Cook County Health, the largest safety-net health system serving the region’s most vulnerable low-income patients, is facing a staffing shortage.
The health system currently has around 5,550 employees – and wants to fill around 2,000 positions. This means that just over a quarter of the budgeted positions are empty. At the same time, the healthcare system is struggling to keep up — losing more workers to retirements, layoffs and “layoffs” than the system can add to the payroll, healthcare system records show.
Most of the loss is due to people quitting, records show.
This problem isn’t unique to Cook County Health. More than two years after the COVID-19 pandemic, the so-called Great Resignation is happening across the country, particularly among burned-out nurses who have quit and are looking for rest, better pay or treatment.
Cook County Health’s staffing has come under closer scrutiny in recent weeks, however, as CEO Israel Rocha Jr. and his executive team unveiled the system’s proposed 2023 budget. One of the aims is to further expand the medical services for patients and thus generate additional income. However, some members of the health system’s board have questioned whether there are enough staff to undertake it.
“We have a chronic inability to fill the vacancies at Stroger and Provident,” board member Ada Mary Gugenheim said during a meeting earlier this month, referring to the system’s two hospitals. “The wait times are absolutely appalling.”
Ophthalmologists, urologists and plastic surgeons wait the longest
From January, patients waited the longest when they had to see an ophthalmologist, a urologist or a plastic surgeon, among other things. According to the latest health system data available, it would take about four to six months to get an appointment.
Cook County Health is part of the county government. It includes two hospitals — the flagship John H. Stroger Jr. Hospital on the Near West Side and Provident Hospital on the South Side — as well as a network of urban and suburban clinics and a large Medicaid health insurance plan called CountyCare with more than 400,000 members. The majority of patients are Black and Hispanic.
The health system is a significant part of the county’s budget, accounting for nearly half of the government’s proposed $8.11 billion budget for 2023. Cook County Health’s financial viability impacts the county’s overall bottom line, as well as taxpayers who help subsidize costs and dependent patients through the health care system for medical care.
In an interview, Rocha said the healthcare system uses nurses from temporary agencies, who are typically more expensive than nurses on the payroll, to help treat patients as hiring increases. He emphasized that the health system meets the needs of patients.
“Every hospital in America is relying more heavily on agencies these days [nurses more] than ever before because we’ve gone through a tremendous shift,” said Rocha. “It’s not just a Cook County Health thing.”
If the health care system doesn’t rely on agency staff to temporarily fill vacancies, the health care system may have to cut its benefits, which means less money flowing in, Rocha said.
“You can go into a place where you cut revenue and staff and revenue and staff and you hit a very dangerous place,” Rocha explained.
Up to 6 months to fill positions
At Cook County Health, human resources executives have detailed in public meetings the difficulty of hiring employees. It takes an average of four to six months to fill a position. HR itself didn’t have enough staff to hire, but has since hired additional staff and set up a dashboard to keep track of the hiring pipeline, Valarie Amos, head of HR, said during a recent board meeting.
Her presentation illustrated the comings and goings of Cook County Health: dozens of nurses, clerks, security guards and technicians had accepted offers over the past few months.
But more than 50 others declined for various reasons. The most common was underpayment.
There are also ongoing morale issues. Many Cook County Health nurses continue to demand extra money they say is owed them after treating patients during the darkest days of the pandemic. Understaffing in the county’s health care system has long been a problem and contributed to nurses going on strike last year.
Rolanda Watson has been a nurse there for 29 years. During a health care system meeting late last week, she recalled being “deployed” in the ICU to treat COVID-19 patients and taking on other roles as well.
“When I say action [it’s] appropriate because it felt like going into battle. … We had to take on the role of domestic help because they wouldn’t come into the unit,” Watson said. “We had to take on the role of serving trays because the kitchen staff couldn’t get into the unit. It was such a big problem that morale dropped.”
In May, former ER nurse Consuelo Vargas wrote to the board: “I left because I couldn’t leave work and felt let down by the hospital leadership every day. Her nurses break down and I can testify that if her wounds heal at all, it takes a long time to heal. Today is your chance to stop the bleeding of RNs from CCHHS.”
Vargas resigned last year.
As Cook County Health competes for employees, Rocha said the health system has created a program to provide sign-on bonuses to new hires and is working to provide retention bonuses to current employees who agree to work for a specified number of years.
The Cook County Board of Directors must approve the proposed county budget, which includes the health care system financial plan. The fiscal year begins on December 1st.
Kristen Schorsch serves on the WBEZ’s Government and Policy team for Public Health and Cook County.