When Dolores Jacoby received her diagnosis of acute myeloid leukemia, her nursing assistant Janeth appeared at her hospital room door in the San Francisco Bay Area with a tray of beverages for the family. "If there's anybody who can recover, it's your mother," Janeth told Dolores's son, John. It was a small gesture that would linger in the family's memory for more than a decade. Dolores lived three years longer than doctors predicted, and her family credits much of that to Janeth's care and presence.
Today, Janeth no longer works at the hospital. In September, the Trump administration revoked temporary protected status for Honduras, a legal designation that had allowed her to work in the United States for over two decades. After 23 years as a nursing assistant and seven prestigious national awards, Janeth suddenly found herself without lawful immigration status. She and her 85-year-old mother moved in with her daughter because she could no longer pay her mortgage. "I just want my job back, I just want my life back. I want to take care of my patients again," Janeth said.
The revocation of TPS for Honduras represents part of a broader administration push to strip thousands of immigrants of legal work status in the United States. Since returning to office in 2025, the Trump administration has ended or attempted to end protected status for 13 of the 17 countries with TPS designations, including Venezuela, Syria, and Haiti.
The impact on healthcare is already measurable. An estimated 1.3 million people in the US held TPS as of early 2025, with at least 50,000 working in the healthcare sector, according to FWD.us, an immigration advocacy organization that analyzed census and government data. About one in six hospital workers directly involved in patient care is an immigrant, and roughly 4 percent of hospital workers are not naturalized citizens. These workers fill gaps in the healthcare system that experts say cannot be easily replaced.
At some facilities, the concentration is far higher. Amina Dubuisson, vice president of clinical services at Ventura Services Florida, oversees nine nursing homes across Miami with 200 to 300 staff members each. At least 20 to 30 percent of their workers held TPS status. "They do a lot of the jobs that Americans don't want to do," Dubuisson said, such as nursing assistants who clean and feed patients.
The strain comes as the US healthcare system is already under pressure. Kimberly Pierce Burke, executive director of the Alliance of Independent Academic Medical Centers, a national organization of about 90 independent teaching hospitals, described the contradiction plainly. "Just because we are stopping immigration pathways and banning people from these countries doesn't mean we can ban patients, too. They continue to come to hospitals and nursing homes, except now there is a shortage of people who can attend to their needs," she said.
Janeth is not alone in her experience. Jhony Silva, who came to the US from Honduras at age three in 1998, grew up in the San Francisco Bay Area and worked as a nursing assistant at Stanford hospital in Palo Alto while enrolled in nursing school. Renee Yee, a senior nurse on the cardiac surgery and heart transplant floor, was so impressed by his skill with complex patients that she requested he be made permanent in her unit. When TPS was revoked, Silva had to leave his job and drop out of nursing school, unable to afford tuition without employment. He remains part of a lawsuit challenging the government's decision to end TPS protections.
Silva's colleagues noticed his absence. Yee described him as unusually comfortable working with seriously ill patients connected to chest tubes and wires. "Most people are nervous around them. But Jhony was very comfortable with very complex patients," she said. Silva still washes his hospital scrubs regularly, hoping to return.
For Janeth, the loss extends beyond income. She has kept a small carton of handwritten letters from patients spanning two decades. A surgery-ward patient wrote in 2004 that Janeth "spends a lot of time doing extra kind things to make your stay pleasant. She was my cheerleader for long walks all over the hospital." Another patient's daughter wrote in 2014 after watching Janeth care for her mother, "I could tell right away that she calmed and comforted my mom. She bathed and took time with her, more than any nurse has done."
Since losing her job, Janeth struggles to look at the letters. One memory stands out in her mind from Dolores's time in the infectious diseases ward, where everyone wore masks. For weeks, Dolores saw only Janeth's eyes above the mask. She told her son that Janeth's fluttering eyelashes reminded her of butterflies. "So every time she enters my room, I feel like I am in a garden," Dolores said.
When word of Janeth's job loss spread to her colleagues at Kaiser, they raised more than 13,000 dollars in a crowdfunding campaign. One nurse who worked with her for eight years recalled a patient with alcoholism who refused care from staff until meeting Janeth. "After one shift with Janeth, the patient only wanted her all the time," the nurse said. "That kind of skillset you can't ever replace."
The impact on morale has been notable. A nurse at Kaiser said that when Janeth was on shift, even alone, the staff was assured patients would be taken care of. "Not everyone has the heart to go above and beyond. There is a lack of joy and camaraderie that's been prompted by her leaving," the nurse said.
In September, a retired Kaiser physician wrote to US Senator Adam Schiff about Janeth, describing her as reliable, compassionate, dedicated, and knowledgeable after 23 years at the hospital. "This is devastating and so unfair," the letter read. Last September, 95 US representatives and 13 senators, all Democrats, wrote to the Department of Homeland Security expressing concern that the TPS revocations would harm vulnerable Americans in need of healthcare. "The most vulnerable Americans in need of healthcare will pay the price," the lawmakers warned.
Author James Rodriguez: "The administration is gutting the healthcare workforce while creating a public health crisis, and the hospitals and patients are the ones who will suffer most for it."
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