Background:  Newly graduated nurses often face complex acute care situations where structured support and simulation-based training can be valuable for building competence and confidence.

Aim: To examine the effect of structured simulation-based education on nurses' acute care competencies.

Method: A multiple-group pre- and post-test design was used with self-reported data collected through the PCAS scale from 12 simulation sessions at a regional hospital in Sweden. Forty-six of 57 participating nurses consented. Participants completed surveys before and after high-fidelity, interprofessional simulation based on the ProACT framework.

Results: The Wilcoxon signed-rank test and the paired samples t-test analyses showed significant improvements in overall care abilities (P < .001), with large effect sizes (Cohen's d) for total score (-1.21) and confidence (-1.38) and medium effects for communication (-0.56) and patient perspective (-0.36).

Conclusion: Structured simulation-based education may enhance acute care competencies in newly graduated nurses.