The World Health Organization (WHO) declared a pandemic in 2020, owing to the rapid spread of coronavirus disease 2019 (COVID-19) [1]. As of April 3, 2022, the number of confirmed cases of COVID-19 worldwide was 490,210,251 and the death toll was 6,176,426, and in South Korea, the number of confirmed cases was 13,874,216, while the number of deaths was 17,235 [2].

With the persistence of the COVID-19 pandemic for a prolonged period, a surge has occurred in the number of infections among healthcare workers (HCWs) caring for COVID-19 patients. More than 230,000 medical personnel have been infected with COVID-19 worldwide, and more than 600 nurses have succumbed to this disease [3]. In South Korea, 415 nurses were infected as of December 31, 2021, which accounted for 73.5% of all infected HCWs [4]. Nurses are directly or indirectly exposed to COVID-19 while doing their best to prevent the transmission and spread of this disease [5].

The COVID-19 pandemic has also affected nursing education, and nursing students are more likely to be exposed to various infectious diseases, including COVID-19, during clinical practice in hospitals. This situation may lead to inaccurate knowledge and foster negative attitudes and vague fears about COVID-19 among nursing students, which can further lead to prejudice or negative views about patients with infectious diseases, resulting in negligent patient care [6-9]. Nursing students are pre-medical workers and key health personnel who can prevent the onset of new communicable diseases in the future and provide nursing care to patients with infections, which may necessitate close contact between patients and nurses [10]. Thus, nursing students’ knowledge, attitude, and fear of COVID-19 require meticulous attention.

Career identity is a clear and stable possession of one's own goals, interests, and abilities related to a career with confidence in one's career path. The concept of career identity refers to the sense of self-identity in a vocational field, where students are certain of the job they will perform in the future, which influences career selection [11]. Career identity is formed during the process of collecting and weighing job-related information [12]. Nursing students have fewer worries about their careers than students in other majors, due to the high employment rate; however, they have less confidence due to low levels of career preparedness and career identity as their career paths are mostly predetermined by their course selection [13].

Job satisfaction decreases and turnover intention increases when nursing students have low confidence in their careers [14]. Career identity is related to the negative experiences of nursing students during actual clinical practice, knowledge and attitudes toward infectious diseases, and psychological factors [15]. Therefore, it is necessary to elucidate the factors affecting the career identity of nursing students whose period of study and practice coincided with the persistent COVID-19 pandemic.

This study was conducted to identify the knowledge, attitude, and fear about COVID-19 among nursing students and their influence on career identity. We anticipate that our findings can be used for the development of educational programs to form and inspire the career identity of nursing students in the face of new infectious diseases that may occur after COVID-19.

This study aimed to investigate the effects of nursing students’ knowledge, attitude, and fear about COVID-19 on their career identity. We anticipate that our findings will enable nursing students to form an appropriate career identity even in the milieu of new infectious diseases that may emerge after COVID-19.

In this study, nursing students’ knowledge score about COVID-19 was 13.32 (maximum score: 23), and the average rate of correct responses was 57.9%. This is similar to the score reported in a previous study (20.22/36) [23] that measured the knowledge of nursing students using a similar tool, and the rate of correct responses was also similar to that of another study (56.5%) on nurses [24].

The item-wise examination of the knowledge of COVID-19 revealed that nursing students possessed excellent general knowledge of the disease, including regarding symptoms, latency period, and COVID-19 infection routes, as well as knowledge related to isolation practices, including “contact,” “active monitoring,” and “confirmed person.” This is because basic information related to COVID-19 is easily acquired through the media, and knowledge has increased during more than 2-year period of living with the new infectious disease.

However, nursing students scored low on professional knowledge, including regarding the types and methods of sample collection for confirming COVID-19, and proper donning and disposal of personal protective equipment. Previous studies [16, 19] show that anyone can obtain universal information from government-led campaigns and publicity, although professional education on COVID-19 is inadequate. Nursing students who are charged with the direct care of patients in hospitals should not simply acquire superficial knowledge through the media but should develop professional knowledge through an in-depth study of infectious diseases since they are pre-medical personnel.

In this study, the average score for nursing students’ attitudes toward COVID-19 was 3.54/5. A similar study conducted among nursing students reported attitude scores of 17.23/32 [21]. However, other studies conducted on nurses using the same tool reported attitude scores of 4.33 [18] and 4.14 points, respectively [25]. This result is reflective of the frequent hospital education received by nurses in line with the diverse epidemiological information provided by the government, acquisition of the latest information, and actual provision of COVID-19-related care.

Meanwhile, nursing students had limited real-world clinical practice due to COVID-19 restrictions, or they underwent actual clinical practice at school rather than in hospitals. Infection-control education programs for nursing students organized by schools are limited, and it is difficult for these institutions to provide detailed information on the way real-world medical institutions deal with new infectious diseases. Active cooperation is needed, such as the launch of a consortium of schools and hospitals, to ensure that nursing students respond appropriately when faced with unfamiliar situations in clinical settings and maintain a positive outlook toward their profession. We also think that periodic student and faculty training and government support will be required.

Nursing students’ fear of COVID-19 scored 3.27/5. These results are difficult to compare and discuss due to the lack of previous studies focusing on nursing students’ fear of COVID-19. However, the results are similar to those of Alici and Copur [26], who showed that the fear of third- and fourth-grade nursing students who experienced hospital practice was higher than that of first and second-year students. The participants of the current study included third and fourth-year nursing students with actual clinical experience with COVID-19. The explosive increase in COVID-19 patients and the threat of infection that could occur during practice have created fear among students.

The fear of COVID-19 is induced by various emotional factors, such as the emergence of new diseases and uncertainty about possible aggravation, which fosters fear, preventing nursing students from focusing on their daily life and actual work [27]. Therefore, a way to relieve this fear of COVID-19 should be devised. To reduce the fear of nursing students who feel the threat of infection during clinical practice, robust, appropriate infection control education such as regarding wearing personal protective equipment and hygiene management is crucial. Furthermore, these should be buttressed by practical and emotional support from schools and hospitals to foster a safe clinical environment.

Factors influencing nursing students’ career identity included job satisfaction and knowledge, attitude, and fear of COVID-19. Fear related to COVID-19 was the strongest influencing factor. Comparison is difficult because no previous study investigated the relationship between fear of COVID-19 and nursing students’ career identity. However, Lee and Song [28] investigated nurses’ experience of caring for patients with COVID-19. Although nurses have myriad fears, they reported that they have the courage and hope that they can perform their duties responsibly because they are nurses, mature even in crises, such as a battlefield, and can provide holistic care in any environment.

As such, the heightened fear experienced by nursing students made them feel anxious at first but is thought to stimulate subsequent changes. In particular, while witnessing the professionalism and responsibility of actual medical personnel through clinical practice, this fear-induced a sense of crisis regarding the current situation among nursing students, thus, awakening their sense of duty and vocation. At the same time, they developed confidence that they could accomplish the job themselves, which is believed to boost their career identity.

Therefore, ameliorating nursing students’ fear requires not only lectures that purvey specialized knowledge, but also education that clearly establishes values and beliefs about nursing (using approaches that utilize role demonstration, group discussion, and fear expression) [29]. Practical education that includes vivid experience of either nurses, medical staff, or patients, may make it possible to effectively eliminate the fear of COVID-19 and enhance career identity.

This study is meaningful because it confirmed COVID-19-related factors as influential factors on nursing students’ career identity. Since this study was conducted for nursing students in one city, the generalizability and application of its results are limited. Moreover, it is difficult to produce generalized results related to the knowledge and attitude about COVID-19, because of the diverse tools used in previous studies. Thus, there exist limitations in the comparison and discussion of the research results. The above-mentioned shortcomings can be overcome by the development of standardized tools to measure knowledge and attitude related to COVID-19. Then also various factors influencing the career identity of nursing students should be identified via successive studies in the future.

Nurses who recognized that they were prepared for a disaster situation such as COVID-19, and who had experience caring for COVID-19 patients, showed high competency in disaster nursing [30]. This is related to the improvement of empirical knowledge while experiencing the COVID-19 pandemic, and the formation of a positive attitude that one can do it. This inner growth can reduce ethical conflicts or dilemmas that nurses experience in sudden disaster situations, helping them to actively cope [30, 31].

But it is realistically limited for nursing students to directly experience a disaster situation such as COVID-19. This can be supplemented by evidence-based educational programs, simulations, or simulated training programs that provide possible hypothetical situations [31]. Education applying augmented reality and virtual reality is a technology that reflects the real world in which we currently live, and can give a sense of reality as if a real situation occurred. This is suggested as a way to make students strongly feel the need for education and to enhance students competence in the future [32]. It is necessary to develop a realistic educational program through multidisciplinary collaboration and linkage between schools and hospitals.

This study confirmed that nursing students’ fear, knowledge, and attitude about COVID-19 and satisfaction with the practice influence career identity. Career guidance programs are necessary to help transform nursing students’ fear of COVID-19 into a beneficial entity, intending to enhance their career identity. Moreover, it is necessary to develop educational interventions that can be implemented during clinical practice to cultivate practically relevant knowledge that is useful in crisis-like situations. These measures will improve nursing students’ practice satisfaction and lead to a change in attitude toward infectious diseases. In addition to active national-level efforts and institutional arrangements, practical education based on multidisciplinary cooperation and feedback between schools and hospitals are of paramount importance to enable a nursing student to form a desirable career identity as a future nurse.