Occupational and environmental health (OEH) encompasses occupational and environmental medicine and OEH nursing. Nurse practitioners specializing in OEH (OEHNPs) assess and mitigate occupational hazards, thereby promoting health and safety among workers, drawing on advanced knowledge and skills. This review had a two-fold aim: (1) to determine whether core competencies for OEHNPs practicing in the United States exist; and (2) to identify relevant occupational and environmental medicine and OEH nursing core competencies for the future development of OEHNP core competencies.
Methods:
An integrative review was conducted in accordance with Whittemore and Knafl’s five-step process and the PRISMA guidelines. Peer-reviewed literature published in the United States within the last 50 years was searched across five databases.
Results:
Of the 31 articles included, 22 were OEH nursing-focused, seven were occupational and environmental medicine-focused, and two were nurse practitioner-focused. The OEH nursing articles addressed topics essential to OEH nursing practice, as well as standards of practice and core competencies. The occupational and environmental medicine literature addressed practice guidance, with core competencies periodically updated to reflect evolving practice. Lastly, the nurse practitioner articles focused on entry-level, general nurse practitioner core competencies. No articles explicitly identified core competencies for OEHNPs.
Conclusion:
Evidence establishes the need to develop specific core competencies that reflect the advanced scope of practice, clinical decision-making, and autonomy of OEHNPs.
Implication for Practice:
Employing a consensus-driven approach to agree upon a preliminary set of core competencies for OEHNPs would support role delineation, inform OEHNP education and certification, and ensure quality OEH care.
American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/essentials
American Association of Occupational Health Nurses. (2004). Standards of occupational and environmental health nursing. American Association of Occupational Health Nurses Journal, 52(7), 270–274.
10.
American Association of Occupational Health Nurses. (2012). Standards of occupational and environmental health nursing. Workplace Health & Safety, 60(3), 97–103. https://doi.org/10.1177/216507991206000301
11.
American Association of Occupational Health Nurses. (2015). Competencies in occupational and environmental health nursing. Workplace Health and Safety, 63(11), 493–494. https://doi.org/10.1177/2165079915608192
12.
American Board for Occupational Health Nurses. (n.d.). Why employers hire certified occupational health nurses. https://www.abohn.org/employers
American College of Occupational and Environmental Medicine. (1998). Occupational and environmental medicine competencies–v 1.0. The American College of Occupational and Environmental Medicine panel to define the competencies of occupational and environmental medicine. Journal of Occupational and Environmental Medicine, 40(5), 427–440.
ArbleJ. (2004). Toxicology primer: Understanding workplace hazards and protecting worker health. American Association of Occupational Health Nurses Journal, 52(6), 254–261; quiz 262–263.
20.
ArendsR. (2024). Competency-based curriculum in nurse practitioner education. Journal of the American Association of Nurse Practitioners, 36(1), 23–28. https://doi.org/10.1097/jxx.0000000000000928
AyvazianJ.MuirheadL.BelizaireS.KingS. S.CampbellJ.KlinkK. (2021). Establishing competency-based measures for Department of Veterans Affairs post-graduate nurse practitioner residencies. Journal of Professional Nursing, 37(5), 962–970. https://doi.org/10.1016/j.profnurs.2021.08.001
23.
BeaverC.MagnanM. A.HendersonD.DeRoseP.CarolinK.BeplerG. (2016). Standardizing assessment of competences and competencies of oncology nurses working in ambulatory care. Journal for Nurses in Professional Development, 32(2), 64–73. https://doi.org/10.1097/nnd.0000000000000250
BerenjiM.BakerB.SaberiP.McLellanR. K.WendlandD.TrangleK. L.SpaethK. R.Green-McKenzieJ.FaganK. M. (2024). Addressing environmental health: Clinician training and practice of environmental medicine, ACOEM guidance statement. Journal of the American College of Occupational and Environmental Medicine, 66(12), 668–673. https://doi.org/10.1097/JOM.0000000000003246
26.
BittnerC. A.MuellerM. (2018). The importance of role clarity for development of interprofessional teams. The Journal of Continuing Education in Nursing, 49(8), 345–347. https://doi.org/10.3928/00220124‑20180718‑04
27.
BobonichM.NolenM. (2018). Competencies for dermatology nurse practitioners. Journal of the American Association of Nurse Practitioners, 30(11), 606–613. https://doi.org/10.1097/jxx.0000000000000137
BurnsC.LachatA. M.GordonK.RyanM. G.GrudenM.BarkerD. P.TaorminaD. (2014). Respiratory protection competencies for the occupational health nurse. Workplace Health & Safety, 62(3), 96–104. https://doi.org/10.1177/216507991406200303
30.
CadetM. J. (2019). Screening for chronic hepatitis C virus: Occupational health nurses interpreting the titers. Workplace Health & Safety, 67(9), 495–496. https://doi.org/10.1177/2165079919865560
31.
CampoT. M.ComerA.Dowling EvansD.KincaidK.NortonL.RamirezE. G.RobertsE.SmithA.StackhouseK.WilbeckJ. (2018). Practice standards for the emergency nurse practitioner specialty. Advanced Emergency Nursing Journal, 40(4), 240–245. https://doi.org/10.1097/tme.0000000000000209
32.
CarraccioC.WolfsthalS. D.EnglanderR.FerentzK.MartinC. (2002). Shifting paradigms: From Flexner to competencies. Academic Medicine, 77(5), 361–367. https://doi.org/10.1097/00001888-200205000-00003
33.
ChanT. E.LockhartJ. S.SchreiberJ. B.KronkR. (2020). Determining nurse practitioner core competencies using a Delphi approach. Journal of the American Association of Nurse Practitioners, 32(3), 200–217. https://doi.org/10.1097/JXX.0000000000000384
34.
ClineG.RinaldiK. (2023). A compelling case for the use of backward design to advance competency-based nursing education. Nurse Educator, 48(5), E168–E169. https://doi.org/10.1097/nne.0000000000001388
35.
CloerenM.GeanC.KeslerD.Green-McKenzieJ.TaylorM.UpfalM.HodgsonM.AdamoP.HarberP.McLellanR. (2014). American College of Occupational And Environmental Medicine’s occupational and environmental medicine competencies-2014: ACOEM OEM competencies task force. Journal of Occupational and Environmental Medicine, 56(5), e21–e40. https://doi.org/10.1097/jom.0000000000000173
36.
DangD.DearholtS.BissettK.AscenziJ.WhalenM. (2021). Johns Hopkins evidence‑based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.
37.
D’AoustR. F.BrownK. M.McIltrotK.AdamjiJ. D.JohnsonH.SeibertD. C.LingC. G. (2022). A competency roadmap for advanced practice nursing education using PRIME-NP. Nursing Outlook, 70(2), 337–346. https://doi.org/10.1016/j.outlook.2021.10.009
DiBenedettoD. (2000). AAOHN: Managing professional risk in occupational and environmental health nursing practice. American Association of Occupational Health Nurses Journal, 48(7), 324a–325a.
40.
EbaughH. (1998). Defining the scope of occupational health services. Effective policy and procedure development. American Association of Occupational Health Nurses Journal, 46(11), 547–552.
41.
EnglanderR.CameronT.BallardA. J.DodgeJ.BullJ.AschenbrenerC. A. (2013). Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Academic Medicine, 88(8), 1088–1094. https://doi.org/10.1097/ACM.0b013e31829a3b2b
42.
Fell-CarlsonD. (2004). OSHA 101: An introduction to OSHA for the occupational health nurse. Journal of the American Association of Occupational Health Nursing, 52(10), 442–449; quiz 450–451.
43.
Fineout-OverholtE.MelnykB. M.StillwellS.WilliamsonK. M. (2010). Critical appraisal of the evidence: Part I. American Journal of Nursing, 110(7), 47–52.
44.
FrankJ. R.MungrooR.AhmadY.WangM.De RossiS.HorsleyT. (2010). Toward a definition of competency-based education in medicine: A systematic review of published definitions. Medical Teacher, 32(8), 631–637. https://doi.org/10.3109/0142159x.2010.500898
45.
FreeH.GroenewoldM. R.LuckhauptS. E. (2020). Lifetime prevalence of self-reported work-related health problems among U.S. workers — United States, 2018. Morbidity and Mortality, 69, 361–365. https://doi.org/10.15585/mmwr.mm6913a1
46.
Green-McKenzieJ.KhanA.RedlichC. A.MargarinA. R.McKinneyZ. J. (2022). The future of occupational and environmental medicine. Journal of Occupational and Environmental Medicine, 64(12), e857–e863. https://doi.org/10.1097/jom.0000000000002676
47.
HaradaN. D.TraylorL.RugenK. W.BowenJ. L.SmithC. S.FelkerB.LudkeD.Tonnu-MiharaI.RubergJ. L.AdlerJ.UhlK.GardnerA. L.GilmanS. C. (2023). Interprofessional transformation of clinical education: The first six years of the Veterans Affairs Centers of Excellence in Primary Care Education. Journal of Interprofessional Care, 37, S86–S94. https://doi.org/10.1080/13561820.2018.1433642
HartenbaumN. P.BakerB. A.LevinJ. L.SaitoK.SayeedY.Green-McKenzieJ. (2021). ACOEM OEM core competencies: 2021. Journal of Occupational and Environmental Medicine, 63(7), e445–e461. https://doi.org/10.1097/jom.0000000000002211
50.
HegmannK. T.WeissM. S.BowdenK.BrancoF.DuBruelerK.ElsC.MandelS.McKinneyD. W.MiguelR.MuellerK. L.NadigR. J.SchafferM. I.StudtL.TalmageJ. B.TravisR. L.WintersT.ThieseM. S.HarrisJ. S. (2014). ACOEM practice guidelines: Opioids for treatment of acute, subacute, chronic, and postoperative pain. Journal of Occupational and Environmental Medicine, 56(12), e143–e159. https://doi.org/10.1097/JOM.0000000000000352
51.
HodgesA. L.KonickiA. J.TalleyM. H.BordelonC. J.HollandA. C.GalinF. S. (2019). Competency-based education in transitioning nurse practitioner students from education into practice. Journal of the American Association of Nurse Practitioners, 31(11), 675–682. https://doi.org/10.1097/jxx.0000000000000327
Institute of Medicine (US) Committee to Assess Training Needs for Occupational Safety and Health Personnel in the United States. (2000). Safe work in the 21st century: Education and training needs for the next decade’s occupational safety and health personnel. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK225528/
KeslerD.UpfalM.TacorontiR.AveryA. N.MartinC.SingerM.WrightD.HartenbaumN.PattersonW.DreyzehnerJ.CarsonC.HarberP.McLellanR.OrfordR.DregerM., & ACOEM Special Committee on Competencies. (2008). American College of Occupational and Environmental Medicine competencies - 2008. Journal of Occupational and Environmental Medicine, 50(6), 712–724. https://doi.org/10.1097/JOM.0b013e318173a90d
56.
KestenK. S.BeebeS. L. (2022). Competency frameworks for nurse practitioner residency and fellowship programs: Comparison, analysis, and recommendations. Journal of the American Association of Nurse Practitioners, 34(1), 160–168. https://doi.org/10.1097/jxx.0000000000000591
57.
LaghezzaM.ClapperT. C.ChristosP. J.SharmaR.NaikN. (2019). Measuring the effect of a competency-based education conference for PAs and NPs. Journal of the American Academy of PAs, 32(9), 44–47. https://doi.org/10.1097/01.JAA.0000578772.39180.0c
58.
LallooD.DemouE.KiranS.CloerenM.MendesR.MacdonaldE. B. (2016). International perspective on common core competencies for occupational physicians: A modified Delphi study. Occupational Environmental Medicine, 73(7), 452–458. https://doi.org/10.1136/oemed-2015-103285
59.
LavinR. P.VeenemaT. G.SasnettL.Schneider-FirestoneS.ThorntonC. P.SaenzD.CobbS.ShahidM.PeacockM.CouigM. P. (2022). Analysis of nurse practitioners’ educational preparation, credentialing, and scope of practice in U.S. emergency departments. Journal of Nursing Regulation, 12(4), 50–62. https://doi.org/10.1016/S2155-8256(22)00010-2
60.
ManiZ. A. (2025). Transitioning to competency-based education in nursing: A scoping review of curriculum review and revision strategies. BMC Nursing, 24(1), Article 1111. https://doi.org/10.1186/s12912-025-03319-y
61.
MartsolfG. R.GigliK. H.ReynoldsB. R.McCorkleM. (2020). Misalignment of specialty nurse practitioners and the Consensus Model. Nursing Outlook, 68(4), 385–387. https://doi.org/10.1016/j.outlook.2020.03.001
62.
McAndrewK. G. (1999). AAOHN advisory: Nurse practitioners in occupational and environmental health. American Association of Occupational Health Nurses Journal, 47(suppl 1–2).
63.
McCleeryE.ChristensenV.PetersonK.HumphreyL.HelfandM. (2014). Evidence brief: The quality of care provided by advanced practice nurses. Department of Veterans Affairs (US).
64.
McHughJ. (2003). Confidentiality of employee health records: Ethical and legal dilemmas for occupational health nurses. American Association of Occupational Health Nurses Journal, 51(9), 378–383.
MirzaR.KirchnerD. B.DobieR. A.CrawfordJ. (2018). Occupational noise-induced hearing loss. Journal of Occupational and Environmental Medicine, 60(9), e498–e501. https://doi.org/10.1097/jom.0000000000001423
67.
MoranK. M.HarrisI. B.ValentaA. L. (2016). Competencies for patient safety and quality improvement: A synthesis of recommendations in influential position papers. Joint Commission Journal on Quality and Patient Safety, 42(4), 162–169. https://doi.org/10.1016/s1553-7250(16)42020-9
68.
MrayyanM. T.AbunabH. Y.Abu KhaitA.RababaM. J.Al-RawashdehS.AlgunmeeynA.Abu SarayaA. (2023). Competency in nursing practice: A concept analysis. BMJ Open, 13(6), Article e067352. https://doi.org/10.1136/bmjopen-2022-067352
National Organization of Nurse Practitioner Faculties. (2017). Nurse practitioner core competencies content. https://www.nonpf.org
72.
National Organization of Nurse Practitioner Faculties. (2022). Nurse practitioner role core competencies. https://www.nonpf.org/page/14
73.
NishikawaJ.JacksonT. (2025). Optimizing FNP clinical education: A path toward standardized training and sustainable workforce development. Standards, 5(3), Article 24. https://doi.org/10.3390/standards5030024
74.
NotarnicolaI.DervishiA.DukaB.GroshaE.GioielloG.CarrodanoS.RoccoG.StievanoA. (2025). A systematic review of nursing competencies: Addressing the challenges of evolving healthcare systems and demographic changes. Nursing Reports, 15(2), Article 56. https://pmc.ncbi.nlm.nih.gov/articles/PMC11858704
O’ConnellJ.GardnerG.CoyerF. (2014). Beyond competencies: Using a capability framework in developing practice standards for advanced practice nursing. Journal of Advanced Nursing, 70(12), 2728–2735. https://doi.org/10.1111/jan.12475
PappE. M.MillerA. S. (2000). Screening and surveillance. OSHA’s medical surveillance provisions. American Association of Occupational Health Nurses Journal, 48(2), 59–72.
80.
PerkisonW. B.KearneyG. D.SaberiP.GuidottiT.McCarthyR.Cook-ShimanekM.PensaM. A.NabeelI. (2018). Responsibilities of the occupational and environmental medicine provider in the treatment and prevention of climate change-related health problems. Journal of Occupational and Environmental Medicine, 60(2), e76–e81. https://doi.org/10.1097/jom.0000000000001251
81.
PetersM. D. J.MarnieC.TriccoA. C.PollockD.MunnZ.AlexanderL.McInerneyP.GodfreyC. M.KhalilH. (2020). Updated methodological guidance for the conduct of scoping reviews. JBI Evidence Synthesis, 18(10), 2119–2126. https://doi.org/10.11124/jbies-20-00167
82.
PleshkanV. (2024). A systematic review: Clinical education and preceptorship during nurse practitioner role transition. Journal of Professional Nursing, 50, 16–34. https://doi.org/10.1016/j.profnurs.2023.10.005
83.
RainerS. R.PappE. (2000). The self-employed occupational and environmental health nurse: Maximizing business success by managing financial resources. American Association of Occupational Health Nurses Journal, 48(4), 185–194; quiz 195–196.
84.
RamirezE.SchumannL.AganD.HoytK. S.WilbeckJ.TylerD.EvansD. D. (2018). Beyond competencies: Practice standards for emergency nurse practitioners-A model for specialty care clinicians, educators, and employers. Journal of the American Association of Nurse Practitioners, 30(10), 570–578. https://doi.org/10.1097/jxx.0000000000000139
85.
RandolphS. A. (2006). Developing policies and procedures. American Association of Occupational Health Nurses Journal, 54(11), 501–504. https://doi.org/10.1177/216507990605401104
86.
RasmorM.BrownC. M. (2003). Physical examination for the occupational health nurse: Skills update. American Association of Occupational Health Nurses Journal, 51(9), 390–401; quiz 402–403.
87.
ReevesS.PeloneF.HarrisonR.GoldmanJ.ZwarensteinM. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, 6(6), Article CD000072. https://doi.org/10.1002/14651858.CD000072.pub
88.
RodgersG. P.LinderbaumJ. A.PearsonD. D.FernandesS. M.Housholder-HughesS. D.MendesL. A.BergN. C.DayJ.DrajpuchD.ErbB.Jr.Farquhar-SnowM.JohnsonH.KeeganP.KindlerC.LarsenR.LeV. T.NickolausM. J.PhillipsC. M.RossL.. . . ZadoE. S. (2020). 2020 ACC clinical competencies for nurse practitioners and physician assistants in adult cardiovascular medicine: A report of the ACC competency management committee. Journal of the American College of Cardiology, 75(19), 2483–2517. https://doi.org/10.1016/j.jacc.2020.01.005
89.
RogersB. (1997). AAOHN advisory: Developing clinical guidelines or protocols for practice. American Association of Occupational Health Nurses Journal, 45(10), 476a–476b.
90.
RoupB. J. (1993). OSHA’s new standard: Exposure to bloodborne pathogens. American Association of Occupational Health Nurses Journal, 41(3), 136–142.
91.
RugenK. W.DolanskyM. A.DulayM.KingS.HaradaN. (2018). Evaluation of Veterans Affairs primary care nurse practitioner residency: Achievement of competencies. Nursing Outlook, 66(1), 25–34. https://doi.org/10.1016/j.outlook.2017.06.004
92.
SalazarM. K. (2002). Applying research to practice. Practical guidelines for occupational health nurses. American Association of Occupational Health Nurses Journal, 50(11), 520–525; quiz 526–527.
93.
StephensK.CarlucciM.DuchnowskaA.BlumenthalR.DickensC. (2023). Creation of a critical care NP onboarding program. Nurse Practitioner, 48(8), 7–10. https://doi.org/10.1097/01.Npr.0000000000000085
94.
Ten CateO.ScheeleF. (2007). Competency-based postgraduate training: Can we bridge the gap between theory and clinical practice?Academic Medicine, 82(6), 542–547. https://doi.org/10.1097/ACM.0b013e31805559c7
95.
ThompsonM. C. (2006). Legislation affecting occupational health nursing: Identifying relevant laws and regulations. American Association of Occupational Health Nurses Journal, 54(1), 38–45; quiz 46–47.
96.
ThompsonM. C. (2010). Medical recordkeeping in an occupational health setting. American Association of Occupational Health Nurses Journal, 58(12), 524–533; quiz 534–535. https://doi.org/10.3928/08910162-20101201-02
97.
TownsendM. C. (2000). ACOEM position statement. Spirometry in the occupational setting. Journal of Occupational and Environmental Medicine, 42(3), 228–245. https://doi.org/10.1097/00043764-200003000-00003
98.
VasquezJ. A.MarcotteK.GruppenL. D. (2021). The parallel evolution of competency-based education in medical and higher education. The Journal of Competency-Based Education, 6(2), Article e1234. https://doi.org/10.1002/cbe2.1234
99.
VorkK. L.OlsonD. K. (1990). Asbestos review and update. American Association of Occupational Health Nurses Journal, 38(4), 160–164.
100.
WagnerL. M.DolanskyM. A.EnglanderR. (2018). Entrustable professional activities for quality and patient safety. Nursing Outlook, 66(3), 237–243. https://doi.org/10.1016/j.outlook.2017.11.001
101.
WhiteK.CoxA. R.WilliamsonG. C. (1999). Competencies in occupational and environmental health nursing: Practice in the new millennium. American Association of Occupational Health Nurses Journal, 47(12), 552–568.
