VIRGINIA — Vicky Brady never imagined she’d be holding a picket sign. After 18 years at Essentia Health and a 17-year military career before that, the nurse practitioner had always worked within the system to solve problems. But standing outside Essentia Health-Virginia last week, she reflected on how different things had become since her days in the military.
“We were respected for our knowledge, our expertise, our officership,” Brady said. “No one made any difference between the positions and the advanced practice providers. When I came out here in the real world, I realized that was not the case.”
Brady’s journey to health care began as a patient. At 19, engaged and expecting her first child, her world collapsed within two weeks – a broken engagement and a miscarriage that left her in despair. The nurses who cared for her showed such kindness and compassion that she decided to dedicate her life to healing others.
“They couldn’t help me, they couldn’t save that loss,” Brady said. “But they were so kind and so caring and so considerate that that day I decided to become a nurse.”
Now, more than three decades later, Brady finds herself fighting for her profession and the respect she believes health care providers deserve. The strike by Essentia Health’s Advanced Practice Providers across the Iron Range represents an 18-month battle that has pitted the health care system against the very professionals it relies on to serve rural communities.
Jenna Coldwell’s path to the picket line started differently but led to the same place. As a child, her primary care provider was a physician assistant, planting seeds that would grow into a career spanning 11 years at Essentia Health as a hospitalist. After studying medical microbiology and immunology at the University of Wisconsin, she worked as a certified nursing assistant before attending Duke University’s PA program.
“I wanted to be the one in control of my patient’s care plan,” Coldwell said. “Patients were always asking me questions as their CNA about what was going on. The doctor was only in five minutes, and I couldn’t answer their questions. That didn’t sit well with me.”
What brought both of them to the strike line was years of accumulated frustrations. Brady recalls three long years of waiting for Essentia to eliminate collaborative agreements with physicians—agreements that became unnecessary when Minnesota granted full practice authority to nurse practitioners. Coldwell remembers the relentless expansion of responsibilities without input from those doing the work.
“When I first started, my patient panel was capped at a certain number,” she said. “We didn’t often see that maximum number except during cold and flu season.”
But as Essentia acquired smaller hospitals and clinics, APPs found themselves mandated to travel throughout the region—sometimes working at more than one facility in Sandstone, Deer River, Aurora, Ely, and Virginia in a day.
The travel demands became crushing. Fourteen-hour days including commutes, driving through blizzards with no inclement weather plan, managing patients via unreliable cellphone connections while covering multiple facilities.
“We were getting burned out, compassion fatigue,” Coldwell said. “It was getting dangerous.”
Both of them emphasized they tried working within the system for years. Hours of meetings, different managers, different administrators.
“When you’ve been talking about the same issues for five years and there’s been no change, you get a little frustrated,” Brady said.
The legal battle that followed their unionization vote has been particularly bitter.
After APPs voted overwhelmingly to organize with the Minnesota Nurses Association in August 2024, Essentia has refused to bargain, taking advantage of what union supporters call a loophole in National Labor Relations Board procedures that allows employers to delay negotiations through appeals.
Since the Trump administration took over the federal government, it has declined to appoint new members to the NLRB. Since it doesn’t have enough members for a quorum, it can’t even meet to take up Essentia’s appeal.
“After 18 months of waiting for Essentia Health to do right by patients and caregivers, we’ve reached our limit,” said Sara McCumber, another APP, in a statement. “Their relentless stalling makes one thing unmistakably clear: Essentia isn’t interested in solutions—only in union-busting.”
Standing on the picket line, both women grapple with guilt—about patients not getting their usual care, about physician partners picking up extra work, about stepping away from the calling that brought them to health care. But they also see the strike as necessary for the long-term health of both the system and the communities it serves.
“We don’t feel that asking for respect is unreasonable,” Brady said. “We don’t feel that’s hard.”
For Coldwell, the irony of the strike is palpable.
“One of the reasons Essentia didn’t want their APPs in a single bargaining unit was because they were worried about impacts to patient care should a work stoppage or strike occur,” she said. “And here we are today, having a strike because they won’t even talk to us.”
Both women are clear about their motivations. This isn’t about money or benefits. The union hasn’t even made any demands.
“All we have said is meet us at the table,” Brady said. “We’ve made zero demands. Zero. We haven’t talked about staffing. We haven’t talked about anything.”
As rural health care faces mounting challenges nationwide, the strike embodies the tension between corporate health care systems and the individual professionals who chose careers in healing.
“We all came to this for various reasons,” Brady said, gesturing to her fellow strikers. “But we came to it because we wanted to care for people. This is the reason why we’ve put up with a lot of the things we put up with. Because caring for people truly is our priority. But we want to be able to do it the right way.”
Standing far from the patients and clinics to which they’ve dedicated their careers, both women maintain that this fight is ultimately about the patients they serve. They want to return to work, but only when they can provide the care their communities deserve.
The Timberjay reached out to Essentia to enquire about how the strike would affect patient care but received no reply.