I think that operating room nursing is a specialty that is often overlooked as a legitimate form of nursing because our patients are not perceived as being “in our care” but rather in the care of the surgeon and the anesthesia personnel. Therefore, our role is diminished somehow. In all honesty, that way of thinking shows a lack of awareness of the mind set of OR nurses who see themselves as the ultimate patient advocates for patients who cannot speak for themselves.

In truth, to be capable patient advocates OR nurses need to be forceful team members in that operating room. To do this, we really need a comprehensive knowledge of all aspects of operating room patient care. This includes an understanding of the impact on the patient of the anesthesia care as well as an understanding of the anatomical and physiological effects of the actual surgical procedure being performed. This is especially important in orthopaedic surgery, where, in many cases the surgeon is going to “take it apart and then put it back together”. We want to understand how this is going to be done and the expected outcome and challenges for our patient.  I remember many years ago when non-reamed intramedullary nails were first available. Some surgeons continued to ream anyway. I thought to myself, I must not understand the purpose of this reaming – I had always thought it was so the surgeon could get such a snug fit for that nail that it would not rotate in the canal since, in those days, locking that nail was not an option. So I did an informal study of the surgeons and found out that they continued to ream because that was what they had always done and were just in a learning curve for these new locked nails. I did notice that, over time, these surgeons did stop reaming but the explanation was not as scientific as I was thinking it might be!!!

Susan Langlois, R.N. recently retired from active nursing after forty years as an OR nurse.  She has had a vast experience at several hospitals, starting with a U.S. Army hospital in Fort Benning, GA and ending with the Cape Fear Orthopaedic Center in Wilmington, N.C.  She has been a tremendous resource for OrthopaedicList.com for many years.

The difference between a good total joint and a great total joint replacement is initially small, but over time the difference can be significant.  A good total joint might last 10 years, but a great total joint could last 30 years.  Being a total joint surgeon is a profession with little or no room for error with every single hand movement. The procedures are demanding and the patient population is complex.

Now, imagine this: The number of total joint replacement surgeons in the United States is cut by over 40 percent. The patient’s option for a surgeon is limited due to demographic or insurance restrictions.  This becomes a significant problem if the joint replacement fails because the subsequent surgery is much more complicated; therefore, fewer surgeons are willing to manage the revision.

Unfortunately, this could be the future of total joint replacement surgeons in America. Orthopaedic residents generally are not going into joint replacement fellowships because of this very issue.  We are 50% filled at best, during a time when we need to be increasing in size. Nationally there is a huge number of impending failures looming. Given the current state of our country, this issue is only going to get worse within the next 5-10 years.

The reimbursement for a single joint replacement surgery has been cut by over 65% in the last ten years.  This isn’t an issue for most surgeons currently in practice; however it does limit the amount of resources they can offer patients.  For example, try calling a doctor’s office and getting an actual person on the phone; these cuts affect everything from the number of front desk employees to the quality of care the surgeon is able to provide.

Cuts of over 65% in 10 years are now being followed with further cuts.  Understandably this makes doctors in training nervous.  Performing this surgery is stressful and I’m afraid it just isn’t worth it for younger doctors considering a specialty surgery career, particularly in joint replacement.

While prevention and patient education remains a goal of all healthcare providers, it does not overshadow the current epidemic that is facing our society with respect to osteoarthritis and its surgical treatment options: the reality is that patients will continue to want the best in surgical care from the best providers.

Please click on the following to see a video entitled “Access Denied:  The Approaching Shortage of Specialist Doctors” and use it to educate your patients on the future of specialized care.  Although it’s a bit biased, it does clearly state the facts.

Dr. Kelley, a third generation surgeon, is a graduate of the University of Iowa School of Medicine.  He performed his orthopaedic residency at the Upstate Medical Center in Syracuse, NY and his fellowship in Adult Hip and Knee Reconstruction at the Mayo Clinic in Rochester, MN.  He is a founder of the North Carolina Orthopaedic Clinic in Durham, NC, an affiliate of the Duke Medical Center where he is a Clinical Professor of Orthopaedic Surgery.  He has authored numerous scientific papers, serves as editor of medical journals, and is a member of a number of prestigious medical organizations.