American Nurses Association president on immigration enforcement in health care

Following the fatal shooting of Alex Pretti by border patrol agents in Minnesota, several medical groups have been speaking out about immigration enforcement, including in healthcare settings.

The American Nurses Association has led the charge. The group called for a full investigation into the shooting of Pretti, an ICU nurse at the Minneapolis VA Medical Center.

But the group also urged its five million members to contact Congress and demand an end to immigration enforcement efforts that impede “the ability to provide care in all healthcare settings.” The association has also called on Congress to block additional funding for immigration enforcement until there is more legislative oversight of immigration enforcement efforts “within our communities and care settings.”

Jennifer Mensik Kennedy, president of the American Nurses Association, spoke with Chief Healthcare Executive® about immigration enforcement in hospitals and other healthcare settings, the death of Pretti and the mindset of nurses at a turbulent time.

She says that she’s encouraged by the support that nurses have received.

When asked about how nurses are responding, Mensik Kennedy says, “I'm getting a lot of great feedback related to feeling connected and recognizing how much the public is supporting them and how much the public is behind them.”

She says Pretti’s death has spurred nurses to speak up and make their voices heard.

“That has brought more people, more nurses out to do some vigils and kind of be more present in some of these areas … It kind of empowered nurses to be more freely speaking about these issues,” she says.

(See part of our conversation in this video. The story continues below.)

‘Unsafe work environment’

Tens of thousands of nurses wrote to Congress in response to the American Nurse Association’s call, Mensik Kennedy says. She says she hoped it made a difference, and notes lawmakers moved to separate funding for immigration enforcement efforts from a broader federal spending package.

“I think they heard nurses' voices loud and clear, and they heard the public loud and clear,” she says.

Nurses have reported some problematic encounters with ICE agents, she says. She says she’s heard of nurses asking for information protected by HIPAA without appropriate documentation, such as subpoenas or warrants signed by judges.

It puts nurses in difficult situations and adds to an “unsafe work environment,” she says.

Within hospitals, many interactions with immigration agents have taken place in the emergency department, Mensik Kennedy said nurses have also had difficult situations in other parts of the hospital.

She says she’s concerned that the fear of running into immigration agents is deterring some patients from getting care, including members of minority groups who are citizens.

“It's really important that people get the care that they need and the care that they're seeking out,” she says. “This goes all the way from emergency care, heart attacks and strokes, to just getting routine vaccinations. So it's really important that healthcare settings be allowed to freely treat, and people shouldn't feel scared to attempt to come on to the site.”

Mensik Kennedy says nurses have encountered problems with immigration agents outside of hospital settings. She said home health nurses have been stopped by federal agents and are being asked for the names of the list of patients they are going to see in the community.

“That's not acceptable,” Mensik Kennedy says. “So it's not just the hospitals that we're seeing this confusion. We're seeing this occur in our communities as well.”

Nurses should be looking at their state boards of nursing to know their rights, and nursing boards have been offering guidance on dealing with ICE agents.

“Nurses are afraid they might lose their license if they don't provide the information, or they're being threatened, saying, ‘We're going to report you if you don't give us this information,’” she says. “So the State Boards of Nursing have been, in a variety of states, coming out with information or just clarifying their stance from their position to help support nurses’ rights on when these things occur.”

Mensik Kennedy also says some clinicians working in hospitals have been worried about being detained by immigration agents.

“They're fearful to even come in to work in their shift at the hospital,” she says. “So it's an issue for everyone, particularly those of ethnic minority backgrounds.”

Training and guidance

Hospitals and health systems need to offer training and guidance for nurses so they know what to do when encountering immigration agents, Mensik Kennedy says.

She says nurses have described varying levels of training for encounters with ICE agents.

“I think there's a lot of organizations who may not be prepared,” she says.

Mensik Kennedy encourages nurses to be asking their managers and hospital leadership about policies for dealing with immigration agents.

But she encouraged health systems to be proactive in helping train nurses.

“I would make sure you do spend some time educating all of your staff, not just nurses, on how your staff should be interacting and engaging,” she says.

Hospitals need to be mindful of ensuring training includes nursing staff on nights and weekends, when executives and the health system’s attorneys may not be immediately available. Those are also shifts where some of the least experienced nurses are working.

“It's really important to make sure they're prepared and that they feel comfortable knowing the escalation process,” she says.

‘We take care of everyone’

Given the size of its membership, the nurses’ association represents nurses who oppose and support the federal government’s approach to immigration. With any issue, Mensik Kennedy says it’s not easy to advocate and represent the opinions of everyone.

“We utilize the code of ethics as that guide and where we should be standing, and let that dictate to us where and how we engage in these matters,” she says.

“And you are a nurse, 24/7,” she adds. “You don't get to take your nursing hat off after your shift and put it away. That's the different part about nursing, is managing your professional expectations in your code of ethics all the time with maybe your personal opinion, and that could very well clash, but at the end of the day, you need to do what's correct for people.”

Nurses remain the most trusted profession because people know that they put aside personal views to deliver the best care, she says.

When asked about the challenge of balancing patient care while also working with law enforcement, Mensik Kennedy again points to the nursing code of ethics.

“Our code of ethics tells us we take care of everyone,” she says. “We take care of people who are murderers, who might have been rapists, or, with domestic violence.

“It doesn't matter what your background is, or what you may have done that might have been bad, we're going to treat you as the human that you are, and make sure that you get the care you receive,” she adds. “And that's kind of the end of the story. We treat everyone the same, and we should treat everybody the same.”