Protecting Our Immigrant Patients and Communities—and Each Other

Across the country, healthcare workers are confronting an unsettling reality: escalating immigration enforcement without regard for the law or—as highlighted by the recent murder of Veterans Affairs nurse Alex Pretti—for the safety of healthcare professionals who are trying to fulfill their ethical duty of care.

How are these terrifying immigration operations impacting patient care, and how can we protect our immigrant patients and communities—including the immigrants who have been the backbone of the US healthcare workforce for decades? We spoke with four leaders and members from AFT affiliates that are at different stages in addressing these questions.

In New York, the threat of Immigration and Customs Enforcement (ICE) is felt, although not as urgently as in other parts of the country. Anne Goldman, RN, BSN, a vice president of the United Federation of Teachers (UFT) and former ICU nurse, and Diana Williams, RN, a nurse and union delegate who is using a pseudonym because she fears retribution, share how the UFT is providing training and resources to meet the moment if ICE ramps up. Across the country in Washington, healthcare workers are already confronting the direct impact of accelerated immigration enforcement in their communities. David Keepnews, RN, PhD, JD, executive director of the Washington State Nurses Association (WSNA) and an AFT vice president, and Jared Richardson, RN and WSNA nurse representative, share how WSNA is organizing for equitable treatment of immigrant staff and advocating for human rights at the local, state, and federal levels.

Whether ICE has already descended on your community or you’re marshaling resources in preparation, we hope you will find inspiration here to continue the essential work of keeping your patients and coworkers safe.

–EDITORS

EDITORS: What led you to nursing and to union activism?

ANNE GOLDMAN: I started out as an ICU nurse in 1973 at Lutheran Medical Center, which is now New York University Langone Hospital–Brooklyn. Nurses were not allowed to form unions separate from the state nursing associations until 1979, when the National Labor Relations Board gave nurses more freedom to organize. My colleagues and I jumped on the opportunity. We chose the UFT because it offered the autonomy, collective bargaining support, and political power we needed to be successful. For me, that led to work developing the Federation of Nurses division of the UFT and the AFT’s healthcare division, so I’ve been part of the labor movement for nurses in the UFT from its inception. Today, we have 27,000 nurses throughout the state of New York in private and public hospitals, in home care, and in schools.

My motivation to organize came first from my coworkers. When I was a new nurse, 19 or 20 years old, and working the evening shift, many of my colleagues were from the Caribbean, England, Jordan, the Philippines, and other places. They were much older, had children in their home countries, and were striving to make a better life for their families. They worked so hard, and they were so vulnerable. They could never do anything the hospital didn’t like or refuse shifts or assignments because they didn’t want to be sent back—and the hospital leveraged their fear. Seeing their disparate treatment and the unfair working conditions gave me the fire to fight for the union, and that earned the confidence of my colleagues. That’s how we got an overwhelming vote to join the union.

As I continued in union work, I saw the need to focus on our professional responsibilities and to create best practices for patient care. Starting out as a nurse, I thought my job was just to care for people and do good, but we had unhoused and uninsured patients the hospital didn’t want to give care to, and I had to stand up and say, “These are human beings who need care.” I began to realize that my job was also to advocate for people. We’re trying to have the strongest voice where it should be—in our hands—because we’re patient advocates.

DIANA WILLIAMS: I am one of those nurses who, like Anne’s early coworkers, came from another country to work in the United States. I grew up in an island nation. When I finished high school, I really wanted to study medicine, but a family member introduced me to a nursing program, and I decided to apply. After graduation, I went to work in the hospital closest to my hometown. I loved my work, but my coworkers and I were always hoping to earn more money. A few years later, recruiters from American hospitals came to my country and promised better-paying jobs in New York. I got two offers, and I chose to work in the emergency department in the hospital where I have now been for more than 25 years, and where the nurses were already organized with the UFT. I remember the recruiter met me and three other nurses at the airport, and we started our orientation a few days later. I have worked in many parts of the hospital as a bedside nurse, and I am also very involved in the work of our union.

JARED RICHARDSON: I spent most of my early adult life in the US Army as a combat medic, and that experience led me to union activism. My time in Afghanistan really opened my eyes to a world that I wasn’t aware of growing up in rural Utah. I saw a lot of social inequity that needed to be addressed. Right after that deployment, I was shipped out to Thailand, where we built elementary schools in some of the poorest parts of the country. That really pushed me toward wanting to see more social justice in the world.

I knew I wanted to go into nursing when I got out of the military, and I wanted to be in a union job where I could push for better opportunities for everyone. I accomplished those goals five years ago when I moved to Washington and got heavily involved with WSNA. The next thing I knew, I was working for WSNA. Now I am a nurse representative, helping our bargaining units with contract negotiations, contract enforcement and grievances, and whatever else they need.

DAVID KEEPNEWS: My parents weren’t union members, but they raised me with an awareness of labor as a force for progress and for social justice. After nursing school, I was fortunate to find work in unionized facilities, and I saw firsthand what a dramatic difference union membership made, not only in terms of pay and working conditions but also in the ways my union siblings and I felt empowered. We had professional autonomy and were able to stand up for patients.

I eventually went back to school to get a law degree, and later a PhD, hoping to help nurses be more effective in influencing policy. I worked for nurses’ associations and spent many years teaching nursing (including several years as a member of the Professional Staff Congress at the City University of New York, an AFT affiliate). When the position of executive director opened up at WSNA, it felt like a fantastic opportunity to bring my nursing, law, and policy backgrounds together to make nursing a better profession and to make a better world for everyone. That’s one of the things I love about being part of the AFT—it unites people from many different backgrounds with the common goal of doing better for all those we serve.

EDITORS: Let’s talk about immigration in the context of healthcare. How was immigration status a factor in your workplaces before 2025?

DAVID: Let’s start with healthcare workers. In Washington, as is the case all over the country, nursing has long included high numbers of immigrants. Our hospital systems and recruitment agencies have brought nurses from the Philippines, India, and several African countries, among other places. Of course, it’s not just nursing—there are many immigrants in all job classifications in healthcare. Some have profession-specific visas, and others have immigrated through other routes. We also have a lot of DACA (Deferred Action for Childhood Arrivals) recipients. People from all over the world have been our colleagues throughout the state for many, many years.

While most nurses who are recruited internationally become hospital employees and union members, with all the protections the union affords, some remain employees of the recruiting agency and get paid less, with far fewer rights in the workplace. This used to be a much worse problem than it is now, but it still happens in some hospitals. Even nurses who are hospital employees have experienced serious mistreatment, including inequitable pay that went undiscovered for a long time. (See “Bargaining for Pay Equity” on page 23 to learn about WSNA’s successful campaign to pay internationally educated nurses fairly.) We also know of internationally recruited nurses in other states who were grossly underpaid and overworked, kept silent by threats of financial ruin and deportation.*

JARED: Immigrant nurses are an essential part of our healthcare workforce and of our bargaining units. As David said, most of our agency nurses become hospital employees right away, but some of our employers use third-party agencies to bring in international nurses and hold them on three- or four-year contracts. They’re not allowed to join the union, which suppresses their pay—and that’s both an equity issue and a union-busting issue. It’s harder to engage in strategic actions like pickets or strikes when 10 or 20 percent of the nursing workforce is contractually held and has concerns about their visas. We had a major win in securing more equitable pay for immigrant nurses through bargaining at St. Joseph Medical Center in Tacoma (St. Joe’s Tacoma), and we’re pushing to include similar contract language at other healthcare facilities, but we don’t have the same ability to help nurses who can’t join the union in the first place.

DAVID: In terms of patients, Washington state has a lot of immigrant patients from all over the world. For example, the largely agricultural Yakima area has a sizable Mexican population, and there are big Ethiopian and Eritrean populations south of Seattle. But before 2025, we didn’t have to deal with day-to-day issues of immigration enforcement in hospitals and clinics. Federal policy recognized these as sensitive locations, along with schools and religious institutions. That’s the biggest difference now—that’s no longer the case.

JARED: Before 2025, hospitals mostly felt safe—although the Northwest ICE Processing Center, one of the largest detention centers in the country, has been in Tacoma for more than 20 years. It’s less than two miles from two of our biggest hospitals. One of them, St. Joe’s Tacoma, has a longstanding contract to provide care for ICE detainees. The other big hospital in the area, Tacoma General, has had such contracts in the past.

Farther north, St. Joseph Medical Center in Bellingham (St. Joe’s Bellingham) has a contract with the Department of Homeland Security to treat people who have been detained at the Canadian border crossing. So we have had regular immigration-enforcement presence in our hospitals, but it wasn’t anything like the situation we have now.

Since we’re a border state, another relevant immigration issue is that a lot of Canadian nurses commute to our northernmost hospitals for the higher wages. At St. Joe’s Bellingham, which is in a somewhat geographically isolated city, about 30 to 35 percent of the current RN workforce is Canadian.

ANNE: We have the same situation with our clinics and hospitals near the Canadian border. Those facilities depend on Canadian nurses who cross the border every day to staff ICUs and acute care hospitals. They’re an important part of our very eclectic workforce in New York state. We have also had waves of nurses recruited from the Caribbean, the Philippines, all over the world. That’s the history of nursing and of healthcare: a mix of cultures and languages, and often different opinions about what’s happening in the world, in their home countries, or in the United States. But we know we’re on the same team, and we can only succeed if we recognize each other’s strengths.

In general, immigration from the employer’s view is intended to circumvent contractual wages, raises, and working conditions, as well as to undermine union voice and power because people on visas are not the first on a picket line. But fortunately, that has not been the case in my history. When now-AFT President Randi Weingarten joined us at the UFT, we were going out on our first strike. She secured letters of support on behalf of the nurses who were on work visas to say, “You will be safe, and you belong on the picket line.” The UFT fought hard for our immigrant nurses so they would know they were safe. And we have always made sure our nurses who are on visas know their rights and know how the union can protect them. But many more nurses don’t have that security, and that’s why we keep organizing.

EDITORS: How has the Trump administration’s aggressive approach to immigration affected your members and your patients? What concerns do you have?

DAVID: ICE has free rein now to enter hospitals, schools, and places of worship, and people are worried. In some clinics that work with large immigrant populations, patients just aren’t coming in because they’re afraid to seek care. Our public health nurses in Seattle/King County and other locations report lower participation in street medicine, primary care, and parent-child programs that serve undocumented community members. And even before the murders of Renée Good and Alex Pretti in Minnesota, fear and anxiety were running through our hospital workforces. It’s especially acute for people with fewer financial resources who may not have access to legal assistance if they get detained. And we’ve heard from several of our nursing units with DACA-recipient members who are very fearful about whether that status will change or what the administration may do with that program.

One of the biggest sources of fear is that, while there are guidelines on what ICE can and can’t do—for example, needing to show a judicial warrant to enter a hospital for enforcement activity—there are no assurances that they will follow the rules. We learned that from Minnesota. That casts a pall for many people, not just immigrant nurses or patients, especially since the Supreme Court essentially allowed ICE to racially profile people.¹ Even our nurses who are natural-born US citizens aren’t protected from that. How do they protect patients and themselves if ICE shows up?

What does ICE presence in our facilities, even if it’s just to accompany a detainee, mean for other patients and community members? Unlike sheriff’s deputies accompanying a patient in the criminal justice system, ICE could potentially look around to see if there are other people they want to detain. And if there’s an ICE officer present, what else might they see and hear? How do our members carry out their duty to protect patient privacy under HIPAA? These are really big concerns.

JARED: I saw one change immediately when President Trump took office. We were coming off this major victory in our fight for pay equity for foreign-trained nurses and compiling a list of people with international experience who might be eligible for pay increases. Being on that list, which was a joyful thing in December of 2024, became terrifying in January 2025. Two nurses asked to have their names taken off the list because they didn’t want any attention on their immigration status. It was heartbreaking.

And we’ve all been waiting for Trump to send ICE or the National Guard into Seattle to try to crush us like he’s done with Chicago, Washington, DC, Los Angeles, Portland, and Minneapolis. That’s a big source of anxiety for the whole community. I’ve heard from several organizations that their community members are seeking alternative forms of healthcare from friends and family because they’re concerned if they go to the ED, they’ll get deported. Access to healthcare, especially preventive care, is already a significant issue. Now, with more people avoiding care for longer, how much worse will things get?

ICE agents also interfere with care more directly. We’ve been involved with the case of a Filipino patient we call Kuya G. (Kuya is an honorific that means “older brother” or “respected elder.”) He had been in detention for a while and had serious health issues, including a bone infection that resulted in the amputation of one toe and part of his foot. He asked for medical care but didn’t get it until he was very sick. They brought him to St. Joe’s Tacoma, and he was admitted to the ICU—but they removed him after two days to receive medical care at the detention center, which is beyond substandard.² Eventually, they tried to deport him, but the plane they chartered wouldn’t take him because he was medically unfit to make the trip. WSNA got involved because we believe that every person has the right to timely healthcare. Thanks to the efforts of many activists, Kuya G has finally been released, but the larger problem remains.

There was also a situation in which an ICE officer left their loaded service weapon in the communal bathroom on one of our units. Luckily, it was found by a nurse after the officer went home. Workplace violence is a constant issue in healthcare facilities, and we had worked so hard in our contract negotiations to secure better protections, including weapons detectors and screening processes for every patient who comes into the ED. Nurses had begun to report feeling safer, with fewer instances of weapons being found in rooms. Then an ICE officer bypassed that system, putting all of us in danger.

DIANA: We haven’t had that kind of ICE presence in my hospital, but I have certainly felt the chilling effect. My niece’s husband was recently pulled over by the police because he resembled someone they were looking for. He showed them his green card, and they let him go. But what happens next time? I have copied my US passport, and I carry it with me every day because I’ve seen videos of people being stopped. If I get stopped, will I be safe with my passport or REAL ID? Will my documents mean anything to them?

Sometimes I talk quietly with my colleagues at work, especially since the two murders in Minneapolis. We don’t all have the same political affiliations, but we agree that this should not be happening. What about the families being broken up and the trauma of children who are living in the prison camps? But I hesitate to publicly express my feelings because I don’t want the employer to say I’m trying to have a political influence on other nurses. I have no problem influencing nurses when it comes to union negotiations, the benefits they’re entitled to, and what the union can do for them. But when it comes to ICE and immigration, I’m very cautious.

No one from the hospital administration has said anything to us about what’s happening with ICE. I haven’t even seen an email acknowledging Alex Pretti’s murder: A nurse was murdered by ICE while trying to provide assistance—that silence is very loud. Sometimes we nurses wonder how much we can trust or rely on nursing management because of how they treat us and how they have dealt with the union. I don’t think they value the union’s perspectives.

I think there are a lot of people like me with internal turmoil about what’s happening to the country. So many of our nurses, nurse aides, patient care technicians, and other technicians are immigrants. We go about our work, we do what we must do, while deep down we are scared about what the future holds.

ANNE: We are fortunate that we haven’t yet had issues with ICE officers trying to enter our facilities. But we see some consequences of the increasing national volatility around immigration that began during the first Trump administration. I used to take groups of nurses on rescue missions around the United States and in other countries. We were very proud of that work. But now I don’t have confidence that I can bring everyone back safely, even from a US territory like Puerto Rico. We also used to have union meetings and classes for immigrants, but we stopped during COVID-19 because it just made people targets, especially our nurses from the Philippines. We have had to become more strategic and private about how we provide support.

One of the biggest patient impacts we’ve seen is that people are avoiding maternity care. Pregnant people are more easily targeted by ICE because pregnancy is hard to hide. So they’re very scared, and more of them avoid coming in until they’re delivering, which increases the risk of complications and other health issues. And they don’t even want to come in when they’re delivering because they don’t want to be separated from their babies. We are also seeing delays in routine care and other treatment for children, where parents don’t bring in their child until the fever is high and their kid is really sick. They’re scared that they’ll be separated.

Among the bigger workforce issues I’m concerned about are Trump’s proposal to charge $100,000 for a work visa³ and the change in the professional degree designation that will make it much harder for people to pursue nursing and other healthcare-related degrees.⁴ Both would significantly affect our ability to maintain our nursing workforce, let alone grow it. Our clinics and hospitals near the Canadian border wouldn’t be able to operate. And nationwide, these policies would make it more likely that hospitals would pay the visa fees or sponsor the education, and then the workforce would be beholden to the employer. That would crush the labor movement and allow the employer to decide best practices, which is what all of us fight against every day. So these two changes have the power to entirely reshape the healthcare workforce. Some people might think these are just other people’s visa or paperwork issues, but they’re all of our unions’ issues and, ultimately, all of our healthcare issues because we’re all patients, too.

EDITORS: How are you organizing in your unions and in your communities to protect patients and each other?

DIANA: At my hospital, we are hoping the management team will give us additional support and preparation because we are not ready to answer questions if ICE tries to come through the door. Will hospital administrators let them in, or will they at least ask for a judicial warrant? All healthcare institutions are required to follow HIPAA—will administrators continue to protect patients and workers from HIPAA violations if ICE comes in?

We also need to know what the hospital will do to protect us as employees. President Trump claimed that he was going to deport people committing terrible crimes, but ICE is picking up people with misdemeanors—or nothing at all—and profiling and arresting random people on the street. People who have lived here all their lives, who are trying to earn a living and support their families, are being deported to countries they’ve never lived in. It seems only a matter of time until it happens at my workplace. ICE could pick up one of my colleagues who has a minor traffic violation on their record, or they might see someone who doesn’t “look” American and handcuff them and throw them to the ground. We need to know what our employer will do. We are asking them to at least tell us what their plan is or to work with us to develop one. We have to be prepared.

ANNE: Our employers may not have protocols in place, but the UFT has protocols with a chain of communication and chapter action teams to support our members. We have Know Your Rights cards and toolkits in many languages, and attorneys are available to address legal questions or needs. We also help members make sure their visas, immigration records, and licensing are all up to date so they can travel as needed to visit their families, and the employers often work with us on that because they have a lot of money invested in the stability of the workforce.

The UFT is also working to address these issues on a broader scale. We passed an emergency resolution supporting the national day of action on January 23 and encouraged members to take part in demonstrations and lobby their representatives to protect immigrant communities.⁵ We also offer workshops to help members organize committees in their workplaces to support and defend immigrant families. We want members who feel vulnerable to know they can trust the union, and we work to build that trust.

At the hospital I’m on release from for the UFT, NYU Langone–Brooklyn, we have excellent security and training because we frequently deal with unwanted visitors. We have a huge volume of patients in the ED, and there are so many ways that chaos can be introduced, so no one gets in but the patients—not the police or anyone else. ICE cannot hang out in the lobby or even outside. We have cameras, audio, and other alerts, and our rooms are secured by buttons and locks as well as by guards to protect patients and staff. And everyone gets de-escalation training, no matter who they are. Everyone needs to know how to function in an emergency setting to mitigate harm and keep people as safe as possible.

In the event of a safety violation or other emergency, we also have a team that comes in to help with de-escalation so we don’t end up with a shooting or something even worse. It’s not an infallible system, but it’s pretty strong. We’d like every hospital to feel that secure so that people won’t be afraid to come to work or to get care. But in the meantime, we arm people with information, and we protect them while they’re with us.

DAVID: As Jared mentioned, we in Washington have expected that our cities will be targets of ICE occupation from the beginning. We put out an advisory early on so our nurses would know what to do and what to expect from the Trump administration and its policies.⁶ So far, the hospital association has been a partner in this. We fight with them on a lot of things, but we all share concern about raids happening in healthcare facilities. WSNA has continued to advocate for nurses and for our responsibility to our immigrant communities. The Code of Ethics for Nurses tells us that we have an ethical responsibility to stand up against human rights violations, and we take that responsibility very seriously.⁷

We’re also working with our labor partners in the Washington State Labor Council, which is our AFL-CIO state federation, as well as with other community organizations. We know it’s important to be prepared for a potential occupation, so we’re organizing now. We don’t want to be caught off guard. And we are tracking policy related to immigrant rights and protections and asking members to engage with their legislators on these issues. We’re working on multiple fronts at the local, state, and federal levels.

JARED: At the hospital level, we’re also focusing on prevention, preparation, and organization, looking at what works and trying to replicate it. At St. Joe’s Tacoma, we have a fantastic racial justice committee that has been a great avenue to talk about ICE presence in the hospital and what to do. The committee began through a pilot program negotiated in a previous bargaining cycle that we made permanent in 2025 negotiations. The committee, which meets monthly, sends people to conferences and offers an annual training on diversity, equity, inclusion, and accessibility. It also has an internal portal where staff can report racist incidents; the portal is a safe place to bring concerns because the staff member doesn’t have to deal with their direct manager. This committee has created so much more conversation and collaboration on addressing these issues at St. Joe’s Tacoma, and that has translated into strength for organizing on important issues, like addressing inequitable treatment of immigrant staff. So we’re trying to introduce something similar at Tacoma General and elsewhere.

As a union, I think one of the most important things we’ve been doing is being visible. WSNA is a comparatively small organization in the state, with only 18,000 members, but we’re lending help where we can. I’m so proud to work for an organization that doesn’t back down from a fight. From the rank and file to the top, we’re taking action, and we’re showing up. We’ve gotten a little pushback, as our membership spans the spectrum of political affiliations and beliefs. But we know that this is the right thing to do, and what we’ve sworn to do as nurses. Immigration, human rights, and social justice are nursing issues. We’re coordinating with other unions in the area, especially within hospitals and healthcare systems, and we’re facilitating member-led interunion collaboration so we can share experiences and strategies.

As unions and professional organizations, this is our time. If your organization has stuck to professional issues in the past, this is our job now. We can’t stay siloed or silent any longer.

*To learn about how some healthcare employers are exploiting immigrant nurses, read “Trapped at Work: How Employers Snare Healthcare Workers in Debt.” (return to article)

Endnotes

1. C. Geidner, “SCOTUS Conservatives OK Trump Admin’s Racial Profiling of Latinos in Low-Wage Jobs,” Law Dork, September 8, 2025, www.lawdork.com/p/scotus-trump-immigration-raids-racial-profiling.

2. Center for Human Rights, Conditions at the NWDC: Allegations of Medical Neglect (Henry M. Jackson School of International Studies, University of Washington, April 16, 2020), jsis.washington.edu/humanrights/2020/04/16/nwdc-medical.

3. D. Gooding, “H-1B Visa Update: Trump’s New Plan Is Losing US Money,” Newsweek, March 13, 2026, newsweek.com/h1b-visa-trump-new-fee-losing-us-money-11675909.

4. Michigan News, “Removing Nursing from List of Professional Degrees Harms Entire Health Care System,” University of Michigan, December 3, 2025, news.umich.edu/removing-nursing-from-list-of-professional-degrees-harms-entire-health-care-system.

5. United Federation of Teachers, “Resolution for UFT Demonstration for Renee Nicole Good, and in Solidarity with Minneapolis Teachers,” January 14, 2026, uft.org/your-union/uft-resolutions/resolution-uft-demonstration-renee-nicole-good-and-solidarity-minneapolis-teachers; and United Federation of Teachers, “Resolution to Stand in Solidarity with AFGE Local 3911 and Support the Memorial Vigil for Alex Pretti,” January 26, 2026, uft.org/your-union/uft-resolutions/resolution-stand-solidarity-afge-local-3911-and-support-memorial-vigil-alex-pretti.

6. Washington State Nurses Association, “What You Need to Know If ICE Agents Come to Your Workplace,” January 27, 2025, wsna.org/news/2025/what-you-need-to-know-if-ice-agents-come-to-your-workplace.

7. Washington State Nurses Association, “Statement on ICE Actions,” January 9, 2026, wsna.org/news/2026/statement-on-ice-actions; and Washington State Nurses Association, “On Killing of Alex Pretti, RN by Federal Agents,” January 24, 2026, wsna.org/news/2026/statement-on-killing-of-alex-pretti-rn-by-federal-agents.

[Photo credits: J.W. Hendricks / NurPhoto; REUTERS / Yoseph Amaya; Dave Decker / ZUMA Press Wire; zz / Andrea Renault / STAR MAX / IPx; Michael Nigro / Pacific Press via ZUMA Press Wire; J.W. Hendricks / NurPhoto; and Boston Globe / Contributor / Getty Images]