But reality at the hospital soon diverged from Spinney’s expectations. Above all, she found the place was understaffed, forcing her to split her time and attention between four fragile infants when she should be charged with one or two. Babies were often left to cry, even though all her training told her to respond immediately. “We’re starting with this blank canvas of this super-delicate being, and we’re not even able to provide the most minimal, basic things,” she said. Sometimes, visiting parents would notice and even offer to help with babies other than their own.

These staffing issues deepened after COVID hit, as veteran nurses left the hospital and were replaced by temporary travel nurses. The understaffing caused a stress at work that soon curdled into a gnawing guilt—a phenomenon that nurse advocates have taken to calling a form of “moral injury,” akin to the experience of soldiers. “It is not uncommon for a nurse to leave their shift and go sit in their car and cry,” Spinney said, as feelings of inadequacy pile up. “It also starts to provoke a lot of anxiety about your next shift. … It’s a really hard cycle to break.”

Last year, Spinney was on the verge of leaving what she’d thought would be her lifelong career. She’d earned a master’s degree related to healthcare leadership, a lifeboat to get her away from hospital bedsides before she drowned. But that’s when she learned her coworkers at Seton were starting the process of unionizing. “Being from Texas, I have very little experience or information with unions, with striking, with the labor movement,” she said. Nevertheless, she saw a chance to turn things around: She ditched her plan to leave and threw herself into the effort.

In 2021, the news outlet STAT revealed that Ascension was running a “Wall Street-style” $1 billion private equity fund. In 2022, the New York Times reported the nonprofit paid its chief executive $13 million the prior year, had $41 billion in an investment arm, and maintained $18 billion in cash reserves—all after openly pursuing reductions in hospital staffing and lobbying against state-level bills mandating safer nurse-to-patient ratios. (In California, where nurses’ salaries also average about $50,000 higher than Texas, such a law mandates low ratios including 1:2 in newborn intensive care.) Being squeezed by such a profitable nonprofit motivated the Austin nurses to organize.