Travel health nursing is often regarded as "just about vaccinations." Immunizations are important, but only one of many risk reduction methods utilized to protect the health and safety of travelers- whether they travel nationally or internationally.
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. ATHNA has developed a Model Core Curriculum Guide that outlines the knowledge and skills necessary for the practice of travel health nursing. Furthermore, Travel Health Nursing: Scope and Standards of Practice, 3rd ed. defines the five levels of nursing proficiency in this specialty from novice to expert. The seventeen Standards describe the necessary practice and professional competencies for this specialty.
Nurses at every educational level who practice travel health nursing find it necessary to take specialty- specific coursework in addition to the basic courses required for their state licensure as RNs or APRNs. Travel health nursing necessitates that all travel health nurses master a body of knowledge distinct from their foundational coursework of professional nursing education; travel health nursing is not routinely taught in the current registered nurse curriculum in the United States. At present, through undergraduate and graduate level classes, short courses, CE activities, on the job mentoring, and self-directed learning, RNs 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.
Entry into Practice
Foundational Knowledge and Skills in the Specialty
As recommended by the ATHNA Model Core Curriculum Guide, a nurse entering the specialty will need to pursue an education in these subject areas:
- 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), 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
Travel health nurses pursue any number of post-licensure educational options to build mastery and maintain currency in the specialty. Travel health nurses consult the ATHNA Model Core Curriculum, the CDC Health Information for International Travel, the CDC Epidemiology and Prevention of Vaccine Preventable Diseases, and the ISTM Body of Knowledge as just four of the 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 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.
Continuing Education Opportunities
A number of 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, free, one day clinical update NED: Networking, Education and Development Day. Earn up to four CE credits each year though website based programming.
- Regularly check the websites of the CDC www.cdc.gov/travel and the Immunization Action Coalition 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, Expert Opinions, 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) now include travel health educational content as part of their conferences, journals and websites. ATHNA lists these opportunities on its Courses and Conferences section of the website.
- Read the 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 examples.
- Travel and work internationally to gain a better understand of health and safety risks - and prevention measures - around the world. ATHNA will initiate it its Learning Journeys in Travel Health with a CE accredited trip to Panama in March 2020.
- Enroll in post baccalaureate nursing and public health courses such as epidemiology, statistics, global health, tropical diseases, health promotion, nursing research, surveillance of international injury and illness, 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 resource on timely travel health nursing topics that have included: Why Are They Spraying Inside My Aircraft Cabin?, Interesting and Unusual Travel Terms, Equitable Care for Transgender Travelers, and Ross River Virus Disease
- Read the ATHNA Glossary on the ATHNA website 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 curriculums, 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 such as Kaiser Permanente, Passport Health, and Premise 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 such as Travel Health 101 and The Westchester Courses. Most nurses in the specialty will seek out and attend relevant sessions of annual conferences of AAOHN, ACHA, the Wilderness Medicine Society (WMS), and AANP. A select few U.S. nurses who seek more knowledge and skills in this specialty post-licensure 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 RN 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. Initially, to address this gap, ATHNA 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, 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 validated by travel health nursing experts and against other international curricula (e.g., ISTM Body of Knowledge, University of Glasgow course), updated regularly, and can be accessed on the ATHNA website.
U.S. Certification in Travel Health Nursing
As of yet, no U.S. nursing certification for travel health nursing comparable to those offered by the American Nurses Credentialing Center exists. Due to this gap, some nurses have turned to alternative methods to acquire a specialty credential signifying professional development, as might be required by employment or for promotion. These nurses have applied for one of three international, interdisciplinary alternatives: the ISTM Certificate of Knowledge (CTH®), the ASTMH Certificate of Knowledge in Clinical Tropical Medicine and Travelers' Health (CTropMed®) or the University of Glasgow Certification in Travel Health.
ANA recognition of the specialty of travel health nursing is the crucial first step necessary for ATHNA to pursue a certification process in alignment with other U.S. specialty nursing 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 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 devoted to the health and education of persons and groups who travel internationally and nationally, and travel health nursing professionals focus on multiple determinants such as infectious disease, environmental risks and personal safety dangers that may impact a traveler to any destination at any stage of their journey. Travel health nurses know that yesterday's knowledge of global health and safety risks may not serve to protect today or tomorrow's world traveler. Failure of the travel health nursing professional to keep current with itinerary hazards and customized risk reduction measures for the various traveling populations (e.g., students, boomers, pregnant travelers, persons with HIV) can result in poor travel advice and counseling at a minimum and excess travel-related illness, injury, even death in the worst cases.
Updated: August 2019