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

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I think that most of us remember those first months as a new graduate or as the newly hired nurse on to the orthopaedic unit. The sight of the bed frames with all the bars for suspension and traction with its ropes and pulleys that made one look in "oh" and wonder how one was going to carry out the activities of daily life (bedpans, bed changes).

Brigitte M. Failner,... - Click to enlarge in new window, MS, RN, ONC NAON President, 2010-2011

Learning to mobilizing the multitrauma patient with femur, radial, and pelvic fractures was challenging because we tried to cause the least amount of pain to the patient. Through the following months, we learned to assess the musculoskeletal system, focusing in on blood loss, neurovascular status, and signs and symptoms of complications, such as pulmonary emboli, fat embolism, and compartment syndrome. In the years that followed, we learned about the new procedures and the assessments and care that went with them. We became the orthopaedic nurse experts. We are confident and proud when a patient who has been on a nonorthopaedic unit transfers in, or after being cared for by a float nurse, the patients tell us the difference it makes when the orthopaedic nurses moved them or mobilized them up to the chair, or how their pain was managed more appropriately. We, the orthopaedic nurses, continue to increase our knowledge and grow in our profession. I am sure that we mentor the new graduates coming to our units and foster collaboration through unit activities. But does it stop there?


I have mentioned before that I believe it is vital that each of us orthoapaedic nurses must help our nursing peers in other specialties or in other nursing units to care for their patients with musculoskeletal needs. The orthopaedic patients who fall and fracture their hip but have a cardiac history and are admitted to a medical monitored unit spend the next 24-48 hr on bed rest in bucks' traction, while tests are done to "clear them for surgery." The nurses are either afraid to move them, so the patients develop a pressure ulcer, or if nurses turn them, it is usually without care and not controlling the affected hip, so the patients experience more pain than needed. The total-hip patient who, immediately after operation, needs to be monitored for arrhythmias so goes to a surgical monitored unit, and the nurses are not aware of neurovascular assessments needed or what to do with the abduction pillow. Yes, we are the experts, so who is better than us to teach others?


The encyclopedia describes a consultant (from the Latin consultare meaning "to discuss") as a professional who provides professional or expert advice in a particular area of expertise. We know that one of the roles of the clinical nurse specialist is that of a consultant, but why is it not part of our role? Who is better than the bedside nurse, who is an expert in orthopaedics, to discuss care of the patient with the nurse who is not an expert? In that nurse consultant role, the rewards are many not only for your peers and the patients but for YOU as well.


Let's picture it. The nurse (on the monitored unit) assigned to the patient with the orthopaedic diagnosis calls up to the orthopaedic unit, asking for a consultant. Each day on the orthopaedic unit, they have one of the nurses assigned as the consultant for the shift, so today Nurse Jane gets the call, and as her coworkers cover her patients, she goes to the monitored unit and meets with the patient's nurse. She reviews the diagnosis, the assessments needed, and the plan of care. She demonstrates proper turning and/or mobilization techniques. She explains the importance of keeping on top of pain management so that the patient can progress with any therapy ordered. The patient is immediately put at ease, the telemetry nurse is now feeling less anxious and less afraid to move the patient, and the nurse consultant who stepped outside her safe domain is an example of a nurse exemplary.


As we head into the new year, what better time then to establish new goals for 2011, not only our personal ones, but our professional ones as well. The professional goal does not necessarily have to encompass all of nursing. Perhaps it can be one that will affect you, in your practice or in your area. Consider a moment becoming that nurse consultant for the orthopaedic patients in your institution or clinic.


If you choose to accept this goal, may the new year bring you wisdom to appropriately facilitate change and the courage to stand alone if necessary to achieve your goal. I would love to hear your stories of your nurse consultant role.