Even amid budget pressures, the economic downturn has been beneficial for Howard County General Hospital in one key area: nurse staffing levels.

During boom times, the Columbia-based facility, like many hospitals around the country, suffered from lingering nurse vacancy rates that required temporary workers to fill in. But since the recession, the hospital has eliminated vacancies and increased the number of full-time permanent nurses. That's helped the hospital's bottom line, allowing it to expand services that generate revenue at a time when operating profits and investments are struggling to rebound.

The reason: Retired nurses suffering financially -- perhaps from having lost jobs in second careers or having spouses who did -- returned to one of the precious few sectors that is hiring in large numbers. Meanwhile, part-timers applied for full-time positions and those on the verge of retiring postponed their plans.

“In terms of the economy, it's been positive,” said Dorothy Brillantes, senior vice president for human resources at Howard County General. Before the recession, “60 percent of our nurses were full-time,” she added. “That's now up to 73 percent.”

Nurse staffing levels are in some way an economic paradox. Good times tend to coincide with high vacancy rates, as workers take advantage of increased employment options. But those positions generally fill up in downturns.

While most sectors lost jobs during the recession, hospitals in the Washington region staffed up. From December 2007 to December 2008, the health services sector experienced a net gain of 9,900 jobs, according to U.S. Bureau of Labor Statistics data culled by the Center for Regional Analysis at George Mason University -- far beyond the gain of 5,600 jobs the year before.

That trend played out in significantly lower nurse vacancy rates at area hospitals. For instance, the vacancy rate for registered nurses in Maryland hospitals dropped to 5.3 percent in 2009 from 10 percent in 2005, according to the Maryland Hospital Association. The vacancy rate for licensed practical nurses fell even more -- to 1.7 percent in 2009 from 6.2 percent in 2005.

“In 2009, we saw some of the lowest vacancy rates ever -- positions were filled,” said Carmela Coyle, president and chief executive of the Maryland Hospital Association, which represents 58 hospitals and eight health care systems in the state. “It was a combination of nurses who were retired coming back into the workforce, part-time nurses going full time and nurses postponing retirement for economic reasons.”

The nurse vacancy rate at Howard University Hospital in Northwest Washington is now in the single digits, down from about 15 percent before the recession, said Mayble E. Craig, the hospital's interim chief nursing officer. The hospital has reduced the number of temporary nurses, who earn up to $100 an hour, to four from 35.

The hospital, Craig said, is generating revenue through new units for conditions such as cancer and sleep apnea. “This is something we could not have done if we didn't have the necessary staff, including nurses,” Craig said, adding that the hospital has eliminated a budget deficit.

Budget-cutting and increased admissions have put many area hospitals on the road to financial recovery. Collectively, profit from investments and revenue at Maryland hospitals rose 6.5 percent in fiscal 2011, compared with an 8.3 percent drop in fiscal 2009, according to the state's Health Services Cost Review Commission. District and Virginia hospital associations did not have post-recession data.

Now, though, the improving economy is beginning to woo veteran nurses away from their hospital jobs.

Since the nearly 10,000 spike in the region's health care jobs, job growth has fallen off sharply, suggesting that staffing levels reached near capacity and that the mass hiring is no longer needed. From December 2008 to December 2009, according to the Center for Regional Analysis, 5,500 health services jobs were gained. During the 12-month period ending in December 2010, the number had slipped to 5,300.

Nurse vacancy rates at Reston Hospital Center inched up to 5 percent in 2010 from 3 percent in 2009, said spokeswoman Joanna Fazio.

“Nurses are saying, ‘I'm going back home.' It says a lot of things about their general confidence of the economy,” said David Alexander, president of Atlanta-based hospital-staffing firm Soliant Health, who follows the Washington region.

The exodus is expected to peak just as hospitals begin to face enormous demand from an influx of previously uninsured patients who will be newly covered when the health care law is fully implemented in 2014.

Officials say the pipeline of newly graduated nurses will provide only a drop in the bucket in meeting the demand: For instance, nursing schools in Virginia annually graduate 3,600 nurses, said Barbara Brown, vice president of the Virginia Hospital & Healthcare Association. That's barely enough to fill the need in Northern Virginia alone.

In Virginia, “you're going to add 250,000 to 400,000 people who need care and haven't gotten it in a while,” Brown said. With an expected gap in staffing levels, she added, “you'll have people at the door with insurance cards and there will be nobody there to see them.”