Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Jane M. Georges, PhD, RN, Chairperson; Cynthia D. Connelly, PhD, RN, Member; Karen, Macauley, Phd, DNP, Member


Nurse Practitioner, Sub-specialty, Orthopedics, Case Study, Specialty NP


Purpose: The overall purpose of this study was to describe the ONP role by exploring how and why NPs are utilized in orthopedic health care settings. Two problems associated with the evolving ONP role were addressed: the concomitant decrease in the supply of and increased demand for orthopedic patient care services and the nursing profession’s unmet challenge to keep pace with that increased demand and protection of the public and nursing profession through credentialing of ONPs and programs providing certification and training for ONPs.

Approach: This study employed a single-embedded case study research approach to answer the research questions and interpret the results through analysis of interview data, participant observations, and document surveys.

Findings and Conclusions: The analysis of the ONP role through the lens of Style’s conceptual model, Nursing as a Social System, and the PEPPA-Plus framework revealed the ONP role lacks the maturity required for long-term sustainability, thereby threatening the viability of the role. Highly specialized knowledge and skill are required for the ONP role and currently the means for supplying adequately trained and/or experienced ONP job applicants is ineffective. The development of the ONP role is contingent upon trusting professional relationships with individuals or groups of orthopedic surgeons, a necessary component of the ONP role. The highly specialized ONP role varies significantly from the general NP role in which it emerged suggesting new methods for training and evaluation may be indicated. Lastly, environmental conditions contribute to the decisions by orthopedic surgeons and health care organizations to employ ONPs. This study identified environmental conditions consistent with those in both Style’s and the PEPPA-Plus models suggesting these models are useful frameworks for ONP-role analysis.

Relevance: Findings from this study may influence and inform policy makers to improve and enhance the orthopedic-patient care provided by ONPs and theory development regarding the role and utilization of sub-specialty NPs. This in turn may influence the eventual establishment of evidence-based standards for orthopedic education, training programs, and fellowship accreditation.


Case Study Method

Analysis of sub-specialty Nurse Practitioner role

Document Type

Dissertation: Open Access