Frequently Asked Questions

These statements by union organizers and/or supporters are simply not true! Section 8(a)(1) of the National Labor Relations Act (NLRA) makes it an unfair labor practice for an employer “to interfere with, restrain, or coerce employees in the exercise of the rights guaranteed in Section 7” of the Act. The NLRB considers situations in which an employer “confers benefits on employees during a union organizing campaign” as an example of such illegal “interference.”

We understand your frustration and we acknowledge and apologize for not moving faster to address APP concerns. We want the chance to prove to you that working directly with you is a better model than unionization and collective bargaining. Please vote no and give us time to keep working together.

We don’t think so. In fact, numerous APPs have voiced concerns to their leaders over feeling divisive, intense peer pressure from union supporters who seem to be intolerant of any view other than support for unionization. Some APPs have volunteered that they’ve been barred from social media groups. Others have said peer pressure is so prevalent they feel uneasy talking with leaders about this topic.

Peer pressure, bullying, and intolerance for different points of view don’t align with our value of respect or with our belief that teamwork and collaboration are vital for the innovation we need to sustain our mission to deliver care to the patients and communities who depend on us.

We have made significant progress in the development of our APRN/PA practices and integration within leadership. We know we have much more work to do. We want to work closely and directly with APPs as we continue this work and feel that a union might interfere with and slow our progress.

From experience, we know that collective bargaining is often difficult and rarely offers “quick fixes” to complex issues.

In reality, collective bargaining is time-consuming and conflict-oriented, and it has an uncertain outcome; neither side can predict how bargaining might turn out.  Essentia Health has experienced first-hand what happens when collective bargaining breaks down and unions, like the MNA, call caregivers out on strike. In our view, health care strikes are disruptive and put patients and communities at risk.

Even though the MNA can’t legally guarantee their promises, they want you to trust them and give them the right to speak on your behalf regarding your compensation, hours, and all other terms and conditions of employment. But consider these facts:

• Every Contract Negotiation is a New Negotiation: Every contract negotiation is its own new negotiation. This applies every time Essentia negotiates new contracts for our unionized colleagues (after previous contracts expire). If the MNA is elected to represent APPs, Essentia will negotiate in good faith. But just because certain terms or language exist in other union contracts at Essentia (e.g., acute-care RNs), doesn’t mean language in those contracts would be included in any contract that might be negotiated for APPs.

• Collective Bargaining is Unpredictable: If elected, MNA organizers and supporters can’t predict how negotiations would turn out or whether the MNA would, ultimately, deliver on any of their promises.

• Financial Impact for APPs: If elected, the only guarantee is the MNA will expect all APPs to pay union dues ($76.20 per month or $914.40 per). For Minnesota APPs, dues (or MNA service fees) would likely be required as a condition of continued employment. Wisconsin APPs would have a legal right to “opt out” of paying dues (or MNA service fees) under Wisconsin’s right-to-work law, but the MNA would still expect Wisconsin APPs to sign up as dues-paying union members.

The MNA organizers may only want you to consider the information shared by MNA organizers and MNA supporters. They may want you to think that there are no risks associated with unionization and collective bargaining. But this is simply not true.

As professionals, you are trained to use critical thinking. The same is true here. You owe it to yourself to hear all the facts – not just what the MNA wants you to hear. For example, we think it is important for you to consider the possible downsides of unionization and how the often conflict-oriented process of collective bargaining could negatively impact you, our patients and the communities we serve.

We sincerely regret that there are APPs who feel this way. Essentia Health not only respects and values the contribution of APPs, we recognize the important role APPs perform today and will continue to perform as health care delivery evolves.

We have more than doubled the number of APPs in our system in the last ten years because we believe they are critical to our ability to provide excellent access and care for those we are privileged to serve.  

After a union files a petition for election, all employers are obligated to follow the laws and procedures defined by the NLRB. Specifically, employers are legally prohibited from making any statements (about pay, benefits, or other terms and conditions of employment) that could be interpreted as promising employees something in exchange for rejecting the union.

We understand this answer is frustrating, it is frustrating for us too! All we ask is that you vote no and continue working with us. If the union is rejected and you end up being dissatisfied with administration’s actions, the MNA is always an option for you.

Yes. As health care administrators, Essentia Health leaders are not experts in union campaigns and navigating the legal complexities associated with National Labor Relations Board (NLRB) law and procedures while making sure our colleagues get all the facts about unionization.

To be sure we comply with the law as we communicate all the facts about unionization and how it can affect our colleagues and the patients we care for, Essentia retained a consulting firm as well as qualified legal advisors to support our internal team. Our practice is no different from the external advisors hired by unions like the MNA to support the union’s business activities.

No, this is not true. Medical staff designation is about medical staff governance (e.g., privileging, credentialing, medical executive committee composition and function, department chairs, etc.).

Medical staff designation has nothing to do with compensation and benefits. So, if APPs joined the medical staff structure, they would become part of the medical staff governance structure; this designation would have no bearing on employment terms such as APP salaries or benefits.

We believe we have been listening to the concerns of our APPs and have steadily worked to address some of the important issues APPs have raised. Issues clearly remain, and we believe that planned improvements can be achieved by working together.

Some changes are moving slowly; this is not for lack of interest but because these issues are complex and defy quick, easy fixes. For example, we understand the desire for a single, standard compensation model for all APPs working in our East and West Markets. We have been developing a model that is fair and equitable for all APPs and are currently piloting this model at an East Market location.

Essentia provides APPs with yearly market-competitive salary increases. For example, in July 2023, more than 90% of APPs received increases averaging about 5%. The table below indicates the average salary increase APPs received in the past three years (figures are in percentages).

As you can see, over the past three years APPs received average increases totaling 15.40%. APPs received these increases without having to pay nearly $3,000.00 in union dues or walk out on strike and away from their patients.

To ensure fairness for those at the top of the salary range, we regularly conduct market surveys and adjust pay ranges when indicated (including range minimums and maximums).

It is important to know that market surveys indicate that APPs at the top of the pay range are already receiving compensation between the 75^th and 90^th percentile of the market, which means they are already compensated near the top of the overall market.

Like other health systems, Essentia Health has grown as several smaller organizations came together to form a large integrated health system. This growth benefits the communities we serve with greater access to services and specialty care, along with a greater ability to navigate challenges like workforce development and declining reimbursement. But this growth also brings complex differences that need to be thoughtfully managed to achieve standardization, without disadvantaging individual colleagues.

For example, a compensation system with a productivity component based on RVUs may work well for Family Practice APPs but might not work as effectively for APPs in specialties like surgery. Our challenge is to create a system that works well for everyone and ensures we can continue providing high-quality care to our patients (i.e., providing incentives, rewarding performance, etc.).

As we have acknowledged, while our goal is to create a single standardized model, the process is not easy. The good news is we are already piloting a new compensation model in the East Market.

On Monday, November 27, 2023, the MNA filed a petition for election with the National Labor Relations Board (NLRB) seeking an election and the right to represent all full-time and part-time nurse practitioners, physician assistants/physician associates, certified Nurse midwives, and clinical nurse specialists at Essentia Health facilities in the East Market in both the acute care and outpatient facilities.

It is up to the National Labor Relations Board (NLRB) to decide what job classifications and facilities would be included in a voting unit if the NLRB decides to hold an election. We will update this site and share information directly with APPs as soon as we have a decision from the NLRB.

No, APPs in individual job classifications cannot opt-out. Surgical APPs were included in the petition for election filed by the MNA. If the MNA is ultimately elected, the union will speak for all East Market APPs in collective bargaining with Essentia leaders.

The MNA petition is still under review by the National Labor Relations Board (NLRB); below we have provided a timeline of the NLRB’s activities regarding the union’s petition and our best estimate of what might happen next:

• On Nov. 27, 2023, the MNA filed for an election for a unit of 400+ East Market APPs (including nine acute-care hospitals and 60 non-acute care clinics).

• On Dec. 14, 2023, after reviewing statements from Essentia and MNA, the NLRB issued an Order to Show Cause to consider if the MNA’s petition should be dismissed because it did not align with the NLRB’s health care rule. In its response to the NLRB, the MNA acknowledged their petition does not conform to NLRB rules, but argued the rules should not apply because of extraordinary circumstances in this case.

• On Monday, Jan. 22, 2024, the NLRB ordered a hearing to gather more information. On Feb. 5, 2024, the NLRB hearing opened during which NLRB representatives heard more testimony from dozens of witnesses (most of whom testified on behalf of Essentia).

• On March 6, 2024, the NLRB concluded the hearing and gave the union and Essential until April 10, 2024, to submit post-hearing briefs summarizing their respective positions.

• The NLRB will consider the briefs and issue a decision on whether the union’s petition should be dismissed or go forward to election, either as filed or with modifications. The decision may be issued by the end of April or sometime later.

• After the decision is issued, either side would have the opportunity to appeal the decision of the NLRB regional office to the full board in Washington, DC. However, even if there is an appeal, the NLRB may schedule and hold an election over a unit or units the regional office thinks appropriate.

Following receipt of the MNA’s petition, Essentia noticed what we considered serious errors in the petition due, in part, to the combining of our acute and non-acute care facilities. As part of the election process, each party was required to provide a Statement of Position on the appropriateness of the union’s petition.

After receiving both our and the MNA’s position statements, the National Labor Relations Board (NLRB) preliminarily agreed with Essentia’s understanding of the law and indefinitely postponed a hearing on the petition originally scheduled to begin Dec. 15. The NLRB requested follow-up petition statements from Essentia and the MNA and has decided to hold a hearing to collect additional information. The outcome of this process is not yet known.

The NLRB will review the MNA’s petition – and the voting unit proposed by the union – to determine if what the union is proposing aligns with NLRB rules and decisions. We feel that the union’s petition is flawed and inconsistent with long standing NLRB precedent regarding health care acute and non-acute care bargaining units.

At this time, there is no election date. The NLRB is currently reviewing the MNA’s petition – and the voting unit proposed by the union – to determine if what the union is proposing aligns with NLRB rules and decisions. We will keep you informed about the NLRB’s review and provide updates as information becomes available.

All NLRB elections are conducted by secret ballot. So, no one will ever know how you vote unless you tell them. The NLRB may conduct the election via mail, in-person or a hybrid approach that involves mail-ballot and in-person voting methodologies. No matter what voting methodology the NLRB employs for the election, you should rest assured that the NLRB will protect the confidentiality of your vote and your choice in the election.

No, this is not correct. In fact, low voter turnout favors the union – which is why union supporters may try to discourage you from voting. The outcome of the election will be determined by a majority of those who vote (50% + 1 vote).

Example: If there are over 400 APPs eligible to vote in the election, but only 100 vote – and 51 of those vote for the union – then the union would win the election and the right to speak for all APPs (including APPs who voted “no” or who didn’t vote at all).

If the union wins, it also means that all APPs included in the voting unit would be bound by whatever the union is able (or unable) to negotiate during good-faith bargaining with Essentia. Regardless of whether the MNA delivers on their promises, the MNA will expect all APPs in the bargaining unit to pay the union $76.20 in union dues/service fees each month – including APPs who voted “no” or who didn’t vote at all. Minnesota APPs could be required to pay union dues or service fees a condition of employment while Wisconsin APPs would have the right to “opt out” of paying union dues based on Wisconsin’s right-to-work state law.

No. We’ve heard that APPs who support the MNA’s petition have pointed to a labor contract covering APPs at the University of Michigan, which supposedly includes acute and non-acute care employees. However, the University of Michigan is a public sector entity – governed by Michigan state law and not subject to private sector rules under the NLRB rules and precedents. Any reference to the University of Michigan contract to support the bargaining unit put forth by the MNA is irrelevant.

If you elect the MNA to speak for you in collective bargaining, Essentia would always negotiate in good faith, but this doesn’t mean APPs would automatically get more of anything.

The union would speak for all APPs who are included in the bargaining unit in collective bargaining with Essentia. Individual leaders would lose the ability to deal directly with APPs as it relates to any changes in wages, benefits, shifts and other terms of employment. 

Regardless of union promises, through collective bargaining, wages, benefits and other terms and conditions of employment could go up, down or stay the same. If the MNA is elected, bargaining unit APPs would be expected to pay hundreds of dollars every year in union dues (or “representation fees”) even if an outcome of bargaining isn’t what APPs hoped for.

It is impossible to predict how long the process might take. However, in a study published in Bloomberg Law in June 2021, researcher Robert Combs analyzed data from union elections held between 2004 and 2021. Combs found that – on average – it took 465 days to reach a first contract for newly unionized workers.¹ These statistics underscore the fact that unionization is not a “quick fix” but rather can take months or years to reach agreement.

If the MNA is elected, how they manage bargaining is up to the union. What the union tells you now, as they try to convince you to support and elect the MNA, may or may not turn out to be accurate. You should know that though the MNA represents about 1,300 nurses at our main campus, only about seven nurses actually sit at the bargaining table during negotiations. You should also consider the real possibility that the people who today are most active in promoting the MNA will be the ones who will speak for you if the union is elected.

No. You would not be able to opt-out; unionization is an “all-or-nothing” proposition for East Market APPs. Under the current petition for election, if the MNA were elected, the union would be the representative for all East Market APPs included in the voting unit.

Individual APPs would not be able to opt-out even if they never supported the union and/or voted against having the union. And, any contract that might be reached between Essentia and the MNA would apply to all East Market APPs without exception. 

The MNA charges members $76.20 in monthly dues ($914.40 annually). The table below shows how much money the MNA stands to collect in union dues from APPs every year and over the life of a typical three-year agreement. These figures could explain the MNA’s motivation for organizing Essentia APPs.

As the table above indicates, all East Market APPs could be forced to pay the MNA $365,760.00 every year, or over $1 million over the life of a typical three-year contract. This is in addition to the roughly $1,830,000.00 the MNA already collects annually from Essentia Health registered nurses.

Unlike Minnesota, Wisconsin is a “right-to-work” state. Under Wisconsin law, union-represented colleagues working in Wisconsin would not be required to pay union dues as a condition of employment. However, if the MNA is elected, APPs working in Wisconsin could be pressured by the MNA or peers to pay dues (i.e., called a “free rider”).
Minnesota is not a right-to-work state. If the MNA is elected, APPs working in Minnesota could be required to pay union dues as (or service fees) a condition of continued employment with Essentia Health.
Regardless of which state you work in, if the MNA is elected then ALL Essentia Health East Market APPs included in the bargaining unit (both Wisconsin and Minnesota) would be covered by any contract that might be reached between Essentia Health and the MNA. This applies irrespective of dues-paying status.

MNA contracts covering in-patient acute care nurses reflect almost nothing akin to the scope, responsibilities, or terms and conditions of employment for APPs. Also, the Twin Ports acute-care nursing contract has been in place for over 60 years; much of its language is long-settled.

If elected, the MNA and Essentia would be required to negotiate a complete, new agreement covering all terms and conditions of employment for all APPs (a workforce with whom the MNA has little experience). As a result, collective bargaining for an APP contract could prove much more time-consuming, complex, and difficult.

We are concerned that APP unionization could negatively impact teamwork between physicians and APPs within individual practices. If the MNA is elected, Essentia would always negotiate in good faith. But there is no way to predict, for example, how processes related to how we manage call or how we address individual scheduling preferences could be impacted by the bargaining process. The uncertainty of bargaining could result in a loss of flexibility, which is so important to much of our APP workforce.

If a union is elected, then under the law, the union and employer are required to bargain over issues related to the terms and conditions of employment for all APPs covered by the agreement (e.g., pay, benefits, hours, schedules, holidays, etc.).

Essentia Health would retain the right to continue to manage operations in accordance with business and patient needs. In addition, it is important to understand that every contract negotiation is its own new negotiation. This is even true every time Essentia meets to negotiate new contracts after previous contracts expire for our unionized colleagues.

If a union is elected to represent APPs, Essentia will negotiate in good faith. But just because certain terms or language exist in union contracts that cover other Essentia colleagues (e.g., RNs), this doesn’t mean things included in those contracts would be included in any contract that might be negotiated for APPs.

We think Essentia APPs should wait to see how the situation evolves for Allina providers. Provider unionization is a relatively new phenomenon. At Allina, the union was elected almost six months ago (September 21, 2023) and certified by the National Labor Relations Board on October 20.  

At this stage, no one can predict how the situation will work out for Allina providers, their patients, and the communities Allina serves. It is possible that collective bargaining could break down. And, if that happens, providers at Allina could end up on strike like the thousands of nurses the MNA has led out on strike in recent years.