On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus (COVID-19) outbreak as a global pandemic (WHO, 2020). Then, on May 5, 2023, WHO announced that COVID-19 was no longer considered a public health emergency of international concern (WHO, 2023). Officially, this marks the end of the COVID-19 pandemic after a duration of three years and two months. However, in light of past occurrences such as severe acute respiratory syndrome (SARS), novel influenza, Middle East respiratory syndrome (MERS), and the most recent COVID-19 crisis, it is evident that novel infectious diseases can resurface at any time. Therefore, now is the critical moment to calmly reflect on the COVID-19 pandemic and prepare a comprehensive system to respond to future outbreaks of novel infectious diseases.

Healthcare institutions play a crucial role in containing the spread of infectious diseases, isolating, treating, and caring for the infected (Beckett et al., 2021). Nurses, the largest group of healthcare professionals, have the most direct patient and caregiver interactions. Therefore, the COVID-19 pandemic has increased the demand for nurses, the frontline workers responsible for infection management and patient care (Kang & Shin, 2020). Comparing nursing workloads between COVID-19 and non-COVID-19 patients consistently reveals significantly higher workloads for COVID-19 patients (Bruyneel et al., 2022; Hoogendoorn et al., 2021; Lima et al., 2023; Lucchini et al., 2020). These findings objectively demonstrate an increase in nursing workloads due to the COVID-19 pandemic. In the era of novel infectious diseases, nursing practices should evolve to include new tasks like donning and doffing personal protective equipment (PPE), implementing family visitation restrictions, managing care time with PPE, and addressing the emotional challenges faced by isolated patients (Kotfis et al., 2020). Recognizing the newly emerged or increased nursing tasks due to the COVID-19 pandemic is of great importance in ensuring patient safety and improving the professional lives of nurses.

Nursing workload is defined as the amount of time and care that a nurse can devote directly and indirectly towards patients, workplace, and professional development (Alghamdi, 2016). It includes both nursing activities, involving direct and indirect patient care, and non-nursing activities unrelated to patient care, such as unit management, staff meetings, mentoring new nurses, training nursing students, and engaging in educational and professional development. Therefore, which patient is being cared for is one of the important factors to consider when determining nursing activities within nursing workload.

In the context of holistic nursing, which represents the ideal pursed by the nursing profession, nursing tasks vary based on individual patient needs. These needs encompass acuity, which indicates the severity of the patient's illness and their clinical condition, as well as dependency, reflecting the patient's daily life abilities (National Institute for Health and Care Excellence, 2014). Therefore, nursing tasks are bound to be diverse across different departments, and as a result, previous studies have investigated the tasks performed by nurses in specific units. In South Korea, nursing task analyses have been conducted in the emergency room (ER) (Baik et al., 2019), medical-surgical unit (Ko & Kim, 2008), intensive care unit (ICU) (Yun et al., 2013), and comprehensive nursing care units (CNCU) (Yi et al., 2022). Investigating nursing tasks by department is essential not only for a more accurate understanding of nursing workloads but also for determining and allocating appropriate staffing levels within each unit (Griffiths et al., 2020).

Nursing professionals play a critical role in responding to public health emergencies triggered by emerging infectious diseases. Nurses have been instrumental in the COVID-19 pandemic, which significantly impacted nursing tasks (Kang & Shin, 2020). Due to the nature of COVID-19, patients often require mechanical ventilation, have higher severity and mortality rates, and experience prolonged stays in the ICU (Hoogendoorn et al., 2021). The pandemic has resulted in a noticeable increase in the number of COVID-19 patients requiring intensive care and admission to the ICU, which has had a significant impact on the nursing workload in these settings (Bruyneel et al., 2022). As a result, a majority of COVID-19 nursing research has predominantly focused on the ICU setting. Studies have consistently shown that the nursing workload for COVID-19 patients in the ICU is significantly higher compared to non-COVID-19 patients (Bruyneel et al., 2022; Hoogendoorn et al., 2021; Lima et al., 2023; Lucchini et al., 2020). The increased workload for COVID-19 patients was mainly attributed to more intense hygienic procedures, mobilization and positioning, support and care for relatives, and respiratory care (Hoogendoorn et al., 2021). Additionally, factors such as continuous hemofiltration, higher medical severity, and a greater number of deceased patients have also been identified as influencing the nursing workload for COVID-19 patients (Bruyneel et al., 2022).

However, to the best our knowledge, the aforementioned studies used nursing workload measurement tools developed prior to the COVID-19 pandemic. This makes it challenging to ascertain the content and frequency of newly emerged nursing tasks specific to COVID-19. To examine the precise impact of the COVID-19 pandemic on nursing workload across different types of hospitals and departments, it is imperative to employ the actual nursing task lists performed in clinical settings during the pandemic. This approach would provide a comprehensive understanding of nursing tasks across different hospital levels and departments, while also offering objective data for workforce planning. These findings are expected to help formulate strategies for addressing future emerging infectious diseases.

Carayon and Gürses (2005) introduced a conceptual framework of ICU nursing workload delineating the ICU nursing workload into four distinct levels: unit level, job level, patient level, and situation level. They suggested that focusing on nursing workload at the situation level, which pertains to nursing tasks within a clinical microsystem and is temporally bound, can provide the information necessary to identify specific causes of workload, thereby alleviating workload and minimizing its adverse effects (Carayon & Gürses, 2005).

The increase in nursing workload has detrimental effects on both patients and nurses. It is associated with higher rates of in-hospital mortality, hospital-acquired infection, medication errors, falls, and abandonment of treatment, while also increasing the burnout, needlestick and sharps injuries, intent to leave, and absenteeism (Assaye et al., 2021). The Systems Engineering Initiative for Patient Safety (SEIPS) model demonstrates that the work system through which care is delivered influences not only the work and care process but also the outcomes of patients, employees, and organizations (Carayon et al., 2006). According to this model, the components of the work system consist of person, organization, technologies and tools, tasks, and environment. Patient outcomes encompass patient safety and quality of care, while employee and organizational outcomes include job satisfaction, burnout, and turnover.

Therefore, based on this model, this study aims to enhance the work system in the unique context of the COVID-19 pandemic, with the goal of creating positive outcomes for patients, nurses, and healthcare institutions. As a first step towards this goal, we intend to investigate nursing tasks during the COVID-19 pandemic, focusing on tasks, one of the components of the work system.

This study aimed to identify the new or increased nursing tasks in South Korea during the COVID-19 pandemic and compare them based on the type of hospital and department. Therefore, specific research objectives are as follows: first, to understand the nursing tasks performed in clinical settings during the COVID-19 pandemic period; second, to compare newly emerged or increased tasks based on the type of hospital; and third, to compare newly emerged or increased tasks based on department.