# Trends and Core Competence Shifts in Nurses’ Infectious Disease Emergency Response Competence Across COVID-19 Pandemic Phases: Repeated Cross-Sectional Survey and Network Analysis

## TL;DR

Nurses' skills in handling infectious disease emergencies declined during the pandemic, shifting from technical skills to decision-making and information handling.

## Contribution

Identified competence shifts in nurses using repeated surveys and network analysis across pandemic phases.

## Key findings

- Nurses' competence scores declined significantly from February 2020 to February 2023.
- Network analysis revealed a shift from technical skills to information integration and decision-making.
- Phase-specific training is recommended to address competence changes during prolonged outbreaks.

## Abstract

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

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

Using the Healthcare Workers’ Infectious Disease Emergency Response Competence Questionnaire, 3 repeated cross-sectional surveys were conducted in February 2020, August 2021, and February 2023. The participants were matched in a 1:1:1 ratio by their demographic characteristics via propensity scores. Temporal trends were analyzed using ANOVA, and competence structure transitions were examined via network analysis.

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 February 2020 and August 2021 (P=.01) and between February 2020 and February 2023 (P=.01), whereas the difference between August 2021 and February 2023 was not significant (P=.07).

Despite accumulated pandemic experience, nurses’ infectious disease response competence declined substantially, 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.