Essentia, striking clinicians stuck in limbo awaiting federal labor ruling

Essentia Health and the hundreds of striking nurse practitioners and physician assistants in northern Minnesota are stuck in a stalemate: They don’t agree whether they should even be negotiating, much less compromising on a contract that would bring the clinicians back to work.

The clinicians went on strike last week after voting in 2024 to join the Minnesota Nurses Association and later growing frustrated over Essentia’s refusal to negotiate.

Essentia is waiting until a challenge to the union’s legitimacy is resolved by the National Labor Relations Board (NLRB), which is on hiatus because President Donald Trump dismissed one member and left it unable to vote.

The central legal question is whether Essentia’s 400 advanced-practice practitioners can negotiate as a single bargaining group, even though they are spread across northeastern Minnesota hospitals and clinics.

Union leaders say the health system is mostly seizing on the federal inertia to wait out the strike by newly unionized clinicians seeking their first contract.

“It’s really just a convenient excuse for delaying and interfering with our union,” said Kelly Higgins, a striking physician assistant who provides inpatient care at Essentia hospitals across northeastern Minnesota.

A regional NLRB director already ruled that the clinicians could be represented as one bargaining group, clearing the way for last year’s vote. Essentia challenged the ruling to the national board.

Decisions from that five-member board can take months or years, even when functioning, but it only has two members and can’t rule on any cases.

Essentia’s leaders said they have every right to appeal a decision that could have far-reaching implications on how health care workers unionize. They said the regional decision didn’t appropriately apply health care rules that prevent unions from banding hospital and clinic workers together and representing caregivers from across a vast geographic area.

“A strike will not speed up that legal review process or change our commitment to advocating for our patients,” said Dr. Krista Skorupa, Essentia’s East Market president, in a statement this week.

On Thursday, Trump nominated two Republicans to the board: a former career NLRB lawyer and a chief counsel at Boeing. But it’s not clear when they would be confirmed by the Senate or how quickly the Essentia dispute would reach their attention.

Essentia and its clinicians disagree on whether they can negotiate in the meantime. Union leaders said the regional decision and other case law support conditional negotiations when a union’s status is in question.

But Essentia leaders pointed to legal decisions suggesting the health system could forfeit its challenge by negotiating in advance. A 1996 District of Columbia appellate court ruling found that an employer “may negotiate with, or challenge the certification of, the Union; it may not do both at once.”

The dispute differs from the current strike by 300 Essentia clinic nurses, who already have held negotiations in pursuit of their first contract.

As many as 15,000 Twin Cities and Duluth-area hospital nurses were prepared to strike as well this month, but they reached last-minute deals.

Essentia’s advanced-practice practitioners include nurse midwives and clinical nurse specialists. Some provide primary or urgent care in clinics while others have surgical roles or tend to patients admitted to hospitals. The clinicians unionized partly in an attempt to gain more control over where and when they are deployed throughout the Essentia system.

How the strike ends is unclear, given that both sides are entrenched and negotiations aren’t scheduled.

Essentia in news statements said it has shuffled existing staff and maintained patient care, albeit with the closure of small clinics in Deerwood, Emily and Hackensack and an urgent care in Staples.

The health system also claimed more than half of the union clinicians didn’t join the strike or returned to work this week.

Essentia has its own pressures, though, anticipating Medicaid cuts as a result of federal budgetary changes that could further strain its hospitals.

The system’s leaders issued a systemwide alert on Thursday because of incidents and near misses in which workers failed to use two ID sources to verify patients before routing them to rooms or preparing them for exams or treatments.

The errors are “unrelated to staffing levels,” though, they stated.

Higgins, the physician assistant, said Essentia’s holdout is galling because while the employer claims the clinicians from across the system are too different to unionize in one group, it requires them to serve in multiple roles and facilities.

She started as a hospitalist caring for patients in Duluth, but was eventually required to drive 60 miles to see patients in Sandstone. Now she also rotates to Essentia hospitals in Aurora and Deer River, which she said is a scheduling hardship as a single mother.

“Using their approach, every one of the hospitals I work in is in a different bargaining unit,” she said.

Higgins urged Essentia to drop its appeal, because she doesn’t believe the two sides will be far apart.

“If they were willing to sit and hear us,” she said, “they would find that what we are asking for is not unreasonable.”