Outcomes-Based Education (OBE) in the Philippines has shifted perioperative training from numeric case quotas toward demonstrated competencies, with simulation increasingly used to address limited operating room (OR) exposure.

This study determined the level of perioperative clinical performance among senior (4th year) nursing students and had also examined associations with four influencing domains: teaching–learning, interpersonal, student-related, and environmental.

A descriptive–correlational study was conducted in AY 2023–2024 across higher education institutions in Eastern Visayas. A universal sample of 280 fourth-year BSN students who met minimum perioperative case requirements participated via online and paper surveys. Aresearcher-developed, expert-validated instrument that was anchored on CHED outcomes and PRC–BON guidelines was used to assess 11 competence domains in order to perceive influencing factors. Internal consistency was excellent (performance α = .987; factors α = .944). Descriptive statistics summarized competence; while Fisher’s Exact Test was used to assess associations (p < .05).

Competence was strongest in aseptic technique, patient safety, teamwork, documentation, and ethical–legal responsibilities. Lower ratings were noted for surgical skin preparation, anesthesia assistance, patient transport, medication safety, health education, and quality improvement. Among the four domains, only environmental factors (resources, workflow support, safety culture) were significantly associated with performance (Fisher’s Exact, p = .013).

Senior nursing students demonstrated strong technical and ethical perioperative competence but showed persistent gaps in less-frequent and higher-order competencies. Environmental supports in the OR decisively shaped performance. Programs should scale simulation for under-practiced tasks, strengthen mentorship, and explicitly integrate health education and quality improvement within perioperative training.