Background: Performance anxiety is a significant challenge for anesthesia nursing students transitioning to clinical practice, potentially compromising patient safety and professional development. Virtual reality (VR)-based simulation offers immersive, repeatable practice opportunities in a safe environment.

Objective: This randomized controlled trial evaluated the effectiveness of VR-based simulation training compared to traditional simulation methods in reducing performance anxiety and enhancing clinical preparedness among anesthesia nursing students.

Methods: A total of 60 second-year anesthesia nursing students were randomly assigned to either an immersive VR simulation group (n=30) or a traditional task-trainer simulation group (n=30). Outcomes were measured at baseline, immediately post-intervention, and at two-week follow-up using the State-Trait Anxiety Inventory (STAI-S), a clinical performance checklist, and a self-efficacy scale.

Results: The VR group demonstrated significantly greater reductions in state anxiety (mean difference: -8.4, p<0.001) and higher self-efficacy scores (p<0.001) compared to the control group. Clinical performance scores improved significantly in both groups, with the VR group showing superior non-technical skills including crisis management and communication (p=0.003).

Conclusion: VR-based simulation training effectively reduces performance anxiety and improves clinical preparedness in anesthesia nursing students, offering a scalable and accessible educational modality for healthcare training programs.