Joint Replacement Nursing: Interview with Angela Garcia, RN

My Specialty

Joint Replacement Nursing: Interview with Angela Garcia, RN

Caring for patients from pre-op through rehabilitation

By Keith Carlson, RN, BSN
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I’ve been at Glendale Adventist Medical Center for seven years. I’ve worked on the ortho, surgical stepdown and neurotelemetry units. At a certain point, a position opened up assisting the facility in earning its JCAHO [Joint Commission] certification for joint replacement. I was accepted as the joint replacement program coordinator and have held that position for two years.

What are your responsibilities as the joint replacement coordinator?
My job is to run the joint replacement program. I see patients prior to surgery and conduct all of the preoperative classes in order to educate the patients about what to expect and how to prepare for their surgery. I also provide education for nurses on new technologies and protocols.

Following surgery, I round on our patients every day and help to manage their pain. I have direct access to the physicians and surgeons and I facilitate many aspects of our patients’ care.

In terms of complying with the Joint Commission, there are disease-specific requirements that need to be met. JCAHO certification is granted based on programs’ consistently achieving high outcomes, providing excellent customer service and nursing care and following standardized surgical procedures. My job is to ensure that we comply with all of these requirements, so I work every day with the surgeons, nurses and therapists to make sure our program is on track.

What skills are most important in your work?

Clinical skills to assess pain are very important, as are communication skills to facilitate the education of both patients and staff. I also need to accurately collect data and submit it to JCAHO in a timely manner for our regular recertification. I was hired to help the facility comply with the requirements of certification. We also use evidence-based gold standards of care as part of our Surgical Care Improvement Project.

Are you also involved in the human resources aspect of the department?
No, I’m not involved in hiring or firing of staff and I have no one who directly reports to me. That responsibility falls on someone else!

Although you don’t hire staff, what qualities do you look for in your nurses?
I look for willingness to listen to the patient. I especially like new grads because they’re eager to learn and it’s easier to teach them, since they have fewer preconceptions.

Postoperatively, the patients are seen by their physicians for follow-up, but the majority of a patient’s hospital stay is spent interacting with their nurses. This is why listening is so very important. Our nurses need to be able and willing to communicate with the physicians and actively advocate for their patients.

I also prefer nurses who are able to work with others easily, interacting with the various members of the multidisciplinary team. Orthopedic patients work with therapists constantly as part of recovery, so the nurse should be able to communicate and work hand in hand with the therapists in order to help patients be successful in their rehabilitation, which helps them successfully transition home.

How has technology impacted your work?
Joint replacement surgery has been around for decades. It is in fact one of the most successful surgeries in modern medicine. The techniques and basic principles for surgery are the same. However, one of the major differences is that the current prostheses generally last longer. The prostheses that are being used today are constantly being improved in order to decrease wear and tear, and this greatly increases the longevity of the replacement — and the ultimate success of the surgery.

Also, computer software programs are now available for the surgeons to use to assist them in very precise placement of the new joint, and this has contributed greatly to our long-term success rate.

What professional certifications do you hold?
Aside from my bachelor’s degree, I hold a specialty certification as an orthopedic nurse.

Do you have any professional plans for the future?

I want to earn an advanced degree so that I can have more autonomy and personally help to adjust medications and manage post-surgical pain.

What do you love about your work? What keeps you coming back?

I love the team that I’m working with! We have a dedicated ortho floor staffed with orthopedic trained nurses and therapists that work with our patients. I am also very proud of our 20-bed, state-of-the-art orthopedic unit, where we have a patients’ gym, private rooms for patients and an open floor nursing station, which is specifically designed to allow ready access for care and intervention.

As to what keeps me coming back to work? That’s easy: It’s the constant improvement I see in our patients. They are often barely able to walk when they come in for their pre-op appointments, but by the time they are discharged from the hospital, there is a significant change in the way they get around.

In our department, our patients are able to become increasingly functional. They’re able to get up and around, become more mobile, experience less pain and have improved outcomes, both in terms of surgical recovery and rehabilitation outcomes.

Patients leave our unit with less pain and an improved outlook regarding their post-surgical lifestyles. Our patients recover from surgery with hope, realizing that their condition is not chronic in nature. I personally witness their improvement and I hear how they have an increased ability to play with their grandchildren, walk without pain and be more functional.

Complications and surgical failures are very rare, so our success is very gratifying. When I call our patients to follow up six weeks, six months or one year after their surgery, they tell me how much better their lives are. I really like what I’m doing. There’s a great deal of interaction with the patients and their families. They want to get better and listen closely to our recommendations. We’re a team that really cares, and that is very fulfilling.

Keith Carlson, RN, BSN, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at


Did You Know?
Most commonly replaced joints: Hips and knees
Other joints commonly replaced: Shoulders, fingers, ankles and elbows
Disease most likely to damage joints: Arthritis
Term for a new joint: Prosthesis
Material likely to be used: Metal, plastic or both
Number of Americans who have joints replaced each year: Over 1 million
When physical therapy usually begins: The day after surgery

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases

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