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  1. Section Editor(s): Pietrowski, Dorothy MSN, ACNP, ONP-C
  2. ONCB President

Article Content

Early in our education as nurses, we were introduced to Dr. Patricia Benner's adaptation of the Dreyfus Model of Skill Acquisition (Benner, 1982). If you recall your days in nursing theory, she was able to describe how nurses progress through their careers in five particular stages: novice, advanced beginner, competent, proficient, and expert. These stages take into account many variables, such as continuing education, skill, and experience. Fifteen years ago, it was clear to me that I needed to focus on acquiring these variables to hone in on my craft as an orthopaedic nurse.

Dorothy Pietrowski, ... - Click to enlarge in new window ONCB President

We all have experiences we can share about our own career development and where we currently reside in these five stages. Needless to say, we quickly learned as novice nurses that moving through the variables is impossible to achieve alone. We rely on the nurses around us to act as guides: pulling us into new situations, showing us a new skill, and allowing us to perform a procedure under their watchful eyes.


Early mentorship by the competent, proficient, and expert nurses in orthopaedics directs us toward professional development. Certification in the specialty becomes a goal to validate knowledge, skills, and abilities. I considered myself truly honored to have someone who continually pushed me to do more for myself, my patients, and the specialty very early in my career as a novice nurse. Certification was a goal and a personal priority. Achieving the credentials of ONC, and later ONP-C, helped me define my practice and professional aspirations.


Certifying as an orthopaedic nurse takes into account Dr. Benner's stages and creates a target for nurses who have identified orthopaedics as their passion. When trying to understand our fundamental goals as an organization, Orthopaedic Nurses Certification Board (ONCB, n.d.) members determined we were operating with four core beliefs that molded our identity:


1. Nurses achieve their fullest potential when they feel valued and recognized.


2. Optimal performance occurs when decisions integrate evidence, intuition, and innovation.


3. An environment of respectful collaboration encourages diversity of thought and fosters open, honest communication.


4. Certification is a powerful vehicle for personal and professional transformation.



ONCB has created a community that focuses on inclusivity versus exclusivity with the understanding that, as caregivers, our outreach is no longer confined to a postoperative acute care setting. Orthopaedic nurses are taking on many unique roles that have been created to adapt to the ways we now care for patients beyond the bedside. Home healthcare, ambulatory surgical centers, nurse navigators, educators, and administrators are now molding the future of how we care for people with musculoskeletal health conditions.


In 2006, a new credential was created to recognize the skill set of nurse practitioners who defined their roles as providers in the musculoskeletal world. At this moment, we have 132 ONP-Cs across the country who are providing expert care and are leading the way in innovation, education, and advocacy. In 2018, ONCB acknowledged the work of master's prepared administrators, community leaders, researchers, and educators in the advancement of musculoskeletal health. ONCB's advanced certification by portfolio (ONC-A) was created to recognize their work for the specialty. We encourage you to bring this forward to your orthopaedic executive directors, ambulatory managers, navigators, and others who would fit the criteria for this certification so they too can be included in our orthopaedic-certified group.


In line with our outreach, we have met many nurses who work in our field internationally and have asked how they can become certified. In the past, we have only offered the examinations in the United States. As of September 3, 2019, our testing vendor changed to Scantron (formerly Castle Worldwide). Although international testing will not be offered immediately, our strategic goal is to offer international testing. In the meantime, we will have more testing sites available across the United States to serve our examination candidates.


Scantron will also help us move forward from a technological standpoint by offering digital badging to certificants. Digital badging allows certificants to share their credentials in real time on email signatures, digital resumes, and social media sites (LinkedIn, Twitter, and Facebook). This is a more efficient way for employers, educators, and professional organizations to securely verify certification. It is a great way for certificants to represent their achievement through multiple media.


Achieving the orthopaedic certification credential is a source of pride and self-validation. But the work doesn't stop with a pin. There were many people who may have come into your career to help you accomplish your goals. Give back. Be inclusive. Mentor. Volunteer. As you find others taking care of musculoskeletal issues in the workplace, at home, in your churches, and communities, reach out and lend a helping hand. It may be hard for a novice to ask questions, so talk out loud so they can hear your process. Encourage them to become members of NAON. Continue to provide them with evidence-based literature to solidify their practice. As much as we are educators and advocates for our patients, we should be doing the same for our orthopaedic nurses to continue to strengthen the future.




Benner P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402-407. [Context Link]


Orthopaedic Nurses Certification Board. (n. d.). Mission, vision, and core beliefs. Retrieved from https://www.oncb.org/about-oncb/mission-vision-values/[Context Link]