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More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation   At a time when U.S. health care facilities are recruiting in Canada because of the nursing shortage, it’s hard to understand the timing of a rule that might slow down foreign nurse recruitment or discourage Canadian nurses from coming here or staying.

Every day, some 500 of 2,500 nurses at the Henry Ford Health System, Detroit, cross the Canadian border to work. A new ruling by the Department of Homeland Security (DHS) that requires visa certification for foreign nurses who work in the U.S. may change this for Henry Ford and other border facilities. Is the new ruling a hardship for foreign nurses, a serious patient safety concern, or a measure of patient protection?

As the transition period for this new ruling comes to an end, discussions about its merits and drawbacks are heating up.

The new view

“The law isn’t new,” says Phyllis Kritek, RN, PhD, FAAN, immediate past-president of the Board of Trustees of the Commission on Graduates of Foreign Nursing Schools (CGFNS). Kritek says that the Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA), aimed at controlling illegal immigration, dates back to 1996. What’s new is the final ruling that DHS made last year regarding how to carry out the IIRIRA.

Under the new rule, nonimmigrant nurses who enter the U.S. after the date of the ruling, July 26, 2003, but before July 26, 2004, would have a year from entry to produce a visa certificate from a DHS-approved agency, such as CGFNS. Nurses already here before the ruling date would have until July 26, 2004, to produce the certificate. After that, whenever nurses ask for an extension or leave and want to return to the U.S., they must have a certificate in hand. Previously under the Trade NAFTA, nonimmigrant nurses from Canada or Mexico who worked in the U.S. were exempt from visa certification.

Border sites

Canadian nurse Joyce Farrer, RN, MSN, ED, director at Henry Ford Hospital, Detroit, sees the new ruling as a hardship, voicing what many of her Canadian staff nurses ask: “Why go through the process especially after working in the states for years?”

“VisaScreen, the program that CGFNS initiated after IIRIRA was passed in 1996, is a long, often frustrating process,” says Farrer (see sidebar for more information).

At a time when U.S. health care facilities are recruiting in Canada because of the nursing shortage, it’s hard to understand the timing of a rule that might slow down foreign nurse recruitment or discourage Canadian nurses from coming here or staying.

“The new ruling doesn’t take into consideration the effect on the border states,” says Maureen Henson, SPHR, Henry Ford director of recruitment strategies. Henson believes that Canadian nurses who currently fortify border health care facilities, many of whom have worked in the U.S. for years, are caught short. “Hardest hit will be cities like Detroit, Buffalo, and Seattle,” she says.

Colleagues at facilities in southeastern Michigan are trying to assess the possible impact of the new ruling. At Henry Ford, where about 20% of nurses are Canadian, Henson estimates that the greatest impact would be in the ED, ICU, and OR. “Though confident that we would not close areas, we might have to redeploy staffing,” she says.

Heading off workforce woes

Hoping to leverage influence over the issue, Henry Ford and area colleagues mustered political support by writing to Michigan Gov. Jennifer Granholm and U.S. senators. They and nursing groups wrote to Secretary of Homeland Security Tom Ridge requesting an extension of the July deadline.

On behalf of the National Council of the State Boards of Nursing (NCSBN) president Donna Dorsey, RN, MS, FAAN, told Ridge that “10,000 to 15,000 nurses who have been licensed and practicing in the U.S. since 1997 will be unable to provide health care because of the retroactive implementation of the rule.”

Dorsey added, “This is a serious patient safety concern for our citizens based on the evidence of medical errors related to short staffing.”