Purpose This study aimed to develop and evaluate a simulation-based autotransfusion device training program to enhance the clinical performance, performance confidence, and educational satisfaction of post-anesthesia care unit (PACU) nurses. Methods: A single-group pretestposttest study was conducted with 30 PACU nurses. The program, based on the ADDIE model, included orientation, simulation training, and debriefing. Data were collected using validated tools before and after the program and analyzed using the Wilcoxon signed-rank test. Results: Clinical performance improved from a median of 30.00 to 43.00 (Z =−4.78, p < .001). Performance confidence increased from 31.00 to 47.50 (Z =−4.71, p < .001), while educational satisfaction rose from 26.00 to 40.00 (Z =−4.73, p < .001). Conclusions: The simulation-based program effectively enhanced the clinical performance, performance confidence, and education satisfaction of PACU nurses. These findings underscore the value of simulation-based training for enhancing nurses’ competence in using complex, high-risk medical devices.