JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic exposed structural vulnerabilities in health emergency workforce globally. Sustained monitoring of response competence dynamics is critical for health system resilience against protracted outbreaks.

Objective:

To investigate trends and structural transitions in nurses’ infectious disease emergency response competence during different phases of the COVID-19 pandemic.

Methods:

Using the Healthcare Workers’ Infectious Disease Emergency Response Competence Questionnaire, three repeated cross-sectional surveys were conducted in February 2020, August 2021, and February 2023. The participants were matched 1:1:1 by their demographic characteristics via propensity scores. Temporal trends were analyzed using ANOVA, and competence structure transitions were examined via network analysis.

Results:

Three-wave analyses (n=2525 per wave) demonstrated a sustained decline in competence, from 4.05 (SD 0.63) in February 2020 to 3.81 (SD 0.66) in August 2021, and further to 3.70 (SD 0.66) in February 2023. All pairwise comparisons were statistically significant (all P <.001). Network analysis identified critical structural shifts in competence architecture: In February 2020, the core network node was T24 (emergency management of body fluid exposure, strength = 1.764), whereas in August 2021 and February 2023, the core network node was T19 (acquisition of key information on emerging infectious diseases, strength = 1.759 and 1.852, respectively). Network-structure comparisons revealed significant differences between each pair of phases (P < .05).

Conclusions:

Despite accumulated pandemic experience, nurses’ infectious disease response competence declined significantly, indicating systemic fragility during prolonged crises. However, this experience reshaped competence architecture, evolving from technical infection prevention toward higher-order competence in information integration and clinical decision-making under uncertainty. To rebuild resilience, phase-specific training programs are essential: early-phase training emphasizes infection prevention, whereas prolonged outbreaks focus on information identification and decision support. Additionally, standardized information platforms and psychological support are essential to manage ongoing pandemic pressures.