AAOS Bulletin - June, 2005

NAON celebrates 25 years of leadership

By Carolyn Rogers

During its May 2005 Annual Congress in Phoenix, members of the National Association of Orthopaedic Nurses (NAON) celebrated the organization’s first 25 years—from its 1980 “birth” in Atlanta to its current maturity as a leader among nursing organizations.

Dedicated to promoting the highest standards of nursing practice through education, research and effective communication, NAON serves more than 5,500 registered, licensed practical and licensed visiting nurses as well as student nurses and associate members from around the world who share an interest in musculoskeletal health care.

NAON’s newly elected executive board includes (back row, from left): Mary Betty Masters, RN, CNOR (treasurer), Jeanne M. Fleagle, MSN, RN, APN, ONC (secretary), Jan Kruse Foecke, MS, RN, ONC (director), Linda L. Altizer, MSN, RN, ONC, CLNC (director) and Joan Lanfear, RN, ONC (director). Seated in the front row (from left) are: Cynthia M. Howe, RN, BSN, ONC (director), Miki Patterson, PhD(c), NP, ONC (president-elect), Cynthia M. Gonzalez, MSN, RN, APN, ONC (president), Robin S. Voss, RN, MHA, TNCC-I (past president), Mary Jo Satusky, BSN, RN, ONC (director).

In the beginning

“Since the days of Florence Nightingale and the Crimean War, the nursing profession grew out of the need to care for large numbers of people at once, such as wounded soldiers during wartime,” says Catherine Smrcina, PhD, RN, ONC—a past president of NAON who has taken a special interest in creating and maintaining the organization’s archives. “The specialty of orthopaedic nursing was based on war diseases and epidemic outbreaks that involved musculoskeletal problems, such as polio.”

The roots of orthopaedic nursing can be traced back to Victorian England and Dame Agnes Hunt, who was crippled by osteomyelitis at the age of nine but trained as a nurse and devoted her entire career to bettering the lives of crippled children and those injured by the ravages of war. In the early 1900s, Hunt established the first orthopaedic hospital in the United Kingdom. A few decades later, an Australian nurse known as “Sister Kenny” fought the medical establishment and ultimately revolutionized the treatment for childhood polio.

“Our current standards of care are based on many of the principles established in the early 20th century by people like Dame Agnes and Sister Kenny —the mothers of orthopaedic nursing,” says Smrcina.

Establishing standards of care

Although many of the basic principles of orthopaedic nursing were in place by the 1920s and 1930s, it took another 50 years—and the founding of NAON—for formal standards of care and practice to be established.

“NAON was the forerunner in the development of standards of practice, standards of care and the establishment of a core curriculum,” says Smrcina. “Because little specific coursework on orthopaedics is taught in nursing schools, much of the training takes place on the job. In years past, this meant that most nurses learned to practice the way another nurse taught them to practice. NAON was responsible for bringing much-needed uniform standards of care to orthopaedic nursing.”

NAON provides resources, training tools

With fewer people going into nursing, it’s more difficult than ever to find nurses with the right background or experience working in the operating room, says Smrcina. “NAON provides that background by supplying hospitals with the resources and tools needed to provide nurses with more structured on-the-job training.”

In the early 1990s, NAON’s membership surged to more than 10,000. “Specialty curricula were being formulated at that time, and significant changes were taking place in the practice of orthopaedics,” Smrcina explains. “All the innovations and technological advances really increased nurses’ awareness of the need for specialty education.”

Since that time, the orthopaedic nursing specialty has continued to evolve. For years, orthopaedic nurses practiced in hospital settings, either in dedicated orthopaedic units or in the OR, Smrcina says. “Within the past few years, however, many orthopaedic units have evolved into mixed units caring for a diverse patient population. With this shift, you now find orthopaedic nurses in a wide array of practice settings, including emergency departments, physician practices, ORs, trauma units, rehabilitation units, pediatric and adult orthopaedic units and home health agencies.”

AAOS, NAON collaborate on educational efforts

Chicago-based NAON has worked collaboratively with the Academy on education courses for nurses since the 1980s, when the organizations began cosponsoring a one-day nursing course each summer. That course eventually evolved into a four-day nursing/allied health professionals program that’s held each year during the Academy’s Annual Meeting. Faculty includes both physicians and nursing professionals, and courses address a variety of topics, such as the 2005 courses “Orthopaedic Complications” and “Management of Pediatric Spine Deformities.”

In addition, NAON administers an orthopaedic nursing certification exam during each AAOS Annual Meeting. RNs who successfully complete the rigorous Orthopaedic Nurse Certified (ONC) exam earn the “ONC” credential, which recognizes attainment of the highest standards of orthopaedic nursing practice. ONC is the only credential that documents expertise in the practice of orthopaedic nursing.

“Good working relationship”

Over time, NAON has developed a good working relationship with the Academy, according to Smrcina. “Orthopaedic nurses don’t practice in isolation—they need the orthopaedic surgeon,” she says. “And the Academy recognizes the value of providing nurses with specific orthopaedic training and resources…We can’t work without them, and they can’t work without us.”

In late May, NAON recognized Richard F. Kyle, MD, AAOS first vice-president, during the opening ceremonies of its 25th Annual Congress in Phoenix.

“Our opening ceremonies always acknowledge the collegiality between NAON and the Academy,” Smrcina says. In turn, the Academy recognizes NAON leadership in a similar fashion during its own Annual Meeting opening ceremonies each year.

“We have a lot to offer each other”

The two associations have worked together on research grants, educational programs and other efforts such as building safe, accessible playgrounds. NAON is also a full participant in the Academy’s 75th Anniversary Project to document, preserve and celebrate the legacy of orthopaedic surgery.

“Orthopaedic nurses and other allied health professionals have become increasingly important to the care of patients, and to orthopaedic surgeons in general,” says Dennis P. Grogan, MD, an orthopaedic surgeon and a member of the Annual Meeting Committee that is responsible for organizing the annual nursing/allied health program. “Whether they work in the OR, in a rehab unit or at a physician’s office, orthopaedic nurses and advanced practice nurses are more deeply involved in patient care than in the past. Rather than playing a ‘supporting’ role, they’re providing a real service of their own.”

“We have a lot to offer each other,” adds Smrcina. “After all, the bottom line for both physicians and nurses is good patient outcomes.”


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