CNOs, Here’s How to Prepare for ICE Agents in Hospitals

Many things in healthcare have changed since the beginning of the year from a policy perspective.

On Jan. 20, the Trump Administration revoked a policy that protected sensitive locations, including hospitals, from Immigration and Customs Enforcement (ICE) and Customs and Border Patrol (CBP) enforcement actions.

In the wake of these removed protections, preparedness is key. CNOs need to take a look at their health system’s policies and provide guidance to nurses who might have future interactions with ICE or CBP agents.

Guidance for organizations

According to the ACLU, there are two laws that health systems should remember when considering immigration enforcement policy: the Fourth Amendment and HIPAA. The Fourth Amendment prohibits illegal searches or seizures, and depends on the reasonable expectation of privacy. Patients can expect privacy in a hospital room.

Currently, health systems are required to allow ICE agents into general areas that are open to the public, such as lobbies, waiting areas, and other public areas. ICE agents can be barred from entering clearly distinguished and enforced private areas, such as treatment rooms, inpatient units, offices, and any space closed to the public.

The ACLU recommends that health systems work with their legal departments to identify and distinguish private spaces from public areas, and leverage signs and security guards to clarify private areas. ICE agents cannot access private spaces without a valid judicial warrant that is signed by a judge and identifies the name of the patient and specific location. Organizations should have their legal counsel review warrants before deciding to grant access. Additionally, a deportation or arrest order does not permit agents to enter private spaces.

CNOs should take a look at their policies and make sure to include a list of designated private areas, and procedures for how to interact with ICE and CBP agents and handle law enforcement requests, according to the ACLU. Health systems should appoint a trained individual or legal advocate who can interact with ICE agents when they arrive.

In states where it is not required for patients to disclose their immigration status, the ACLU recommends instructing healthcare staff not to ask questions regarding that status, and to inform the patient that they may decline to answer such questions. Currently, there is no legal obligation for health systems to record a patient’s immigration status unless required by state laws.

Guidance for nurses

CNOs must prepare nurses for what to do when ICE agents arrive at the hospital. According to the Ohio Nurses Association (ONA), the nurse’s first priority should be advocating and caring for patients while protecting their rights and privacy. ONA emphasized that nurses should only engage with ICE agents to direct them to the correct authority figure or department. These include legal services, security, and/or a compliance officer.

Patient safety is also critical. CNOs should instruct nurses not to discuss a patient’s health, immigration status, or any identifying details in the presence of ICE agents or any other unauthorized individuals. Patient care must not be delayed or interrupted by ICE agents, the ONA states. If a patient expresses fear or a safety concern, the nurse should immediately contact their supervisor, social worker, or hospital security.

ONA recommends that nurses document any incidents they witness regarding immigration enforcement. The date, time, location, agents and individuals involved, and actions taken should be recorded and forwarded to the nurse’s supervisor and to the health system’s legal office. CNOs must make sure nurses are familiar with all policies regarding immigration enforcement, and disseminate those policies throughout the workforce.

For more information, you can view the ACLU guidance and ONA guidance here.