History of ATHNA

History of the American Travel Health Nurses Association

A Short Synopsis: 20 Years in the Making

In 2024 ATHNA celebrates its 20^th anniversary as an incorporated 501 c 3 professional nursing organization. These last two decades have seen a small group of travel health nurses meeting informally in NYC evolve into a national organization comprised of more than 3,300 members representing more than 25,000 travel health nursing professionals in North America. Highlights of those two decades:

Incorporation as a not-for-profit in NY State in 2004
The addition of Canadian members and a Canadian director in 2011
The 2015 creation of the NED, a unique Networking, Education, and Development model for very low cost, one day simultaneous professional conferences across the US
In 2019, ATHNA hosted its first national meeting in Washington, DC, the creation of a Fellows program to acknowledge leaders in our specialty, and the drafting of a Model Core Curriculum for travel health nursing
ANA formal recognition of the specialty in 2020
The joint ANA/ATHNA publication of Travel Health Nursing: Scope and Standards of Practice in 2021 that includes the first Code of Ethics in the specialty worldwide
2024-ATHNA enters its third decade actively working to create a US nursing board certification by portfolio for the specialty of travel health nursing

What follows below is a more in- depth history of ATHNA…

A Formal Beginning for Travel Health Nursing in the United States: 1980-2004

While there have always been citizens traveling internationally, travel health nursing started to formally evolve as a specialty in parallel with travel health medicine in the United States in the mid-1980's. During the next decade, U.S businesses expanded globally, adventure travel grew in popularity, and more university students elected to study abroad. Nurses in a variety of practice settings started to regularly see travelers for preventive care. As the number of international travelers grew, nurses in college health, occupational health, and ambulatory care were increasingly called upon to add pre-travel assessment and risk management services to their clinical role. Working mostly in isolation, these nurses came from many different professional nursing backgrounds; all were self-taught in travel health as there were no travel medicine textbooks, the CDC Yellow Book was only a small pamphlet at the time, and no nursing school offered curricula specific to travel health.

In time, nurses in different locales across the United States started to meet informally for continuing education, case rounds, and networking. One group was meeting in Madison WI. Another such group started to meet at Citibank offices in NYC. Many of the NY members had been present and instrumental in the formation of the International Society of Travel Medicine (ISTM) in 1985 in Atlanta. One member, Lynne Bunnell, had already participated in a successful networking group in the Midwest. Active in the early years of ISTM, these NYC area nurses were eager for more local contact, more attention to U.S. travel health nursing concerns and standards, and more opportunities for continuing education in this expanding field. Toward that end, the New York Nurses' Network was officially formed in 1999; it met 6-8 times each year for professional development and was a loosely organized, self-funded group with no dues. The NYC group reached out to nurses they knew in other areas of the country to grow a larger network. An informal email "clipping" service was started to help get new information out to nurses. By the time the NYC group had moved its meetings to the TimeLife building, the list of interested nurses through the U.S. had grown considerably along with the recognition of our unique practice area; it became evident that we should try to formalize the network and the practice.

ATHNA Incorporation & the Early Years: 2004-2009

As travel health nursing grew, both here and abroad, the need and value for a national U.S. nursing organization became apparent. In 2004, the New York Nurses' Network was disbanded and the American Travel Health Nurses Association (ATHNA) was launched. ATHNA was formally incorporated in New York State in 2004. At its inception, ATHNA was not a membership organization and there were no dues. During these first years ATHNA did receive support from both Berna/Crucell and Shoreland as well as donations from Board members. The first ATHNA Chair (now termed President) was Peg Meyersburg from Ridgewood, NJ and founding members included some of the principals of the New York Network: Lynne Bunnell, Mary Brust, Susan Wynne, Rebecca Acosta, Marianna Perry, Bev Doran, Mary Levine, Gail Rosselot, and Sue Ann McDevitt. In 2005, the inaugural Board of Directors (BOD) was formed and active participants came from additional sites outside the NYC area, including California, Colorado, Texas, Wisconsin, Massachusetts and New Hampshire. From the beginning, the BOD made a commitment to diversity with directors nominated from different practice sites (e.g. occupational health, college health, public health, private practice), different regions, as well as different professional nursing roles (RNs, NPs, LPNs, administrators). Also that year, plans for an ATHNA website were completed with the help of Shoreland (Milwaukee, WI) and ATHNA launched www.athna.org as an open access site for travel health nurses. From the beginning, ATHNA saw as its purpose to serve as a primary professional resource for U.S. nurses entering our field and as an engine for professional development and advocacy for travel health nursing in this country. Towards that end, ATHNA published on its website the first edition of Scope & Standards of Travel Health Nursing in 2004. In 2006 ATHNA stated its mission as follows: The Mission of ATHNA is the advancement of the profession of travel health nurses through education and public awareness. ATHNA initially focused on developing a Clinic Manual of standing orders for travel health nursing, creating a prototype pre-travel assessment tool, contributing to travel health nursing research with posters at national and international meetings, and working with the international groups Royal College of Nursing and ISTM to advance the practice. As part of those collaborative efforts in 2007, ATHNA sponsored its first Meet & Greet at the 10th ISTM Congress in Vancouver and presented a poster there as well. During these years, ATHNA also started to offer the Travel Well Scholarship (2007-2017) in support of travel health nursing research. On its website, ATHNA published updates about travel health clinical practices, regulations, and employment opportunities. Two components-What's News and Courses & Conferences- proved to be very popular. As a supplement to the website, ATHNA also started in 2010 sending out a quarterly newsletter, NewsShare, written by Gail Rosselot. Popular features included Member Profiles, the Travel Health Crossword, Did You Know? a column about travel medicine history, and News From Around the World. During this time, the ATHNA Board and its standing committees (Executive Committee, Membership, Professional Development) communicated using Meeting One, a teleconferencing program that the organization continues to use to this day.

ATHNA Transitions to a Membership Organization: 2009-2010

In 2009, on its fifth year anniversary as a professional society, ATHNA voted to expand into a membership organization. That goal was fully achieved on April 15, 2010 and dues were set at $25 using a PayPal account for the first time. The rationale for the minimal dues was an effort to eliminate finances as a barrier to ATHNA membership recognizing that many nurses are self-funded for their education and professional memberships. ATHNA was established as a tax-exempt entity under Section 501(c) (3) of the US Internal Revenue Service and was registered with the NY State Charities Bureau. As described in the Articles of Incorporation:

"This corporation is formed to advance the profession of travel health nurses. Its purpose is educational within the meaning of 501(c)(3) of the Internal Revenue Code, including but not limited to the advancement of travel health nursing through education and public awareness."

At this time, the first set of ATHNA By-laws were published (February 2010) with the role of President-elect established and the role of the Immediate Past President defined as advisor. In the spring of 2011, ATHNA voted to further expand its membership to include Canadian nurses. It was acknowledged that travel health nurses in the United States and Canada share many of the same professional issues and clinical challenges. The ATHNA Board saw the possibility of "across the border" collaboration. At the May 2011 elections, we increased the size of our board from 9 to 11 members and welcomed our first Canadian director, Michele Sabourin. That same month we held our first member reception at the Boston ISTM conference and presented a poster on our November 2010 membership survey. Later that October, ATHNA held its first Director Retreat at the Edith Macy Conference Center in Briarcliff Manor, New York with Elaine Rosenblatt presiding as our President.

ATHNA Updates Scope & Standards of Travel Health Nursing: 2011-2014

During the years 2010-2015, ATHNA embarked on a number of special projects, including the development of the second Scope & Standards of Travel Health Nursing (February 2012) based on a role delineation study and guidelines of the American Nurses Association. The BOD also made significant changes to the Standing Committees adding a Communications Committee (2011) to manage the website and the Organizational Development Committee (2011) to assist the officers with strategic planning. The BOD also voted to rename the Professional Development Committee to Professional Resources (2011) to more accurately describe its role as the creator of clinical content for the membership. ATHNA continued to expand its website with the ongoing sponsorship of Shoreland and delivered 3-5 editions of its NewsShare newsletter to members each year. A Clinical Tool Kit was added to the Clinic Manual and ATHNA initiated a Facebook presence (Twitter followed after that). Efforts to expand membership became an important focus of the Board and dues were held steady at $25 per year. In Maastricht (2013), ATHNA presented posters and sponsored another Meet & Greet at the 13th ISTM biennial conferences.

ATHNA Introduces the NED: 2015-2017

Committed to the expansion of travel health nursing education, ATHNA created a novel clinical gathering termed the NED: Networking, Education and Development. Offered on the same summer day at member homes across the country, the first NED in 2015 provided 4 CE credits and took place in Briarcliff Manor, NY and Menlo Park, CA. Overwhelming appreciated, NEDs became an annual, free benefit of ATHNA membership with Boone, NC added as a site in 2016 and 2017. Zoom was utilized to transmit powerpoint presentations to all the sites. Feedback from attendees helped to not only grow the NED program, but also other aspects of ATHNA. For example, in response to NED feedback, ATHNA Member Certificates were designed and issued for the first time. A new category of membership, Lifetime Membership, was also launched with the one- time payment of $250. After an extensive effort to identify a new web platform that would offer more options, the BOD made the decision to retain the current website hosted by Shoreland. Supporting this decision was the issue of cost and because a new web provider would require ATHNA to either find a volunteer or hire someone to manage the site. Since its inception ATHNA has been most fortunate to have the wonderful help of Dawn Keough, a Shoreland employee. Additional educational efforts during those years included adding "A Little Something Extra" to the website and creating TravelBytes, a new blog started in 2016 to replace feature articles when NewsShare ceased publication that year. ATHNA continued its established tradition of sponsoring a member reception at ISTM conferences with Meets & Greets in Quebec City (2015) and Barcelona (2017). Of major importance during this time period, and after preliminary work on the issue had been ongoing for several years, the BOD voted to seek official specialty recognition for travel health nursing through the American Nurses Association. While conversations with ANA had started in 2012, now the effort became a priority and a second goal was established to develop certification for travel health nursing through portfolio (no exam, but rather a review of a professional portfolio of practice and education). A second Directors Retreat under the leadership of then President, Julie Richards, was convened in Atlanta on November 11 and 12, 2017. The mission of ATHNA was revised at that gathering into its current form "THE MISSION OF THE AMERICAN TRAVEL HEALTHNURSES ASSOCIATION IS TO ADVANCE NURSES ENGAGED IN THE CARE OF INTERNATIONAL TRAVELERS THROUGH PROFESSIONAL DEVELOPMENT, EVIDENCE BASED PRACTICE AND ADVOCACY." The BOD also voted to raise regular dues to $40 annually and the decision was made to continue to welcome Canadian members, but not to continue to create specific Canadian website content. The reasons for this policy change were several: ATHNA had not been successful in its multi-year effort to add significant numbers of Canadian nurses, Canadian travel health guidelines differ in many ways from US guidelines, and we no longer had a Board member able to write/edit the content useful to Canadian travelers; also, Canadian content had to be translated from English into French to be used with patients. Following the ISTM Barcelona meeting in 2017, ATHNA officially joined with CDC, ISTM and ACHA to collaborate on a multi-year study of student travel health.

Go-Teams and the Drive for ANA Specialty Recognition: 2017-2018

During this time, the ATHNA website underwent a redesign and a rapid expansion of monthly content. A President's Monthly email to members was started. A decision was made by the BOD to change the committee structure of ATHNA due to inactivity. With the exception of the Executive Committee, the various Standing Committees were eliminated by the BOD (Communications, Professional Resources, Organizational Development, Membership) and the Zero Committee organizational design for small non-profits was adopted. In this format, in place of permanent Standing Committees, Go-Teams are created for time-limited, project- specific purposes. The first Go-Team was created to usher ATHNA through the ANA process for specialty recognition. This group met for a weekend of writing in March 2017 and their efforts are ongoing. During this time, plans were also initiated to sponsor the first national ATHNA meeting in Washington DC in June 2019. This one day meeting would replace the regional NEDs in 2019, serve to make the anticipated announcement of U.S. specialty recognition, and provide the occasion to introduce a first class of ATHNA Fellows. The meeting date corresponds with the June 2019 ISTM Congress. A second Go-Team was created to implement this DC conference and a third Go-Team took on the task of creating a BOD Manual and revising the ATHNA By-laws. A proposal for an ATHNA Fellows program was developed by a fourth Go-Team. A major effort to grow ATHNA membership was approved by the BOD, after two years of discussion, and ATHNA adopted a year of free membership from March 2018-March 2019. We created our first postcard to help with marketing ATHNA, collaborated with ACHA and the NSNA to add members, and Board members promoted membership at several national meetings. As of August 2018 membership had grown from 170 to over 1000 members. To accommodate this larger membership, we took first steps to activate a Constant Contact contract so we could offer regular email messages.

Specialty Recognition, Publication of the Scope & Standards and Covid-19 Moratorium 2019-2021

By January 2019 ATHNA had far exceeded its membership goal and by the end of that year ATHNA had registered more than 2200 members. That winter a task force was established to develop the ATHNA Fellows program. The first national meeting of ATHNA took place in June 2019 at the donated space of the Kaiser Family Foundation in Washington DC. The theme was “Advancing Nurses Critical Role in Global Health.” The event was well attended and extremely well received. At that meeting the inaugural class of ATHNA Fellows was introduced: Julie Richards, Sandy Weinberg, Elaine Rosenblatt, Kevin Long, Metter Riis, Nancy Masunaga, Gail Rosselot, Nancy Di Rubbio, SueAnn McDevitt, Charlotte Kazin, and honorary Fellow Jane Chiodini from the UK. In June 2019 Candace Sandal was elected President and served until December 2019. The Task Force responsible for working with ANA to create Travel Health Nursing: Scope and Standards of Practice delivered the final document for ANA consideration in August of 2019. In December, Sandy Weinberg, a previous President, accepted the position of Interim President. During the spring of 2020 ATHNA received official recognition of travel health nursing as a distinct ANA nursing specialty in the U.S. and ANA agreed to publish Travel Health Nursing: Scope and Standards of Practice, 1st edition. This concluded a seven-year effort by the Task Force (SueAnn McDevitt, Sandy Weinberg, Mette Riis, Candace Sandal, Julie Richards, Elaine Rosenblatt, Gail Rosselot, Chair) Then the Covid-19 pandemic struck. With the collapse of the travel market, the BOD decided to go “into moratorium” only working on unfinished projects and continued to offer free membership through the end of 2021. In January 2021, a Nominations Committee was established to expand the BOD, and to bring onto the BOD individuals with special expertise. That same month the first of four NED sessions via Zoom was held. In February a revised edition of the Bylaws was approved that incorporated the new Code of Ethics of Travel Health Nursing. That spring, Emergent Pharmaceuticals offered ATHNA an opportunity to collaborate on a travel bulletin to address some of the issues of international travel post-Covid. At the June Annual BOD Meeting, 6 new directors were elected, the BOD voted to start investing some of the treasury in a managed Fidelity account, and plans were initiated for a July Virtual Book Launch to formally announce the March 2021 publication of the Scope and Standards.

2021-2022

As planned, in July 2021 ATHNA held a very successful Zoom membership book launch for the new Scope and Standards. Throughout the fall, membership continued to grow, and as of July 2022, exceeds 2700 members representing all 50 states, most Canadian provinces and 30 other countries. The Board approved the continuance of free membership with the ongoing pandemic. In January 2022 ATHNA launched on its website a new educational offering Educational Resource that features monthly content of value to travel health nurses. During this timeframe ATHNA has entered into conversations with several pharmaceutical companies to develop educational activities following the strict guidelines of our Code of Ethics. ATHNA also appointed a Director of Communications to review all internal and external communications with a goal to expand ATHNA membership to 10,000 by 2024 (twentieth anniversary of the corporation) and expand the recognition of travel health nursing as a distinct US nursing specialty. After the 2022 Annual meeting, four new directors, including our first non-nurse member, were added to the Board expanding that body to 15. The Finance Committee is undertaking a review of procedures as recommended by the 2022 Audit Committee. The Board has agreed to develop essential administrative policies and procedures as part of the 2022-2023 agenda.

2023-2024

ATHNA continues to offer free membership and our numbers exceeded 3,300 at the beginning of 2024. Our newly elected leadership team includes President Kathryn Reid, Treasurer Amy Manion, and Secretary Susan Cruz. Gail Rosselot continued as Vice President. President Sandy Weinberg and long- time treasurer, Mette Riis, stepped down as officers and three new directors joined the board. A list of current directors on the 15- member board is available through the website directory. ATHNA has several priorities for 2024: establishing a board certification akin to other US nursing certifications, sponsoring a NED at multiple locations in June 2024, preparing for a second national conference in May 2025 in New Orleans (first was in DC in 2019) and enhancing member engagement. Two grant funded, on demand accredited learning modules are available free on our website to members and non-members alike – rabies (grant from Bavarian Nordic) and dengue (grant from Takeda).

Gail Rosselot, Website editor, February 2024