Nurses Being Turned Away at Canadian Border

NO ENTRY Specialized healthcare workers from Canada, including advanced practice nurses and nurse anesthetists, are being prevented from crossing the border to work in U.S. hospitals.

Imagine the shock and anger Canadian nurses working at Michigan hospitals felt earlier this month when border security officers stopped them from entering the U.S. because of changes to their working visas under President Trump's new immigration policies.

Take, for example, a newly hired Canadian employee who tried to start her job at Detroit's Henry Ford Hospital, but was turned away at the border between Detroit and Windsor, Ontario, according to a CBC News report. She was told advanced practice nurses and nurse anesthetists no longer qualify for working visas because of shifts in U.S. immigration policy under President Trump.

"All of the immigration executive orders and all the things being rolled out have been focused on national security first, and this is clearly not an issue of national security whatsoever," says Marc Topoleski, an immigration attorney who works for a law firm being retained by the hospital.

All Canadian nurses working in the United States have non-immigrant NAFTA (North American Free Trade Agreement) Professional (TN) visas. An estimated 30,000 to 40,000 Canadians work in the United States with TN visas, which permit experts in certain fields — economics and science, for example — if they have a job offer. At present, only advanced practice nurses and nurse anesthetists are being refused entry.

Henry Ford Hospital has hundreds of Canadians on staff, including about 30 advanced practice nurses or nurse anesthetists with TN visas. The nurses have been advised they need to apply for H-1B visa status, which is a separate category under NAFTA for more specialized employment. Those applications can cost $3,000 to $4,000 per applicant, says Mr. Topoleski.

"My very big concern with this is that I may get turned away at the border tomorrow and not be able to do my job, which I do love," Patti Kunkel, a Canadian who works as an acute-care nurse practitioner for Henry Ford Hospital, told The Detroit News. "That will also put a lot of stress on my current team that I work with because we are already in a critical shortage in the care of our patients."

Other policy changes recently announced by the U.S. Citizenship and Immigration Services will suspend a fast-track program for processing H-1B applications as of April 3. Standard application processes for work visas could take 6 months or more, said Mr. Topoleski, adding that long wait times could leave hospitals in need of specialty nurses desperately short staffed.

Mr. Topoleski told The Detroit News he has heard from attorneys in other border states — specifically Washington — who have experienced similar situations.

"Their livelihood is at stake," he added. "All they've been doing is just coming here and helping Americans get better by providing patient care."

Bill Donahue

Can a Computer Program Improve Surgeons' Posture?

ERGONOMIC INJURY Surgeons suffer after years of manipulating instruments through small ports.

To help ease the physical demands of laparoscopic surgery, researchers have developed a computer program that alerts surgeons when their poor posture is causing the aches and pains that could shorten their careers.

Engineers at the University of Buffalo teamed with GYN surgeons at MedStar Washington Hospital Center in Washington, D.C., to develop the ErgoPART (ergonomics postural assessment in real-time) tool, which generates reports of factors that impact a surgeon's ergonomic comfort. The system relies on information observers input about the surgery type, the surgeon's positioning in relation to the sterile field — including the position of his neck, trunk and shoulders — and operating room features, such as the equipment that's used and how it's placed around the table.

The researchers tested the system during a single laparoscopic GYN case. Instead of attaching sensors to the surgeon to record posture, which the researchers thought might interfere with his technique, they had ergonomic experts, surgeons and medical school students watch the surgeon's posture throughout the case and input the info into the ErgoPART system.

At the end of surgery, the system generated quantitative information about the frequency and duration of dangerous body postures. This was a proof-of-concept study that showed the potential of using the system to identify pain-inducing positions for surgeons and served as an initial step toward making surgery safer.

"Everyone knows that surgeons operate in a high-stress environment," says researcher Victor Paquet, PhD, an associate professor in the department of industrial and systems engineering at the University at Buffalo. "Our research looks at something less obvious: The long-term risks that surgeons face by putting themselves in uncomfortable positions in the OR."

Daniel Cook

Study: Sexes Differ on What Matters Most After Hip Surgery

DIFFERENT NEEDS Patient gender may be a factor when it comes to providing the best post-op care.

The differences between men and women extend to how they evaluate their care after total hip surgery, a new study finds, suggesting that tailoring post-op care according to gender might be worthwhile.

Women are more focused on responsiveness and communication. Men care most about controlling pain.

The study, which was presented at the 2017 Annual Meeting of the American Academy of Orthopaedic Surgeons, analyzed survey results from 277 men and 414 women who had surgery between 2009 and 2015.

Overall satisfaction scores were comparable, as were the grading of nurse and doctor communication, staff responsiveness, hospital environment, pain management, and communication about medication.

But for the women, the factors that most influenced their scores were communication with nurses and doctors and staff responsiveness. For the men, pain management made the greatest difference.

Jim Burger

InstaPoll: What Do Patients Dread Most About Surgery?

Surgery can be an unpleasant experience for many patients. Tell us in this week's InstaPoll what patients dread most: the IV start, post-op pain, or post-op nausea and vomiting.

More than half (54%) of the 300 respondents to last week's poll say surgeons and staff should be required to double-glove. The results:

Double-gloving should be mandatory for _____ .

  • surgeons 13%
  • staff 3%
  • surgeons and staff 54%
  • neither 30%

Dan O'Connor

News & Notes

  • AAAHC to accredit prisons The Accreditation Association for Ambulatory Health Care (AAAHC) has been selected to accredit the Federal Bureau of Prisons' (BOP) ambulatory health care facilities nationwide. The majority of BOP health services are outpatient facilities that mirror the operations of a community clinic.
  • Total knee patients just as well off at home Total knee outpatients with monitored home-based rehabilitation programs did just as well after 26 weeks as total knee patients who had 10 days of inpatient rehabilitation followed by an 8-week home-based program, a new study finds. The results were based on the 6-Minute Walk Test, the Oxford Knee Score and a self-reporting questionnaire.
  • Spine health impacts hip replacements Patients with sagittal spinal deformity who undergo total hip replacement are at greater risk for dislocation or follow-up revision surgery, according to research presented last week at the American Academy of Orthopaedic Surgeons annual meeting in San Diego, Calif. The findings suggest orthopedic surgeons should collaborate with spine surgeons when planning hip replacements in patients with any degree of spinal deformity in order to achieve optimal outcomes.