Uncertainty has become a way of life for the nearly 670,000 active recipients of the Deferred Action for Childhood Arrivals (DACA) program. Created in 2012 by the Obama administration, DACA allows people brought to the United States illegally as young children (more than 75% are from Mexico) to receive a reprieve from deportation along with the eligibility to study and work.

Figure. Dania Cervantes Ayala, who was brought to the United States illegally as a child, will soon become a nurse in Nebraska, one of at least 10 states that allow "Dreamers" to apply for professional licenses. Photo by Kent Sievers / Omaha World-Herald via AP.

But the program has faced repeated threats, including an ongoing lawsuit filed by 22 states in 2014 against the federal government, a request in 2017 by the attorneys general of Texas and 10 other states to repeal the program, and the Trump administration's repeatedly declared intention to end it.

The legal and political wrangling has trapped DACA recipients, also known as "Dreamers," in a confusing mix of federal and state interpretations of the program that grant them some rights of citizenship, but not others. For example, DACA recipients may be permitted to pursue a professional degree in a given state but prohibited from becoming licensed in that state. So for DACA nursing students, a cruel surprise may accompany graduation: the discovery that their states bar them from taking the National Council Licensure Examination (NCLEX).

Currently, at least 10 states-California, Florida, Illinois, Minnesota, Nebraska, Nevada, South Dakota, Utah, West Virginia, and Wyoming-allow DACA recipients to obtain certain professional licenses. In addition, New York allows teacher certifications and licenses through its Board of Regents.

The American Nurses Association (ANA) bases its support for better DACA policies on humanitarian and professional grounds. "Standardizing the ability for all DACA recipient nursing students to take the NCLEX is a matter of social justice and can advance nursing's goal toward a more diverse workforce," the ANA said in a statement. To that end, the organization recommends that nurses advocate for legislation in all states to allow DACA nursing students to take the NCLEX. And if they are not eligible in a particular state, then nursing programs in that state should be required to disclose this information.

While the number of DACA recipients enrolled in undergraduate nursing programs isn't known, the Migration Policy Institute estimates that about 14,000 Dreamers are health care practitioners or work in health-related support jobs. In July, the Association of American Medical Colleges, along with more than 70 health organizations-including the ANA and the American Association of Colleges of Nursing-sent a letter to the U.S. Senate leadership, urging passage of legislation that would establish a pathway to citizenship for DACA recipients.

There are economic as well as professional reasons for clearing away employment barriers for DACA recipients. According to Interfaith Worker Justice, whose mission is to advance the rights of workers, ending DACA would result in a loss of $460.3 billion from the national gross domestic product over the next decade.

For now, that pathway is uncertain. The DACA program remains intact, thanks to several federal court rulings blocking Trump administration orders to abolish it. But the program faces another legal test. The U.S. Supreme Court has agreed to hear the administration's appeal of the lower court rulings later this year.-Dalia Sofer