For twenty-nine years, Angela Spohn has worked at the same hospital in Grand Blanc, Michigan, a suburb south of Flint along the long stretch of exurban highway connecting Flint to metro Detroit. She started there in 1997, back when it was still just Genesys Hospital, before mergers and acquisitions folded the roughly four hundred–bed facility into the expanding Henry Ford Health system. She has spent nearly three decades in labor and delivery, helping deliver babies, running assignments, managing crises, and working alongside the same nurses long enough that they can anticipate each other’s movements before anyone speaks.

“We are a very well-oiled machine,” Spohn told me. “I’m doing one thing and my friend’s doing the other, and if I’m doing that thing, she knows what’s coming next.”

Now she sees many of those coworkers on a picket line instead. When roughly 750 nurses and case managers at Henry Ford Genesys Hospital walked off the job on Labor Day weekend last year, the strike centered on staffing levels, with nurses claiming the administration was requiring them to care for far more patients than they could while still providing state-of-the-art care. Intensive care nurses who should have had one patient were taking two, three, or sometimes four. Medical-surgical nurses assigned four or five patients sometimes had ten or twelve. There were nights, Spohn said, when three nurses were responsible for forty patients.