The Roles & Responsibilities of An Orthopaedic Nurse

“You have to wear many different hats as an Orthopaedic Nurse… the best advice I can offer anyone is to prioritise a couple of patients who you think will need more of your time throughout the day…”

Jonathan explains the roles and responsibilities of an acute Orthopaedic Nurse, from admission through to supporting patients with their short- and long-term recovery.

As a nurse working in acute orthopaedic care, the roles and responsibilities probably differ to those working in elective surgery.

This article will explore the necessary requirements in looking after an unplanned or emergency orthopaedic patient within a hospital setting, from admission to discharge.

Admission

Admission is important on all ward settings but is particularly important in the orthopaedic setting, as you will learn valuable information. This information is critical to both the pre- surgical and surgical part of the patient’s journey.

It is important to gather knowledge around medication at this stage, as you would need to know if they are on any anti-coagulation medication as this may need to be stopped, swapped, or altered prior to surgery.

Also, it is important to know if the patient is diabetic as they may need adjustments to medication and considerations whether to administer insulin via a sliding scale on the day of surgery.

Surgery

This is when an Orthopaedic Nurse is expected to be meticulous in their approach to the patient. You must ensure anti-coagulation medication has been administered correctly, IVI has been administered to keep the patient hydrated, and if morning medications must be omitted if they could potentially impair patients’ vitals during surgery.

Each patient is required to have a surgical check list completed prior to surgery. This will include a routine set of observations to give the surgical team a base line to work to during surgery and in the recovery setting.

This must include the last time food and drink were consumed, and any previous surgical operations to identify metalwork. For females it is also important to establish if there is a possibility of pregnancy, so a test is always required prior to surgery.

Going down to theatre, it is the nurse’s responsibility to ensure they have TED stockings on if applicable and that they have venous access which has been flushed to ensure patency.

You also need to ensure if the patients are asthmatic that their inhalers go down to theatre with them, or any visual or hearing items that the patient requires.

You have to wear many different hats as an Orthopaedic Nurse… the best advice I can offer anyone is to prioritise a couple of patients who you think will need more of your time throughout the day…

Recovery

An Orthopaedic Nurse has two important responsibilities to do once a patient is in recovery.

First, they must agree with the recovery team that the patient is now suitable to return to the ward. It’s important that the nurse considers their ward staff’s skills and capabilities, and that they can deal with any potential complications if they occur.

The other main responsibility is, once the patient has returned to the ward, to carry out all the necessary post operative instructions as outlined by the surgical team. These will include routine observations as outlined by Trust guidelines, urine output, medications regimes, op site monitoring and managing pain through various devices and equipment.

As the nurse you can delegate some of these tasks to other team members if they have the skills and knowledge to undertake them within their own competencies.

It is important to be very vigilant with these tasks in the first six hours as this can often be the time that further input maybe required, or when the patient starts to exhibit signs of deterioration. This could include giving fluids intravenously due to low blood pressure, changing pain management regime or simply staying with the patient if they have become delirious from anaesthetics.

Generally, within the first 12 hours of surgery you may also be required to administer some form of anti-coagulant such as fragmin (Dalteparin) and an IV antibiotic.

Elevation And Checking For Infections

That is the role and responsibilities of an Orthopaedic Nurse when a patient is going to theatre, however Orthopaedic Nurses do have further responsibilities to those patients who are waiting to go to surgery but may be waiting, possibly due to swelling or other needs.

This could range from simple elevation of the leg using pillows and ice or having a leg placed in traction with daily changes to try a straighten the leg for example prior to surgical intervention.

Some patients may also have some minor surgery to attach a device called an external fixator device to set and immobilise the fractured bone. The pins on the external fixator need to be cleaned daily to prevent any infection and is a good opportunity for both nurses and doctors to looks for excess bleeding or indeed infection.

Mobilising The Patient

Lastly, the role of an Orthopaedic Nurse is to encourage both the patient and the team around them to mobilise the patient at the earliest possible opportunity.

Nursing teams work closely with both the physiotherapists and occupational therapists in creating a care plan for early mobilisation and faster discharge from the hospital setting.

The Takeaway

You have to wear many different hats as an Orthopaedic Nurse.

The best advice I can offer anyone is to prioritise a couple of patients who you think will need more of your time throughout the day and try to delegate other tasks where possible, so you are hopefully free when required. A great time to do this at that start of your shift.

I totally understand that planning doesn’t always work but you can always adapt the plan through flexibility.

Thank you for reading.

Interested in a career as a Orthopaedic Nurse? Check out our latest job roles here.