arXiv:2610.19152v1 Announce Type: new Abstract: This paper presents the iterative design and evaluation of a virtual reality (VR) nursing training system developed in collaboration with nursing education specialists to enhance procedural skill acquisition, clinical decision-making, and critical thinking among pre-licensure nursing students. Two clinical scenarios, chest pain and oxygen therapy, were created to simulate acute care settings, with design refinements informed by an expert evaluation study (n=8) and further assessed through an effectiveness study involving nursing students (n=17). Results demonstrate high user acceptance, perceived usefulness, and significant post-simulation increases in learner confidence. The VR system was found to be an accessible supplemental training tool that can foster self-directed learning. Finally, we present design recommendations for developing VR simulations for nursing education, emphasizing collaboration with domain experts, accommodating diverse learning goals, and simulating complex clinical workflows.