Background <p>Globally, there has been an increase in incidents of acting out in general hospital wards. Nurses’ competencies can play an important role in addressing this issue, while at the same time, the use of virtual reality simulation to support knowledge and skills development is rapidly developing in the healthcare field. The purpose of this study was to explore general hospital ward nurses’ perceptions about the use of virtual reality simulation to enhance their competencies in managing violent and threatening behaviours.</p> Methods <p>A qualitative interpretive study design through focus groups with twenty-five general hospital ward nurses who had participated in virtual reality simulation was conducted. A semi-structured interview guide facilitated the two focus group interviews. Data were analysed thematically using Braun and Clarke’s six-phase framework to understand and interpret the nurses’ perceptions regarding competency development.</p> Results <p>Three main themes emerged: (1) the development of competencies related to relational communication and risk assessment; (2) the value of virtual reality simulation as a complement to other educational methods for competency development; and (3) nurses’ perceptions of the barriers and facilitators associated with the use of virtual reality simulation for competency enhancement.</p> Conclusions <p>The results of this study support the use of virtual reality simulation to enhance competencies in managing violent and threatening behaviours, although it is important that virtual reality simulation supplement other pedagogical learning methods. Virtual reality simulation can be used to enhance the learning experience and prepare healthcare workers for their roles. A greater understanding of using virtual reality simulation in healthcare settings is needed to utilize this technology effectively for competency development.</p>