Background <p>Nursing education aims to cultivate highly competent nursing professionals, yet traditional teaching methods are insufficient to meet evolving clinical demands. While escape room teaching can help improve nursing students’ comprehensive abilities, research systematically examining students’ holistic perspectives on this educational approach remains scarce. This study aims to explore the experiences, perceived competency transformation, and optimization strategies of undergraduate nursing students in escape room teaching, thereby supporting the optimization and advancement of this instructional model.</p> Methods <p>A qualitative meta-synthesis was performed following PRISMA and ENTREQ guidelines. 11 databases were searched from inception to March 25, 2026, using keywords including “undergraduate nursing student”, “nursing education”, and “escape room”. From 3,236 initial records, 18 eligible studies were included after screening, and data were analyzed using thematic synthesis.</p> Results <p>Three core themes were identified: (1) contradictory experiences, combining immersive engagement and operational difficulties, exploratory motivation and performance anxiety, teamwork belonging and responsibility diffusion; (2) multidimensional competency transformation, including contextualized cognitive integration, task-driven skill internalization, and experiential development of professional literacy; (3) targeted optimization strategies, emphasizing authentic clinical scenarios, clear procedural guidance, personalized team allocation, and systematic assessment and feedback.</p> Conclusion <p>Escape room teaching represents an innovative, experience-rich approach in nursing education that cultivates students’ positive experiences and their perceived growth in cognition, practical skills and professional competence. At the same time, it also brings about mixed emotions and operational dilemmas. Enhancing scenario authenticity, procedural clarity, personalized support and systematic evaluation can better meet students’ subjective learning needs and further promote the innovation of nursing education.</p> Review Registration <p>This study was registered on the PROSPERO platform on November 11, 2025 (Registration number: CRD420251186004).</p> Clinical trial number <p>Not applicable.</p>