The Scope of Practice for an Orthopedic Nurse Practitioner

While orthopedics* originally referred to the treatment of crippled children, modern orthopedics has evolved into a broad specialty that now includes patients of all ages who have musculoskeletal problems that are acute, chronic, or congenital in origin. Orthopedic care can be complex when patients have chronic medical problems such as diabetes, cancer, obesity, depression, heart disease, nutritional deficiencies, or genetic disorders.

According to the National Association of Orthopaedic Nurses1, an Orthopedic Nurse Practitioner** is a nationally certified Advanced Practice Registered Nurse (APRN) who has specific orthopedic and medical knowledge for the direct and indirect care of orthopedic patients in acute, chronic, and rehabilitative settings. The Orthopedic Nurse Practitioner is directly responsible and accountable for the assessment, diagnosis, and management of the patient’s problems, including prescriptive medications and non-pharmacologic interventions.

Orthopedic Nurse Practitioners may choose to obtain the specialty certification of ONP-C (Orthopaedic Nurse Practitioner-Certified) through the Orthopaedic Nurses Certification Board (ONCB).

Major aspects of practice for an Orthopedic Nurse Practitioner include:

  • Acute care of injuries, fractures, and trauma
  • Acute and chronic pain management
  • Management of chronic medically-related orthopedic conditions (with examples):
    • Metabolic disorders (osteoporosis)
    • Degenerative disorders (osteoarthritis)
    • Inflammatory disorders (rheumatoid arthritis)
    • Neuromuscular disorders (multiple sclerosis, stroke)
    • Oncologic disorders (bone cancer)
    • Congenital pediatric disorders (congenital hip dysplasia)
  • Prevention, early recognition, and treatment of orthopedic complications
  • Ordering and interpreting diagnostic tests
  • Perioperative care
  • Casting and splinting
  • Treatment and closure of wounds
  • Deep vein thrombosis (DVT) prevention/DVT management
  • Joint aspiration/Joint injection
  • Rehabilitative therapy regimens
  • Care transition decisions
  • Discharge orders/Discharge instructions
  • Patient education
  • Work restrictions/Activity restrictions
  • Injury prevention/Fall prevention
  • Multi-disciplinary collaboration

*Orthopedics comes from the Greek, 'ortho' meaning ‘straight’, and 'pedics' arising from 'pais', meaning ‘children’. This historical meaning is depicted in the traditional symbol for orthopedics: a bent tree staked with poles to force the tree to grow straight.

** The National Association of Orthopaedic Nurses Scope and Standards of Orthopaedic Nursing Practice, 3rd edition, (2013) states on page six that these standards mirror the American Nurses Association ANA Nursing: Scope and Standards of Practice (2010), and contains specific criteria related to basic and advanced orthopedic nursing practice.

1National Association of Orthopaedic Nurses. (2013). Scope and Standards of Orthopaedic Nursing Practice, 3rd