During the course of a typical day at the busy Kaplan Joint Center at Newton Wellesley Hospital, nurse practitioner (NP) Judy Walsh does everything from injecting medicine in someone's knee to ease the pain, to explaining the results of MRIs and CTs. One minute she might be teaching patients about how to recover from hip surgery; the next, she's fighting with insurance companies to get tests and medications covered. As the sole "constant care" provider - overseeing the patient's progress from the initial call through the rehabilitation process - Walsh brings a caring style and medical expertise to a practice that also includes nine orthopedic surgeons. Walsh says as a nurse practitioner, she enjoys being able to do the handholding, "coddling" nursing piece as well as the more practical treatment and prescribing of pain medications.

Orthopedic surgery is one of Newton Wellesley's largest clinical services, serving both weekend warriors and sidelined youth as well as professional athletes. As a nurse practitioner working with surgeons, Walsh provides patients with an intermediary or devil's advocate. Often she'll often answer questions that patients are uncomfortable asking their physician. "There has to be deliverer of hard cold news - the M.D. - and someone who has to help creatively integrate hard changes in folks' lifestyles, which is often me," says Walsh, who, as a nurse practitioner can take health histories and provide physical exams; diagnose and treat chronic and acute problems; interpret X-rays and lab results, and manage medications and other therapies. In an orthopedic setting, NP tasks also include splinting, bracing, and casting, while the surgeon does the "fixing" in the OR.

The nurse practitioner role evolved in the mid-1960s in response to a nationwide shortage of physicians. Nurse practitioners are registered nurses with a graduate degree in advanced practice nursing (APN), and licensed through the state, and certified through national organizations. The job outlook for nurse practitioners is excellent, because of the services they provide. "I spent 10 years as an emergency room nurse, and then it was a natural move for me to take advantage of a tuition reimbursement policy to get my master's degree as an adult nurse practitioner," says Walsh, whose first NP job was doing geriatric assessments in a small community hospital, followed by working in a sports medicine clinic.

Q: How did you move into orthopedics as a specialty area?
A: It's funny, because while I was in the program at UMass Worcester, I vividly remember an orthopedic NP giving a lecture, and thinking, "Yuck, I wouldn't want her job, putting casts on all day and dealing with broken bones." So you never know where you will end up. But I decided to work with the sports medicine doctor because I figured I could deal with the orthopedic issues, as long as they were sports medicine based, rather than strictly trauma. Over time, I've come to appreciate the caring/nurturing piece of orthopedics quite thoroughly.

Q: How do you feel about the move, by 2015, for all new APNs to have a doctorate?
A: Theoretically, the shift to the doctoral level makes great sense. Practically, though it?s nearly impossible. The capital outlay to get a doctorate today alone is enough to scare most NPs off. Then there is the problem of getting qualified teachers. Until these inequities are addressed it's going to be difficult to require the NP doctorate.

Q: Do you get asked medical questions at cocktail parties?
A: My non-medical husband is very helpful in this kind of situation. He immediately informs people that my advice for any and all medical problems is, "Take a shower you'll feel better." It's worked for me for years!

Q: Have you had to use your nurse training in an emergency situation outside the job?
A: These days my favorite emergency intervention is to call 911! I am very good if anyone faints but I dread the day that I'm at the Natick Collection and I have to use an AED (automated external defibrillator) on someone.