When I first began my orthopaedic nursing career (a very long time ago), patients came into the hospital a couple of days before their intended surgery to prepare for their procedures. A patient undergoing a total joint replacement surgery would be admitted 2 days prior to surgery and a patient admitted for scoliosis surgery, 3 or more days. During those preparation days, the patient would have their normal preoperative laboratory test results, chest radiographs, and electrocardiograms performed and get acquainted with their nurses. A specific preoperative checklist for each procedure was completed prior to surgery. If the patient needed to be "tuned up" prior to the surgical date, there was time to get that accomplished.
Today the idea of admitting a patient, with no other comorbidities, to the hospital prior to the day of surgery seems wasteful and unimaginable. Over time, those preoperative preparation days were decreased and more of those preoperative tests were done in the outpatient setting. There was an increasing need for patient management. Equally important was making sure that not only were "things" done but also a review that outcomes were maintained and even improved.
During these times of change, some orthopaedic practices and hospitals began to employ nurses who were able to help patients with their specific needs. There were various names for this particular role depending on the setting. Although not specifically called nurse navigators, it was the beginning. The value was clear.
Were there patients who could have improved outcomes with fewer complications if their medical problems were addressed prior to surgery? What was important to be evaluating? Hypertension, elevated hemoglobin A1c levels, or body mass index? Optimization clinics were opened to help evaluate patients who would potentially have better outcomes if comorbidities were managed first.
Management of orthopaedic surgical patients today is becoming even more complicated because of the increased number of procedures moving to the outpatient setting. Having nurse navigators as part of the patient's care team can only help improve both the patient experience and patient outcomes. It is a necessity today.
In this issue, we begin a series of articles on nurse navigation. Dlott et al. (p. 48) in their article, "Orthopaedic Nurse Navigator Involvement in Preoperative Optimization for Total Joint Arthroplasty," begin the series. We will learn about the various ways nurse navigators help manage a multitude of aspects of patients with orthopaedic conditions. From surgical to nonsurgical patients, nurse navigators bring orthopaedic expertise to manage clinical patient care situations.