IN THE BALANCE Orthopedic nurses toe the line between maintaining case efficiencies and looking out for their own safety.

Orthopedics is a tough haul. There's ever-evolving technology to master, patients with only 3 working limbs to lift and obstacle fields of cords and equipment to step around, all while trying to keep pace with the demands of a high-volume specialty that continues to grow. Your staff might not think to protect themselves before protecting patients, but you can do your part to make sure the OR is a safer place for them to work.

' Fluid capture. Run an intensive education program about the dangers of fluid waste runoff, which is especially relevant for nurses who work in the specialty with the messiest cases. Using a direct-to-drain fluid management system is almost a must for busy orthopedic facilities (see "5 Benefits of Direct-to-Drain Fluid Management" on page 2). The units capture fluid waste at the surgical site, keeping OR floors bone-dry and free of the slick patches that can slip up unsuspecting nurses.

' Cord control. Consider shifting to wireless technology to limit the number of tripping hazards in the OR. Can your surgeons use battery-operated power tools or can you install wireless HD monitors? Emphasize that staff need to slow down during cases, take a few seconds to focus on what needs to be done, how it can be accomplished safely and where they're going, even when they're pressed for time. But no matter how much you preach the importance of slowing down and focusing while moving around the OR, staff will inevitably hurry from one location to another. Wireless technology may not eliminate all tripping risks, but it would certainly decrease them.

Due to the amount of equipment needed for orthopedics — fluid management devices, arthroscopy pumps and imaging modalities, for example — you'll never do away with cords entirely. Whenever possible, organize cords on the side of the surgical bed where the surgeon is working, since he'll be stationary for most of the procedure. When cords must be placed across high-traffic areas, pull them taut so they sit flush to the floor, cover them with a cord cover or braid them together so your nurses aren't forced to take a leap of faith over a tangled mess.

MENTAL & PHYSICAL FATIGUE

Why Is Orthopedic Nursing So Challenging?

Technological advancements in orthopedics are leaps and bounds beyond other service lines. Orthopedic nurses and surgical techs have a lot to learn due to the sheer volume of instrumentation, and good circulators and techs must constantly stay a step ahead of the surgeon to have needed tools in hand as soon as he extends his. Advancing technology lets cases be completed faster, so nurses are turning over rooms, setting up equipment and working cases more often in the course of a day than ever before.

MIND BENDER Ortho nurses must learn how to use ever-evolving instrumentation and technology.

Those are some of the reasons why it's so hard to find nurses who can thrive in the orthopedic setting. It probably takes a minimum of 2 years of training before a new nurse feels like she's not completely lost in the OR.

Let your new hires know from Day 1 that the pace in your surgery center is the hardest thing to get used to. Nurses might work a set amount of hours each day, but they spend most, if not all, of those hours on their feet. The physical stamina needed to keep up and thrive in an orthopedic OR is probably what surgical nurses complain about the most.

And don't ignore the risks involved in seemingly straightforward cases. When staff members are really busy, they're intently focused on the task at hand and ensure everything is done properly. On the other hand, I've seen more mistakes occur during lulls in the schedule, when the ORs aren't buzzing with activity. Nurses let down their guard, and that's when the potential for trouble starts.

— Terri Gatton, RN, CNOR, CASC

' Ergonomics. Many of the tasks nurses face on a daily basis are rooted in repetitive motion and it's very easy to become complacent about physical movements you've completed countless times without incident.

Wait until the entire surgical team is in the room, including the surgeon (which is best practice) be-fore positioning the patient. That way you'll have more manpower on hand to maneuver patients into position. Nurses tend to incur blame when patients are positioned improperly, when in fact it's the responsibility of the entire surgical team. Stress to your nurses that they must always use proper body mechanics when moving patients, that they should never try to be a hero and should always call for help if they have even a sliver of doubt about their abilities to safely move or position a limb. (My center hosts a number of professional athletes who sometimes dwarf our OR nurses, so my staff is keenly aware of this precaution.)

It's easy for nurses to ignore proper body mechanics and their well-being, but that split-second of casualness can result in an injury that keeps them out of work and your center short-staffed, causing a great deal of angst not only for the nurse who got injured, but also for administrators like yourself who need to keep the schedule in order. Conduct yearly in-services about body mechanics, and repeat the lesson if one of your nurses sustains a patient handling injury to keep staff safety in the forefront of everyone's mind. Be cognizant of giving your staff a rest whenever possible, and ensure regular breaks are scheduled and taken. Tired bodies and overtaxed brains make mistakes, putting your staff and patients in jeopardy.

The mind's willing
Orthopedic nurses are good at navigating minefields because they face a series of them every day. The physical challenge of bending, stretching and lifting during cases is extremely taxing, and might be why there may not be a lot of older nurses still involved in the specialty as our experienced OR nurse workforce continues to age. But great nurses shouldn't be pushed from the specialty because their bodies aren't up to the tasks that their minds still master. You may never be able to make orthopedic surgery a walk in the park, but you can make it safer.

DID YOU KNOW?

PATIENT HANDLING Back injuries are a primary reason nurses leave the profession.

• In the course of an 8-hour day, a nurse will typically lift 1.8 tons.
• The official guideline from the National Institute for Occupational Safety and Health is that nurses should lift no more than 35 pounds at any given time.
• A 2011 health and safety survey from the American Nurses Association showed that disabling injuries from lifting are a top concern among 62% of nurses. Eight in 10 nurses said muscle and joint pain is a frequent occurrence.
• Only 10 states — California, Illinois, Maryland, Minnesota, Ohio, New Jersey, New York, Rhode Island, Texas and Washington — have adopted laws or regulations that require healthcare institutions to have patient-handling requirements to protect nursing staffs, according to the American Nurses Association.

SOURCE: USA Today, "Hospital's heavy lifting lightens load on nurses" (tinyurl.com/73mc5np)