COHN common mistakes
COHN · Understand the traps and how to avoid them.
Recommending 'off work until symptoms resolve' or an immediate full-duty release after an injury or illness, without documenting functional restrictions or considering transitional duty.
Candidates default to acute-care discharge logic, where the endpoint is symptom resolution, rather than the occupational health endpoint of safe functional capacity; occupational health training emphasizes fit-for-duty and accommodation, which is less familiar.
What to do instead
For any return-to-work item, identify the essential job demands, state specific restrictions (e.g., no lifting >20 lb, no ladder climbing), and select transitional duty or an interactive accommodation process before considering leave.
Telling a supervisor the employee's diagnosis or forwarding the full medical record when the supervisor asks why the worker is on restrictions.
The desire to be helpful and transparent with management conflicts with the need-to-know rule; candidates may not have internalized that diagnosis is confidential while restrictions are not.
What to do instead
Release only work restrictions, functional limitations, and accommodation needs. State in the answer that diagnosis and treatment details stay in the confidential medical file and are shared only with signed authorization or as legally required.
Answering a program-planning item with a list of clinical tasks (classes, screenings, posters) and omitting needs assessment, measurable objectives, budget, and evaluation metrics.
Nurses are trained to deliver services, not to build programs; the management domain requires a planning cycle (assess, plan, implement, evaluate) that is less practiced.
What to do instead
Before choosing interventions, name the needs assessment data source, write objectives in measurable terms (who, what, how much, by when), and include a cost and evaluation component in the plan.
Treating FMLA, ADA, and workers' compensation as interchangeable - for example, saying the ADA requires the employer to create a new position, or designating FMLA leave without the required notice and eligibility analysis.
All three are triggered by the same absence or injury, so the boundaries blur; candidates memorize each law separately and never practice applying them to one scenario.
What to do instead
For each absence or injury, run three separate checks: is it compensable under workers' comp; is the employee eligible and is the condition serious under FMLA; does the ADA interactive process require a reasonable accommodation (modifying the existing job, not creating a new one)?
Selecting PPE (respirators, gloves, hearing protection) as the primary control measure when the question asks how to reduce a hazard.
PPE is the most visible and quickly implemented control, and clinical training emphasizes personal protective equipment; the hierarchy of controls is learned but not applied under time pressure.
What to do instead
Rank controls from most to least effective: elimination, substitution, engineering controls (ventilation, enclosure, guarding), administrative/work-practice controls, then PPE as the last layer. Choose the highest-level feasible control the stem describes.
Misapplying OSHA recordkeeping criteria - logging a first-aid-only case, failing to log a case with days of restricted duty, or counting calendar days instead of workdays for the days-away/restricted columns.
The distinction between first aid and medical treatment is a specific list that is easy to misremember, and the day-counting rules differ from how nurses usually count disability days.
What to do instead
Memorize the first-aid list and the medical-treatment examples; apply the two-part test (work-related and meets a recording criterion: death, days away, restricted work/transfer, medical treatment beyond first aid, loss of consciousness, significant diagnosis). Count calendar days for the case but workdays for the 180-day counting of away/restricted days.
Using OSHA PELs, NIOSH RELs, and ACGIH TLVs interchangeably, or citing a TLV as the legally enforceable limit.
All three are expressed as airborne concentrations for the same chemicals, so the labels blur; candidates remember the numbers and forget the legal status and basis of each.
What to do instead
Anchor each limit to its source and legal weight: OSHA PEL = enforceable regulation (with many outdated values); NIOSH REL = recommended, health-based, often lower; ACGIH TLV = consensus guideline, not law. When a question asks about compliance, answer with the PEL; when it asks about best practice or risk reduction, the lower REL/TLV is relevant.
Misclassifying prevention activities - labeling a screening or surveillance program as primary prevention, or calling a fitness/wellness class tertiary prevention.
The three levels are defined by disease stage, not by setting or activity type; worksite programs often blend all three, so the label is assigned by feel rather than by definition.
What to do instead
Classify by target population and disease stage: primary = prevent onset in healthy workers (immunization, hazard elimination, fitness); secondary = detect early in asymptomatic workers (audiometry, spirometry, TB screening, BP checks); tertiary = limit disability and restore function after disease (case management, return-to-work conditioning, chronic disease self-management).
Equating a statistically significant result with a clinically important one, or reading a screening test's sensitivity as the probability that a positive result means disease.
These are the most commonly conflated concepts in the evidence-based practice literature; p-values and sensitivity are easier to remember than the reasoning behind predictive values and effect size.
What to do instead
Ask two separate questions: is the effect large enough to matter for this workforce (effect size, confidence interval, number needed to treat), and what does a positive test mean here (positive predictive value depends on prevalence; sensitivity is a property of the test, not of the result).
Responding to a worker's risky behaviour (smoking, poor glucose control, missed hearing protection) with directive advice or a warning rather than an assessment of readiness and barriers.
Nurses are trained to educate and advise, and time-pressured encounters reward quick instruction; motivational interviewing requires tolerating ambivalence and is less practiced.
What to do instead
Use an assessment-first sequence: ask permission, explore importance and confidence on a 0-10 scale, reflect back the worker's own reasons, and set a goal the worker chooses. Reserve direct advice for imminent safety risk and document the worker's stated plan.