"We would be crippled without our Canadian nurses," -Gwen Gnam, chief of nursing at Henry Ford Hospital.

August 28, 2018 12:18 PM EDT

by Natalie Fertig/Circa

DETROIT - President Donald Trump announced Monday that he will dissolve NAFTA now that Mexico and the United States have reached an agreement on a bilateral trade deal. While many more steps must happen — some that involve congress — before NAFTA can officially be dissolved, the president's decision starts the clock ticking on negotiations with Canada if it wants to be a part of any bilateral or trilateral replacement for NAFTA.

And it also starts the clock ticking on the futures of many Canadian nurses working in the United States — as well as for the hospitals who employ them.

Henry Ford Hospital in Detroit, Michigan, is one hospital that employs Canadian nurses — approximately 300, or 20 percent, of the hospital's 1500 staff RNs.

"We would be crippled without our Canadian nurses," explained Gwen Gnam, chief of nursing at Henry Ford. According to Gnam, Canadian nurses fill a hole the hospital cannot fill with American nurses, due to an ongoing nursing shortage in the United States.

"They do job fairs over here all the time," explained Angela Gobel, 25, from Bell River, Ontario. “I feel like if they did have the Americans to fill the jobs, that they wouldn’t reach out for the Canadians."

Gobel is a registered nurse at Beaumont hospital, just outside of Detroit. She estimates that around 20 percent of the nursing staff is from Canada, and says that on her night shift up to half the nurses can be Canadian at a time. If NAFTA were to dissolve without a solution to the TN visa program, Angie and other nurses Circa spoke with said their hospitals would become chaos.

“If floors are short it is very hard to make sure patients are safe and they get the quality they deserve," said Gobel. "If all of a sudden Trump was like 'no, sorry' it would be chaotic in the hospital."

President Trump can't just say 'no, sorry,' and dissolve NAFTA. He needs congress to approve any new trade deal. But the president has expressed an interest in changing the visa programs that exist within the current framework.

In May, McClatchy reported that NAFTA professional visas, or TN visas, are potentially on the chopping block. There is currently no cap on the number of Canadians who can receive TN visa status. But according to McClatchy, U.S. Trade Representative Robert Lighthizer is working to decrease both the number of eligible professionals and the number of visa renewals under any new agreement.

"There are specific sectors that rely on foreign workers to come over," explained Simon Lester, a trade policy analyst at the Cato institute, a libertarian think tank. "It seems like it's kinda been forgotten. When it first started, it was a big deal, and now everyone talks about manufacturing or dairy.”

Lester said that the odds of Canada and the U.S. not coming to a final agreement are "unlikely," but that he can see a world in which changes are made to the TN program.

"Given how [the Trump administration] feel about immigration in general, I wouldn’t be surprised if they wanted to change that.”

TN visas, or NAFTA professional visas, are primarily for workers who have bachelors degrees or specialized certificates. Many of the workers coming into the U.S. with TN status are architects, computer programmers, engineers, as well as nurses and other healthcare staff.

The United States healthcare system relies on workers from out of the country. According to a Migration Policy Institute tabulation of U.S. Census bureau data, 15.8 percent of nurses and 27.9 percent of physicians and surgeons in the United States came from outside the county — many from Asia, Africa and Europe in addition to North America.

Online services like Onward Healthcare and CE Health Centers offer to help Canadian nurses get placements at United States hospitals, listing postings in North Carolina, California, Washington state, and more. Virginia Mason Medical Center in Seattle, Washington, for example, employs a small number of Canadian nurses in their facility.

***Screenshot of the homepage for CE Health Centers, a service dedicated to finding healthcare jobs for Canadian nurses in the U.S.***

And back in Detroit, the proximity to Ontario compounds the issue. Angela Li, a nurse at DMC Childrens' Hospital, estimated that anywhere between 30 and 50 percent of the nurses she works with are from Canada.

"My concern is not only for my job, but for the residents of the cities who's [sic] resources would be taken away," Li wrote via text message. "Our hospitals are already grossly understaffed. It would do our patients and our community a great injustice to further under-staff the care they receive... Removing specialized nurse [sic] and bedside nurses would only harm a struggling city like Detroit more when it's trying to get on its feet."

Joseph Toma agrees, explaining that Canadians are so numerous at Henry Ford Hospital, he doesn't know what the hospital would do should the TN program change.

"It would be like hundreds of nurses overnight that wouldn't be able to work or have to go away," explained Toma. "The hospital wouldn't be able to function safely without that many staff. It'd be an emergency."

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