This study identified and evaluated risk factors for needlestick injuries (NSIs) among nursing students at a Colombian educational institution where NSIs were the most common accidents. Nursing students were observed during training in a simulated learning environment. Multiple visits were conducted to observe tasks, take photos, and record videos. Activities observed included syringe preparation, venipuncture, and needle disposal. Established protocols were reviewed and compared with observed practices to identify deviations and areas for improvement. A 19-question survey was administered to 48 nursing students to assess conditions and risk factors for NSIs during practical training. Several conditions and behaviors were identified that increase NSI risk, such as proximity between students handling uncapped needles and prolonged maintenance of uncapped needles. Needlestick recapping (91%) and time pressure (77%) were frequently perceived as risk factors during practice in real settings. Only 20% of participants indicated that fatigue influences NSI risk. Better adherence to established protocols should be ensured during training, and organizational improvements should be implemented. Time pressure should be avoided, and needle recapping should be monitored during field practice.