VIRGINIA — In the early morning humidity, two dozen red-clad health care professionals picketed up and down the block in front of Essentia Health-Virginia.
Over 400 advanced practice providers across 69 facilities stretching from Brainerd to International Falls to Ashland, Wisconsin, began an open-ended unfair labor practice strike Thursday, July 10.
APPs, which include nurse practitioners, physician assistants, certified nurse midwives and clinical nurse specialists, serve similar roles to physicians. They treat patients in clinics, urgent care centers and hospitals.
They voted to join the Minnesota Nurses Association last summer and were certified by the National Labor Relations Board, but Essentia has requested a review of that decision.
MNA said the health care organization is violating federal labor law by refusing to begin negotiations for a first contract. Essentia said the proposed APP bargaining unit is “uniquely problematic and wrongly constituted,” and it is exercising its legal right to review.
“We are not on the strike line because Essentia has not met our demands,” said Vicky Brady, a Duluth-based nurse practitioner, at a Thursday news conference in Virginia. “We are on the strike line because Essentia is unwilling to even ask what our demands are.”
Impacts on facilities and Essentia’s bottom line
Essentia Health announced Tuesday that its clinics in Emily, Deerwood and Hackensack would suspend services during the strike. It added the Staples urgent care to that list on Thursday.
Those facilities have low volumes, and there are others nearby, Essentia said.
“We really focused on consolidating to those nearby clinics to make sure that we can still have that service available. It’s just kind of right down the road,” said Beth Young, an Essentia nursing director in Duluth.
More details on the impact on appointments, surgeries and more are available on Essentia’s website. Clinic nurses and health care workers in the Duluth area began a separate strike on Tuesday.
Essentia says 44% of all patient encounters are with an APP, and 88% of all urgent care encounters are with an APP. The numbers are higher in rural communities, which rely overwhelmingly on APPs for patient care.
According to Essentia, only about half of its APPs are halting work during the strike. The other half are still working, with some even picking up extra shifts to cover gaps in care.
“I’ve got patients that I’ve been taking care of for years and sometimes decades,” said Christie Erickson, a nurse practitioner in Hermantown, in an interview organized by Essentia. Erickson is also the nurse practitioner/physician assistant director for Essentia's East Market.
“And so those relationships are really important, and so it’s a big part of why many of our APPs are choosing to show up to work and care for their patients.”
The Minnesota Nurses Association said it’s not surprising some APPs aren’t striking because Essentia “made it clear through surveillance, intimidation and pressure that speaking up would come at a cost.”
“APPs are being used as props in a union-busting strategy, not as partners in patient care,” MNA said.
Physicians are also working extra shifts to cover gaps in care during the strike, Essentia said.
Gidget Peterson, a physician assistant at the urgent care in Virginia, pointed to that at the picket line news conference. She said Essentia is paying $1,500 per shift to doctors to cover her shifts, plus another $700 if they’re coming in during their time off.
“It’s not only unsustainable; it’s an irresponsible use of resources, especially for a health system that constantly speaks to us about the challenges of rural health care,” Peterson said. “This kind of spending should raise serious questions.”
When asked about the financial impact of the strike, Essentia said it’s premature to even speculate.
Erickson said whether or not to work is a personal, individualized decision for each APP.
“For the most part, folks are respecting that and we’re upholding our values and really being able to be respectful to each other through the process,” she said.
Stretched thin and seeking bargaining power
The specific issues motivating the hundreds of APPs to fight for unionization also vary, but they’ve also said one thing: They don’t want to strike.
“We’re all just kind of sad that that’s what it’s come down to,” said Jenna Coldwell, a hospitalist physician assistant in Duluth.
The decision to strike comes nearly a year after APPs voted to unionize. Almost 60% of eligible voters supported unionization.
The whole process began in November 2023, when the Minnesota Nurses Association filed a petition with the National Labor Relations Board. Essentia objected to the makeup of the bargaining unit, arguing in part that hospital and clinic nurses should be separated because of the potential impact on patient care if a strike were to occur.
The regional NLRB director in Minneapolis ruled the unit was valid in June 2024 because the APPs share similar responsibilities, working conditions and management.
Essentia appealed that decision to the national office just after the union election. That request for review is still pending. When it will occur is unclear, as the NLRB has been without a quorum for months.
In an internal memo to APPs, Essentia pointed to legal precedent that says employers cannot bargain without waiving their rights to appeal.
Coldwell said before the vote, Essentia told the APPs that if they chose to form a union, it would bargain with them.
“To have them change their minds and kind of change their reasoning over time just kind of makes it very obvious that they don’t want to talk with us,” Coldwell said.
She said floating — working at facilities other than your primary workplace — is her biggest concern.
Coldwell was hired more than a decade ago to work in Duluth. Since then, Essentia has acquired more facilities, and she and her colleagues were told they had to staff them.
She often splits her time between Duluth and Sandstone, an hour away, sometimes working at both in the same day. Her colleagues have been asked to cover sites like Deer River and Aurora.
They’re often guilt-tripped into taking these shifts, she said, and APPs are under more stress and patients are getting worse care. She estimates APPs are floated for 30%-60% of their shifts.
“It’s become just really, really difficult to do my job,” she said. “ ... I’ve had many, many times after a difficult week like that where I think, ‘I just can’t do this job anymore.’
“I love hospital medicine. It’s what I’ve always done. I’ve always wanted to make it my lifelong job. But when conditions are like that, we just can’t do it.”
Essentia said health care is dynamic, and it must be flexible to meet patients' needs.
“Just like health care, [APP] roles have evolved and continue to evolve. Additionally, some of our clinicians are hired specifically to float and fill care gaps, though the vast majority provide services at a single location,” Essentia said in a written statement.
Another concern, particularly in the Brainerd lakes area is noncompetes, which prevent employees from working for similar businesses after they leave their job.
Erin Swanson, a nurse practitioner in Baxter, said colleagues have had to move out of the area to find work after leaving Essentia. She works three 12-hour shifts a week and has been asked to pick up shifts at other organizations. But her noncompete doesn’t allow that.
“That also puts a burden on the community, right?” she said. “Because there’s other clinics that need APPs, and we can’t work for them.”
Minnesota banned all new noncompetes in 2023, but old agreements still stand. A new rule banning them was approved on the federal level under the Biden administration, but it never took effect after a judge’s ruling. It might now be rolled back under the Trump administration.
Essentia said only a small percentage of APPs are impacted, and noncompetes are standard in health care. Thirty million Americans are bound by noncompetes.
Picketing, politics and protections
On the picket line, Brady, the Duluth-based nurse practitioner, said APPs give exceptional, patient-centered care, and that is the reason Essentia has such a good reputation in their communities.
“They brag over being the leader in rural health care. We’re the reason for that,” Brady told Minnesota Congresswoman Angie Craig, who picketed and spoke with APPs.
Craig, a Democrat who is running for U.S. Senate now that Sen. Tina Smith is retiring, said she wanted Minnesotans to know that she’ll fight for the rights of all workers.
Lt. Gov. Peggy Flanagan, who is also among the Democrats running for Smith’s seat, visited the picket line in Duluth on Wednesday.
Minnesota Nurses Association President Chris Rubesch said Essentia knows the NLRB is without a quorum, and that it has more money than MNA and APPs.
“And Essentia Health is using all of these things to attempt to destroy these workers’ legal right to unionize,” he said.
“But rest assured that these advanced practice providers before you today and hundreds of their colleagues will not settle for anything less than a fair contract that protects them and puts their patients first.”
Editor's Note: This story has been updated to include that Christie Erickson is the nurse practitioner/physician assistant director for Essentia's East Market.
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