Career Advice for a New Nurse wanting to go into Occupational Health

MikeCOHN · Mar 7, 2020

Occupational Health Nursing is a great specialty and can pay 20-25% above traditional bedside nursing. I have been a nurse for 20 years and have worked in Occupational Health for 15. I manage programs in the manufacturing industry and have oversight of 11 facilities and about 25 nurses. The typical day of an OHN is never predictable. and challenging and you do a lot of different things. The job is very interesting. I will tell you what I look for in an occupational health nurse that I hire.

- I don't require OHN experience, 2-3 years experience as a nurse is good. I like to recruit ED nurses looking for a change. The skill set is a good match. Fast paced, multi-tasking, handle stressful situations, deal with difficult people, can work independently and most important be able to critically think.

- The learning curve is large and can take a year or more to get to the point where you think you have it under control, a lot of what you do will be on the job training. Depending on your work site you will be doing things like drug testing, post offer medical assessments, treating minor injuries or illnesses, breath alcohol testing, hearing conservation, ergonomics, STD/LTD/FMLA, workers comp case management, DOT drug/alcohol testing, wellness programs, teaching CPR/AED/BBP classes, respiratory protection and fit testing, etc.

- Depending on your site once hired you will be sent for training to be certified in NIOSH Pulmonary Function Testing, CAOHC Hearing Conservation, CPR Instructor, DOT Specimen Collector and Breath Alcohol Tech.

- Advancement - An OHN can advance into management positions, multi-site management, regional roles and corporate leadership. Many OHN's move into case management roles. You can get your MSN as an occupational health NP. Certifications including COHN, COHN-S, COHN/CM, CCM are all possible after a couple of years of experience. Certification is marketable and will increase your salary as an OHN.

- Pay for OHN's can vary widely based on your industry. In general an experienced OHN with a certification can make 20% + more than a traditional bedside nurse. In my area (Southeast) we pay OHN's between $68-86k depending on experience.

OH is a challenging and rewarding specialty, can be very demanding at times but I enjoy getting to know the employees and working with them and helping them work through whatever might be going on.

I hope this helps. Good luck!

-

RN61, BSN, RN · Mar 8, 2020

MikeCOHN,

Thank you so much! That answers my questions. I did not know that nurse practitioners can be specialized in the occupational health field; that's really interesting. I will continue to do my research in this field of nursing but I am very interested in it and hope that I can join it one day.

42pines · Jul 31, 2020

NP's can earn over 100k. In MA the normal range is about 70-90k for those who have more than 5 years experience and preferably be COHN or COHN-S.

katkonk, BSN, RN · Apr 15, 2021

I'll point out that there are really two primary types of environment in which to practice Occ Health Nursing. One is in industry, and it seems like you have already explored that. The other is in the hospital setting, in Employee Health. Those two environments have completely different foci. In the industrial setting, the type of work you will do will also depend on what type of industry you are in. You can be working in high tech, in heavy industry with large equipment or heavy product (think locomotives or large steel tubing for oil production), or corporate type of Occ Health Nursing, where your focus will be on treating/triaging primary care type complaints, facilitating lactation room use and scheduling the times employees can use it, and a LOT of health and wellness. They typically have you do emergency response, and typically there is not much of that, but it can be very important when it does. I am fortunate enough to have worked for 20 years in this specialty, and have worked in all the types of environemnts listed above. If you are lucky enough to get a good fit and love what you do in one type of company, and especially if it is with a premier company with very good benefits, then stick with it. If you are curious about the different types of practice, then certainly explore a bit. I chose variety, partly to facilitate time off for my personal life and some of the changes just happened (one company was merged and dissolved, for instance). Usually in industry MUCH of what you will do and decisions you will make about clinical care and what you try to provide onsite or whether you decide to send them for an evaluation, will have the element of OSHA recordability incorporated into your decision making. You need to know OSHA rules by memory and learn how much you can do to keep the treatment for injuries on site and what you can and cannot use that will affect the OSHA recordability. Some will say that this should not affect decision making, and but it does (to a certain degree). You must be a patient advocate, but at the same time, there can be HEAVY pressure by the company managers, directors and VP's to minimize outside treatment. And sometimes you have to draw the line and defend your decisions and advocate for the patient. This is where being confident in your assessment skills becomes very, very important. Know that this can also get you fired. (I had one company ask me if I would talk to the surgeon that had to repair a fracture, and was doing the surgery on a Friday morning, and ask the surgeon to release the employee to return to work for half the day on Friday (then he would be off for the weekend). They said they would allow the employee to just sit in the office at work after surgery. I said no, that the employee needed to go home and keep his leg ELEVATED to minimize swelling, and that he needed to go sleep off the anesthesia and rest to promote his recovery. That decision was not well received by the Director worked for, and he let me know it in no uncertain terms. I have been told point-blank that if we (my nurses and I) did not "play ball" with the company's wishes as far as "keeping things OSHA non-recordable, or avoiding lost time", that they would find someone who would. (And mind you, I am very, very good at playing that OSHA "dance", as I like to call it.) There is that very dark side to Occupational Health Nursing that OHN nurses don't like to talk about, and that is that companies often cheat (some cheat BIG and some simply bend the rules a bit) on OSHA rules and regulations. This is a great source of stress in many environments in certain industries, because as an OHN, you are party to their actions. You must figure out how to give prudent care, and advocate for BOTH your patient AND the company. I say both, because there is a world also full of malingerers out there, who want to abuse the worker's compensation system and get every dime and every hour of paid time off they can from a company when they have an injury. Or ALLEGE they have an injury. I have pursued surveillance for worker's compensation injuries which I felt were not legitimate, where undercover people follow employees around and video their activities at home or when they go somewhere in the car, etc. to collect proof that they are faking a disability. And most of the times I have been right. The others were inconclusive, because we never got anything on film. (For instance one employee said that his arm was causing so much pain that he had to wear a sling and couldn't even hold a paperweight -and therefore had to be off work and paid by worker's compensation- yet we had video of him loading bags of concrete into the back of his truck and then putting on his sling to attend a meeting with a work manager directly afterward.) So, while treating injuries and seeing employees for personal health problems may take up some of your time, the essence of your job is going to revolve around activities that are regulatory in nature. Regulatory, Regulatory, and more Regulatory is going to be your job. In chemical/oil/gas/some manufacturing, etc. it is going to center around hearing conservation programs and OSHA regs for hearing loss and testing, NIOSH regs regarding respirators, what kind, PFT's and fit testing, knowing your different filters and requirements, etc. So, just be prepared, there are volumes of information you will need to assimilate, if you choose the industry environ. If you like it, you will probably want to do nothing else but that for your entire career. If you don't like the rules and regs, then it might not be for you. Good luck in your path that you decide to go on.

RN61, BSN, RN · Jun 14, 2021

Thank you katkonk! That is a lot of extremely helpful information and I greatly appreciate it!