Occupational Health Nurse: Career Guide, COHN Certification, and Salary Data

Occupational health nursing is one of the cleaner transitions in healthcare. You keep your clinical license. You trade hospital shifts for business hours. And you move into a role where you’re managing programs, not just responding to whatever walks through the door.

The work sits at the intersection of nursing and workplace safety. An occupational health nurse (OHN) is the person at a company who handles the medical side of keeping workers healthy and getting them back to work when they’re not. That means something different at a 5,000-person manufacturing plant than it does at a 200-person distribution center, but the core responsibilities stay consistent.

What Occupational Health Nurses Actually Do

Hospital nursing is reactive. Someone is hurt or sick, and you respond. OHN work has reactive components, but it’s built around programs and prevention.

At a large industrial employer, an OHN typically manages the pre-employment physical program, conducts or coordinates occupational health surveillance (hearing tests, pulmonary function tests, respirator fit testing), handles workers’ compensation case management from first report through return to work, runs the drug and alcohol testing program, and provides first aid and triage. They often write and maintain health-related company policies, coordinate with occupational medicine physicians, and report workplace health data to the EHS manager or directly to HR leadership.

At a smaller company, one OHN may own all of that plus some safety functions that would go to a dedicated safety professional in a larger operation. At an occupational medicine clinic, the work shifts toward clinical evaluation of work-related injuries and illness rather than the program management side.

The difference matters when you’re choosing a setting. Employer-based OHN roles tend to pay more and offer broader autonomy. Clinic roles offer more variety in patient presentations and may suit nurses who want to stay closer to clinical practice.

The COHN and COHN-S Credentials

Both credentials come from ABOHN, the American Board for Occupational Health Nurses. They’re the two recognized certifications in the field, and they’re not interchangeable.

The COHN (Certified Occupational Health Nurse) targets clinical practice. To sit for the exam, you need an active RN license, 3,000 hours of occupational health nursing practice within the past five years, and 50 hours of continuing education in occupational health within the past five years. The exam covers case management, health promotion, occupational and environmental health concepts, and regulatory compliance. It’s a 150-question computer-based test.

The COHN-S (Certified Occupational Health Nurse, Specialist) goes further. It requires a BSN minimum, 5,500 hours of OHN practice within the past five years, and 75 hours of continuing education. The exam adds safety management, education, and health administration competency areas. For OHNs moving into program leadership or management roles, the COHN-S is the right target.

Renewal for both is every five years. You can recertify by exam or by continuing education. ABOHN requires 75 CE hours for COHN renewal and 100 hours for COHN-S. A minimum portion of those hours must be in occupational health content specifically.

The credential matters most in corporate and government hiring. Many manufacturing and industrial employers list COHN or COHN-S as preferred or required in their job postings. Without it, you’re competing for the same positions at a disadvantage.

The American Association of Occupational Health Nurses (AAOHN) is the main professional organization for the field. Membership gives you access to continuing education, practice guidelines, and local chapter events that count toward ABOHN renewal hours. If you’re building toward COHN or COHN-S, joining AAOHN early is worth the annual cost. The CE opportunities alone cover most of what you need for renewal.

Salary: What the Data Shows

BLS OEWS data for registered nurses (SOC 29-1141) shows a national median annual wage of $86,070 as of May 2024. That’s the baseline. Occupational health nursing typically pays above that median.

The premium comes from a few factors. Specialized certification, particularly COHN-S, commands higher pay. Corporate and industrial settings pay more than clinic or hospital-based OHN roles. Geography matters too, with California, Alaska, and Oregon consistently at the top of RN wages overall.

Nurses with COHN-S credentials in corporate or government roles frequently earn $90,000 to $115,000 annually. Oil and gas, utilities, aerospace, and chemical manufacturing are the industries that pay most for OHN positions, reflecting the complexity of their occupational health programs and the regulatory scrutiny they face.

Workers’ compensation experience adds value. Nurses who can manage complex comp cases, coordinate with adjusters, and document return-to-work outcomes are worth more to large self-insured employers than nurses who can only handle triage and physicals.

BLS notes that employment for registered nurses broadly is projected to grow 6% from 2023 to 2033, about as fast as average. OHN demand specifically tracks closely with industrial employment levels and the expansion of corporate wellness programs. Neither of those is going away.

Transitioning from Clinical Nursing

The most common paths into OHN come from emergency nursing, employee health nursing in hospital systems, and case management. Each transfers different skills.

Emergency nurses bring triage competency, comfort with trauma, and the ability to make fast assessments with limited information. That background serves well in large industrial settings where the OHN is the first responder for workplace injuries before the hospital transfer.

Employee health nurses in hospitals have already been doing OHN-adjacent work: occupational exposures, vaccine programs, return-to-work coordination for staff injuries. The move to a corporate or industrial setting is a smaller jump than it looks.

Case managers come in with the administrative and documentation skills that workers’ comp case management demands. The clinical depth may need building, but the process management side is already there.

What clinical nurses often underestimate is the regulatory knowledge required. An OHN at a manufacturing plant needs working knowledge of OSHA recordkeeping requirements under 29 CFR 1904, noise exposure limits and audiometric testing protocols under 29 CFR 1910.95, respiratory protection medical evaluations under 29 CFR 1910.134, and OSHA’s bloodborne pathogen standard. None of that is covered in nursing school. It’s learned on the job or through the COHN exam preparation process.

The industrial hygiene program guide gives you a solid foundation for understanding how the industrial hygienist’s exposure assessment work connects to the OHN’s health surveillance programs. Those two roles overlap constantly in occupational health.

Working with the Rest of the EHS Team

OHNs don’t work in isolation at larger employers. They operate as part of or alongside the EHS function, which means regular coordination with safety professionals, industrial hygienists, and EHS managers.

The clearest collaboration point is occupational health surveillance. The industrial hygienist identifies exposure hazards through air sampling and noise dosimetry. The OHN runs the corresponding medical surveillance program, whether that’s audiometry for noise, pulmonary function tests for dust or chemical exposures, or biological monitoring for specific chemicals. The IH and OHN need to understand each other’s work to run the program correctly.

Understanding the CIH certification and what industrial hygienists actually do puts OHNs in a better position to collaborate. The medical and industrial hygiene pieces of occupational health are complementary, and the OHNs who understand both sides tend to run stronger programs.

Which Setting Is Right

If you want autonomy, program ownership, and higher pay, employer-based OHN is the better choice. You’ll manage programs, deal with company politics, and have a real stake in health outcomes at a specific employer. The tradeoff is that one plant’s OHN role can get narrow and repetitive over time.

Occupational medicine clinic work offers more case variety and stays closer to clinical practice. Pay tends to be lower, and the scope is more reactive. It suits nurses who want to keep their clinical skills sharp while building occupational health knowledge before moving to an employer-based role.

For most nurses planning a long-term OHN career, starting employer-based, earning the COHN early, and pursuing the COHN-S after meeting the experience hours is the direct path to the best-paying positions in the field.