Nurses as Immigrant Advocates: A Brief Overview

Mary Ellen Biggerstaff, DNP, MSN, RN, FNP; Taiyyeba Safri Skomra, JD


Online J Issues Nurs. 2020;25(2) 

In This Article

Understanding the Immigration System

The first immigration laws passed soon after the Revolutionary War, with the Naturalization Act of 1790 (National Archives, 2019), which limited eligibility for citizenship to free white propertied males. In 1866, the Fourteenth Amendment guaranteed citizenship to former slaves (National Constitution Center, 2006), but in 1882, Congress passed the Chinese Exclusion Act to ban immigration from China. (African American Policy Forum, 2019). In 1924, country quotas were created to limit immigration from countries other than Northern and Western Europe. In the aftermath of World War II, the refugee convention was adopted to protect people from persecution. In 1986, laws enabled legalization for Latin American and other immigrants who had been in the U.S. since before 1982. In 1996, there was a tightening of laws to restrict immigration and increase the number of people who could be deportable. This was the last major reform of immigration laws, leaving millions of immigrants in the U.S. without a path to attain lawful status.

In 2003, as a response to September 11th, the provision of immigration services was restructured under the Department of Homeland Security, with a focus on preventing terrorism (Cohn, 2015). The Department of Justice oversees the Immigration Courts and the Board of Immigration Appeals, which have a backlog of nearly one million cases.

There are many types of immigrant status. Non-citizens can be lawful permanent residents (i.e., green card holders); hold temporary legal status (e.g., as tourists, students, temporary workers); or may be considered undocumented (immigrants who overstay a visa or enter the country without permission). People granted Deferred Action for Childhood Arrivals are neither in lawful status nor fully undocumented, having been given a two-year protection from deportation. Generally, U.S. citizenship can be acquired at birth or applied for by those who reside in the country as lawful permanent residents, but is not an option for most undocumented people living here.

The majority of permanent immigration to the United States is family- and employment-based, requiring a petition by a particular relative or employer. Other narrower avenues for immigration include the diversity lottery, refugees, and asylees. Refugees and asylum seekers both have to prove that they have been persecuted or have a well-founded fear of being persecuted on account of their race, religion, nationality, membership in a particular social group, or political opinion (Blizzard & Batalova, 2019). Refugees are screened and processed abroad, while asylum seekers first reach the US and then make their claim. The United States is obligated to accept both of these populations under international law (International Rescue Committee, 2018).

There is widespread confusion about the ability of immigrants to access public benefits. (Skomra, 2019) While the laws are in flux as to the immigration consequences a person might later face for having used services such as emergency care, the legal right to use those services is not in question.

The U.S. immigration system is complex, but a basic understanding can be useful when working with immigrant populations. Providing healthcare services to undocumented immigrants is not against the law, and healthcare providers are not required to report or collect immigration information about their patients. (National Immigration Law Center, 2017).

Table 1 provides additional facts about current immigrants.