How To Become an Orthopedic Nurse (Steps, Duties & Salary)

Orthopedic nurses care for patients with musculoskeletal disorders and injuries: arthritis, osteoporosis, fractures, joint replacements, and conditions affecting bones, joints, tendons, ligaments, nerves, and muscles. Here is a snapshot before the details.

Where you'll work: Emergency rooms, trauma units, surgical units, orthopedic units and specialty offices, sports medicine practices, long-term care, home health, and nursing homes.

What you'll do: Care for patients with musculoskeletal disorders and injuries before, during, and after surgery.

Minimum degree: ADN or BSN, though a BSN is increasingly standard.

Who it fits: You should be comfortable with pre- and post-operative patients, many of them older, since musculoskeletal conditions hit older populations hardest.

Certification: Optional credentials demonstrate your skills, make you more competitive, and can raise your pay.

Median annual salary: $93,600

Demand for orthopedic services keeps growing as the population ages and lives longer. "Life expectancy is longer, but health expectancy is not, so people who live to 90 can still have musculoskeletal conditions," says Tandy Gabbert, MSN, RN, ONC, director of education for the National Association of Orthopaedic Nurses. "We do one and a half million total joint arthroplasties a year in this country, and we're going to do more."

Steps to become an orthopedic nurse

Experience in emergency rooms, surgical suites, and critical care helps, but you start with your education.

1. Make sure it fits. You will work with patients before, during, and after invasive surgery, often when they are afraid and in pain. Get comfortable in operating rooms and surgical suites.
2. Earn your degree. Complete an accredited two-year ADN or four-year BSN program. Unaccredited credits may not transfer and may bar you from the RN exam.
3. Pass the NCLEX. This computerized, mostly multiple-choice exam is required for your RN license.
4. Get licensed. Work with your state board to meet any remaining requirements.
5. Gain experience. Build it in an orthopedics-focused unit such as a surgical unit, emergency department, or long-term care facility. Some employers prefer experienced nurses, but many hire new nurses willing to learn and certify.
6. Get certified. An optional orthopedic certification requires a set number of work hours. The more experience you have, the faster you qualify.

"How long it takes depends on the organization and the nursing school," Gabbert says. "It could be as little as three months, less if someone has hospital experience before graduating."

Certifications

Certification is not required for a new orthopedic nurse in most settings, since the practice-hour requirements mean hospitals expect to hire many uncertified nurses. Still, many pursue it.

"Certification is the gold standard," Gabbert says. "A unit where 80% of nurses are certified supports magnet status, keeps staff current, and improves care. Research has shown better patient outcomes."

RNs can pursue the Orthopaedic Nursing Certification (ONC) through the Orthopaedic Nurses Certification Board (ONCB), which requires two full years as an RN and 1,000 hours of orthopedic nursing experience within the past three years. It is the most popular orthopedic credential and best fits bedside care providers.

Two certifications serve advanced practice registered nurses with a master's or doctoral degree:

• Orthopaedic Nurse Practitioner Certification (ONP-C): Requires an RN license, a master's-level APRN degree, and at least 2,000 hours of APRN work in musculoskeletal health within the past three years. Built for nurses working as orthopedic nurse practitioners.
• Orthopaedic Nursing Certification - Advanced (ONC-A): Requires an RN license, three full years as an RN, a master's or higher in nursing or a related discipline involving musculoskeletal health, and 2,500 hours of musculoskeletal nursing experience since the graduate degree. Built for orthopedic nurses with an advanced degree.

What orthopedic nurses do

Trained in pain management, casting, traction, and mobility devices, orthopedic nurses support physicians and patients with pre- and post-operative care and assist in the operating room. Unlike home health or rehabilitation roles that only support recovery, orthopedic nurses work mostly in acute settings, helping patients before, during, and after surgery. Common duties include:

• Collecting detailed patient histories
• Examining and prepping pre-operative patients
• Assisting surgeons during procedures
• Examining post-operative patients and administering medication
• Educating patients and families
• Assisting with continuous passive motion therapy
• Caring for wounds, changing bandages, setting fractures, and casting
• Monitoring neurovascular status

The work takes a good memory, skillful hands, empathy, and calm communication. "A patient who just had surgery and taken narcotics has a limited threshold for feeling better, so the ability to communicate well and have a calming influence is essential," Gabbert says. "People in the hospital are vulnerable, and recognizing that is essential."

Within a hospital you will find several orthopedic nursing roles:

Orthopedic staff nurse: Provides bedside pre- and post-operative care, assessing patients for complications and carrying a caseload based on the unit's needs.

Orthopedic surgical/perioperative nurse: Supports surgical teams in the operating room during scheduled surgeries, monitoring vitals, circulation, and breathing. Many earn the Certified Perioperative Nurse (CNOR) certification.

Orthopedic PACU nurse: Works in the post-anesthesia care unit, monitoring patients recovering from general anesthesia and IV sedation and supporting the transition to the recovery floor.

Orthopedic navigator nurse: Carries no caseload but guides patients through the continuum of care with one-on-one counsel and classes, prepares them for surgery, and assists with discharge planning. Navigators serve a key role in advocacy, encouragement, and education.

Where orthopedic nurses work

Orthopedic nurses serve patients of all ages across fast-paced settings. Those in clinics or outpatient settings usually work days, while hospital nurses may work day, evening, or night shifts. Workplaces include emergency rooms, trauma units, surgical units, orthopedic units and specialty offices, outpatient surgical practices, ambulatory infusion centers, long-term care, home health agencies, nursing homes, sports medicine practices, rehabilitation facilities, pediatric units, and oncology units.

A day in the life: hospital orthopedic unit

Orthopedic staff nurses typically work three 12-hour shifts, with patient ratios set at the organizational level. A shift might run like this:

6:50 a.m. Arrive early to get time-sensitive handoff information from the outgoing nurses and check on patients from the day before.

7 a.m. Review your assignment and join interdisciplinary walking rounds, often at the bedside with family present so the outgoing and incoming nurses can align on patient needs.

8 a.m. Orient a new patient and family before that morning's surgery, walking them through what to expect from post-operative care.

Noon The patient returns from surgery. You run a neurovascular assessment on the legs and lower extremities, checking pulses, capillary refill, and signs of deep vein thrombosis, and set a monitoring plan.

2 p.m. Administer medication for pain, nausea, and post-op urinary retention, then evaluate how the patient tolerates it and consult the care team.

4 p.m. Discuss discharge with the patient and family, since longer hospital stays raise complication risk. Consult a nurse navigator and the care team about recovery resources.

6 p.m. Manage surgical drains and change dressings, coordinate with physical and occupational therapists, and escalate to the care team after spotting signs of a possible blood clot.

6:50 p.m. Hand off to the incoming nurse, sharing the care plan, the family's concerns, and the discharge plan.

Salary

The BLS reports a median annual wage of $93,600 for registered nurses, including those in orthopedics, as of May 2024. Pay varies with setting, experience, licensure, location, certification, and specialized skills.

Orthopedic nurse practitioners, who hold an MSN or DNP, earn a median of about $129,210. "Stark pay differences come with educational differences," Gabbert says. "A nurse practitioner's experience can be considered halfway between the staff nurse and the physician." An RN or NP specializing in orthopedics may earn more than a non-specialized nurse, comparable to specialties like telemetry or med-surg.

Orthopedic nurse vs. orthopedic nurse practitioner

	Orthopedic Nurse	Orthopedic Nurse Practitioner
Degree	ADN or BSN	ADN or BSN, plus MSN or DNP from an APRN program
License	RN	RN and NP
Certification	ONC through ONCB	ONP-C through ONCB
Responsibilities	Patient assessment and monitoring, assisting physicians, treating injuries, pain management	Complex assessment, identifying problems and making a differential diagnosis
Workplaces	Hospitals, surgical units, inpatient and outpatient settings	Hospitals, surgical units, inpatient and outpatient settings

The ONC requires an RN license, two full years as an RN, and 1,000 hours of orthopedic nursing within the past three years. The ONP-C requires an RN license, a master's-level APRN degree, and at least 2,000 hours of APRN work in the last three years, renewed every five years through the board.

Career outlook

Demand for orthopedic nurses keeps growing as the population ages and needs care for hip replacements, arthritis, and similar conditions. Social determinants of health will matter more in expanding equitable care for aging populations. "There are more orthopedic procedures all the time, increasing demand," Gabbert says. "Orthopedic departments don't mind starting with someone fresh out of school."

The BLS projects about 5% job growth for registered nurses from 2024 to 2034. That outlook is reinforced by retirements: 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

• National Association of Orthopaedic Nurses: Education, certification prep, and professional tools
• Orthopaedic Nurses Certification Board: Information on the ONC, ONP-C, and ONC-A exams
• National Student Nurses Association: Professional development for student nurses
• Orthopaedic Nursing: A peer-reviewed journal for the field
• American Academy of Orthopaedic Surgeons: Up-to-date surgical information and evidence-based practices