By Brian Hofmann, Medill, Immigrant Connect
Patti Kunkel’s schedule mirrors that of most nurse practitioners in her field. In the car by 5 a.m., she begins her half-hour commute to work at Henry Ford Hospital in Midtown, Detroit by picking up a cup of coffee. However, Patti’s commute is different. She crosses the border, and as a Canadian resident, she’s gets that cup of coffee at a Tim Hortons before entering the U.S.
After the coffee, Patti’s drive takes her north from her home in LaSalle, Ont. while passing by the region’s signature French-colonial influenced long-lot farms, “the true striking geographic difference between the U.S. and Southwestern Ontario,” according to Kunkel. Winding northbound on streets through Windsor, Ont., Kunkel makes the approach to the border crossing while going over the Ambassador Bridge.
“When I look to my right, it’s a great view of the Renaissance Center and rest of downtown Detroit. Looking back on the road, there’s a huge Maple Leaf flag hanging from the bridge tower on the Canadian side.”
Descending from the midpoint of the Ambassador Bridge, Patti pulls out her NEXUS card and readies it for the U.S. Customs and Border Patrol agent awaiting on the other side of the Detroit River. When asked if she is bringing anything over the border, Patti holds up her brown bagged lunch for the agent to see and there are no further questions. Clearing customs and merging onto I-96, Patti has five minutes more on the road and she’s at work.
This has been Patti Kunkel’s routine for 17 years. Through three different U.S. presidents, the procedure has remained the same. However, events that have occurred already in 2017 have thrown a wrench into what used to be a perfectly seamless process.
“Never have I been held up at the border at 5 in the morning with additional questioning more than I have in these first few months of the Trump administration,” says Kunkel.
At Henry Ford Hospital, there are 50 nurses in the same surgical department as Kunkel who commute daily into the United States from Canada.
In Detroit, a city perhaps hit the hardest by declining demand for manufacturing, the health care industry has been bolstered by Canadian nurses. “It’s been increasingly hard to staff hospitals in inner-city Detroit with qualified American nurses over the years,” says Marc Topolewski, an attorney for the Detroit law firm Ellis Porter, who specializes in business immigration services. “Many American nurses with advanced specialty training would prefer an easier work-life balance in a suburban hospital environment, leaving hospitals in downtown Detroit incredibly understaffed.”
The vital influx of nurses has been made possible by a certain stipulation of the North American Free Trade Agreement (NAFTA). According to U.S. Citizenship and Immigration Services, “the non-immigrant NAFTA professional TN status allows citizens of Mexico and Canada to work in the United States as NAFTA professionals” provided their trained occupation is designated in a list created at the drafting of NAFTA in the mid-1990s.
Fortunately enough for health care in cities across the American Rust Belt, like Detroit, one of those listed professions is “registered nurse.” Hailed as “the worst trade deal maybe ever signed anywhere, but certainly ever signed in this country” by the current president of the United States, NAFTA has allowed tens-of-thousands of nonimmigrant professionals to cross the U.S. border and fill employment gaps that exist in the American economy.
On the Canadian side of the border, there are existing factors that drive well-qualified nurses to cross into the United States every day. According to Topolewski, many of his clients are Canadian nurses who can’t find enough work in their nation’s single-payer health care system. “There just isn’t the demand,” says Topolewski, “especially in a smaller regional community like Windsor.”
Recent nursing graduates from the University of Windsor find it increasingly difficult to find work in Southwestern Ontario. Tien Nguyen graduated with a Bachelor of Science in Nursing from UWindsor, completing her studies in 2015 to become a registered nurse (RN). “I worked as a student nurse at both major hospitals in Windsor as an undergraduate student. When I got my diploma and sought openings for nurses in the specialized departments at Windsor Regional [Hospital], there was nothing available,” says Nguyen.
“Often, Canadian nurses have to move to a different province in order to find employment in the fields they desire,” says Topolewski. Instead of moving far away from her family in the Windsor/Southwestern Ontario region, Nguyen’s sights shifted somewhere much closer, right across the river bordering her college campus into Detroit.
With four years of experience as a student nurse, Nguyen was an extremely attractive candidate when she applied for a position in the Spinal Cord Injury Unit of Detroit Medical Center’s Rehabilitation Institute of Michigan. The Institute, located in the Midtown neighborhood of Detroit, is just a 15-minute drive across the Detroit River on the Ambassador Bridge from Nguyen’s apartment near the University of Windsor’s campus.
“[In Canada] the closest job to home, in any nursing specialty field that was hiring, was in Kingston. That’s a six-hour drive away from my family and a completely different culture to Windsor,” says Nguyen.
This cross-border employment is not unique to just the Detroit-Windsor Region. Karen Franco’s commute from her home in Ridgeway, Ont. to Niagara Falls Memorial Medical Center in Upstate New York preceded NAFTA when she first took a position as a nurse there 28 years ago. She, in fact, does not commute under a TN (Treaty NAFTA) status and instead holds a C2 Green Card that she was issued under the predecessor to NAFTA, the bilateral Free Trade Agreement between the U.S. and Canada passed in 1988.
“I was young and could receive better pay working in the U.S. health care system,” says Franco. “My lawyer at the time talked me through the [transnational] taxation reciprocity that was passed in the early-’80s and I was able to retain all of my Canadian national benefits.”
The reciprocity agreement Franco refers to is the U.S.-Canada Income Tax Treaty (1980) that allows her to receive any income withheld by the IRS and U.S. Social Security, as well as avoid instances of double-taxation by both the IRS and Canada Revenue Service.
With her C2 Green Card and designation as a permanent resident in commuter status, Franco is in a much more secure position with the new administration than Patti Kunkel and most of the nurses at Henry Ford Hospital.
Earlier this year in March, new Trump immigration policies stirred up a lot of confusion for a newly hired colleague of Kunkel’s when Customs and Border Patrol agents questioned the legitimacy of her profession under TN status. “The law has not been interpreted this way in the 25 years of its existence,” says Topoleski. “There is no precedent for a CBP (Customs & Border Patrol) agent to deny a specialized nurse practitioner entry to the United States under a TN status visa.”
“There is currently a lot of confusion in our field about the designation of a registered nurse versus a specialized nurse practitioner,” says Kathy Macki, VP of Human Resources at Henry Ford Health System in Wyandotte, Mich. “Whether or not our nurses will make it across the border on a day to day basis is of real concern. We are working to clarify whether our specialized nurses will continue to be renewed under TN status.”
TN status is temporary. It typically lasts for three years but is reviewed each time the person enters the country at the border. Any wrong answer to an additional question that Kunkel receives more frequently at the Ambassador Bridge crossing could result in her disqualification as a nonimmigrant commuting professional and she fears, the end of her 17-year career.