Answered by an NP)


Written By: Kasee Wiesen DNP, APRN, FNP-C

Have you ever wondered what is an orthopedic nurse practitioner? Do you like learning about musculoskeletal injuries or delivering care to patients with fractures? Are you interested in assisting with surgery or looking for variety in the workplace? If so, becoming an orthopedic NP may be for you!

Orthopedic nurse practitioners are a growing specialty. They deliver care to patients experiencing musculoskeletal problems. Some examples of common musculoskeletal problems include osteoarthritis, osteoporosis, fractures, and tendon or ligament injuries. The number of injuries or issues to the musculoskeletal system has steadily increased over the last several years, thus leading to the need for more practitioners to become orthopedic nurse practitioners to deliver care to this population.

Below, I provide you with information about what is an orthopedic nurse practitioner, how to become one, and other questions you may have.


What Does An Orthopedic Nurse Practitioner Do?


Have you ever wondered what does an orthopedic nurse practitioner do? Orthopedic NPs deliver care to patients suffering from musculoskeletal problems, including injury to tendons and ligaments. The orthopedic nurse practitioner's duties include obtaining a history from the patient to determine what happened and formulate a list of differentials and assess the patient to determine the next steps. After collecting the HPI and assessment date, they order diagnostic tests as indicated, interpret the tests, and initiate treatment. They will also follow up with the patient as needed to ensure they improve and the appropriate treatment plan is still in place.

Depending on where they work, orthopedic NPs may assist the orthopedic surgeon during surgery and see the patient pre-operatively and post-operatively. It is not uncommon for orthopedic NPs to round on their patients while in the hospital, which is usually done alongside the orthopedic surgeon.

Regardless of whether the orthopedic NP is caring for the patient in the hospital or the clinic, they work closely with the orthopedic surgeon when managing the patient's care. They also communicate frequently with the interdisciplinary team to ensure their patients receive the appropriate treatment and improve their clinical condition.


What Skills And Abilities Are Needed To Work As An Orthopedic NP?


To be an orthopedic nurse practitioner, you need various skills to be successful and ensure the best care possible to the patients. The skills range from interprofessional to leadership to clinical skills. All of these are necessary, and lacking one may affect the care delivered to the patient. Below, I have compiled a list of orthopedic nurse practitioner skills to be successful in no specific order.

1. Teamwork: Teamwork is critical in all aspects of healthcare, including orthopedics. It is not uncommon for the patient receiving treatment for the musculoskeletal problem to have multiple people/specialties involved to ensure all aspects of their medical problem are cared for. The orthopedic NP needs to be an active and positive team member to provide the best possible outcome for the patient.
2. Strong communication skills: Communication goes hand in hand with teamwork. The orthopedic NP needs to communicate with an interprofessional team to ensure the patient receives the best care possible. Communication also occurs between the patient, their family, and the orthopedic nurse practitioner as you will have to explain diagnoses and treatment plans to patients and their family members. Good communication between the patient and you will help improve the outcome for the patient.
3. Professional Development: The orthopedic NP must always want to grow in their skills and career. For the orthopedic NP to further develop their skills, they must set goals for themselves. Some organizations require this to be done annually, and if it is not needed, it is highly recommended to ensure you continue to grow as a practitioner. This is achieved through professional development, which includes completing various CEUs, which allows you to solidify skills, learn new skills, and stay current with trends and practice in orthopedics and healthcare.
4. Clinical Skills: Having the appropriate clinical skills is obvious. The orthopedic NP must be competent, confident, and utilize evidence-based practice when delivering care. Examples of what they must know include appropriately assessing multiple musculoskeletal problems and diagnosing and treating them. They must know how to interpret results from diagnostic imaging, including the next step for the patient. They must know how to assess wounds post-operatively to ensure no infection has developed. The orthopedic NP must stitch a wound, place and remove a cast, and know the appropriate brace/splint that should be used for each injury.

The list above is not comprehensive in regards to all skills needed to become an orthopedic nurse practitioner. This is a starting point and what I believe are a few of the essential skills to ensure competency, confidence, and success as an orthopedic NP.


Where Do Orthopedic Nurse Practitioners Work?


It is not uncommon for the orthopedic nurse practitioner to work in both the inpatient and outpatient settings. They can work for private practices or large organizations and may deliver care to people across the lifespan. They have a unique opportunity to see patients in the clinic and assist with surgery and round on patients in the hospital. This provides variety to your week, allowing you to use different skills in different settings. They may also work in rehabilitation facilities and for sports medicine practices. These settings allow the orthopedic NP to care for the patient from the time of injury or pain until they are discharged or "cleared" by orthopedics.


What Is The Typical Work Schedule For An Orthopedic NP?


The typical schedule for an orthopedic NP is variable, depending on the setting they work. Those working in both the inpatient and outpatient setting may work 4 10 hour days or five 8-hour days. They may also work three 4-hour days and one 10-hour day. There is a lot of variability due to the number of days you help with the surgery. Also, your schedule may not always be the same because on the days you assist with surgery, you may be done at 2 pm or not until 8 pm, depending on the caseload for the day.

If you work strictly in an office setting, whether an orthopedic clinic, rehabilitation clinic, or sports medicine, you may again work four 10-hour days or five 8-hour days.

One other point to consider is you may be on-call as an orthopedic nurse practitioner. This would not typically require you to go to the hospital (as that is usually the physician), but you may need to answer patient or long-term care facilities questions overnight or on the weekends. In most settings, you do not work weekends or holidays, but you would have a few weekends and holidays if you take a call.


What Is The Difference Between Orthopedic NP And Orthopedic Nurse?


A registered orthopedic nurse has the opportunity to work in a variety of settings. They may deliver care to patients suffering from a musculoskeletal problem in the hospital to working with patients in the outpatient or long-term care setting. The orthopedic RN assesses the patient, initiates treatment plans, evaluates the patient, and notifies the providers of patient status changes. In the hospital setting, they may also be caring for patients post-operatively, ensuring their recovery from surgery is going well. The orthopedic RN is a vital member of the interdisciplinary team. They play a crucial role in coordinating care for their patients and ensuring all specialties and support services are aware of what each other is doing to ensure the patient receives the best care possible. In both the inpatient and outpatient settings, the orthopedic RN answers questions for the patient and their family members.

Becoming an orthopedic NP provides a much broader scope of practice due to your education and passing the board certification exam. Orthopedic nurse practitioners can assess, diagnose, treat and evaluate patients suffering from a musculoskeletal condition. These conditions are diagnosed through interpretations of diagnostic tests such as x-ray, ct-scans, and MRIs. The treatment includes non-pharmacologic and pharmacologic medications, including physical therapy, ice or heat therapy, NSAIDs, non-controlled substances, and controlled substances. They also directly assist the surgeon with surgical procedures, can round on patients in the hospital, and follow up with outpatient patients to ensure the treatment plan initiated is helping. Their work setting may differ slightly from the RN because they may have the opportunity to work in the clinic, round on patients, and assist with surgery while working only in one position.

On a side note, both an orthopedic RN and an orthopedic NP can become certified orthopedic nurses. I discuss this certification below and also provide a link to the website.


Pros And Cons Of Becoming An Orthopedic Nurse Practitioner


There are many pros of becoming an orthopedic nurse practitioner. You get to specialize and deliver care to a population you have a great passion for and their overall outcome. This is unique, as not many people get to specialize in their true passion. Second, for the most part, you do not have to work weekends or holidays (again, though, this may be variable based on the job you accept). You may have to work a few longer days during the week, but the reward may be knowing you work in healthcare but have your weekends and holidays open. Another pro includes the opportunity to become a certified orthopedic nurse indicating your competence and dedication to your career. Not all NPs can become certified to provide credibility to their practice. In most job settings, you also get to work in various settings, including clinic, surgery, and possibly rounding on the inpatients after surgery. This provides variety to the workweek and schedule that many enjoy.

I do not believe there are cons to becoming an orthopedic nurse practitioner, but instead, some points to consider before accepting a job. It is important to note, depending on the position you accept, you may have to take the call. This is not an option for some people or something they want to do, dependent on their life outside. Another point to consider is the hours may be variable. For some people, this may not bother them, but others may need to know their set schedule to manage their lives outside of work.


How Long Does It Take To Become An Orthopedic Nurse Practitioner?


To become an orthopedic nurse practitioner, it takes on average 6-8 years which does not include obtaining a terminal degree or completing a fellowship program. Let's break that number down.

On average, it takes four years to complete your BSN through a traditional program. Obtaining your MSN will take another 2-4 years depending on where you attend and if you attend full time vs. part-time, and if your program offers classes in the summer. If you choose to pursue a terminal degree such as your DNP, add another 1-2 years to your schooling. Then, if you complete a fellowship or residency program, add one more year to your education.


How Much Does It Cost To Become An Orthopedic Nurse Practitioner?


Multiple factors can influence the cost of becoming an orthopedic nurse practitioner. The first is the decision of where and how you will get your BSN. The traditional four-year program can range from $40,000 to $200,000 in cost. This range is so broad because it depends on multiple variables. Choosing a public university versus a private university will affect the cost, but if you pay out-of-state tuition at a public university, that may also be more expensive. Also, attending part-time vs. full-time will affect costs. A cheaper route to obtaining your BSN may be to get your ADN and then complete an RN-BSN program. While there is a chance it is more affordable, it may take more time, so that is something to consider.

After completing your BSN, you will need to pass the NCLEX-RN before applying for graduate school. Most BSN-to-MSN programs cost between $81,810 to $185,280. There is also an option to obtain your DNP which is an added expense as it adds another 1-2 years of your schooling. The average cost of a BSN-to-DNP program is $26,490 to $254,260 and for the MSN-to-DNP program the cost is 17,660 to $169,510. Just like the BSN programs, the cost will be influenced by the school you select. Private is usually more expensive than public but paying out-of-state public tuition may be more comparable to private tuition.


Step-By-Step Process Of Becoming An Orthopedic Nurse Practitioner


There are several steps that must be completed to become an orthopedic nurse practitioner. Below, I have provided a step-by-step process to become an orthopedic NP.

1. Get your BSN: You must have a Bachelor of Science in Nursing (BSN) before applying for graduate school. There are a few paths to obtain your BSN, and I will discuss two. You can attend a four-year program and get your BSN. If that isn't an option for you or does not interest you, you can also complete an associate's degree in nursing (ADN) and then complete an RN-BSN program. Either path you choose will lead you to a BSN and one step closer to becoming an NP.

2. Pass NCLEX-RN: You must pass the NCLEX-RN exam before applying for your nursing license.

3. Become licensed in your state of practice: Once you pass the NCLEX, you can apply for RN licensure in the state you practice. Once you obtain state licensure, you may work as an RN.

4. Recommend you gain experience: This is not required. However, I do recommend you gain nursing experience before applying for graduate school, specifically as an orthopedic nurse. The experience gained will build on the knowledge you learned in school and increase your confidence in delivering care to the orthopedic patient. It may also expose you to other job opportunities in nursing and specialties for the NP that may be of interest.

5. Apply to NP school(s): Research schools you would like to attend for graduate school and apply. Be sure to know what their prerequisites are to ensure you have completed them before applying.

6. Graduate from NP school. You must graduate from an accredited NP school before you can apply for your board certification exam and state licensure.

7. Pass board certification exam and apply for state licensure: After you graduate from NP school, you must sit for the board certification exam specific to the degree received in NP school. After you pass the board certification exam, you can apply for licensure in the state you practice.

8. Apply for orthopedic nurse practitioner jobs: Find orthopedic nurse practitioner jobs that are of interest to you and apply. During this step, also brush up on your interviewing skills, and the interview process for an orthopedic NP position may be different than other jobs you interviewed for in the past. This step can occur before passing your board certification exam and attaining an NP license, but you cannot start your new job until these two steps are done.

9. Complete certifications for the orthopedic nurse: This is not required, but will help distinguish you from other NPs. One certification that is recommended is the ONP-C, which is the orthopedic nurse practitioner certification. I discuss this certification below.

10. Optional-Continue education to receive a terminal degree: It is not required to achieve a terminal degree to practice as an NP at this time. However, many people still choose to for multiple reasons. Getting your doctorate of nursing practice (DNP) will enhance your career. It can lead to more job opportunities, including leadership and educator roles and, in some instances, higher pay.


Top Orthopedic Nurse Practitioner Programs


There are no specific programs to become an orthopedic NP. Still, instead, you graduate from an accredited graduate program in pediatrics, adult-geriatrics, family practice, etc., and complete post-MSN/DNP programs to enhance your orthopedic knowledge. Below I have listed some of the orthopedic programs that offer a post-MSN/DNP certificate.

Duke University School of Nursing: The orthopedic program dedicated to NPs at Duke University is a one-of-a-kind opportunity. They are the only orthopedic NP program in the world, and the faculty are internationally recognized NPs and are board-certified in orthopedics. The program is only eight credits long, and the goal is to enhance your knowledge and improve the orthopedic care delivered to people across the lifespan. The program also prepares you to work in various settings, including both the acute and outpatient settings.

UMass Lowell: This orthopedic program is a post-master's certificate in orthopedic and rehabilitation nursing. It is a 12-credit hour hybrid program and includes both online and in-person learning. The program is to enhance the competence and confidence in the nurse practitioner, enhancing the delivery of orthopedic care to those across the lifespan.


Recommended Certifications To Enhance Your Job Role As An Orthopedic NP


There are multiple certifications available to nurse practitioners. Below, I have discussed one specific certification for the orthopedic NP, as well as three others that may be required.

ONP-C®: The orthopedic nurse practitioner certification is designated for advanced practice registered nurses (APRNs), otherwise known as NPs. This certification establishes you as an expert in orthopedic care and is used to distinguish yourself from other orthopedic nurses. The certification requires recertification every five years, which helps you stay current with practice and trends when delivering orthopedic care. This certification is available for orthopedic RNs, RNs working towards becoming an orthopedic nurse practitioner, and experienced NPs looking to increase their knowledge.

Below, you will find three additional certifications for the orthopedic NP. These are typically required to be an orthopedic NP depending on the setting where you work.

Basic Life Support (BLS): BLS is required for almost all people working in healthcare, regardless of the population served or setting you practice. BLS provides education on correctly performing cardiopulmonary resuscitation (CPR), initiating care to patients in respiratory distress, and help those with an airway obstruction. It also teaches you about using an automated external defibrillator (AED). The education provided is for the pediatric and adult populations.

Advanced Cardiovascular Life Support (ACLS): ACLS builds on the knowledge learned in BLS but is explicitly geared to the adult patient. This course will teach you early recognition and treatment of both respiratory and cardiac arrest. It will also teach how to identify arrhythmias and the treatment that the patient may need. You will learn about early recognition and management of stroke and sepsis. In ACLS, you will learn more about medication management, including oxygen therapy, IV placement, and other additional treatment options. You may not need this certification, based on the environment worked and population served.

Pediatric Cardiovascular Life Support: PALS builds on the knowledge gained in BLS but is directed towards the pediatric patient. Just like in ACLS, you will learn early recognition and treatment of respiratory and cardiac arrest. You will also learn airway management and identification of cardiac arrhythmias, including possible treatment. In PALS, you will learn more about medication management of acute cardiac and pulmonary illnesses, as well as sepsis. You may not need this certification based on the environment worked, and population served.


List Of Fellowships & Residency Programs For Orthopedic Nurse Practitioners


Below I discuss three different fellowship programs that are available for NPs who want to become an orthopedic nurse practitioner.

Ohio State University College of Medicine: Ohio State University offers an orthopedic fellowship program for advanced practice providers (APPs), including the NP and the physician assistant (PA). This program is 12 months long and is for the new APPs, who have already completed their graduate degree and board certification exam, or for experienced APPs looking to transition into the specialty of orthopedics. The program is designed to enhance the knowledge of the APP to ensure they are competent and safe while delivering safe, evidence-based practice orthopedic care to people across the lifespan.

Medical College of Wisconsin: The Medical College of Wisconsin offers an orthopedic fellowship for both NPs and PAs. This program is 12 months long and for the new graduate or the APP transitioning to orthopedics from a different specialty. The program is designed to prepare you to care for patients in need of orthopedic care and provide you with multiple experiences to build your confidence and enhance your competence. It also prepares you to care for patients ranging from pediatrics to geriatrics.

University of Rochester Medical Center in New York: This is a 12-month fellowship program in Orthopedic Surgery. Like the other two programs I discussed, this program is for the NP or PA who is either a new graduate or early in their career. The program will provide a multitude of experiences to build on your orthopedic knowledge and become confident and competent in delivering your care.

For information on a few additional orthopedic fellowships and residency programs, please click here.


Continuing Education Requirements For Orthopedic Nurse Practitioners


Continuing education requirements for the orthopedic NP are very similar to other specialties. First, as I have mentioned above, you must maintain an active RN license which will have its specific requirements based on the state you are licensed. However, you may be able to apply many of the continuing education hours completed towards both your RN and APRN licenses.

In regards to your APRN/NP license, this is again variable between states. Most states will list a required number of hours that must be completed within a stated time frame. Many states do have a mandated number of pharmacology hours needed. Of those hours, a specified number must be dedicated to prescribing controlled substances and managing patients on controlled substances.

You may also have to complete CEUs for any certifications you hold, as they often require renewal as well. Each organization you hold a certification through can provide information regarding the specifics for renewal. Some of these hours may carry over to your RN and APRN CEU requirements.

For more information, please visit your state board of nursing.


Starting Salary Of An Orthopedic Nurse Practitioner


The starting orthopedic nurse practitioner salary is $39.08 an hour, leading to an annual salary of $81,290 for those who work 40 hours a week. This is an average, and therefore will be variable between states. Working private practice vs. large organization and rural vs. urban will also influence your pay. Lastly, suppose you have experience as an NP before becoming an orthopedic nurse practitioner. In that case, this will also lead to a higher starting pay, and some organizations even consider years of experience as an RN in determining starting pay.

Per Hour $39.08
Per Month $6,770
Per Year $81,290


Average Salary Of An Orthopedic Nurse Practitioner


Now that I have told you the starting salary, have you wondered what is the average salary of an orthopedic nurse practitioner? The average orthopedic nurse practitioner salary is $52.69 an hour, leading to an annual salary of $111,681 for the NP working 40 hours a week. As I stated above, this salary is an average and is dependent on multiple factors such as the state and environment worked, hours worked, and overall experience.

Per Hour $53.69
Per Month $9,310
Per Year $111,681
(Source: Ziprecruiter.Com)


Job Outlook For Orthopedic Nurse Practitioners


The job outlook for the orthopedic NP is very promising. Continual advancements are being made in the delivery of orthopedic care, meaning we can meet the musculoskeletal needs of more patients.

Most people develop some form of arthritis, joint pain, back pain, or some other form of musculoskeletal pain throughout their life. Orthopedic NPs can provide care to these patients, treating their musculoskeletal problems. More people are having joint and back surgery as well. This is partly due to our aging population and the ability to fix work-related injuries that may not have been possible to be surgically or non-surgically repaired 20 or more years ago.

Either way, orthopedics is a booming specialty. With the ability to work in a variety of settings such as inpatient, outpatient, surgery, and sports medicine, the opportunities are endless for the orthopedic NP.


Useful Organizations & Associations


There are a few organizations and associations that will support experienced and those just becoming orthopedic NPs. I have provided information on two of these organizations below.

National Association of Orthopaedic Nurses (NAON): This organization is for all orthopedic nurses, including RNs, LPNs, and LVNs. Their goal is to educate, support, and encourage communication between specialties similar to orthopedics. They provide multiple educational opportunities, including webinars, online education, live events, certification prep courses, and podcasts. With membership to this organization, you also gain access to numerous publications, a career center, and access to a community of more than 5,000 other orthopedic nurses.

Canadian Orthopaedic Nurses Association: This organization is for all orthopedic nurses delivering care to patients ranging from pediatrics to geriatrics. Their goal is to improve the knowledge of orthopedic nurses, allowing them to excel in their practice. This is completed through education, research, and the implementation of evidence-based practice. The conferences offered through this association, due occur throughout the United States as well.


Finally, Is Orthopedic Nursing The Right NP Specialty For You?


So, after reading the information above, was I able to answer your question, what is an orthopedic NP? You have the opportunity to treat patients with various musculoskeletal problems and help them achieve their mobility and pain goals. Plus, your job can offer a variety of settings to deliver care, and you get the opportunity to work with other disciplines to improve the quality of life of your patient. Becoming an orthopedic nurse practitioner is a rewarding career path with many opportunities to grow and flourish as an NP.


Kasee Wiesen DNP, APRN, FNP-C
Kasee Wiesen is a practicing family nurse practitioner. Her nursing background includes emergency medicine, pediatrics and peri-op. Education is a passion of Kasee’s, and she has taught BSN, RN-BSN and DNP students, and has enjoyed every moment of it!