Travel health nursing is often regarded by the public and some health professionals as "just about vaccinations." Immunizations are important, but only one of many risk management strategies utilized to protect the health and safety of travelers – whether they travel domestically or internationally. Over the years the role of the travel health nurse has evolved into one with specialized knowledge and significant professional autonomy.
The ANA recognized specialty of travel health nursing is defined as the specialized nursing practice that advances the well-being of all travelers in all phases/stages of travel and in all settings. As clinicians, travel health nurses deliver pre-travel, in-transit, and post-travel services to individuals and families who travel for pleasure, business, education, or other reasons. In addition, travel health nurses function in myriad roles as educators, managers, advisors, faculty, researchers, and consultants to organizations and government entities. They work in travel health clinics, public health centers, academia, the military, colleges and universities, corporations, and the travel industry. To fully understand travel health nursing roles, scope, and competencies, ATHNA published, in collaboration with ANA, Travel Health Nursing: Scope and Standards of Practice, 1st ed. (2021) Anyone wishing to know more about the specialty will find that text useful. It can be accessed at https://www.nursingworld.org/~4951d0/globalassets/catalog/book-toc/2021_travel-health-nursing_toc.pdf
Entry into Practice
Nurses engaged in travel health services, in every setting and at every educational level, find it necessary to take travel health-specific coursework, in addition to the basic courses required for their state licensure as LPNs, RNs or APRNs. Nurses must master a body of knowledge distinct from their foundational coursework as travel health nursing is not routinely taught in the traditional U.S. professional curriculum. At present, through undergraduate and graduate level classes, short courses, CE activities, on the job mentoring, and self-directed learning, nursing professionals acquire the knowledge and skills to provide the complete pre-travel consultation and post-travel triage. APRNs take additional courses to provide post-travel comprehensive evaluation and disease management.
Foundational Knowledge and Skills in the Specialty
As recommended by the ATHNA Model Core Curriculum Guide (available to ATHNA members on the Members Only Portal), a nurse entering the specialty will need to pursue education in a number of subject areas, including:
- Knowledge and resources for national and international standards of travel health care
- Pre-travel and post-travel assessment of the traveler and itinerary
- Research methods and statistics
- Global epidemiology of health and safety risks to the traveler
- Behavioral measures for the prevention of travel-related injury and illness
- Techniques for customized, motivating health counseling designed to maximize the health and safety of diverse travelers with varied itineraries
- If not previously acquired through basic nursing education or through employment: Internet search skills, knowledge of world geography and illness risks (e.g., Meningitis Belt, Yellow Fever Belt, etc.), cultural competency, and excellent written and verbal communication skills
- Knowledge of current CDC travel health and safety guidelines that include ACIP pre-travel vaccine recommendations and requirements, as well as destination-specific and activity-specific risks and prevention recommendations
- Understanding of the role and guidelines of WHO, plus international differences in pre- and post-travel standards, tropical disease transmission and avoidance, personal injury risks, and preventive and therapeutic pharmacology
- Ability to use map reading, global geography knowledge, including specific health concerns and likely activities in selected destinations, health risk analysis, individual traveler and group prevention counseling, tropical disease triage, and complex vaccination care and schedules for multiple age groups and foreign-borne travelers, and travelers with special conditions (e.g., pregnancy, immune suppression, chronic illness, etc.)
Travel health nurses pursue any number of post-licensure educational options to build mastery and maintain currency in the specialty. To determine their learning needs they consult the ATHNA Model Core Curriculum, Travel Health Nursing: Scope and Standards of Practice, 2021, CDC's Health Information for International Travel, CDC's Epidemiology and Prevention of Vaccine Preventable Diseases, and the ISTM Body of Knowledge as primary resources for acquiring and maintaining current knowledge. Additional resources include subscriptions to travel health journals, memberships in ATHNA and other travel medicine associations (e.g. ISTM, ASTMH), participation in travel health webinars, courses and journal clubs, and attendance at national and international travel health, vaccinology, public health, nursing, and tropical disease conferences. Nurses also enroll in well-established short courses developed by experts in the specialty and listed on the ATHNA Courses and Conferences website. Travel health risks, regulations, and therapeutic interventions change frequently – sometimes overnight – so travel health nurses recognize the necessity of ongoing education to insure quality patient care and compliance with current best practices and regulations.
Continuing Education Opportunities
Several opportunities exist in the U.S. for nurses to gain knowledge and expertise in travel health care. Here are some of the most recognized avenues that new and more seasoned nursing professionals utilize to advance their education and training in travel health:
- Enroll in nursing school and public health elective courses to supplement their basic baccalaureate nursing coursework (e.g. epidemiology, global health, health risk analysis, prevention counseling)
- Join ATHNA and regularly check the ATHNA website for education, news and links to important educational resources for travel health nurses. Participate in ATHNA's annual one day clinical update NED: Networking, Education and Development Day. Earn additional CE credits each year through website-based programming.
- Regularly check the websites of the CDC www.cdc.gov/travel and Immunize.org www.immunize.org for updates, educational opportunities, and essential new information on travel health and immunizations.
- Subscribe to Mortality and Morbidity Weekly Review (MMWR at www.cdc.gov/mmwr) to receive infection disease and travel-related disease reports and updates.
- Visit the website (www.ISTM.org) and consider joining the International Society of Travel Medicine. The ISTM offers a variety of benefits to members including: the Journal of Travel Medicine, announcements of conferences, and an active on-line listserv forum for discussion of travel medicine clinical and other issues.
- Participate in one of the growing number of travel medicine conferences offered in the United States, Canada and abroad. Note that other nursing organizations such as The American Association of Occupational Health Nurses (AAOHN) and the American College Health Association (ACHA) often include travel health educational content as part of their conferences, journals, and websites. ATHNA lists these opportunities on its Courses and Conferences section of this website.
- Read professional literature. The New England Journal of Medicine, Lancet Infectious Diseases, and the dedicated travel medicine journals such as the Journal of Travel Medicine and Travel Medicine and Infectious Diseases are all sources of clinical updates. Emerging Infectious Diseases and Clinical Infectious Diseases are other journals with relevant content. Periodically journals of AAOHN, ACHA, and AANP will feature travel heath nursing content as well.
- Read the lay literature. There are wonderful books and articles that address the health and safety challenges of travel. Gina Kolata's Flu: The Story of the Great Influenza Pandemic, Steven Johnson's The Ghost Map (about the London Cholera outbreak and the beginning of Epidemiology as a discipline), and David Oshinsky's Pulitzer Prize winning Polio: An American Story (about the March of Dimes and Salk vaccine) are just three well-regarded examples.
- Travel and work internationally to gain a better understand of health and safety risks – and prevention measures – around the world.
- Enroll in baccalaureate and graduate nursing and public health degrees to study such courses as epidemiology, statistics, global health, tropical diseases, health promotion, nursing research, surveillance of international injury and illness, behavioral counseling, etc.
- Participate in relevant research projects such as vaccine clinical trials, self-care management research, and surveillance of international injury and illness.
- Read ATHNA's blog, TravelBytes, a peer reviewed, referenced, and archived resource on timely travel health nursing topics. Past topics include: Why Are They Spraying Inside My Aircraft Cabin?, Interesting and Unusual Travel Terms, Equitable Care for Transgender Travelers, and Ross River Virus Disease.
- Visit the ATHNA website regularly to learn about new educational offerings, such as a rabies and a dengue online and free learning module.
- Read the ATHNA Glossary on the ATHNA website (available on the Members Only Portal) to expand travel health vocabulary.
U.S. Nursing Programs
Comprehensive academic programs for travel health nursing in the United States continue to lag behind international learning options. To address this gap, and once ANA grants specialty recognition for travel health nursing, ATHNA plans to initiate a comprehensive effort to work with U.S. nursing schools to establish 1)more undergraduate courses and concentrations in travel health nursing, 2)a post-baccalaureate certificate, and 3)a graduate degree in the specialty.
Until nursing schools expand their travel health nursing curricula, U.S. nurses may seek public health and tropical health degrees or complete additional academic coursework in courses such as global health, global epidemiology, tropical disease, and health coaching to supplement standard nursing courses. Many U.S. nurses take advantage of in-house training programs offered by health care organizations as well as corporations and university employers. Nurses also enroll in the several CE accredited short courses offered year-round by U.S. travel health nursing experts. ATHNA posts these different programs on their Courses and Conferences webpage. Some nurses in the specialty will seek out and attend virtual or in -person sessions on travel health topics at regional and annual conferences of AAOHN, ACHA, the Wilderness Medicine Society (WMS), AANP, and others. Some U.S. nurses who seek more knowledge and skills in this specialty may choose to undertake international courses of study such as those offered at the University of Glasgow, Royal College of Physicians and Surgeons, Faculty of Travel Medicine or attend courses at the London School of Tropical Medicine or participate in summer courses offered by McGill University and the University of British Columbia.
The graduate-level prepared nursing professional in this specialty has completed a Masters, DNP, ED, or PhD program that includes academic courses in advanced research methods, statistics, epidemiology, advanced pharmacology, advanced counseling theories, and graduate-level courses in global health, tropical disease, injury prevention, and health education. Additional coursework can include any number of graduate-level management, education, or clinical courses, such as health administration, finance, grant writing, project management, adult learning, advanced courses in infectious disease, courses in chronic disease management, and behavioral studies.
APRNs who practice travel health will need to complete a course of study that meets the requirements for state licensure and their professional certification (pediatrics, geriatrics, family, etc.). In addition, APRNs will need to master all the travel health knowledge and skills of the RN and take additional graduate-level courses appropriate to their role as prescribing clinician, practice director, educator and / or researcher. APRNs who provide post-travel care will need to take advanced course work in tropical disease diagnosis and management. Language courses to facilitate communication with different travel populations are also valuable.
The ATHNA Model Core Curriculum Guide
Although most schools offer some relevant courses, presently there are no academic centers in the United States that offer a defined nursing concentration or degree in travel health. To address this gap, ATHNA has developed a travel health nursing Model Core Curriculum Guide that outlines the knowledge, skills and attitudes required for competent practice. First written in 2002, over the years this curriculum has served as a foundation for a number of short courses, orientation and training programs, and CE activities offered by nurse experts, travel health companies, government agencies and academics. Posted on the ATHNA website Members Only Portal, it is available for use by individuals and groups seeking to educate nurses in the specialty, to inform and engage many more U.S. nurses in the care of travelers, and to educate travelers about quality travel health nursing care and the specialty. This curriculum is periodically updated and validated by travel health nursing experts and against other international curricula (e.g., ISTM Body of Knowledge, University of Glasgow course, UK RCN Competencies) and can be accessed through the ATHNA website.
U.S. Certification in Travel Health Nursing
To date, there is no U.S. board certification for the specialty of travel health nursing comparable to those offered for other nursing specialties by the American Nurses Credentialing Center, ABOHN and other accreditation groups. As a result, some nurses have turned to alternative methods to acquire a credential signifying professional development, as might be required by employment or used for promotion. Nurses have applied for one of several international, interdisciplinary alternatives (e.g., the ISTM Certificate of Knowledge (CTH®), the ASTMH Certificate of Knowledge in Clinical Tropical Medicine and Travelers' Health CTropMed®), the University of Glasgow Certification in Travel Health, the London School of Trop Med Certificate).
ATHNA is actively pursuing a board certification process in alignment with other U.S. specialty nursing board certifications. Not international or interdisciplinary in focus, this travel health nursing certification will be based on the U.S. standards of care and U.S. nursing regulations. The travel health nurse's attainment of this credential will have legal validity and document the highest skills and knowledge of travel health nursing as practiced in this country.
Commitment to Lifelong Learning
Travel health is a dynamic and ever-changing specialty. Travel health nurses are committed to the health, safety and prevention education of individuals and groups who travel domestically and internationally. Travel health nursing professionals focus on multiple wellness determinants such as infectious disease, environmental risks, and personal safety hazards that may impact a traveler to any destination at any stage of their journey. Clinicians know that yesterday's knowledge of global health and safety risks may not serve to best protect today or tomorrow's world traveler. Failure of the travel health nursing professional to keep current with itinerary hazards and risk management measures can have serious consequences for the traveler, their destination, and the community to which they return. Nurses in the specialty understand the need to customize their travel health preparation plans for various travel populations (e.g., students, older travelers, pregnant travelers, persons with HIV, etc.) as must nursing professionals caring for returning travelers from every destination. Travel health learning is a lifelong commitment.