Nursing is a profession that transcends borders, identities, and ideologies. In Iowa and across the United States, nurses care for individuals from all walks of life, including immigrants and undocumented patients. Upholding the core principles of nursing such as compassion, advocacy, and equity requires an unwavering commitment to treat all patients objectively and compassionately, regardless of their background.
The Ethical Mandate to Care for All Patients
The American Nurses Association (ANA) Code of Ethics (2015) explicitly calls on nurses to respect the inherent dignity, worth, and uniqueness of every individual (Provision 1). This includes caring for patients without prejudice regarding their sex, gender, religion, political affiliation, nationality, or immigration status. Provision 8 further emphasizes the nurse’s role in advocating for social justice and reducing health disparities, a mission particularly important when working with vulnerable populations such as undocumented patients.
Similarly, the Hippocratic Oath, a longstanding cornerstone of healthcare ethics, urges practitioners to “do no harm” and provide care with impartiality (Centers for Medicare and Medicaid Services, 2023). For nurses, this ethical foundation reinforces the commitment to equitable care for all, aligning with the core values of the profession.
Regulations Supporting Inclusive Care
Federal Protections
Under federal law, particularly through the Emergency Medical Treatment and Labor Act (EMTALA), all individuals presenting to an emergency department are entitled to medical screening and stabilizing treatment, regardless of their ability to pay or immigration status (CMS, 2024). In addition, healthcare providers must uphold patient confidentiality in accordance with the Health Insurance Portability and Accountability Act (HIPAA), which applies equally to both documented and undocumented patients (HHS, n.d.).
Iowa Rules and Regulations
Iowa’s healthcare regulations align closely with federal protections. The Iowa Board of Nursing emphasizes that licensed nurses must practice with professionalism, cultural competence, and adherence to ethical standards. As Iowa is home to many immigrant communities, many of whom face barriers to accessing care, nurses have an opportunity to bridge gaps and ensure that care delivery remains just and inclusive (American Immigration Council, 2025).
Addressing Patient Concerns Through Legal Counsel
As trusted professionals, nurses are in a unique position to address patient concerns related to immigration. Changes in immigration policies can significantly impact the mental health of immigrants. By educating themselves on the immigration system and participating in “Know Your Rights” trainings, nurses can better support their patients and advocate for their well-being. To enhance our role as advocates, it’s important for nurses to recognize how supporting patients’ legal concerns directly contributes to quality care and safety. In cases where patients express concerns about their legal status or other sensitive matters, nurses can collaborate with legal counsel to provide resources and reassurance. Many hospitals and clinics partner with legal aid organizations and immigrant advocacy groups, which provide valuable guidance and support. Proactively connecting patients with these services can reduce fear, build trust, and ensure they receive care without hesitation. Nurses can educate themselves about local and national legal resources, strengthening their ability to advocate for the rights and well-being of their patients.
Cultural Humility and Sensitivity in Action
Providing care for undocumented and immigrant patients requires understanding their unique challenges, including fear of deportation, language barriers, and limited access to health insurance. Cultural humility and sensitivity, a cornerstone of nursing practice, enable nurses to build trust and rapport with diverse patient populations. Tools such as interpreters, culturally sensitive health education materials, and partnerships with community-based organizations can help nurses navigate these complexities effectively.
Advocating for Equity
The pandemic has shown us that diseases do not discriminate. To improve health outcomes for everyone, it is essential to prioritize the care and well-being of all individuals. Equitable care goes beyond treating all patients the same; it requires addressing systemic barriers and social determinants of health that disproportionately affect marginalized populations. This includes advocating for policies that enhance access to care, such as expanding Medicaid eligibility, growing the number of free and federally qualified health centers, supporting migrant health clinics, and collaborating with organizations like Proteus, which serves agricultural workers in Iowa. By implementing these strategies, we can move toward a healthcare system that ensures equitable access and improves health outcomes for all.
A Call to Action
As nurses, we are bound by our professional and ethical responsibilities to care for all patients with respect and dignity. By embracing inclusivity, cultural humility, sensitivity, and advocacy, we not only uphold our obligations under the ANA Code of Ethics and Iowa Board of Nursing regulations but also strengthen the fabric of our communities. Let us reaffirm our commitment to compassionate care, remembering that at the heart of nursing is the belief that every patient deserves dignity, equity, and the highest quality of care.
Authors: Jimmy A. Reyes1,2, Ph.D., Yamnia I. Cortes3, Ph.D., Olivia Croskey2,3, DNP, Juliana DeSouza Talarico3, Ph.D., Shawn T. McClain, DBA1, Trina Radske-Suchan4, PT, and Emily Sinnwell2,3, DNP
Author affiliation: MyHealthIowa/MiSaludIowa1,Proteus2,University of Iowa College of Nursing3,Iowa Community HUB4
References
American Immigration Council. (2025). Immigrants in Iowa. Retrieved from https://map.americanimmigrationcouncil.org/locations/iowa/
American Nurses Association (ANA). (2015). Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: ANA.
Centers for Medicare & Medicaid Services (CMS). (2023). First, do no harm. Retrieved from https://www.cms.gov/blog/first-do-no-harm
Centers for Medicare & Medicaid Services (CMS). (2024). Emergency Medical Treatment & Labor Act (EMTALA). Retrieved from https://www.cms.gov/medicare/regulations-guidance/legislation/emergency-medical-treatment-labor-act
Iowa Board of Nursing. (2024). RN/LPN Role and Scope. Retrieved from https://dial.iowa.gov/licenses/medical/nursing-professional-midwifery/nursing-practice/rnlpn-role-scope
U.S. Department of Health and Human Services. (HHS). (n.d.). Health Insurance Portability and Accountability Act (HIPAA). Retrieved from https://www.hhs.gov/hipaa/index.html
