1. Davis, Jack MSN, RN, ONC

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I was heartened to see the results of the 2019 Gallup poll about how Americans rank 22 major professions. Once again, for the 18th consecutive year, nurses have come out on top. Yes, we are most trusted profession in the public's eye when it comes to honesty and ethical standards. I have been thinking about how orthopaedic nurses might influence this poll.

Jack Davis, MSN, RN,... - Click to enlarge in new window NAON President

The poll results had the public scoring nurses at (85%; very high/high) when asked the following question: Please tell me how you would rate the honesty and ethical standards of people in these different fields-very high, high, average, low, or very low. Nurses were well in front of other professions and were followed by engineers (66%), medical doctors (65%), pharmacists (64%), and dentists (61%) (Gallup, 2020).


The public opinion is that nurses are honest and ethical. Honesty is described as a facet of moral character synonymous with having integrity and fairness while being loyal, sincere, and straightforward in the absence of lying or cheating. Being ethical implies having a strong moral belief and the ability to distinguish between right and wrong.


These qualities are visible and apparent in our care delivery across all settings. As you know, orthopaedic nurse are everywhere and the public trusts nurses because they believe and are confident that nurses will keep them safe and advocate for them during vulnerable states. Trust does not come automatically and requires faith, confidence, and hope.


Consider the diabetic patient with sleep apnea planning to undergo spinal fusion surgery. How many nurses do you think the patient will come in direct contact with during his or her episode of care? My initial response was five to 10. When I looked a little deeper, and tracked the flow at my institution, I changed the number and felt it would to be closer to 25. That's right, 25 nurses are involved in an orthopaedic surgical procedure. Let's do the math.


The patient begins with a surgical consult and may meet the office practice nurse for a history and physical examination. When placed on the surgical pathway, the patient will likely require a presurgical optimization, nurse consultation with a diabetic nurse practitioner, followed by a preoperative patient education class delivered by a nurse educator. On the day prior to surgery, a nurse from the call center will reach out to review medications and diet and provide additional instructions to clarify expectations. Upon arrival at the hospital on the day of surgery, the holding area nurse will reevaluate and prepare the patient for surgery. The operating room team circulator and the scrub nurse will greet, position, and protect the patient during the procedure. The certified registered nurse anesthetist will assist with anesthesia. Then it is on to the postanesthesia care unit where a team of nurses monitor vital signs and recovery after intubation. Acute pain nurses manage discomfort and prepare the transfer to another monitored setting for nurses to safely observe sleep apnea and mitigate risk. Again, once stable, the patient will be transferred to an inpatient unit where the primary nurse and colleagues will be there to address all patient and family needs, using pathways to guide them through the predetermined estimated length of stay. Case management nurses will help plan discharge from the hospital to a safe environment. Double the number of nurses who encountered the patient on the units across all shifts and add the manager/coordinators who stop in to provide oversight throughout the 48 hours' hospitalization. Following discharge, the patient will receive follow-up calls from nurses to check on progress and may also need to communicate with the home care nurse team.


When you really analyze the number of nurses and measure the questions, support, and interactions they routinely deliver as part of their orthopaedic surgical care, it is very impressive. The consistent achievement of high-quality patient outcomes is team dependent, but nursing care is arguably the most unrecognized contributory component. It should not be surprising to nurses that we are deemed very trustworthy.


As the NAON President, I am proud to witness the dedication of our members and their desire to continue to learn and grow. This year, the NAON is celebrating the 40th year of advancing the art and science of orthopaedic nursing. There is so much to celebrate. Forty years of high-quality education that has supported nursing care delivery. The NAON should take some credit for building confidence in nurses who provide safe patient care across the orthopaedic continuum. The NAON builds trust in the member that can translate to public trust in our profession.


Please continue to stay an engaged NAON member who can keep building trust by:


* Sharing the value of NAON membership with colleagues;


* Keeping up with new practice guidelines;


* Participating in instructional webinars;


* Reading the Journal of Orthopaedic Nursing;


* Purchasing certification preparation and other education materials; and


* Attending our fabulous Annual Congress.



As an aside, for those interested, I am sorry to report the least trustworthy professions identified in the Gallup poll were senators (13%), members of Congress (12%), and car salespeople (9%). Perhaps, a solution to our political strife is to have more nurses enter politics. I hope to see many of you in Pittsburgh, PA, this May. Engage Your Core!




Gallup. (2020). Nurses continue to rate highest in honesty, ethics. Retrieved from[Context Link]