CNOs must prepare their nurses for potential interactions with ICE or CBP agents.
This is an updated version of the original story published on June 2, 2025.
In the wake of the killing of Alex Pretti, a 37-year-old ICU nurse who worked at the Minneapolis VA Health Care System, it's time for CNOs to take another look at their hospital policies regarding what to do when Immigration and Customs Enforcement (ICE) and Customs and Border Patrol (CPB) agents interact with their staff.
The American Nurses Association released a statement on January 24 extending condolences to Pretti's loved ones while also calling for an investigation into the incident and connecting the issue to a broader trend of violence.
"One in four nurses already experience workplace violence," the statement read. "As incidents with federal law enforcement continue to rise across the country, we are deeply concerned for the safety of nurses, both on the job and in the communities they serve."
The American Association of Colleges of Nursing also released a statement with a similar sentiment.
"As we reflect on who we are as a profession and a nation, we remember all nurses that have been victims of violence and uphold our core values of caring and advocacy that have defined nursing," the statement said. "Let us act together using our voices to advance policies and practices that preserve human dignity and promote health and safety for all."
The Oregon Nurses Association stated that along with caring for patients, nurses are ethically bound to speak up in the face of injustice and human rights violations.
"Provision 8.2 of the American Nurses Association Code of Ethics for Nurses is clear: 'Where there are human rights violations, nurses ought to and must stand up for those rights and demand accountability,'" the statement said. "[…] No one should be targeted by federal agents for speaking out. No nurse should be killed for standing up for human rights."
What CNOs need to know
On January 20, the Trump Administration revoked a policy that protected sensitive locations, including hospitals, from ICE and 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.
ONA recommends nurses state politely, "I'm not authorized to provide information. Let me notify the appropriate person to assist you," while not revealing the patient's location, status, or care without explicit authorization from the legal team. The nurse's supervisor or security team should check the ICE agent's identification and verify any judicial warrants that are presented, and notify the legal team if that is the case.
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. For information on patient protections, read here.
G Hatfield is the CNO editor for HealthLeaders.
KEY TAKEAWAYS
As of now, Immigration and Customs Enforcement (ICE) and Customs and Border Patrol (CBP) are allowed to enter hospitals to take enforcement actions.
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.
Nurses should only directly engage with ICE agents to direct them to the correct authority figure or department.