How to Become an Orthopedic Nurse

Orthopedic nurses are involved in the care and treatment of patients who have musculoskeletal problems, including diseases or injuries of the bones, muscles, joints, and supporting connective tissue.

Orthopedic nurses can function as generalists, providing care to all patient populations for a wide range of conditions, and can further specialize in a number of different orthopedic interventions, areas, or disorders:

  • Congenital musculoskeletal disorders
  • Foot and ankle surgery
  • Joint reconstruction
  • Metabolic disorders
  • Neuromuscular disorders
  • Orthopedic oncology
  • Spine surgery
  • Sports medicine

Advanced practice registered nurses practice orthopedics as a subspecialty, and many who pursue this area of practice have a background in orthopedics before beginning advanced practice. Although conditions of the musculoskeletal system are the primary cause of disability among middle aged adults, and one of the most common reasons patients visit their primary health care providers, the American Academy of Nurse Practitioners reported in 2010 that only about two percent of NPs practice in orthopedics and sports medicine.

Orthopedic Nurse Certification

The Orthopaedic Nurses Certification Board (ONCB) offers three certifications.

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Registered Nurses who don’t have a graduate degree can pursue the Orthopaedic Nurse Certified (ONC) credential. To be eligible to sit for the exam requires a current RN license, two full years of RN experience, and at least 1,000 hours of RN work experience specific to orthopedics during the three years prior to applying for the exam. ONC recertification occurs every five years and requires 100 contact hours of continuing education and 1,000 hours of work experience.

Nurse practitioners pursue the Orthopaedic Nurse Practitioner Certified (ONP-C) exam, while clinical nurse specialists (CNS) take the Orthopaedic Clinical Nurse Specialist Certified (OCNS-C) exam. In addition to having a master’s degree or higher in nursing from an advanced practice nursing program, NP and CNS exam candidates who currently hold ONC certification need at least 1,500 hours of advance practice nursing work experience during the three years prior to applying, and must currently be working in orthopedics. Exam candidates who do not currently hold ONC certification must have at least 2,500 hours of work experience in orthopedic practice during the three years prior to applying, and must currently work as an NP or CNS orthopaedic nurse.

About one-third of the 150 questions on the ONP-C and OCNS-C exams are devoted to degenerative disorders, with the remaining questions covering:

  • Inflammatory disorders
  • Metabolic bone disorders
  • Musculoskeletal tumors
  • Neuromuscular
  • Orthopaedic trauma
  • Pediatric/congenital
  • Sports injuries

Recertification for ONP-C or OCNS-C occurs every five years and requires 125 contact hours of continuing education, a minimum number of practice hours, and a current employment status working in an advanced practice nursing role.

Advance Practice Orthopedic Nurse Education

Orthopedics is not offered as a primary specialty by most schools of nursing. Instead, it can be pursued as a subspecialty concentration through graduate study for advanced practice nurses whose graduate-level education is in a patient population primary specialty track such as gerontological, family, pediatric, adult primary care, or adult acute care nursing. Students interested in the orthopedic subspecialty are advised to request a clinical rotation in the area of practice during their MSN or DNP programs.

Post-master’s certificates are available that are designed to prepare advanced practice nurses for national certification exams. Some doctoral programs may also offer the option of creating a focus in orthopedic nursing.

Associations and Resources

The National Association of Orthopaedic Nurses (NAON) is the specialty association for all orthopedic nurses. The official journal published by NAON, Orthopaedic Nursing, is the only journal written by and for orthopedic nurses.

Orthopedic nurses working with children may be interested in membership with the Pediatric Orthopaedic Practitioners Society or the Pediatric Orthopaedic Society of North America.

The International Alliance of Orthopaedic Nursing Associations is a collaboration of orthopedic nursing associations from around the world.

Orthopedic Nursing Salaries

In December 2010, Scrubs Magazine reported that orthopedic nursing was the eighth highest paying nursing specialty, paying an average annual salary of $81,000. This salary represents all orthopedic nurses, including those without advanced practice recognition, so this average is recognized as being skewed lower than what would typically be expected for nurse practitioners and clinical nurse specialists with an orthopedic subspecialty.

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Although the 2011 AANP National NP Compensation Survey doesn’t provide salaries specific to orthopedic NPs or CNSs, the survey does show the following average base salaries for primary specialties under which orthopedic NPs and CNSs frequently practice:

  • Acute Care NP: $96,580
  • Adult NP: $93,990
  • Family NP $87,630
  • Pediatric NP: $87,610

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