Matt Helms

Detroit Free Press

Specialized Canadian nurses have been stopped from entering the U.S. to work at metro Detroit hospital systems, and many more could lose their ability to work here under the Trump administration's visa changes, one of the region's largest health systems warned Thursday.

Officials from Henry Ford Health System, which operates five metro Detroit hospitals, said registered nurses with advanced specialties — including nurse anesthetists and nurse practitioners — may no longer qualify for NAFTA Professional visas.

The nonimmigrant NAFTA visas, also called TN visas, allow citizens of Canada and Mexico to work in the U.S. "in prearranged business activities for U.S. foreign employers," according to the State Department.

U.S. Customs and Border Protection, however, denied late Thursday any policy change had occurred.

Canada's CBC News reports that as many as 40,000 Canadians work on TN visas in the U.S.

Marc Topoleski, an immigration lawyer representing Henry Ford Health System, said about 400 Canadian nurses work for Henry Ford, and about 30 of them are nurse practitioners or nurse anesthetists. Hundreds more work for the region's other major health care systems, including the Detroit Medical Center, Beaumont and St. John Providence.

Topoleski said the health system and hospital operators in U.S. border states around the country are scrambling to understand U.S. Customs and Border Patrol changes that could have a dramatic impact on providing care because of a critical shortage of nurses with advanced specialties.

Patti Kunkel, a Windsor, Ontario, area resident who's been a nurse in Detroit since 2000, said she's worried that she may be stopped at the border and her privileges to work here revoked because she's a nurse practitioner, a registered nurse with advanced training able to diagnose and treat illness and prescribe medication to patients.

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"We are already short staffed," Kunkel said at a news conference this afternoon at Henry Ford's administrative offices in Midtown Detroit. "We are all overworked because of being short-staffed, so going down one more is going to be very difficult on my team as well as myself, because I will be at home. I already feel guilty when I can't come in for overtime because I'm burned out."

Kunkel said her current visa doesn't expire until 2018, but she said she and other nurses are worried that their visas could be revoked at any time.

In a statement released Thursday evening, however, U.S. Customs and Border Protection denied there had been any step-up in enforcement.

"U.S. Customs and Border Protection has not had any policy changes that would affect TN status," said the statement e-mailed by Kris Grogan, public affairs officer. "One of the most common issues CBP sees is improper paperwork presented by the traveler in relation to the position classification they are applying under. Another common issues is the lack of proper documents needed to grant a TN nonimmigrant classification."

It added: "U.S. Customs and Border Protection is currently working closely with U.S. Citizenship and Immigration Services for greater clarity in regards to specialized categories that fall under the registered nurse classification."

Topoleski said Customs officials have told him and other lawyers little about the changes that apparently are a part of President Donald Trump's overhaul of immigration laws and a crackdown in the North American Free Trade Agreement, the 1994 agreement between the U.S., Canada and Mexico to liberalize trade between the nations. Trump has pledged to renegotiate NAFTA, blaming it for significant American job losses.

Topoleski said Customs officials are saying that the advanced nurses skills are "too advanced" for them to fit under the registered nurse category, although the nurses are still, indeed, registered nurses.

"Our argument is the opposite, that Marsince those two jobs require as a foundational requirement that you have to be a registered nurse to even perform those jobs, that is why it should continue to be considered under the registered nurse category," Topoleski said. "To say that, because they're advanced or have a more advanced duties or require more advanced education, that they're still not at their core registered nurses just doesn't make a lot of sense to us."

Topoleski said Henry Ford is exploring whether to get more of its specialized nurses H-1B visas, which are issued to highly skilled workers. But that process potentially could take six months and would cost health providers significantly more money — about $4,000 for H-1Bs compared with $200 for TN visas.

It's an expense he said Henry Ford will make if it must, although he said he believes the money is better spent on patient care instead of bureaucratic visa changes. In the meantime, he said, it could put hundreds of specialized nurses at risk of not being able to get to their jobs for months while they await new visas.

Topoleski, a member of a nationwide task force of immigration lawyers, said he has heard from other attorneys around the country about advanced nurses being turned away at the border. He said it primarily is impacting northern border states because similarities in education education and training in the U.S. and Canada make it easier for American health providers to hire Canadian nurses.

Contact Matt Helms: 313-222-1450 or mhelms@freepress.com.