Few issues facing America's hospitals are more important than recruiting, retaining and developing adequate numbers of high-quality caregivers and support personnel. This is embedded in our promise to our communities - to be there for our patients, doors open 24 hours a day, seven days a week providing the right care at the right time in the right place.

Unfortunately, concerns about protecting American borders under the Homeland Security Act are creating an unintended roadblock to the recruitment and retention of nursing staff at a time when hospitals nationally are facing critical shortages.

Beginning July 27, the Department of Homeland Security will require Canadian and other immigrant nurses and health professionals - physical and occupational therapists, medical technologists and technicians, speech and language pathologists, audiologists and physician assistants - to be certified by an agency-approved credentialing body before they can be granted a visa and work as a caregiver in the United States. The requirement also will apply to those immigrant health professionals who are already licensed and working in our hospitals.

If the Department of Homeland Security implements the new certification rule, personnel shortages already facing America's hospitals will get dramatically worse. It will deal a particularly harsh blow to hospitals in northern states, such as Michigan, Maine and New York, where thousands of Canadian residents cross the border each day to work as nurses in our hospitals. The regulation will apply even to nurses who have been practicing in the United States for 20 years or more. Recredentialing every five years is also part of the regulation.

In many states like Michigan, licensing and credentialing of nurses and other essential health care professionals from neighboring Canadian communities has been fine tuned over the years to assure the highest standards of quality, and at the same time reduce barriers to recruitment and retention. Preliminary estimates indicate that close to 3,000 Canadian nurses cross the border on a daily basis to work in our Michigan hospitals and in other health care settings. This is 20-25% of total nurse workforce in southeastern Michigan. Without these workers, services and whole facilities are in jeopardy.

Nearly 40% of our area hospitals' intensive care and other specialty units are staffed by workers who commute daily from Canada. We can't afford to lose this resource. Nationally, the average cost for recruiting is about $15,600 per nurse. Replacement costs for specialty nurses in communities like Detroit, where we face a continuing shortage of qualified workers, can run as high as $40,000 per nurse. The hospitals and health systems in Michigan and other states have entered into agreements with training institutions to expand the number of American nurses, but there just are not enough professionals entering the pipeline to meet present and future needs of our communities.

We worry that the uncertainty created by this unnecessarily burdensome regulation will discourage these loyal workers and encourage them to seek work elsewhere. We are as supportive as anyone about border protection measures that have had to be instituted following the terrorist attack on September 11, 2001, but this new requirement does nothing to keep Americans safe and hurts our efforts to provide adequate health services to our communities.

If the problem is not fixed, hospitals across the country will be hard pressed to replace these health professionals, forcing tough decisions about reducing the number of inpatient beds available, postponing or canceling elective surgeries, and implementing rolling closures of already overflowing emergency departments.

Securing the new credential costs more than $325 and many of us are taking steps to cover this cost for our workers. However, this is a cost that just gets folded into our overall charge structure and health insurance premiums without producing any good for patients. We are concerned that forcing nurses to go through extra cumbersome steps to make sure they comply with the new requirements in effect slams the border shut.

Given what is at stake for our communities and patients, the AHA is urging Homeland Security Secretary Tom Ridge to delay and review the new certification requirement. In a recent letter to the secretary, the AHA recommends that the agency delay the rule's effective date by at least one year.

Significantly, the Commission on Graduates of Foreign Nursing Schools (CGFNS), which is the nation's major credentialing body for foreign nurses, has told Secretary Ridge that it does not object to AHA's call to delay its pending rule on certifying Canadian and other immigrant nurses. CGFNS is the only agency that reviews applications and grants the new credential.

Many nurses in our Michigan health systems report a growing backlog at CGFNS and the possibility of delays due to volume of applications is a growing concern in Michigan. In addition, the National Council of State Boards of Nursing has also endorsed delay to provide time to work out solutions that protect the nation's borders, assure high quality care and keep the "hassle factor" for recruitment and retention of nurses out of the picture.

The AHA is taking our case to the administration and Congress. With the strong demand for highly skilled health care professionals far outpacing supply, hospitals can't sit idle and allow cumbersome and redundant new administrative processes to get in the way of recruiting and retaining a variety of qualified professionals, especially our valuable nurses.

Now is the time for hospitals and health systems to send a strong message to the administration and Congress to delay the certification rules, and to work with us for sound, sensible and effective immigration policies that won't get in the way of the care people need.

Schlichting is president & CEO of Detroit's Henry Ford Health System in Detroit; Fitzgerald is president & CEO of Oakwood Healthcare, Inc. in Dearborn; Duggan is president & CEO of Detroit Medical Center; and Joseph is president & CEO of St John Health in Detroit.