COHN(C) cheat sheet

Scope of practice: OHNs assess, plan, implement, and evaluate care for worker populations; authority derives from state nurse practice acts and specialty certification (COHN).

Core ethical principles: autonomy, beneficence, nonmaleficence, justice, veracity, and confidentiality; conflicts between worker and employer interests are resolved with primary obligation to the worker's health.

Confidentiality: medical records are kept separately from personnel files; release requires written authorization except as required by law (e.g., OSHA access to exposure records, workers' compensation).

Role functions: clinician, case manager, educator, consultant, researcher, administrator, and health advocate; the balance varies by worksite size and industry.

Evidence-based practice: use current research, clinical guidelines, and surveillance data to guide interventions; document outcomes to demonstrate value.

Professional development: maintain continuing education, stay current with OSHA/NIOSH/AAOHN standards, and pursue certification (COHN, COHN-S) to validate expertise.

Interprofessional collaboration: coordinate with safety, HR, management, physicians, and industrial hygienists to integrate health protection and health promotion.

Advocacy: ensure workers have access to appropriate care, accommodations, and information; protect workers from retaliation when reporting hazards or injuries.

Pre-placement assessment: baseline health history, physical exam, and job-specific screening to establish fitness for duty and detect pre-existing conditions; results guide placement and accommodation.

Periodic health surveillance: required when workers are exposed to specific hazards (e.g., noise, lead, asbestos, silica); frequency and content follow OSHA standards (e.g., 29 CFR 1910.95 for noise).

Biological monitoring: measure internal dose (e.g., blood lead level, urinary metabolites) to assess exposure and early health effects; interpret against reference values and action levels.

Spirometry: perform according to ATS/ERS standards; compare to predicted values based on age, height, sex, and ethnicity; observe for obstructive or restrictive patterns.

Audiometric testing: baseline within 6 months of exposure, annual thereafter; standard threshold shift (STS) defined as ≥10 dB average change at 2000, 3000, and 4000 Hz in either ear.

Return-to-work evaluation: assess functional capacity, restrictions, and accommodation needs; communicate with treating provider and employer to ensure safe transition.

Clinical care: provide first aid, triage, and management of minor illnesses/injuries; recognize work-relatedness and report according to OSHA recordkeeping (29 CFR 1904).

Health promotion: integrate screening (e.g., blood pressure, BMI), counseling, and referrals into surveillance visits to address modifiable risk factors.

Health promotion program design: use needs assessment data (e.g., HRA, claims, absenteeism) to target modifiable risks and prioritize interventions.

Adult learning principles: adults learn best when content is relevant, problem-centered, and interactive; use teach-back to confirm understanding.

Behavior change models: Transtheoretical Model (stages of change), Health Belief Model, and Social Cognitive Theory guide intervention design and evaluation.

Program evaluation: measure process (participation), impact (knowledge, behavior), and outcome (health status, productivity, cost) using pre/post or comparison designs.

Workplace wellness: address physical activity, nutrition, tobacco cessation, stress management, and sleep; integrate with safety culture and organizational policies.

Education methods: toolbox talks, posters, online modules, and hands-on demonstrations; tailor to literacy, language, and shift schedules.

Incentives and engagement: use incentives ethically (avoid coercion), ensure privacy, and align programs with worker interests and union agreements.

Return on investment: calculate cost savings from reduced absenteeism, workers' compensation claims, and healthcare costs; communicate value to management.

Hierarchy of controls: elimination, substitution, engineering controls, administrative controls, and PPE (last line of defense).

Hazard recognition: identify physical, chemical, biological, ergonomic, psychosocial, and safety hazards through walk-throughs, job hazard analysis, and incident data.

Exposure assessment: use air sampling, noise dosimetry, and wipe tests; compare results to OSHA PELs, NIOSH RELs, and ACGIH TLVs.

Noise: measure with sound level meter or dosimeter; 85 dBA TWA triggers hearing conservation program; 90 dBA TWA is PEL for general industry.

Respiratory protection: use NIOSH-certified respirators; require medical evaluation, fit testing, and training per 29 CFR 1910.134.

Ergonomics: assess repetitive motion, force, posture, and vibration; implement workstation adjustments, job rotation, and tool redesign.

Chemical safety: maintain SDS, label containers, and provide training on safe handling, storage, and spill response per HazCom standard (29 CFR 1910.1200).

Indoor air quality: investigate ventilation, temperature, humidity, and contaminants; respond to complaints with environmental sampling and remediation.

OSHA General Duty Clause: employers must provide a workplace free from recognized hazards likely to cause death or serious physical harm.

Recordkeeping: record work-related injuries/illnesses meeting criteria (29 CFR 1904); maintain OSHA 300 log, 301 incident reports, and 300A annual summary.

Workers' compensation: no-fault system providing medical and wage replacement benefits; OHN documents work-relatedness and coordinates care.

ADA: prohibits discrimination based on disability; requires reasonable accommodation unless undue hardship; medical inquiries must be job-related and consistent with business necessity.

FMLA: eligible employees may take up to 12 weeks unpaid leave for serious health condition or family care; OHN may certify medical necessity.

HIPAA: protects individually identifiable health information; OHN must follow privacy rule, minimum necessary standard, and authorization requirements.

Ethical standards: AAOHN Code of Ethics emphasizes responsibility to workers, confidentiality, competence, and integrity; conflicts of interest must be disclosed.

Legal liability: OHN accountable for competent practice, accurate documentation, and adherence to state nurse practice act and employer policies.

Case management process: assessment, planning, implementation, coordination, monitoring, and evaluation; focus on cost-effective outcomes and quality of care.

Return-to-work (RTW) planning: early intervention, transitional duty, and accommodation; use functional capacity evaluation to match job demands.

Disability management: prevent unnecessary disability through early reporting, proactive case management, and workplace accommodation.

Communication: maintain confidentiality while coordinating with treating provider, employer, and insurer; obtain written authorization for release of information.

Workers' compensation coordination: understand state-specific rules for reporting, benefits, and dispute resolution; assist worker with claims process.

Functional capacity evaluation (FCE): objective measure of physical abilities; used to determine work restrictions and readiness for duty.

Accommodation strategies: modify tasks, schedules, equipment, or environment; document accommodations and monitor effectiveness.

Outcome measures: track RTW rates, lost workdays, claim costs, and worker satisfaction to evaluate case management effectiveness.

Emergency action plan (EAP): written plan for evacuation, shelter-in-place, and communication; required by OSHA for certain workplaces (29 CFR 1910.38).

First aid/CPR: OHN should be trained and maintain certification; ensure adequate supplies and AED availability.

Triage: prioritize care based on severity (e.g., simple triage and rapid treatment-START); allocate resources during mass casualty incidents.

Disaster response roles: OHN may serve as responder, coordinator, or educator; understand incident command system (ICS) and personal protective equipment.

Injury management: assess, treat, and refer; document mechanism of injury, treatment, and follow-up; report to OSHA if recordable.

Bloodborne pathogens: follow exposure control plan (29 CFR 1910.1030); use universal precautions, report exposures, and provide post-exposure prophylaxis.

Emergency drills: participate in and evaluate drills; update plans based on lessons learned and after-action reports.

Psychological first aid: provide supportive care, assess needs, and refer to mental health resources after critical incidents.

Program development: assess needs, set goals/objectives (SMART), design interventions, implement, and evaluate using a logic model.

Budgeting: justify costs (staffing, supplies, equipment) and demonstrate return on investment through reduced claims, absenteeism, and improved productivity.

Leadership styles: transformational, transactional, and servant leadership; adapt to organizational culture and situation.

Quality improvement: use PDSA (Plan-Do-Study-Act) cycles, benchmarking, and root cause analysis to enhance care and efficiency.

Data management: use electronic health records, aggregate data for trends, and protect confidentiality; report key metrics to management.

Policy development: create written policies for clinical protocols, recordkeeping, and emergency response; review and update regularly.

Staffing and delegation: assign tasks based on scope of practice, competence, and legal authority; provide supervision and training.

Accreditation and standards: align program with AAOHN standards, OSHA, and Joint Commission (if applicable); prepare for audits and inspections.