How to Become an Orthopedic Nurse Practitioner

For many nurses, becoming a nurse practitioner is the ultimate career goal. But with so many different specialty options, deciding what kind of nurse practitioner you want to be can be a challenge. In this guide, we’ll explore what an orthopedic nurse practitioner is, what it takes to become one, and how much you could make. 

An orthopedic nurse practitioner is a specialized nurse practitioner who focuses on the care and treatment of patients suffering from musculoskeletal problems. These can include disease and/or injuries of the bones, muscles, joints, and supporting connective tissue. 

Problems with the musculoskeletal system can include genetic abnormalities and deformations, diseases, and injuries. Some common musculoskeletal problems that orthopedic nurses may see on an everyday basis include arthritis, fractures, sprains, muscular dystrophy, temporomandibular joint disorder, and fibromyalgia.

Orthopedic NPs comprise a very small percentage of NPs in the United States but require highly advanced training. We’ll dig into how to become one in section three. 

According to Payscale, the average salary for an orthopedic nurse practitioner as of August 2022 is $100,035 or $43.90 per hour, making it a very lucrative nursing career. 

Orthopedic nurse practitioners can be either salary-based or earn an hourly rate. This will vary based on the place of employment. Those paid on an hourly scale are able to earn overtime pay, whereas salaried employees would need to discuss that with the hiring committee. As with all jobs in the nursing field, earning potential increases with additional education and experience. 

>>Related: Nurse Practitioner: MSN vs. DNP

Becoming an orthopedic NP can be a long and daunting task; however, it is possible and worth it. To become an Orthopedic NP, you’ll need to complete the following steps. 

Step 1: Become a Registered Nurse

The first step to becoming an orthopedic nurse practitioner is to become a registered nurse, you can do this through either an ADN or BSN program, and then passing the NCLEX. 

Nurses who earn their Associates Degree in Nursing will need to either supplement their education and earn their BSN before progressing to an MSN program, or go through an accelerated RN to NP program. 

Step 2: Gain Experience

Many MSN or DNP programs look for nurses who have experience, and working for a few years can prepare nurses for the duties they’ll have to perform on the job. Additionally, in order to get certified, you'll need three years of experience as a nurse. 

Step 3: Earn Your MSN or DNP

For nurses that have a BSN, there are two main types of NP programs offered both in-person and online: 

• MSN-NP: One of the most common options for NP programs, the MSN-NP is for students who already have their BSN and can enroll directly into the program at the graduate level. 
  • Basic requirements: Applicant must possess a BSN degree. 
• DNP: Doctorate Nurse Practitioner programs allow students to receive their doctorate degrees while meeting the requirements to become an NP. The DNP is generally suited for nurses who plan on working more in an academic or research-based setting, 
  • Basic requirements: Applicant must possess a BSN degree. 
• Post-graduate certificate: If you have a graduate degree that is different from the area that you wish to specialize in now with your NP, you can search for a school that offers a post-graduate certification option to allow you to enroll directly in the program. 
  • Basic requirements: Post-grad certificate programs require you to either possess your Master’s Degree of Science in Nursing (MSN) or have a Nurse Practitioner qualification in another specialty.

Step 4: Get Certified

After earning an NP, interested students will have to enroll in a one-year post-graduate certificate program specializing in orthopedic care.

The Orthopedic Nurses Certification Board offers the ONP-C Certification to qualified individuals who pass their certification exam. This certification is available to APRNs that meet the following criteria:

• Have three full years of experience practicing as an RN or APRN, or with an equivalent license as described below.
• Hold a Master’s degree or higher in nursing from an APRN nursing program with preparation as an NP.
• Have a minimum of 2,000 hours of advanced practice nursing work experience within the past three years and presently be functioning as an NP who cares for patients with musculoskeletal conditions NPs who are enrolled in orthopedic fellowships or postgraduate nurse practitioner residency programs through accredited colleges or universities can use program practice hours to meet the APN practice requirement for ONP-C certification.
• Fellowship/residency hours do NOT count in the 3 years of minimum RN practice to test for the ONP-C credential.
• Hold a current, full and unencumbered license as a registered nurse (RN) in the United States, or its possessions, OR
• Hold a current, full and unrestricted license to practice as a first-level, general nurse in the country in which the candidate’s general nursing education was completed, and meet the eligibility criteria for licensure as a registered nurse (RN) in the United States.

Additional exam information includes:

• 150 questions. 135 are scored; the remaining 15 questions are pilot items
• A raw score of 96 is needed to pass the examination.
• $345 fee for NAON/AANP/NOVA members
• $460 fee for non-members

A breakdown of the exam is as follows:

• Degenerative Disorders (53 questions)
• Orthopaedic Trauma (24 questions)
• Sports Injuries (19 questions)
• Inflammatory Disorders (11 questions)
• Metabolic Bone Disorders (11 questions)
• Congenital/Pediatric (8 questions)
• Musculoskeletal Tumors (4 questions)
• Neuromuscular (5 questions)
• Clinician/Practitioner (85-95 questions)
• Educator (13-23 questions)
• Manager (3-9 questions)
• Consultant (11-19 questions)
• Researcher (3-9 questions)

Recertification is valid for 5 years. ONP-Cs must present 1,500 hours of practice as a nurse practitioner during the last five years before renewal and 100 contact hours of education (65 in clinical orthopaedics and up to 35 in general nursing). 

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Orthopedic Nurse Practitioners perform a variety of skills, generally related to the bones, muscles, joints, and supporting connective tissue of a patient. They can serve as generalists and cover all aspects of orthopedic care or they can further specialize in one of the following orthopedic interventions, areas, or disorders:

• Congenital musculoskeletal disorders
• Foot and ankle surgery
• Joint reconstruction
• Metabolic disorders
• Neuromuscular disorders
• Orthopedic oncology
• Spine surgery
• Sports medicine

Other specific duties for an Orthopedic NP include:

• Consult and collaborate with health care team members to assess, plan, implement, and evaluate patient care plans.
• Implement safe administration of analgesics for pain management and other patient medications within compliance of The Joint Commission
• Provide direct care and coordinate an interdisciplinary plan of care for inpatient orthopedic/plastic and reconstructive surgery patients
• Prepare/recover/discharge patients on the day of surgery and assist with surgery, as needed
• Assist in Orthopedic inpatient surgical total joint procedures and outpatient arthroscopic surgery and ACL reconstructions.
• Educate patients and family on patient-specific diagnosis, therapeutic regimens and pain management techniques including patient-controlled analgesia
• Perform pain management and orthopedic consultations and follow-up visits of established patients
• Schedule patients for surgery and coordinate with the healthcare system and surgical department
• Prepare patients for surgery, procedures, and post-operative plans of care
• Order, perform and interpret diagnostic and laboratory tests
• Design treatment plans and prescribe medications (independently or in a collaborative agreement with a physician)
• Cast and splint treatment including application, removal, and teaching
• Provide trauma care to patients suffering from musculoskeletal injuries

Orthopedic NPs can work in a variety of settings. Most commonly they are found in the following areas:

• Hospitals
• Operating Rooms
• Pain Clinics
• Emergency Room
• Military
• Occupational Medicine
• Rehabilitation Medicine
• Occupational Health
• Radiology centers
• Long-term care facilities
• Medical supply companies
• Hospice
• Palliative care
• Community health centers
• Public health centers
• Surgical Centers
• Outpatient clinics
• Home healthcare companies
• Government agencies
• Medical Evacuation and Transport Services
• Private homes providing health care services
• Universities and research agencies
• Private practice
• Phone triage centers
• Rural care facilities
• Nurse-managed medical centers
• Urgent care sites
• Academia
• International health missions

An orthopedic NP’s schedule will vary based on the setting they work in. Nurses can work 40 hours a week with a set schedule, or work a rotating shift schedule. Others will have to take call time for orthopedic emergencies. It is important to speak to the employer to determine the schedule that is expected.

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According to the U.S. Bureau of Labor Statistics (BLS),  the career outlook for NPs is excellent, with an expected 38% growth rate from 2022 to 2032.

While the BLS does not differentiate between the different types of NPs, Orthopedic NPs will always be in need as the baby boomer generation continues to age. Furthermore, the National Center for Workforce Analysis (NCHWA) reported an estimated shortfall of 20,000 primary care physicians by 2025. Orthopedic NPs will be needed to help fill this void. 

The idea of working independently of physicians is a great incentive for some people to move into the nurse practitioner career. In fact, the profession rates #1 as the best job in health care and No. 2 job overall in the top 100 jobs, according to the U.S. News & World Report 2022.

According to the American Association of Nurse Practitioners, musculoskeletal problems are one of the top reasons for primary care visits, and over half of chronic medical conditions in the United States are related to underlying musculoskeletal problems. And as obesity becomes an ongoing issue in America, the additional weight puts stress on the musculoskeletal system. Orthopedic NPs will continue to be needed.

CEU hours will vary based on the state of licensure. For each state an individual is licensed, CEU hours will be required. Generally, NPs are required a minimum of 75 contact hours of continuing education in the specialty area (orthopedics).

Additional CEU hours are required based on additional certifications.

American Association of Nurse Practitioners

Orthopaedic Nurses Certification Board

National Association of Orthopaedic Nurses

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$100,000+ Masters Doctorate Orthopedic Bedside NP