North America Works -- Part III: Detroit/Windsor border-hopping nurses

As published by the George W. Bush Presidential Center:

Many voices are calling for the United States to retrench and retreat from the world, including distancing ourselves from neighbors in North America. Yet the reality of life across our continent, from Tijuana and San Diego to Dallas and Fort Worth to Windsor and Detroit, shows that we are connected to our neighbors in ways that benefit every side of each North American border.

In this essay, we show a slice of those connections and how they impact everyday lives.


(Find the full essay by Matthew Rooney, Laura Collins, Sarah Reid and William McKenzie here. Part III, my part on the Detroit/Windsor nurses, is reprinted below.)

Part III: Detroit/Windsor border-hopping nurses

Lee Anne Raper is living the North American life along another border, the one that separates Canada and the U.S. A nurse at the Henry Ford Hospital close to downtown Detroit, Raper doesn’t live in Detroit. Actually, she doesn’t even live in the United States. For the past 19 years, she has driven to work every day across the Ambassador Bridge from her home in Windsor, Ontario, a trip of only about six miles.

“I can see where I live from the 17th story of the hospital,” she says. “I actually know some of the (border) guards. They call me by name and ask me if I’m going to work.”

Raper is just one of about 800 Canadian nurses who cross the border every day to work in the U.S. These border-hopping nurses highlight some of the similarities but also the differences between the economies of the two North American neighbors that share a 5,525-mile border and enjoy one of the world’s longest-standing and most amicable relationships.

Over 400,000 people cross the U.S.-Canada border every day. In 2015, the trade in goods and services between the two countries totaled $662 billion.

The connection between the two nations comes to light in the nursing shortage both nations are experiencing. Because of Windsor’s relatively small population, and a corresponding lack of full-time nursing jobs, many nurses have been forced to look for jobs across the border. As they do, they help American hospitals fill their staffing needs.

“We have a very large hospital that’s growing and we cannot fill all our positions if we did not include our Canadian neighbors,” says Gwen Gnam, chief nursing officer and vice president of patient care services at Henry Ford Hospital. The hospital currently has 292 Canadian nurses on staff.

The nursing shortage on both sides of the border is due mostly to demographic trends: aging populations require greater care, and the nursing workforce itself is greying too. Even though nursing is one of the fastest growing occupations in the United States, the Bureau of Labor Statistics estimates that by 2022, the U.S. will face a shortage of more than a million nurses.

“The only place those nurses are likely to come from is probably Canada,” says Anne Snowdon, chair of the Odette World Health Innovation Network at the University of Windsor. “Their workforce shortages become our workforce challenges.”

Joanna Roupas Mardegan is a registered nurse who has been working in Detroit and living in Windsor for the last 15 years. She works at the Karmanos Cancer Center at the Detroit Medical Center. “They’re making a bridge with Windsor’s cancer center,” she says. “They’re doing research together, and Karmanos will do bone marrow transplants now for Windsor patients, instead of us having to send them further away.”

The College of Nurses of Ontario estimates that 610 Canadian nurses crossed the border each day in 2014. The number was lower than in previous years, when it hovered around 1,000. The decline is in part because the college has changed to a self-reporting system. Also, in 2013 they changed their licensing requirements, meaning that fewer nurses were counted working in the U.S.

“I think it’s the largest group of professionals that cross the border on a daily basis,” says Sarah Dunphy, an adjunct assistant professor of political science at the University of Windsor. Dunphy conducted a study of border-hopping nurses in 2015. She estimates that about 800 Canadian nurses cross the border every day.

Canadian nurses have been crossing the border to work in Michigan since the 1980s. Under the 1994 North American Free Trade Agreement, nurses from Canada and Mexico were designated as professionals eligible to work in the United States, using a NAFTA trade visa like the one that Elizabeth Brown and her husband use in San Diego.

Prior to 9/11, all nursing students at the University of Windsor did clinical rotations in Detroit as part of their training, says Snowdon. “The American hospitals loved it because they had a pipeline of highly-trained and educated nurses,” she says. But after the attacks, the U.S. Department of Homeland Security “literally stopped dead all education training traffic, despite lots of attempts by universities to overcome that hurdle,” says Snowdon.

The daily exodus of nurses across the border has raised concerns in Canada. “We’re losing nurses to the U.S. after we paid for their education. It’s a terrible return on investment for taxpayers,” says Doris Grinspun, chief executive officer of the Registered Nurses’ Association of Ontario.

Nurses are not the only workers who commute across the Canada-U.S. border. In 2014, 2.6 million Americans traveled to Canada for business purposes, including conventions and employment, according to Statistics Canada.

Many U.S. firms, such as IBM and the three Detroit carmakers, and Canadian companies, such as Bombardier and Nova Bus Company, have substantial operations in both countries, and employees that travel between them.

In 2010, Air Canada Jazz became the first new airline in six years to fly into Cincinnati. Its service from Toronto caters mainly to Proctor & Gamble, whose head office is in Cincinnati but which has a sizeable operation north of the border.

People who live in border towns in New York “don’t think of anybody from Ontario as being different from anyone in New Jersey. That is the ultimate achievement of integration,” says Jim Philips, president of the Canadian/American Border Trade Alliance.

At some points, it is hard to tell that the border exists at all. In the towns of Stanstead, Quebec and Derby Line, Vermont, the border runs right through the middle of a local library.

For Roupas Mardegan, one of the border-hopping Windsor nurses, the decision to live in Canada and work in the U.S. is personal. Her husband is a construction worker. If they were to consider moving, she would need a green card to help her husband move, because his job is not covered by the NAFTA visa exemption.

It’s not only work that draws Roupas Mardegan and other Canadians south. “We’ll go see concerts. We’ll go see the Detroit Red Wings or to a Tigers game,” she says.

The cross-border traffic seems unlikely to slow any time soon. “We’re looking for opportunities to expand recruitment to fill needed jobs,” says Gnam at the Henry Ford Hospital. “We’re very interested in continuing to work with Canadians.”

The hospital held a recruitment fair in Windsor last year. Gnam says, “We had an overwhelming response.”

The arrangement works well for the nurses too. Lee Anne Raper says, “I just found that the [Henry Ford Hospital] environment was something that was very conducive to my happiness as a nursing professional.

“You can even choose to live in Detroit if you so desire, but my parents are on the other side in Canada, and I do a lot of things with my family. I actually have the best of both worlds.”