From Nurse to Patient: One BOSC CNA shares her personal experience with the Outpatient Joint Journey

Diane is a certified nursing assistant (CNA) at BOSC in the peri-op area. She’s on her feet for seven or more hours each day taking care of patients, prepping them for surgery, turning over rooms, moving patient carts, restocking areas, and many other responsibilities. But this past February, Diane went from working at the surgery center to being one of its patients.

“Six years ago, I was told I needed a new knee,” Diane says. “As the years passed, I felt myself limping more and having pain constantly, but I just decided to live with it.”

In her role as a CNA, Diane has worked with many patients who’ve had their joint replacement surgeries performed right at BOSC as part of the outpatient joint journey. Working with these patients – who were living with the same symptoms as her – and seeing how well they were doing after their surgeries inspired Diane to go see one of the OSMS doctors about her knee. She chose Dr. Michael Tressler based on the fact that he replaced her 85-year-old mother’s knee, and she was doing remarkable.

Diane and Dr. Tressler

Diane and Dr. Tressler

“About four hours after my surgery, when the block wore off and I had to get up, I remember holding my breath and thinking, ‘no way can I walk on this thing,'” Diane says. “But I did, and I’ve been moving along ever since!”

Diane went to therapy two times a week for three weeks, and then once a week for two more weeks. During this time, she also did home therapy twice a day. At about 4-5 weeks post-surgery, she walked her first mile. In the next few weeks, she stained a deck, raked leaves, and mulched her landscape. After 11 weeks, Diane was able to return to work and within a month progress back up to full time.

Diane in PT

Diane at physical therapy

“Before surgery, Dr. Tressler told me that I could get my life back, and he was right!” Diane says.

Her pain is gone. Stairs are no longer a chore. Diane is back to living the life she loves and sometimes even forgets that she has a new knee!

“Now, I’m six months post-op, and I wonder why I didn’t do it sooner. But you definitely have to be ready physically and mentally for a joint replacement,” Diane says. “After going through this experience, I feel like I can give our patients the support they may need to get over the anxieties or just share with them positive thoughts that may help them feel more at ease.”

Is Your Child Having Surgery? Read These Tips.

Kids like to run and jump, play sports, and rough house. These are all great ways to keep them active and wear off energy, but they can also lead to injuries like broken bones, torn ligaments, strains, and sprains. If your child does sustain an injury, and it requires a surgical treatment, hearing the word “surgery” might be scary for your child – and your whole family. Here are some tips from our staff to help your child feel more comfortable and prepared for surgery.

Before Surgery

Once it’s determined that your child needs surgery, begin to help your child feel confident about the experience. One way to do this is to make sure you – as the parent or guardian – understand as much as you can about the surgery. Our staff is available to answer questions and get you more information. This will not only reduce your nerves about the procedure, but you will also be able to help answer questions your child may ask.

When questions pop up that you can’t answer, see if your child would like to ask the surgeon or nurse the question themselves. This will help them feel involved and may help reduce some anxiety.

Make sure to have open and honest discussions with your child. Ask questions to figure out what they might be nervous about and how you might be able to help. For example:

  • What do you think will be the hardest part about having surgery?
  • Is there anything about surgery that makes you feel scared or nervous?
  • What do you think will be the easiest part about having surgery?

As you have these discussions, use language and wording that your child will understand. For example, when explaining anesthesia to a younger child, say that the doctor will help them take a nap during surgery instead of “the doctor will put you to sleep.” Since children understand what naps are, they may be less afraid of going in to the procedure.

Other things to help your child feel more comfortable leading up to surgery:

  • Use books or pictures to show what the doctors and nurses will be wearing, like scrubs, gloves, and masks.
  • Use play to explain what will happen. Maybe conduct a pretend surgery with one of their stuffed animals.
  • Watch this virtual tour with your child so everyone is more familiar with the surgery center.

Day of Surgery

A tough thing for children on the day of surgery is not being able to eat or drink anything. If you are the parent or guardian taking them to the surgery center, maybe do this step with them so that they don’t feel left out or like they are being punished. Before leaving home, have your child pick out a toy to bring with them.

When you arrive at the surgery center, show your child where you will be waiting so they know you won’t be too far away.

After Surgery

As the anesthesia wears off, your child can feel tired, restless, and irritable for up to 24-48 hours. You will need to be with them during this time. As your child’s appetite returns, make sure to have healthy and easily digestible foods on hand such as:

  • Brown rice
  • Oatmeal
  • Yogurt
  • Bananas

The surgery center will provide pain medications in an appropriate does for your child – based on weight. However, you will need to talk with your child about pain so you can properly manage it. A registered nurse from the surgery center will call the day after surgery to see how your child is doing. If you have questions or concerns, you can always call the surgery staff at 920-569-4300 or your OSMS physician and nurse at 920-430-8113.

Meet Our Total Joint Coordinator

A successful surgery encompasses much more than just the day of your procedure. Understanding how to properly prepare for surgery and what you’ll need to do during recovery are equally important.

Patients who go through our outpatient joint journey will work with our total joint coordinator to make sure that each piece of the surgery experience is taken care of. The total joint coordinator is here to help patients feel comfortable going into surgery and prepared to go home within 23 hours of their procedure with a new joint.

RachelRachel Petermann is the BOSC total joint coordinator. She began her career as a surgical technologist and is now a registered nurse. The majority of her career has been working with patients throughout the entire perioperative setting, which includes preparing for surgery, in the operating room, and during recovery.

“As the total joint coordinator, I work with patients to create a unique road map of the outpatient total joint experience so that they have an individualized care plan,” Rachel says.


To do this, Rachel:

  • Takes patients and their coaches through pre-surgery education to ensure that they understand the surgery and how to care for themselves and their new joint at home.
  • Helps coordinate any necessary pre-surgical testing, ordering of medications as well as post-surgery medical equipment.
  • Reviews discharge goals with patients and their caregivers.
  • Becomes a point of contact for questions throughout the entire outpatient joint journey.

Rachel says, “The most rewarding part of being the outpatient joint coordinator is witness firsthand the increased mobility that our patients experience after their surgeries, which gets them back to doing the things that they enjoy most in life.”

Learn more about the outpatient joint journey here.

Is Outpatient Joint Replacement Possible?

When people hear the phrase “joint replacement,” many probably think of a complicated surgery, a long hospital stay, and months of limited mobility. However, with advancements in technology and surgical techniques, this way of thinking is changing. Instead of needing inpatient hospital stays, patients can now turn to ambulatory surgery centers (ASC) to receive quality outpatient joint replacement care.

surgerycenter4What is an ASC? They are outpatient surgery centers that present an alternative option where consumers and businesses can find quality, efficient, and cost-effective surgical care.

Orthopedic-focused ASCs such as the Bellin Orthopedic Surgery Center (BOSC) are able to perform a variety of outpatient surgeries such as knee arthroscopy, rotator cuff repair, and even ACL reconstruction. With the opening of our 23-hour patient stay rooms last May, we’ve added total joint replacement to the list.

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23-hour stay area

“The 23-hour stay rooms provide a comfortable and convenient place for patients to stay following their joint replacement surgery; it’s right down the hall from the operating room,” says Amanda Sosnosky, MBA, BSN, RN, CASC and the surgery center administrator. “We have orthopedic certified nurses to monitor patients during their stay, and after a visit from the physical therapist and their surgeon, patients are discharged home the morning after their joint replacement surgery.”

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Extended stay patient room

For motivated patients who have a strong support system at home, outpatient joint replacement and our 23-hour stay rooms safely put them on an accelerated course of recovery. This includes:

  • Flexible and convenient scheduling
  • Accelerated rehab
  • Comprehensive pain control
  • A quicker return home and back to everyday activities

All together, these benefits mean less time away from family, less time off of work, and a significant reduction in cost. In fact, the cost may be up to 40% lower than an inpatient joint replacement.

The surgeons at OSMS are able to perform total hip, knee and shoulder replacements  in the outpatient surgery setting. Learn more about the outpatient joint journey here.

Serving Beyond the Community

Doreen Messerli and Sue Burkard are both registered nurses, and they both work at Bellin Orthopedic Surgery Center. They both have also always wanted to do a medical mission trip. Earlier this month, they were able to go on one together.IMG_0917

Their trip was through the Green Bay chapter of the Friends of Haiti, a nonprofit organization that serves four areas of Thomazeau Haiti through medical and surgical mission trips.

“We were assigned to the community of Grand Boulage, a mountain community approximately 18 miles from Port Au Prince,” Doreen says. “There were no paved runs, no running water or electricity, and our group saw about 1,300 patients in the three-and-a-half days the clinic was set up in their community center.”

“We worked with family practice physicians and interpreters to provide assessments, medications, and education to the residents, and we also assisted with procedures from lab testing to wound care and even the delivery of a baby,” Sue says.

Both Sue and Doreen also got to experience providing care outside of the clinic set up by the medical mission group. Sue accompanied two patients who were in critical condition down the mountain to be admitted to the hospital. Doreen had the opportunity to make a home visit,which took her farther up the mountain.

Sue and Doreen“The Haitian people dressed in their very best to come see us, and they smiled a lot and were very thankful,” Doreen says.

“No matter how much or little we did, and despite the language barrier, you could see in their eyes how much they appreciated the care,” Sue adds.

Now, back in Green Bay, Doreen and Sue have refreshed perspectives on life.

“I’ve come back wanting to focus on the basics in my life: health, family, community, and thankfulness,” Doreen says.

“It was a positive and uplifting experience seeing the impact we were able to make,” Sue says. “It makes you truly appreciate all that we have.”IMG_1097

9 Commonly Used Surgery Terms and What They Actually Mean

NPO, arthro, outpatient…? What qualifies as a clear liquid?

The healthcare world is full of abbreviations, acronyms, and terminology that the people who work in healthcare may use every day, but that patients may hear for the first time only when they need surgery.

Here are 9 medical terms commonly used at BOSC and their definitions.

Arthroscopic Surgery

The word “arthroscopy” comes from the Greek words “arthro” and “scope,” which mean “joint” and “look,” respectively. When an arthroscopy is performed, a camera is inserted into the joint through an incision approximately one centimeter long. The camera is attached to a light source and displays a picture of the inside of the joint on a television screen in the operating room. The surgeon uses fluid to expand the joint, aid in visibility, and clear the joint of debris. One or more other incisions are made to insert instruments that are used to treat a variety of conditions such as a torn meniscus or rotator cuff. This type of surgery is commonly referred to as a scope.

Outpatient Surgery

This type of surgery is also called “ambulatory surgery” or “same-day surgery.” It refers to surgical procedures that do not require an overnight hospital stay, meaning you will go home the same day your surgery is performed. The one exception is the BOSC outpatient joint replacement program. With these procedures, you will stay overnight in our extended stay area, but you will return home within 23 hours of your surgery. Learn more about outpatient joint replacement here.


NPO is a medically approved abbreviation that means NOTHING BY MOUTH. The abbreviation is based on the Latin phrase “ni per os,” which translates to “nothing by mouth.”

For patients, NPO is the reason you can’t eat or drink anything before your surgery. It is recommended that patients have nothing by mouth (no food or fluid) for a minimum of six hours and a preferred 8-12 hours prior to their surgery start time. NPO status is used to help prevent aspiration pneumonia. Aspiration pneumonia can occur when food or fluid from your stomach is aspirated (or inhaled) into your lungs, which can cause an infection and lead to pneumonia.

Clear Liquid

If your surgery is in the afternoon, despite NPO status, you may be allowed to have clear liquids until six hours before surgery. Clear liquids are defined by MedLine Plus as liquids that are easily digested and leave no undigested residue in the intestinal tract. This also includes foods that turn into clear liquids at room temperature.

Foods that qualify as clear liquids include:

  • Plain water
  • Fruit juice with no pulp (apple, grape, cranberry)
  • Clear, fat free broth (Bouillon or Consomme)
  • Clear sodas (7-Up, Sprite, ginger ale)
  • Sports drinks
  • Kool-Aid
  • Plain gelatin, Jello-O
  • Popsicles (no fruit pulp or pieces)
  • Tea or coffee (no milk or cream)

Weight Bearing Acronyms

Often after surgery on the hip, knee, or ankle, your physician will order specific weight-bearing restrictions. These include:

NWB – Non-weight bearing

TT – Toe Touch weight bearing (less than 10 lbs)

WBAT – Weight bearing as tolerated

If these restrictions are ordered by the physician, they will be be reviewed with you before you are discharged. Additionally, if you are NWB or TT weight bearing status, an assistive device such as crutches, a cane, walker, wheel chair, or knee scooter will be recommended.


DVT stands for Deep Vein Thrombosis. It occurs when a blood clot forms in a deep vein, usually in a lower limb. The blood clot is formed when blood flow is reduced or slowed due to a trauma such as surgery, injuries, inflammation, or immune response. Blood flow can also be slowed by prolonged immobility, such as what might result from surgery or serious illness.

If you are having surgery that requires general anesthesia, a BOSC nurse will use a tool to assess your risk of developing a DVT. Depending upon your score, you will receive sequential compression stockings (SCDs). SCDs are placed on your lower legs and then hooked up to a small machine, which will intermittently compress your lower legs. This helps move the blood throughout your body, preventing pooling of the blood in your veins, which can lead to clots.



3 Reasons Why a Support System is Critical After Surgery


One of the main benefits of an outpatient surgery is how quickly you can go home! However, it’s important to remember that every surgery requires some recovery time – whether it’s a joint replacement with an overnight stay or a carpal tunnel repair that allows you to go home within hours of your procedure.

Here are three reasons why a support system is so important during your recovery – no matter what surgery you’ve had.

Reason 1. You can’t drive within the first 24 hours after your surgery.

When you are discharged from the surgery center, you are technically awake, but the anesthesia can actually remain in your system for up to 24 hours after your surgery. During these 24 hours, the anesthesia can cause you to feel dizzy, drowsy, lightheaded, or nauseous. Plus, you will most likely be taking a pain medication that can also make you experience these symptoms.

For these two reasons, you are prohibited from driving for 24 hours and must have someone from your support system take you home after surgery. This person can also be a second set of ears to hear your discharge instructions and help you remember them once you are back home.

Reason 2. You’ll probably have some physical restrictions.

For a larger surgery, like a total joint replacement or ACL repair, your post-surgical restrictions could limit your ability to do major daily activities like walk, drive, lift, or bend.  In these cases, your support system will be instrumental in helping you with daily activities like getting around your home, cooking, and driving you to follow up appointments.

For smaller surgeries that don’t have any specific restrictions, your support system can lend a hand the first few days by making sure you are eating nutritious meals, drinking lots of water, and getting plenty of rest.

Just remember, overdoing it or not following your restrictions can lead to a slower and potentially less successful recovery.

Reason 3. Surgery can be stressful.

Beyond the physical impact surgery has on your body, it can also affect you mentally and emotionally. Having a family member or friend to talk to throughout your recovery can help relieve any built up emotional stress. Your support system can also provide extra motivation if the recovery process ever seems too difficult or too long.

A full recovery is always our goal at BOSC. If you have any additional questions about the importance of a support system or what areas you may specifically need help with after your surgery, make sure to talk to your physician or one of our nurses.

Who’s On Your Surgical Care Team?

When you schedule a surgery at Bellin Orthopedic Surgery Center (BOSC), there are a lot of people who become involved with your care besides your OSMS physician and the nurses that work with him in the clinic. Some of them you will meet as you prepare for surgery or during your recovery. Others work behind the scenes in the operating room and administrative office. But all of them play an essential role in ensuring you have a positive surgical experience.


Here are a few of the specific job duties that are vital to our team:

PrePARE Registered Nurses (RNs)

The PrePARE RNs main responsibility is to meet with patients and their families prior to surgery. They become the main contact person for patients prior to the day of surgery and are available to answer any questions. The PrePARE nurses must accomplish several tasks before a surgery can occur, including:

  • Obtaining preoperative testing (EKG, lab work)
  • Reviewing the patient’s health history and home medications
  • Screening the patients and obtaining physician clearance for surgery, if needed
  • Setting up follow up appointments and physical therapy appointments when necessary

As part of the BOSC Outpatient Joint Journey, patients who are having total joint replacements performed at the surgery center will work directly with the Total Joint Coordinator. The Total Joint Coordinator is a PrePARE nurse who helps patients through every step of the joint replacement process, including pre-surgery education and coordination of post-surgical care.

Pre- and Post-Operative RNs

Two types of nurses work with patients and families right before and right after a surgery. These are the pre- and post-operative RNs.

The main responsibilities of the pre-operative nurses include:

  • Preparing patients for surgery, both physically and mentally
  • Answering any questions that patients or their families may have
  • Conducting assessments
  • Taking and monitoring vital signs
  • Placing an IV
  • Preparing the operative site
  • Administering medications

The main responsibilities of the post-operative nurses include:

  • Monitoring patients closely during recovery
  • Frequently taking and monitoring vitals
  • Administering medications as needed
  • Educating the patient and family on discharge instructions

Operating Room (OR) RNs

Operating room nurses are not typically seen by the patient’s family, as these nurses are responsible for transporting the patient safely to and from surgery as well as continually monitoring the patient during surgery. And while the pre-operative nurses help prepare the patient before surgery, the OR nurses prepare the operating room. They are also available in the OR throughout the surgery to help keep things running smoothly.

Surgical Technicians

During surgery, the surgical technician is positioned right next to the surgeon, carefully assisting. Their responsibilities include:

  • Maintaining a sterile environment
  • Handing the needed equipment to the surgeon
  • Managing surgical equipment before and after the procedure

Anesthesiologists and Certified Registered Nurse Anesthesiologists (CRNA)

Anesthesiologists are physicians who specialize in the administration of anesthesia. Prior to surgery, the anesthesiologist is responsible for carefully reviewing the patient’s health history as well as explaining the anesthesia that will be used and answering any questions from the patient. During the operation, the anesthesiologist and the CRNA work together to maintain the patient’s safety using anesthetic agents. They are constantly monitoring the patient and administering medication as needed. Once the surgery is over, the anesthesia team ensures the patient is stable and assists with the transfer of the patient to the recovery room.

Sterile Processing

Sterile processing personnel are working behind the scenes to promote patient safety by cleaning and sterilizing equipment that can be reused as well as ensuring that all equipment is working properly.

If you have any questions about who will be assisting you on your day of surgery, please ask the PrePARE nurse during your pre-surgery meeting.

Business Office and Administration

Our business office and administrative staff are responsible for the day-to-day operations of the facility, including financial and billing duties, handling insurances, and managing patient charts.

The Knee

How well do you know your knee?

The knee is a hinge joint formed by two bones, the femur and the tibia.

The knee has four ligaments which provide support. They are the medial collateral ligament (MCL), lateral collateral ligament (LCL), anterior cruciate ligament (ACL), and posterior cruciate ligament (PCL).

Knee AnatomyBetween the femur and the tibia there are two crescent shaped cartilage structures called the medial meniscus and lateral meniscus. The menisci act as shock absorbers and decrease the load on the femur and tibia.

The patella (knee cap) is on the front of the knee and tracks between the medial and lateral condyle (round prominence at the end of a bone) of the femur. The ends of the femur and tibia, as well as underside of the patella, are covered by a shiny articular cartilage called hyaline cartilage. Ideally, articular cartilage allows for a friction and pain free movement.