Nurses Are Talking About: Concerns and Misconceptions About Foreign Nurses and Visas

Troy Brown, RN


June 02, 2017

In This Article

Advanced Practice Nurses and Visa Issues

A recent article, Trump Visa Changes Hit US Nursing Supply From Canada, Mexico by Diana Swift on Medscape Medical News, described how US Customs and Border Protection (CBP) personnel denied visas and US entry for some Canadian advanced practice nurses trying to work in the United States in March 2017.

"Under NAFTA [the North American Free Trade Agreement], Canadian and Mexican registered nurses have for decades practiced in the United States on nonimmigrant NAFTA Professional [Treaty NAFTA, or TN] visas, and each day many Canadian registered nurses (RNs) cross the border to work in US hospitals," Swift wrote. "But under recent stricter interpretations by [CBP], advanced practice nurses...are no longer eligible to work under the old RN category and must now apply for H-1B visas. The latter cover specialized positions for foreign workers from any country and can cost several thousand dollars per applicant for expedited processing."

CBP officers mistakenly believed that these nurses no longer qualified for TN visas, under which most Canadian and Mexican nurses work in the United States because they have advanced education, and said that they needed to apply for H-1B visas.

CBP officers mistakenly believed that these nurses no longer qualified for TN visas.

Things were pretty intense for about the first 2 weeks, with the border denying these TN applications, Marc A. Topoleski, managing attorney of the immigration law firm of Ellis Porter, Troy, Michigan, told Medscape Nurses. "It's important to know that this issue is limited specifically to advanced practice nurses—nurse practitioners (NPs) and nurse anesthetists. RNs were not having [more issues than usual]," he said.

"All of a sudden...they were making the interpretation of NAFTA to say that those advanced practice nurses no longer qualify under the [RN] category, which is the only nursing category under NAFTA," Mr Topoleski explained.

Initially, that caught everybody by surprise, but the CBP leadership looked into it further and determined that additional training of frontline CBP personnel was needed, Mr Topoleski said. There continued to be some misunderstandings about whether the status of the nurses might change in the future, but those worries seem to be resolved. "It was a little rocky there for another week or so, but in the United States since then, we have not received any comments or complaints from any nurses.... For the time being, it seems like that issue has been resolved, and it's fairly quiet," Mr Topoleski added.

Approximately 400 Canadian nurses work for Henry Ford Health System in the metropolitan Detroit, Michigan, area, about 30 of whom are NPs or nurse anesthetists, according to the Detroit Free Press (See: "Trump visa changes keep Canadian nurses from metro Detroit hospitals.") Hundreds more work for other major healthcare systems in the area, including the Detroit Medical Center, Beaumont Health System, and St. John Providence. Nurses also cross the border to work in other northern states including Minnesota and Washington.

"We did not experience any staffing issues. We had one [NP] who was denied under the policy change, and, had that policy not been reversed, it could have affected up to 30 of Henry Ford's advanced practice nurses," Brenda D. Craig, director, Media Relations, Henry Ford Health System, Detroit, Michigan, told Medscape Nurses.

"According to our attorney, this issue originated from verbal communications made by frontline CBP officers to Canadian advanced practice nurses," Ms Craig said. "CBP leadership later confirmed that such communications were based on a misunderstanding of the NAFTA treaty and were incorrect," Ms Craig added.

Far fewer nurses cross the border from Mexico to work in the United States, in part because of the language barrier and differences in education and licensure requirements in Mexico.


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