Nursing care delivery systems vary depending on the national policies, socioeconomic environment, and health care systems in each country. The difference in hospital culture between South Korea and countries such as the United States, United Kingdom, Germany, and France is that the latter strictly restrict hospital visiting times by family members and caregivers, which are firmly established by the nurse-centered nursing system. In general, both formal and informal patient caregivers in low-income and certain other countries are intimately involved in patient care and often live on the hospital grounds [
1]. In addition to South Korea, many Asian countries, including China and Taiwan, and some African countries allow caregivers such as family members to reside in hospital rooms to support the daily tasks of patient care [
2]. South Korea has maintained this patient–individual caregiver nursing system for the past 70 years. It is a system in which caregivers (typically family members) live in the hospital during the hospitalization period, enabling a small number of nurses to care for a larger number of hospitalized patients, as compared to Western countries. However, the form of patient care in hospitals has changed from care by family members to care by paid caregivers [
3]. Approximately 40% of inpatients in Korea are now cared for by paid caregivers who are employed directly by the patients [
4]. The cost of hiring such caregivers has increased indirect medical expenses and placed an economic burden on patients [
5]. Thus, with the aim of solving these problems, since May 2010, the Korean government has invested KRW 2.4 billion from the government budget and KRW 2 billion from the budget of the health insurance corporation to conduct a pilot project in 10 hospitals. In July 2013, 13 medical institutions implemented the first pilot project, which required hospitals to disallow individual caregivers [
6]. In February 2014, the project began its second phase and includes 20 more public hospitals; the name of the project was also changed to the “comprehensive nursing service.” In the comprehensive nursing service project, all inpatient nursing services are provided by assigning appropriate nursing personnel to patients, without any individual caregivers. The number of beds covered by the comprehensive nursing and caregiving service doubled from 7000 in 2015 to 15,000 in 2016; then, as it extended its nationwide reach, the service reached 23,000 beds in 2017. In 2019, the government further expanded the number of comprehensive nursing service hospitals, which now include not only national and public hospitals but also private ones. However, it is true that in the early days of the government-led initiative, before the nationwide expansion, there were several concerns about this policy. For example, a typical concern was whether a nurse could care sufficiently for a patient in the absence of a caregiver, either formal or informal, with regard to patient safety and treatment outcomes [
7]. Assessment of the new nursing care delivery system can be classified into two categories: the impact of the policy on the user’s side and that on the supplier’s side. Patient satisfaction with the new system is a concern of the users, whereas nurse performance, job satisfaction, and turnover intention are concerns of the suppliers [
8]. It is noteworthy that this new nursing care delivery system would change the scope of practice of the nursing profession. For example, nurses directly assist and care for patients in all activities of daily living. Nurses who provide comprehensive nursing services feel that the scope of their work and role is not well delineated or clear; hence, they experience “role conflict” due to their simultaneous rendering of caregiver services, and feel burdened by excessive work [
9]. Low job satisfaction makes it difficult for nurses to perform their tasks efficiently and positively, and leads to poor quality of patient care and an increased nurses’ turnover rate [
10]. The problem of job satisfaction among nurses who provide comprehensive nursing services can obstruct the steady expansion and institutionalization of comprehensive nursing service hospitals by making the supply of nurses scarce and their management difficult.
Based on the above, this study aimed to identify and evaluate the effectiveness of the comprehensive nursing service. The study hypothesized that there is no difference in the indicators of nurses and patients between the comprehensive nursing service ward and the non-comprehensive nursing service ward. Specifically, it attempted to evaluate nursing outcomes such as nursing performance, job satisfaction, and turnover intention, and the patient outcome, patient satisfaction (
Figure 1). Evaluation of the comprehensive nursing service would enable countries implementing this policy to verify the efficacy of nursing services through trial and error in other countries like South Korea. Evaluation would also help to confirm the strengths and weaknesses of the system for countries that have not yet implemented it.