Cook County Health, which is the biggest safety net health system for the most vulnerable low-income patients in the region, is facing a staffing crunch.
The health system currently has around 5,550 employees — and is looking to fill some 2,000 vacancies. That means just over one quarter of budgeted positions are empty. At the same time, the health system can’t keep up — it’s losing more workers to retirements, resignations and “discharges” than the system can add to the payroll, health system records show.
Most of the loss is due to people quitting, records show.
This issue isn’t unique to Cook County Health. More than two years into the COVID-19 pandemic, the so-called Great Resignation is happening across the nation, especially among burned out nurses who have quit, looking for rest, better pay or treatment.
But staffing at Cook County Health has come under more scrutiny in recent weeks as CEO Israel Rocha Jr. and his leadership team pitched the system’s proposed 2023 budget. Among the goals is to continue to expand medical services for patients, which would help generate more revenue. But some members of the health system’s board have questioned if there are enough staff to take that on.
“We have a chronic inability to fill the slots at Stroger and Provident,” board member Ada Mary Gugenheim said during a meeting earlier this month, referring to the system’s two hospitals. “Waiting times are absolutely appalling.”
Longest waits for eye doctors, urologists and plastic surgeons
As of January, patients waited the longest if they needed to see an eye doctor, a urologist or a plastic surgeon, among other specialties. It would take about four to six months to get an appointment, according to the most recent data available from the health system.
Cook County Health is part of the county government. It includes two hospitals — flagship John H. Stroger Jr. Hospital on the Near West Side and Provident Hospital on the South Side — as well as a network of city and suburban clinics and a large Medicaid health insurance plan called CountyCare that has more than 400,000 members. The majority of patients are Black and Latino.
The health system is a significant piece of the county budget, making up nearly half of the government’s proposed $8.11 billion budget in 2023. Cook County Health’s financial viability impacts the county’s overall bottom line, as well as taxpayers who help subsidize costs and patients who depend on the health system for medical care.
In an interview, Rocha said the health system is using temporary agency nurses, which are typically more expensive than nurses who are on the payroll, to help treat patients while hiring ramps up. He emphasized the health system is meeting the needs of patients.
“Every hospital in America right now is relying heavier on agency [nurses more] than they ever have because we’ve had a tremendous shift,” Rocha said. “It’s not just a Cook County Health thing.”
If the health system didn’t rely on agency staff to temporarily fill vacancies, the health system might have to cut services, which means less money flowing in, Rocha said.
“You can enter a place where you keep cutting revenue and staff and revenue and staff, and you hit a very dangerous place,” Rocha explained.
Up to 6 months to fill jobs
At Cook County Health, leaders in human resources have detailed in public meetings how hard it is to hire people. It takes on average four to six months to fill a position. The human resources department itself didn’t have enough staffers to recruit employees, but has since hired additional workers as well as set up a dashboard to help keep track of the hiring pipeline, Valarie Amos, chief of human resources, said during a recent board meeting.
Her presentation illustrated the comings and goings of Cook County Health: dozens of nurses, clerical staff, security workers and technicians had accepted offers in the last few months.
But more than 50 others have declined for a variety of reasons. Not enough pay was the most common.
There are also persistent morale issues. Many Cook County Health nurses continue to demand extra money they say they are owed after treating patients in the darkest days of the pandemic. Understaffing at the county health system has long been an issue and contributed to nurses striking last year.
Rolanda Watson has been a nurse there for 29 years. During a health system board meeting late last week, she recalled how she was “deployed” to the intensive care unit to treat COVID-19 patients and also took on other roles.
“When I say deployment [it’s] befitting because it felt like I was going into battle. … We had to fill the roles of housekeeping because they would not come to the unit,” Watson said. “We had to fill the roles of passing out trays because the kitchen staff would not come to the unit. It was such a big issue that the morale went down.”
‘Nurses are breaking’
In May, former emergency department nurse Consuelo Vargas, wrote to the board: “I left because I could not leave work feeling disappointed in hospital leadership every single day. Your nurses are breaking and I can attest that the healing takes a long time if their wounds heal at all. Today you have the opportunity to stop the hemorrhaging of RNs from CCHHS.”
Vargas quit last year.
As Cook County Health competes for employees, Rocha said the health system has created a program to give sign-on bonuses to new hires, and is working to give retention bonuses to current staff who agree to work for a set number of years.
The full Cook County Board must approve the county’s overall proposed budget, which includes the health system’s financial plan. The fiscal year begins on Dec. 1.
Kristen Schorsch covers public health and Cook County on WBEZ’s government and politics team.
