Cook County Health, which is the largest safety net health system for the region’s most vulnerable low-income patients, is facing a staffing crisis.
The health system currently has about 5,550 employees – and is looking to fill about 2,000 vacancies. This means that just over a quarter of the budgeted positions are vacant. At the same time, the health system can’t keep up — it’s losing more workers to retirements, resignations and “layoffs” than the system can add to the payroll, health system data show.
Most of the losses are due to people leaving, the data show.
This problem is not unique to Cook County Health. More than two years after the COVID-19 pandemic, the so-called Great Resignation is happening across the country, especially among burned-out nurses who have quit, seeking time off, better pay or treatment.
But staff at Cook County Health have come under increased scrutiny in recent weeks as CEO Israel Rocha Jr. and his leadership team presented the system’s proposed budget for 2023. Among the goals is to continue to expand medical services for patients, which will help generate more revenue. But some members of the health system’s board have questioned whether there is enough staff to take it on.
“We have a chronic inability to fill slots at Stroger and Providence,” board member Ada Mary Gugenheim said during a meeting earlier this month, referring to the system’s two hospitals. “The wait times are absolutely horrendous.”
Longer waits for eye doctors, urologists and plastic surgeons
As of January, patients waited longer 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 – John H. Stroger Jr. Main 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. Most patients are black and Latino.
The health system is a significant part of the county’s budget, making up nearly half of the government’s proposed $8.11 billion budget in 2023. Cook County Health’s financial sustainability affects the county’s bottom line, as well as the taxpayers who help support it. subsidizing 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, who are typically more expensive than nurses on the payroll, to help treat patients while staffing ramps. He emphasized that the health system is meeting the needs of patients.
“Every hospital in America is now relying more heavily on agencies [nurses more] than they’ve ever had because we’ve had tremendous change,” Rocha said. “It’s not just a Cook County health issue.”
If the health system didn’t rely on agency staff to temporarily fill vacancies, the health system might have to cut services, which would mean less money, Rocha said.
“You can get into a place where you keep cutting revenue, staff, revenue and staff, and you hit a very dangerous place,” Rocha explained.
Israel Rocha Jr., CEO of Cook County Health, pictured with Cook County Board President Toni Preckwinkle, says the system is relying on the agency’s temporary nurses more than before to help treat patients.
Up to 6 months to fill the jobs
At Cook County Health, HR leaders have detailed in public meetings how difficult it is to hire people. It takes an average of four to six months to fill a position. The Human Resources Department itself was understaffed to recruit employees, but has since hired additional workers as well as set up a dashboard to help keep track of the hiring pipeline, said Valarie Amos, Chief Human Resources, 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 recent months.
But more than 50 others have fallen for a variety of reasons. Insufficient pay was more common.
There are also ongoing moral problems. Many Cook County Health nurses continue to seek extra money they say they are owed as they treat patients in the darkest days of the pandemic. Appearance in the county health system has long been an issue and contributed to the 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 “placed” in the intensive care unit to treat patients with COVID-19 and also took on other roles.
“When I say deployment [it’s] loving because it felt like I was going into battle. … We had to fill custodial roles because they wouldn’t come to the unit,” Watson said. “We have to fill the roles of passing the trays because the kitchen staff would not come to the unit. It was such a big deal that 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 my job feeling let down by the leadership of the hospital every day. Your nurses are breaking and I can attest that it takes a long time to heal if their wounds heal at all. Today you have the opportunity to stop the hemorrhaging of RNs from CCHHS.”
Vargas left 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 certain number of years.
The full Cook County Board must approve the county’s proposed overall budget, which includes the health system’s financial plan. The fiscal year begins on December 1.
Kristen Schorsch covers public health and Cook County on WBEZ’s government and politics team.