Virtual reality (VR) describes a computer-generated, three-dimensional space in which participants — typically through the use of a headset and controllers — interact with a simulated environment. This emerging technology can serve as a beneficial tool in meeting competency-based nursing education standards, which call for competencies to be identified, observed, and measured (American Association of Colleges of Nursing, 2021). Assisting students in acquiring such competencies requires that they engage in active learning and guided practice. VR simulations have the potential to provide this engagement, as demonstrated in one recent systematic review, which found that the use of such simulations in nursing education led to improved competence, knowledge, and skill acquisition (Ropponen et al., 2025). Additionally, for nursing students, learning in VR is akin to learning in real life, helping them gain immediate and enduring outcomes (Liu et al., 2023). To integrate VR simulations into its curriculum and further evaluate the technology’s ability to meet these standards, Research College of Nursing (RCoN) utilized funding from the Nursing Education Incentive Program from the Missouri State Board of Nursing to purchase 30 Meta Quest headsets and a 3-year contract with UbiSim (https://www.ubisimvr.com/) by Labster. The Enterprise access included 42 UbiSim pre-made clinical nursing scenarios, an editor tool to make changes to existing scenarios, and faculty training and support.

Methods

A pilot study was performed at RCoN to explore student and faculty experiences with VR. Eight VR scenarios, including pneumonia/dehydration, heart failure exacerbation, unwitnessed fall, anemia requiring a blood transfusion, preterm labor, preeclampsia, suspected sepsis, and sickle cell crisis, were implemented and evaluated in three courses in the accelerated Bachelor of Science in Nursing track.

Investigator-created tools were used to assess faculty and staff experiences with VR at two data points. At the conclusion of each scenario, faculty and students evaluated their level of satisfaction on a scale of 1 (extremely dissatisfied) to 4 (extremely satisfied) with the VR equipment and learning scenario. These evaluations also indicated whether it was believed the experience improved students’ clinical reasoning and decision-making skills. A final evaluation was administered at the end of the students’ 1-year program. Students rated the perceived level of impact VR had on their critical thinking and decision-making, communication, and clinical performance skills using a scale of 1 (greatly reduced) to 5 (greatly improved).
Descriptive statistics were used to analyze satisfaction and perceived level of impact. Comparative analysis was used to identify patterns and commonalities among responses to open-ended questions.

Results

The study included 57 accelerated BSN students and nine faculty. On a scale of 1 to 4, average student satisfaction with the use of VR was 3.05; average faculty satisfaction was 3.09. Regarding the learning scenarios, average student satisfaction was 3.09; average faculty satisfaction was 3.45. It was reported that 85% of students and 97% of faculty found the experience improved students’ clinical reasoning and decision-making skills.

At the conclusion of their program, the students’ average perceived level of impact of VR on critical thinking and decision-making skills was 4.21, on a scale of 1 to 5. The average level of perceived impact on communication and clinical performance skills was 3.98 for each. Themes identified included practice and confidence; ability to perform skills that students cannot in traditional clinical; ability to provide care for patients not guaranteed in traditional clinical; technology issues; and negative side effects of VR.

Practice and Confidence

“I really enjoy this patient interaction because it allows for a realistic experience to practice, learn from mistakes, and adjust our skills in a simulated setting.”

Ability to Perform Skills

“I think blood transfusion is one of the skills/scenarios students do not have access to during their clinical rotation. Providing the student the opportunity to administer blood and recognize a blood transfusion reaction familiarizes them with the protocol, [while encouraging] problem solving, communication, and decision making.”

Ability to Provide Care

“It was helpful to experience interacting with a patient in a high-stakes scenario. I like that it was safe to make mistakes.”

Technology Issues

“VR helped me go through the steps of the nursing process and perform skills. There were some glitches that made things difficult, like the small boundaries and hand functions; however, with these fixed I think VR would be very beneficial.”

Negative Side Effects

“I felt dizzy and motion sick and like I was trying to figure out how to overcome this for most of the scenario and not focused on the medical side.”

Discussion

Students and faculty who participated in VR simulations were generally satisfied with both equipment and scenarios. The majority of students and faculty believed the experience improved students’ clinical reasoning and decision-making skills. After participating in eight VR scenarios, students reported an improvement in their critical-thinking and decision-making skills.

The ability to practice skills and care for a variety of patient conditions is a significant benefit of VR simulations. This, coupled with the reported positive impact on clinical decision-making, supports the conclusion that VR can be a viable instruction tool to engage prelicensure nursing students in active learning to achieve identified competencies.

Students who participated in the study suggested that VR be placed earlier in the curriculum, at a time when students have had less experience and feel less confident in their skills. This, combined with a better understanding of the technology’s undesirable side effects (nausea, disorientation, eye strain), can mitigate negative impacts to the experience.

Results of this study have been shared with RCoN’s curriculum committee as part of the development of a new competency-based curriculum. The results of the study suggest VR can be used to augment traditional clinical instruction, offering the ability to provide all students consistent guided practice with similar patients/conditions/skills, ultimately validating core nursing competencies.

References

American Association of Colleges of Nursing. (2021). The Essentials: Core competencies for professional nursing education. Accessible online at https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf

Liu, K., Zhang, W., Li, W., Wang, T., & Zheng, Y. (2023). Effectiveness of virtual reality in nursing education: a systematic review and meta-analysis. BMC Medical Education, 23(1), Article 710. https://doi.org/10.1186/s12909-023-04662-x

Ropponen, P., Tomietto, M., Pramila-Savukoski, S., Kuivila, H., Koskenranta, M., Liaw, S. Y., & Mikkonen, K. (2025). Impacts of VR simulation on nursing students’ competence, confidence, and satisfaction: A systematic review and meta-analysis of randomised controlled trials. Nurse Education
Today, 152, Article 106756. https://doi.org/10.1016/j.nedt.2025.106756y.