1. Failner, Brigitte M. MS, RN, ONC

Article Content

We know for a fact that the average inpatient today is "sicker." Along with that, the role of the nurse is constantly changing, and nursing practice is becoming more sophisticated. New theories, techniques, skills, and tools that are highly technological, complex, and dynamic are being used more today than ever before. The expectations of the institution from the nurse and from the patient regarding nursing, the process, and documentation are more encompassing and complex; that is also a fact.


Today the nurse is expected to be many things to many people and to function in a variety of settings. We are to be excellent caregivers, adequate researchers, seekers of knowledge, and thinkers grounded in scientific and logical thought. Nurses are involved with scientific and technical advances and with all types of new roles that have broadened their opportunities but increased their scope of responsibilities. Responsibility brings with it accountability that is reflected in patient outcomes.


As an orthopaedic nurse, we assume the responsibility for the nursing care of our patients. That care must be given on the basis of sound knowledge of many different things: orthopaedic problems and disease, surgical procedures, and the effects on the patient and the family. Would you meet the high standards set before you in the Florence Nightingale Pledge? Would you be worthy of the profession each and every day? How would others judge the nursing profession by your example today? Is your work, your nursing, "just a job," or is it the exciting, challenging profession you dreamed of when you wrote the initials RN after your name the first time? Are you anxious for the day to begin? Or, are you anxious for the day to end? As I talk to nurses across the country, many are having problems with positive responses. They find themselves overwhelmed with what they see as added "tasks" of mandated compliance and regulatory standards by The Joint Commission and Institutional Performance Improvement or Quality Measure Initiatives.


Let us look at the purpose of The Joint Commission's National Safety Goals: to promote specific improvements in patient safety. The goals highlight problematic areas in healthcare and describe evidence- and expert-based solutions to these problems. One NPSG is No Hospital Acquired Stage 3 or 4. Does this differ from the Nurse Practice Act, the ANA Standards for Care and the Orthopaedic Standards of care? Within the standards of care for patients with high risk for skin breakdown, it states that the nurse collaborates with the team and develops a plan that includes prevention of and monitoring for signs and symptoms of impending skin breakdown. The use of the nursing process daily will ensure the best possible care for our patients. We are accountable for patient care that includes planning and the delivery of safe care. We must be accountable for our actions.


Every time we walk into a patient room and give a medication, we make the choice as to whether we complete the 5 Rights or we do a workaround/cut a corner. I believe that if the choices we make are the right/safe choices, then those mandated compliance and regulatory standards are not added tasks but part of our routine daily nursing care. Our outcomes will speak to meeting the quality measure goals.


As our practice expands and continues to become more complex, we must make the commitment to adhere to our practice standards: to "critically think" as we go through the nursing process. As professionals, we are obligated to use every opportunity to improve our skills, sharpen our judgment, and develop qualities of leadership. We must apply the team concept in our daily practice for it allows us to share with other professional colleagues both skills and techniques that enhance our nursing practice in a cost-effective environment that provides quality patient care.


Providing opportunities for continued growth in your nursing knowledge through continuing education has and is a mission of NAON. Resources available through NAON are this NAON Journal and many publications such as the Core Curriculum, Orthopaedic Nursing, and Orthopaedic Nursing Self-Assessment. NAONs Annual Congress and Nursing and Allied Health courses (AAOS), along with regional conferences and Chapter offers, offer opportunities to attend educational programs. Presently there are 11 Online Educational courses available. Continuing education helps to ensure competence and NAON will continue to be there to help you.