OBJECTIVE: This study aimed to investigate the efficacy of virtual reality in enhancing nursing students' knowledge, clinical skill performance, and self-confidence. DESIGN: A systematic review and meta-analysis. DATA SOURCES: Six databases-CINAHL, Cochrane Library, Embase, MEDLINE, PubMed, and Web of Science-were comprehensively searched for randomized controlled trials, published from database inception to May 3, 2024, which investigated virtual reality in nursing education. REVIEW METHODS: Version 2 of the Cochrane risk-of-bias tool for randomized trials was used to examine five domains of potential bias in the trials. Random effects models were applied in the meta-analysis and assessment of heterogeneity. RESULTS: Nine studies with a total of 660 nursing students were included in the final analysis. Virtual-reality teaching and learning appeared to improve students' knowledge (pooled standardized mean difference [SMD] = 0.24
95 % confidence interval [CI] = 0.01-0.46
p = 0.04) and self-confidence (pooled SMD = 0.40
95 % CI = 0.16-0.64
p <
0.002). Egger's regression test of each pooled result indicated that publication bias had only a minor influence on the pooled analysis. CONCLUSION: Virtual-reality learning was effective in increasing nursing students' knowledge and self-confidence in nursing learning. The incorporation of virtual reality into the teaching and learning process in nursing education is a promising strategy to enhance nursing students' competencies. Future research is necessary to improve virtual reality-based learning methods, as well as to determine their long-term implications for nursing education.