AIM: This study examined the effects of an immersive virtual reality (IVR) blood transfusion nursing simulation on the skill performance, confidence and satisfaction among Korean undergraduate nursing students. BACKGROUND: Blood transfusion nursing is a critical skill that has a significant impact on patient safety, as errors in transfusion can lead to fatal complications and even death. To enhance patient safety in complex clinical settings, it is essential to implement educational methods that ensure a thorough understanding of accurate transfusion procedures. DESIGN: A quasi-experimental study was conducted. METHODS: The study included 37 fourth-year nursing students in the experimental group and 45 in the control group. Pre- and post-assessments were conducted to evaluate blood transfusion nursing skill performance, learning satisfaction and confidence. The experimental group participated in immersive 3D VR training, while the control group watched a video lecture. Statistical analysis was performed using SPSS 26.0 and an independent t-test was used to compare the effects between the two groups. RESULTS: Significant difference between the groups in skill performance (t = 2.104, p = .039) and satisfaction (t = -3.015, p = .004). However, no significant difference was observed in confidence (t = .667, p = .507). CONCLUSION: The IVR blood transfusion nursing simulation was shown to be an effective educational method for improving skill performance and achieving high satisfaction among nursing students. The IVR method is recommended as an alternative to traditional clinical practice, as it allows for repeated learning without the constraints of time and space in limited clinical practice environments.