Now that immigration enforcement can happen in hospitals, CNOs must prepare their nurses.
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.
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.
The next goal of this health system's virtual nursing program is to see how virtual care can impact other areas, says this nurse leader.
Health systems everywhere are experimenting with virtual nursing, and there are many key strategies that they can learn from each other.
Maria Brown, nursing excellence manager at ChristianaCare, outlined what ChristianaCare wants to accomplish with their virtual nursing model.
Brown is a part of the HealthLeaders Virtual Nursing Mastermind series, an exclusive, six-month series of calls and an in-person event where several health systems discuss the ins and outs of their virtual nursing programs.
Goals for the program
ChristianaCare launched a pilot of their virtual care program in 2022 with the primary goal of reducing burden at the bedside and giving time back to nurses to care for patients. The program then expanded to 500 beds in 2023, starting on med surg units and growing to include a postpartum unit and other specialty units, such as elderly, stroke, and cardiac step-down units.
According to Brown, the virtual acute care nurse program has had a significant impact on patient experience and on new nurses.
"Our experienced nurses function as clinical coaches," Brown said. "For those new nurses or novice nurses that are at the bedside providing hands-on patient care, if they have questions on clinical situations or need an experienced perspective, they're able to call the virtual nurse."
Brown says there is the possibility of using the virtual care program to keep tenured nurses in the workforce. ChristianaCare specifically uses experienced nurses in the program so they can provide the best care and guidance to other nurses.
"We definitely want to be able to keep our nurses practicing as nurses as long as they can, even if their bodies may not be able to physically do it, but they really want to continue as a nurse," Brown said.
Logistics
According to Brown, the nurses taking part in the program are pulled from practice areas to function as a virtual nurse—they are not being hired externally.
"We do have a few full-time nurses that have transitioned from those areas to a full-time virtual nurse role," Brown said.
The virtual nurses are housed in a remote location together and they are not allowed to work from home.
As for technology, ChristianaCare is leveraging a homegrown app paired with iPads at the bedside, which were initially used during the COVID-19 pandemic.
"They are in each patient's room purposely placed at each bedside—they don't come out," Brown said. "The only thing that comes out is the patients from admissions and discharges."
The health system created a dashboard to keep track of metrics such as length of stay, 30-day readmissions, and some harm metrics. Brown noted the significant impact on patient experience.
"We definitely think that's attributed to that nurse one-on-one time with the individual patient, and [the nurse] not being called [away] for a phone call or to help the patient in the next room, and those kinds of things," Brown said.
From present to future
According to Brown, both the nurses and the patients are positively reacting to the program. The nurses see the program as an opportunity to take a physical break from the bedside and connect with patients in a more focused manner.
"Culture change is hard, especially when you've been doing this for many, many years, and then we throw technology into the mix and then a different care delivery model into practice," Brown said. “Sometimes it takes a little bit of getting used to, but I think overall, nurses also support this new model."
Going forward, Brown believes that the health system's current staffing model may change from pulling nurses off of units to having a fully staffed virtual nursing model. The next goal is to expand further and see how virtual nursing can impact other areas.
"We hope to evolve to all other kinds of settings, meaning potential ICU type areas and EDs," Brown said. "We are doing some pilots in different types of areas, like an ambulatory space to kind of see how nurses could function that was as well."
As for technology, Brown expressed that the model is evolving, and due to the significant cost of switching technologies, some patience is necessary.
"I don't know if we've found that perfect technology that does everything, and so we wanted to wait and see what we can do with what we have," Brown said. "By the time we are able to decide on a technology, I think we would include things that have AI technology, maybe some ambient listening, [and] maybe some ways to use predictive analytics."
Advice for CNOs
For those CNOs and other nurse leaders who are attempting virtual nursing for the first time, Brown had several pearls of wisdom.
"I would say first and foremost, don't wait for the perfect scenario, because there never is a perfect scenario," Brown said. "If you're waiting for perfection in technology [or] staffing, you're going to be waiting a long time."
Brown also recommended getting stakeholders involved in the project as early on as possible, and ensuring that buy-in and support are present from all participating departments.
"You want to make sure that they're involved and have a stake in the process," Brown said, "and that everything is bought in, so that your program is successful."
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights intoexcelling your virtual nursing program.Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
The global state of nursing is complex and CNOs must understand it to make the most informed decisions.
In the U.S., industry leaders and experts often discuss the nursing shortage and its impact on the healthcare industry. Shortages can leave the entire workforce feeling burned out, resentful, and angry, and the impact on patient care is even greater.
As CNOs work to recruit and retain nurses, both locally and internationally, it's important to understand that the nursing industry in the U.S. is only one piece of the puzzle. Globally, the situation is incredibly complex and the challenges go beyond just workforce shortages.
The World Health Organization’s (WHO) State of the world’s nursing 2025 report states that progress in closing workforce gaps has slowed, despite the number of healthcare workers increasing steadily over the last 10 years.
Here are some key findings that CNOs should be aware of.
Nurse employment
According to the report, there are 29.8 million nurses globally, but the distribution and density of those nurses around the world is extremely unequitable and hides a shortage of 5.8 million nurses. Additionally, 78% of nurses are found in countries representing only 49% of the world population, and high-income countries, which are about 17% of the population, contain 46% of nurses globally.
The density of nurses across countries is largely based on income, with high-income countries having 10 times the density of nurses than low-income countries. African and Eastern Mediterranean regions have significantly less nurses than European regions, as defined by WHO.
These facts show a troubling trend throughout the world and indicate a lack of access to healthcare services provided by nurses for large populations. However, the report also showed that the nursing industry has become more professional, with 80% identifying as "professional nurses," and around 70% of them work in public sector facilities.
WHO emphasizes that differentiated roles, scopes of practice, and corresponding compensation are necessary to prevent nurse migration to only countries with better professional opportunities. The report also predicts that the number of nurses will increase to 36 million by 2030, and while the overall shortage will lessen, there will still be inequity in the global density of nurses.
In terms of leadership, the report provides a mixed outlook. According to WHO, 82% of the participating countries reported having a government CNO (GCNO) or a similar position, but their roles in workforce, policy, and planning are undefined.
WHO emphasizes in the report that the gap in governance impacts education, working conditions, patient care quality, and more. GCNOs must have clarified authority and the proper resources so that they can have a hand in important healthcare decisions for each country.
Additionally, 92% of responding countries reported having a regulatory body for nursing, along with competencies (72%), continued professional development (72%), and advanced practice nurse (APN) positions (62%). However, many of the competency standards and APN regulations are different per country, which can complicate nurse qualifications and potentially impact patient safety, according to WHO.
Lastly, most countries reported having laws surrounding minimum wage (94%), social protection measures (92%), and health worker safety (78%), but only 55% reported regulations for working hours and conditions, and 42% reported provisions for mental health and wellbeing. More mental health support and emphasis on healthy work environments are needed for nurses globally if the industry wants to remain sustainable.
The needs of Gen Z nurses and veteren nurses are different, and CNOs need to adjust their plans accordingly.
On this episode of HL Shorts, we hear from Peggy Norton-Rosko, senior vice president and chief nurse executive at the University of Maryland Medical System, Corporate Executive Office, about how CNOs can adjust their retention strategies for nurses at every career stage. Tune in to hear her insights.
WVU Medicine's diploma program gives traditional nursing education a contemporary approach, according to this CNE.
As CNOs across the country look for solutions to the nursing shortage, one key factor to consider is nursing education.
Nurse leaders and education partners must find new ways to increase the number of students entering and graduating from programs, who can then step into clinical roles as fully prepared nurses. Lowering barriers to entry in nursing education takes some creative thinking, and WVU Medicine has found an innovative pathway forward: a hospital-based diploma program.
According to Melanie Heuston, chief nurse executive at WVU Medicine and HealthLeaders Exchange member, the inspiration for the Center of Nursing Education was the nursing shortage.
"When we did an assessment of the state and what was being produced, and how many [nurses] we needed at WVU Medicine, [we realized] many schools were not filling all their seats," Heuston said. "So, we wanted to do something disruptive [and] innovative, and we decided to create our own program."
WVU Medicine is approaching their diploma program differently than traditional diploma programs. Heuston explained that they are looking holistically at the whole person and what support they need to complete their education.
"We created it in the way that we believe nursing should be taught today," Heuston said. "It's traditional nursing education with a contemporary approach."
HealthLeaders sat down with Heuston, live from the CNO Exchange in Nashville, Tennessee, to discuss how WVU Medicine's hospital-based diploma program is revolutionizing nursing education. Tune in to hear her insights.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
For CNOs who want to improve nurse retention, it's important to identify the biggest hurdles.
On this episode of HL Shorts, we hear from Abby Rudy, VP of Nursing, Adult Critical Care at Penn State Milton S. Hershey Medical Center, about the biggest barriers to nurse retention in 2025. Tune in to hear her insights.
This health system's virtual nursing program has matured into a scalable and sustainable care model since last year.
Virtual nursing is quickly becoming a staple of care delivery in nursing workflows. Creative program expansion is what will keep the ball rolling for health systems who want to continue exploring the technology's potential.
Derek Godino, senior director of nursing at Geisinger, recently gave HealthLeaders an update on the health system's virtual nursing progress over the past year.
Godino is part of the HealthLeaders Virtual Nursing Mastermind program, which brings together several health systems to discuss the ins and outs of their virtual nursing programs and what their goals are for now and the future.
New year, new goals
In 2024, Geisinger had several goals for virtual nursing: to open up the workforce by creating a new role to consider, to improve care quality, and to boost nurse and patient engagement and experience. According to Godino, the program has matured into a scalable and sustainable care model.
"We've optimized workflows and refined our onboarding and training protocols," Godino said.
Additionally, Geisinger has put emphasis on integrating virtual nursing into many different aspects of nursing workflows.
"We've also strengthened our interdisciplinary partnerships and improved the integration of virtual nurses into daily clinical routines," Godino said, "enhancing team cohesion and patient experience."
Going forward, the health system plans to expand virtual nursing services into transitional care and chronic disease management in the post-acute and ambulatory spaces, Godino explained. New technologies are also on the horizon for the program.
"From a technology perspective, we are exploring AI-powered decision support tools, biometric monitoring integration, and more advanced virtual rounding capabilities to improve efficiency and patient engagement," Godino said.
The current strategy
Godino explained that the biggest challenge so far has been ensuring consistent technology infrastructure across sites due to infrastructure requirements and limitations. As of right now, Geisinger is working with two to three primary vendors for technology platforms, hardware, and support services.
"This number has slightly decreased as we've consolidated, to streamline integration and support," Godino said. "We anticipate this may change as we evaluate new partnerships for expansion into outpatient settings or adopt more sophisticated analytics and AI tools."
The health system's staffing strategy has moved towards blending experienced nurses who want flexible or alternative roles with nurses who have specialized skillsets that are ideal for remote care, Godino explained.
"We've aligned our recruitment and retention strategies with these profiles and have invested in remote work support and engagement programs to maintain a strong sense of team identity," Godino said.
To measure the program's results, Geisinger is looking at clinical outcomes, such as falls, readmissions, and escalation events, and operational outcomes, such as staff satisfaction and time savings. Godino said they are also looking at financial metrics, like cost avoidance and length of stay.
"Early data has shown positive trends, particularly in nurse workload reduction and improved patient communication, with ongoing efforts to quantify broader ROI," Godino said.
Onward and upward
Moving forward, Geisinger is looking beyond just virtual nursing. According to Godino, the program will serve as a critical connector between inpatient discharge and outpatient follow-up, specifically for care coordination, chronic condition management, and the Geisinger at Home program.
"By embedding virtual nurses into these models, we can provide continuous, proactive support and reinforce care plan adherence, reducing unnecessary readmissions and improving patient satisfaction," Godino said.
The biggest surprise so far, for Godino, has been how quickly both nurses and patients have adapted to the virtual nursing program.
"The acceptance and appreciation from patients, especially around responsiveness and continuity of care, have exceeded expectations," Godino said.
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights intoexcelling your virtual nursing program.Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Solving for staffing, burnout, and workplace violence issues will require thinking differently about solutions, says this CEO.
HealthLeaders spoke to Phil Dickison, CEO of the National Council of State Boards of Nursing (NCSBN), about the 2024 National Nursing Workforce Study and what CNOs should take from it. Tune in to hear his insights.
As CNOs deal with nursing shortages, it's critical to understand why they are happening.
The National Council of State Boards of Nursing (NCSBN) recently published the latest 2024 National Nursing Workforce Study which surveyed 800,000 nurses about the state of the nursing workforce.
According to the study, there are five main reasons that nurses are leaving, according to the data. According to Phil Dickison, CEO of NCSBN, solving these issues will take thinking differently.
"Every one of those numbers is a voice, it is not simply a number on a page," Dickison said in regard to the survey participants. "My argument is that [as leaders] we need to be better about…listening to these voices of the nurses before we invoke solutions."
Prioritizing nurse wellbeing has an impact on the entire workforce, not just nurses, says this nurse thought leader.
On this episode of HL Shorts, we hear from Diane Sieg, Registered Nurse, Author, Coach, and Creator of the Well-Being Coaching Initiative, about how health systems benefit from prioritizing nurse wellbeing. Tune in to hear her insights.
