Since 1990, the National Association of Orthopaedic Nurses (NAON) has taken time to honor the work they do. This week from October 29 through November 2 marks the National Orthopaedic Nurses Week.
Minority Nurse had a chance to hear from Mickey Haryanto RN-BC, MBA, ONC, and program manager of the Joint Replacement Program at the Medical University of South Carolina to find out about a career in orthopaedic nursing.
“I have always loved the challenge of orthopaedic patient care,” says Haryanto, NAON’s president. “When I graduated from nursing school my first position was on an orthopedic unit. I found that it was a great place to hone my skills.”
As Haryanto’s career progressed, she found herself in varied roles such as in critical care or home care, where her orthopaedic skills were needed and where she enjoyed seeing the results of her work with patients. She continues to see how orthopaedic nurses bring varied skills to healthcare that continue to be in high demand. And, of course, she can’t resist this explanation for her career choice: “I guess it’s ‘in my bones’!”
Eventually, a position came along that was just right for her. “When I was offered a position doing ortho case management, I jumped at the chance when no one else was interested,” she says. “Too bad for them!”
And bone jokes aside, Haryanto says the career brings the kind of gratification that helps nurses continue in such a challenging day-to-day career. “Being involved with helping people recover from injuries and musculoskeletal conditions where you can see people progress is very satisfying,” she says. Still, the challenges orthopaedic nurses face, including an increasing demand on healthcare resources and nursing shortages, are echoed throughout the nursing entire profession.
But a career as an orthopaedic nurse requires an interdisciplinary approach. As the motion and movement of joints and bones impacts other body systems directly and indirectly, Haryanto calls orthopaedics “a team sport. We never stop learning from each other.”
If you’re a nurse or a nursing student who is interested in this nursing path, Haryanto suggests shadowing an orthopaedic nurse. “We love to share knowledge and bring new nurses into the fold,” she says. As with other nursing specialties, nurses should plan to get certified with the Orthopaedic Nurse Certification -ONC credential. Shadowing a nurse with that credential will give you a full picture of what a day might look like and what skills are used most often.
As a leader of NAON, Haryanto knows the benefits of a professional organization. “The mission of NAON is to advance the specialty of orthopaedic nursing through excellence in research, education and nursing practice,” she says. “We fulfill this mission by providing education and networking opportunities both online with webinars, an active Issues in Practice Forum, and at live events such as our annual congress (in Atlanta in 2019). We are a community of nurses for nurses.” New members are always welcome, as are inquiries from nurses who are curious about the specialty.
As the debate over nurse staffing levels continues, the Massachusetts Ballot Question 1, the Nurse-Patient Assignment Limits Initiative, is being followed very closely.
Up before the voters in November is the issue of assigning patient limits for registered nurses working in hospitals. A “yes” vote approves of establishing limits and a “no” vote opposes the limits. Essentially, a “no” majority would leave things as they are in the state now.
The issue is hotly contested in the state and will be closely followed by the nation. As hospitals, nurses, and patients seek to provide and receive the best care possible, there are still increasing costs, more complex patient conditions, and staffing challenges to face.
Is this ballot question proposing a legal establishment of Massachusetts nurse staffing limits what it takes to provide that?
In Massachusetts, the Committee to Ensure Safe Patient Care is supported by the Massachusetts Nurses Association and seeks to limit the number of patients one registered nurse in a hospital setting may care for.
The Coalition to Protect Patient Safety is in opposition to Question 1 and is backed by the Massachusetts Health and Hospital Association. They seek to make no changes to Massachusetts’ legislation.
Both sides of the issue have several well-known associations, organizations, and individuals behind their stance. Both sides have also spent millions of dollars to call attention to their views. With similar campaign names and representative colors, the messaging is similar for two distinct messages.
According to information supplied by the Massachusetts Secretary of State William Galvin’s website, limits would include the following:
- In units with step-down/intermediate care patients: 3 patients per nurse;
- In units with post-anesthesia care or operating room patients: 1 patient under anesthesia per nurse; 2 patients post-anesthesia per nurse;
- In the emergency services department: 1 critical or intensive care patient per nurse (or 2 if the nurse has assessed each patient’s condition as stable); 2 urgent non-stable patients per nurse; 3 urgent stable patients per nurse; or 5 non-urgent stable patients per nurse;
- In units with maternity patients: (a) active labor patients: 1 patient per nurse; (b) during birth and for up to two hours immediately postpartum: 1 mother per nurse and 1 baby per nurse; (c) when the condition of the mother and baby are determined to be stable: 1 mother and her baby or babies per nurse; (d) postpartum: 6 patients per nurse; (e) intermediate care or continuing care babies: 2 babies per nurse; (f) well-babies: 6 babies per nurse;
- In units with pediatric, medical, surgical, telemetry, or observational/outpatient treatment patients, or any other unit: 4 patients per nurse; and
- In units with psychiatric or rehabilitation patients: 5 patients per nurse.
Taylor Maher, a media spokesperson for the Committee to Ensure Safe Patient Care says the issue is a matter of patient and nurse safety. “The negative consequences of not having staffing limits are clear,” she says. “Patients are sicker and nurses have too many patients to care for. There’s a detrimental effect on patient outcomes.”
The Coalition to Protect Patient Safety did not respond to Minority Nurse’s repeated requests for comment. According to their website, a “no” vote would keep hospitals from closing or sliding into longer wait times for patients.
California is the only other state in the nation that has passed legislation and imposed limits on nurse staffing. In Massachusetts the issue is not entirely new, but the scope is. ICU nurses in the state do have staffing limits that were prompted by a past ballot question although the limits were agreed to, not voted upon.
As a nurse, what are your views of establishing legal patient limits?
Today is Emergency Nurses Day, so Minority Nurse wanted to connect with an emergency department (ED) nurse and find out a little more about this career path.
Martha Saroop MS, RN, CEN, NE-BC, has worked in the United States and in England as an ED nurse. She started out with a different goal in mind, until a colleague’s comment started her down this path. She hasn’t looked back.
How did you get started on a career path as an emergency nurse? How long have you been a nurse?
I started my emergency nursing career at Addenbrookes, Cambridge University Hospital in England. I initially worked on a hepatology (liver transplant) unit. One of my colleagues said to me, “You function like an emergency nurse,” and she suggested that I transfer to the emergency department. The nurse had come to the Hepatology Unit in a supervisory role, but had previously worked in the ED for a number of years. I took her advice and started doing shifts in the ED and absolutely loved it. Sometimes, others see our strengths when we do not. I have been a nurse for 22 years amazing years with 18 years of emergency nursing experience.
What makes your day satisfying as a nurse?
I have always worked in very busy emergency departments including those in Florida, Maryland, and England. We can often forget to show appreciation. What makes my day most satisfying as a nurse is remembering to say a sincere “thank you” to a member of staff and seeing the impact on that person.
It’s important to thank the team generally, but finding that one person who may least expect a personal “thank you” and making it meaningful changes lives.
What did you not expect in this path that you enjoy?
I am currently living and working in England and traveling across Europe. I, however, stay active as a member of the Emergency Nurses Association (ENA). I am also a member of the Royal College of Nursing (RCN) in England. This is a huge benefit as an emergency nurse. Your skills, knowledge and experience are of global value. I now have the opportunity to learn about emergency nursing at an international level, and at the same time, travel and see the world. It is an enriching experience.
What helps you be a better ED nurse?
I can immediately say that my colleagues make me a better ED nurse. Working as an ED nurse has allowed me to work with some of the most knowledgeable and kind nurses and staff you can wish to meet. They are always willing to share their knowledge and ensure safe and the highest quality of patient care. As an emergency nurse, you are never alone. Additionally, my peers recognize that my calm and patient disposition helps me to make better decisions in the often chaotic ED environment, helping me to be a better ED nurse.
What advice would you give to student nurses who are considering this path in nursing?
Stay true to yourself; it is your unique qualities which will make a difference on the team. It is okay to say that you don’t know something. There is a lot to learn. Join your professional organization at the earliest opportunity. You can become a member of the Emergency Nurses Association (ENA) as a nursing student at a discounted rate. You will be provided with a rich source of information and support including the new ENA mentorship support.
Plan to get certified early in your career. It identifies you as an expert, having the skills and knowledge to practice in your area of specialty. Most important, remember to relax, you are never alone, you will always be a part of a strong team. Remember, your colleagues are your first-line resource, use them wisely.
As a new nurse in the ED you can be assured, you will be provided with the training, support and guidance to help you to be successful as an emergency nurse. Emergency nursing is a gratifying and fulfilling career.
A case manager oversees patients and patient care with a holistic view, and that makes it an excellent role for nurses. As a case manager, nurses advocate for patients as they establish care plans and coordinate care for cases that are often complex.
October 7 to 13, marks National Case Management Week and gives nurses a chance to learn about and explore this career path. A case manager role offers opportunities to make a difference in patient care, especially for patients and families who work with many caregivers.
According to the American Case Management Association (ACMA), case managers work with various physicians, nurses, caregivers, social workers, community resources, and patients to ensure access to needed services and resources. Then, they coordinate those resources to give the patients the best care options that also help meet the patient’s needs and desires.
A patient with several conditions, who relies on physical and occupational therapists, has home health care on certain days, takes multiple medications, and who is recovering from surgery is going to need a specialized care plan. This is where case managers are able to offer expert coordination. They keep an eye on each of the moving parts of the care plan.
With a nursing background, a case manager is able to watch for medical changes and anticipate potential care needs. The nursing expertise is valuable as a case manager, as nurses know how hospital and healthcare systems operate and also what patients need from providers. They are able to notice gaps in care that can make a difference in healthcare outcomes.
ACMA identified the following five core areas of a case manager’s role.
- Care coordination
- Transition management
- Utilization management
Each area overlaps with others and involves many partners to succeed. The role is independent, but requires teamwork and collaboration for successful outcomes. Case managers take a broad view of the patient’s needs to ensure the patient and the patient’s family is fully informed. They explain the patient’s condition, the care needs that are presented, how they will be put into place, any additional screening or testing, and then a continuum of follow-up care to make sure the patient is receiving needed care.
Nurses in a case manager role gain immense career satisfaction from helping patients navigate the sometimes overwhelming healthcare system. Families are often grateful for the expertise case managers provide. Because they are so familiar with the healthcare system, they often know approaches or solutions families might not have access to. But case managers’ knowledge extends past the immediate healthcare system. They are able to help with emotional or mental health supports, home assistance, community resources, any necessary transition to facility assistance, and even spiritual resources.
Certification for case managers is highly recommended after at least one year of work in the field. If you are looking for a way to help patients and families in varied healthcare situations, a case manager role is an excellent way to do that.
For this year’s Emergency Nurses Week, the Emergency Nurses Association (ENA) focuses on nurses being “EmpowerED” and what that means for each nurse.
As an emergency nurse, being empowered in your role and in your career can look different for each nurse. During Emergency Nurses Week (October 7-13) condsider some ways you feel “EmpowerED.”
Some nurses want to learn more about particular conditions or situations they see routinely. A busy urban ED will see fairly different visits from an ED in a farming community. Learning how to best treat patients with the more common injuries and conditions can help your performance and care. Sometimes, it’s just being continually prepared for the things you never expect to see. If something is going to happen, it will happen in the ED and you won’t have notice. Learning how to stay agile and use your critical thinking skills in high-pressure situations is essential.
Other nurses might find working on teamwork skills is an important way to feel empowered in their careers and their daily roles. In an emergency department, teamwork truly is life-or-death. Teams that work seamlessly will have more potential for better results. They will also have more resources to lean on when they lose a patient or when injuries are overwhelming. Like any skill, teamwork takes practice, study, and repetition. If you feel your collaborative skills could use a boost, learning more will only make you a better nurse.
For other emergency nurses, becoming empowered might mean taking on more leadership responsibilities and roles. As you become more familiar with the workings of your own department, you might find you have ideas to make the department work better and be more effective. Maybe you have already implemented some actions that have turned out with positive results. Becoming empowered for you might encompass making a difference in your department and which can have an immediate and long-lasting impact on patient care.
Emergency nurses aren’t always in the unit. They can become powerful and persistent advocates for nurses and patients. They can speak out on issues like nurse bullying, violence in the workplace, safety concerns, and push to make changes for the better. Emergency nurses can take action and connect with government officials. They can use their voices to let them know of issues that could improve patient outcomes like improved hygiene processes, more detailed paperwork processing, increased medication checks, or training new nurses on staff.
If you’re an emergency nurse, what makes you feel empowered?