Are you in 'employee health' or 'occ health'?

'Boot camp' raises training of HEH nurses

Q: What's the difference between an employee health nurse and an occupational health nurse?

A: "Occupational health" is a specialty with certification that requires knowledge of workers' compensation, injury prevention, and wellness.

It may sound like mere semantics. But the distinction between "employee health" and "occupational health" is an important one in a high-hazard field. As hospitals seek to contain workers' compensation costs and retain workers, there's a new push to elevate the training and professionalism of hospital employee health nurses.

Many hospitals offer occupational health services to local businesses and industrial plants. But internally, their program may be confined to regulatory compliance (vaccination, TB screening, bloodborne pathogen follow-up) rather than injury prevention, notes Larry Gray, AIC, executive vice president, Property and Casualty, for PHT Services, a risk management alliance and workers' compensation pool for hospitals and other health care employers in Columbia, SC.

Last fall, PHT Services encouraged its member hospitals to send employee health nurses to a "boot camp" organized by the American Association for Occupational Health Nurses (AAOHN) for a refresher on occupational health basics.

"When it comes to employee safety, health care tends to lag what they're doing in industry by 10 or 20 years," says Gray. "This is one of those prime examples. The typical employee health nurse is promoted into employee health usually from the floor in the hospital and doesn't really know anything about workers' compensation. We do our best to educate them. But they certainly don't have, in most cases, any occupational health background whatsoever."

The nurses themselves aren't the only ones who may take a narrow view of their role. The Association of Occupational Health Professionals in Healthcare (AOHP) seeks to educate hospital CEOs, as well, by sending them letters each year during Occupational Health Nurses' Week." I focused on the challenges in health care, [asking them,] 'Do you have someone who takes care of your people and keeps them well and safe?'" says Denise Knoblauch, RN, BSN, COHN-S/CM, president emeritus of AOHP and clinical case manager at the Center for Occupational Health at the Saint Francis Medical Center in Peoria, IL.

In fact, when AOHP formed 26 years ago, it set out a mission to professionalize the hospital-based employee health nurse. Today, AOHP continues to educate nurses about such issues as making a business case for employee health. "We are not [just] the TB test nurses anymore," she says.

In many hospitals, employee health nurses also are responsible for workers' compensation programs. Even if they aren't, their activities influence accident prevention and return to work, says Gray. For example, they should conduct root-cause analysis of significant injuries to determine how to prevent future incidents, he says.

Hospital employee health nurses should look for trends in injuries and report them to the safety committee and risk manager, he says.

Employee health nurses also should identify themselves with the larger specialty field, says Dean Burgess, MSN, RN, COHN-S, director of professional affairs for AAOHN.

"'Employee health nurses' and 'occupational health nurses' are synonymous [terms]," says Burgess. "Occupational health nurses take care of employees and workers populations. In the hospital environment, they're termed employee health, but they're still occupational health nurses."

Seeking certification is one way to demonstrate competence and knowledge in workers' compensation and other occupational health areas. The American Board for Occupational Health Nurses (ABOHN) in Hinsdale, IL, set a goal of certifying 500 new hospital employee health nurses over a two-year period.

To be a certified occupational health nurse (COHN), you must be a licensed registered nurse, have 4,000 hours of occupational health experience in the past five years, and at least 50 hours of continuing education in the past five years. Nurses with a bachelor's degree may receive the designation COHN-S.

Hospital employee health nurses often don't seek certification, but when they do, they typically score well on the certification exam, says Ann Lachat, RN, BSN, COHN-S/CM, executive director of ABOHN. "There are a lot of hospitals that don't have certified employee health nurses on board," she says.

Certification requires an understanding of injury prevention, biological, chemical and physical hazards, disease management, and regulations. "They need to know the whole scope and practice of an occupational health nurse," she says. With a designation of COHN, the nurses also are qualified to work in occupational health in other industries, she notes.

(Editor's note: More information on COHN certification is available at More information about occupational health educational programs is available at and