BACKGROUND:Virtual gaming simulation (VGS) is increasingly used in nursing education; however, limited research has examined the effect of enhanced gaming elements on student outcomes. METHOD:A randomized controlled experimental design with pre- and posttests was used to evaluate VGS enhanced with storylines, sound effects, and progress bars. Undergraduate nursing students were randomly assigned to either an enhanced VGS group or a traditional branching VGS group. Outcomes included knowledge retention, enjoyment, satisfaction, and self-confidence. RESULTS:Students in the enhanced VGS group demonstrated significantly greater improvement in knowledge scores and significantly higher satisfaction and self-confidence scores compared with the control group. No significant differences were found in overall enjoyment scores; however, the enhanced group reported significantly higher Challenge/Improvement subscale scores. CONCLUSION:Enhanced gaming elements within VGS may improve knowledge retention, satisfaction, and confidence in undergraduate nursing students while promoting a more challenging and engaging learning experience.