The novel coronavirus disease-2019 (COVID-19), declared a pandemic by World Health Organization (WHO), is an ongoing respiratory infectious disease [1]. South Korea was initially affected by COVID-19 due to its geographical proximity to China [2]. When the first pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported on December 31st, 2019, in Wuhan [3], the Korea Disease Control and Prevention Agency (KDCA) issued the lowest threat alert (blue) of 4 levels. Despite the confirmed cases that occurred sporadically, they seemed to be controlled stably by tracking case movement routes, rapid diagnosis, and widespread testing [4]. However, things changed abruptly when the 31st case occurred in Daegu Metropolitan City with 2.5 million people located inland of South Korea, on February 18th, 2020 [5]. As the mass infection was confirmed to be centered on the specific church where the 31st case participated, the Korean government immediately started an active response by raising the alert system to the highest threat alert (red) [4,6].

Daegu Metropolitan City has reorganized the ten local hospitals as designated COVID-19 hospitals for the increasing number of infected patients management [5]. However, as the number of patients waiting for other hospitals increased because the isolation ward could not accommodate all infected patients with the rapidly increasing number of confirmed COVID-19, designated COVID-19 hospitals transferred existing inpatients to another hospitals sequentially in order to treat COVID-19 entirely [7]. Among the hospitals, a regional district public hospital (Daegu Medical Center), most of the nurses were assigned to isolation ward for an infected patient that was completely different from their existing duties except for artificial kidney rooms, hospice centers, and minimal outpatients with volunteer medical staff from all over the country [7,8]. These changes in the medical system directly and/or indirectly affected frontline nurses [9]. In particular, nurses’ work was aggravated due to mass cluster outbreaks in the psychiatric and long-term care and poor treatment of dispatched nurses [10]. In addition, nurses who were fighting COVID-19 have experienced dehydration and exhaustion due to wearing Personal Protective Equipment (PPE), a dilemma in an ethical conflict situation, and threatening their mental health such as anxiety, depression, burnout, and post-traumatic stress disorder [10–12].

Currently, nurses worldwide are writing a new history of nursing against a novel infectious disease. Like Nightingale, medical staff, including nurses, are portrayed as heroes or martyrs and are praised by the public for their hard work [13]. However, existing studies on the experiences of nurses while caring for patients with a COVID-19 show the need to improve the treatment of nurses in the future, such as the caring difficulties for novel diseases [14,15], extended working hours [16], and stress [17]. Although nurses are dedicated to caring for infected patients and the working experience of nurses, it is necessary to look at the driving force and pride that keep them working. Therefore, this study was conducted to examine the experience and professional pride of the frontline nurses who treated the explosively increasing number of patients during the first wave in the absence of a proper medical system for emerging infectious diseases. Through this, it is intended to be used as primary data for preparing nursing support policies in an infectious disease outbreak.

The researchers investigated the experiences such as status of work, the adequacy of support system, and nursing professionals’ pride for nurses who worked at a designated COVID-19 hospital from February to May 2020 as the early pandemic as primary data for establishing an appropriate and systemic nurse working environment in the pandemic situation.

First, looking at the general characteristics of COVID-19 patients who directly affect nurses’ working environment. A total of 851 patients were hospitalized during the three months, and the average age was 53.60 years. The most common underlying diseases of COVID-19 patients were high blood pressure (27.4%) and diabetes (15.9%), and 90.6% were discharged from the hospital after hospitalization, but 4.8% were transferred to tertiary medical institutions, and 4.6% died. This result is similar to the results of a study by Hong et al. [19]; at the same time, 98 COVID-19 patients were admitted to tertiary medical; institutions. Among them, 5.1% died, and their average age was 55.4. In addition, most patients had respiratory symptoms (64.0%), other fever (39.4%), gastrointestinal symptoms (35.3%), and pain (32.1%), and 19.2% were asymptomatic, similar to the proportion of mild patients admitted to the residential treatment center [20].

In this study, the average working days of nurses dedicated to COVID-19 were 21.32 working days per month, 8.60 closed days, 7.52 overtime working days per month, and 2.06 overtime hours per day. Hospital where the study was conducted, could not accommodate all patients with COVID-19 infectious diseases rapidly increasing during the first pandemic, increasing the number of patients waiting for hospitalization. Therefore, existing general ward patients were sequentially discharged or transferred, and a panel door was installed from the first removed ward to create a ward. Then a mobile negative pressure device was installed in each ward and corridor to switch to a negative pressure ward. In addition, hospital facilities were reorganized so that isolated patients with advanced diseases could be cohort quarantined in negative pressure rooms and isolated patients with mild diseases from single negative pressure rooms to multi-person rooms. Finally, except for artificial kidney rooms, hospice centers, and minimal outpatient clinics, the entire ward was removed sequentially. Excluding the minimum number of nursing personnel, all nurses, including general wards, emergency rooms, intensive care units, neonatal rooms, delivery rooms, operating rooms, psychiatric wards, health examination centers, and screening teams, participated in direct nursing COVID-19 patients. Nevertheless, it was difficult to handle the rapidly increasing number of patient care only with the own nursing staff, so it was changed from three to two shifts from February 19 to February 28, 2020. Since then, due to the influx of dispatched personnel, it has been changed to three shifts from March 1. In addition, as temporary negative pressure wards were newly established one by one, changes in the workplace, shift hours, overtime, and overtime occurred. This is the same result as a study showing that 25% of Canadian nurses worked overtime during the COVID-19 pandemic in April and May 2020, and overtime hours were 9.7 hours per week in April and 10.3 hours per week in May [21]. In addition, this is the same result as 109 nurses working at 10 COVID-19 hospitals in China prefer to work four hours, but the actual working hours have been extended to five hours [22]. The subsequent most time-consuming nursing work for patients with COV-ID-19 infectious diseases was nutrition nursing helping patients eat and administrating medication, and the most challenging nursing work was wearing PPE. This is the same result as a study [22] in which 109 nurses working at a hospital dedicated to COVID-19 reported a lot of time wearing PPE, pain, dehydration, sweating, and other inconveniences caused by wearing PPE as a study [14] reported that people experience a lot of discomforts when wearing PPE and nursing patients directly. Above all, one of the findings to be noted in this study was that 97.5% of nurses were worried about infection with COVID-19 infection. This is the same result as a study [23–25] that reported that medical personnel who select and treat patients at the forefront when a new infectious disease occurs, especially nurses, have a very high risk of infection because they contact patients closer and longer. However, the main reason for continuing working without resigning was a sense of professional mission and fellowship even in such a complex working environment. This is similar to the result that was shown at the proud to be a nurse in the experiences of 43 nurses caring for COVID-19 patients [17]. In other words, the more complex the working environment was, the more nurses helped and relied on each other. As a result, they provide the best nursing care to patients by strengthening the cohesion and solidarity of the group. These results indicate the urgent need to prepare practical and actionable policies to properly utilize and deploy nursing personnel in a medical disaster such as a new infectious disease.

Meanwhile, 77.1% of nurses evaluated the appropriateness of the government/local government/institutional support system for nurses dedicated to COVID-19 as ‘ inappropriate’, and the amount and timing of support for overtime and risk allowances were ‘ inappropriate’. This is the same result as a study [14] that reported that no financial compensation or professional benefits were made for nurses in hospitals dedicated to COVID-19. In addition, about 40% of nurses answered that they were directly put into nursing without receiving retraining on infection control and wearing PPE after the outbreak of COVID-19. In a study by Lee et al. [26], which reviewed the strengths and weaknesses of nursing in the post-COVID environment through literature reviews, one of the weaknesses was the lack of face-to-face education and training, so it is necessary to provide regular and systematic infection control education for nurses in the future. In addition, Danesh et al. [27] 13 consider 22 studies related to difficulties in nursing work due to COVID-19 and suggest that appropriate support from institutions and society helps overcome the problematic situation of nursing patients with new infectious diseases. Hence, policies need to be established to improve this.

Finally, the nursing professional pride of nurses at COVID-19 dedicated hospitals revealed in this study was 3.44 points, and the score of the sub-factor of ‘ problem solver’ was the highest. This is similar to 3.52 points in a study [18] that developed a nursing professional pride tool for 294 nurses working in general wards and special departments. In particular, the sub-factor of ‘ problem solver,’ which had the highest score, is related to the professional work of nurses, which means that various patient needs are smoothly addressed. In other words, the higher the pride of nurses, the better they play the role assigned to them within the organization, and have a positive effect on improving the quality of nursing care services [18]. These results are the same as a study [28] that reported that 15 nurses in charge of rescue work for COVID-19 patients in tertiary hospitals experienced increased professional pride and a study [17] that reported that ‘ I felt proud of my job as a nurse’ in interviewing 43 nurses’ experiences.

Despite these results, the limitations of this study are as follows. First, this study was conducted in one designated COVID-19 hospital, so there is a limitation in generalizing the results of this study. Second, from February 18 to May 18, 2020, they participated in nursing patients with COVID-19 infectious diseases, but 26 nurses who left at the data collection were excluded from the study. However, since the number of people excluded from the study subjects is small, the study results’ impact is considered insufficient.

Based on the results of this study, it is suggested that it is necessary to prepare a policy to ensure a stable working environment for nurses no matter what unexpected new infectious diseases occur in the future.

This study attempted to investigate the experiences and the pride of nursing professionals of nurses working at a designated COVID-19 hospital during the early stage of the COVID-19 pandemic and use this as primary data to improve treatment and professional awareness. This study is a descriptive survey of 157 nurses who participated in nursing COVID-19 patients at the designated COVID-19 hospital when the number of COVID-19 patients exploded from February 18 to May 18, 2020. As a result of the study, nurses, who had to handle many patients with insufficient nursing personnel, worked an average of 21.32 days a month while working in two and three shifts and worked 7.72 days overtime a month, but 77.1% of nurses estimated that government and local government support was not appropriate. However, a sense of professional mission and fellowship was the driving force behind working without leaving the hospital in a challenging working environment. In addition, most nurses evaluated that they improved their perception of nurses through COVID-19. Furthermore, according to this study, nurses who take care of infectious disease patients at the forefront of the epidemic did extended work and worked overtime because wearing PPE and managing infectious diseases accompanied the more nursing tasks. Therefore, policies should be prepared to utilize nurse personnel and establish a government and local government support system.