Leadership qualities often emerge in individuals who can remain calm, focused, and decisive in high-pressure situations (Torrence & Connelly, 2019). Individuals can inspire and guide others by staying composed and displaying practical decision-making skills when faced with uncertainty (Malkawi et al., 2021). Nurses and emergency responders are frequently called upon to lead and care for others due to their specific training (American Nurses Association [ANA], 2017; Belonick, 2023; Langan et al., 2017; Lose & Joseph, 2023). This study focuses on nursing and emergency medical technician (EMT) students' experiences while participating in a mass casualty incident simulation (MCIS).

MCISs are transformative experiential learning platforms for healthcare professionals (Dittmar et al., 2018; Endacott et al., 2015). Simulation provides a realistic and immersive environment for participants to practice their skills in managing a large-scale emergency and undergo a profound personal and professional transformation (Fernandez et al., 2019; Vuojarvi & Korva, 2020). Through simulation, opportunities arise for nurses to enhance critical thinking, decision-making, and communication skills in controlled situations that closely mimic real-life emergencies (Abdulmohdi & Mcvicar, 2022; Young et al., 2024). Simulation training can also allow less experienced students to develop teamwork and leadership skills, paving the way for their growth and development (Fernandez et al., 2019; Vuojarvi & Korva, 2020).

Training through simulated experiences can help develop leadership skills in healthcare. Ryan et al. (2019) demonstrated simulation significantly improves code blue response leadership skills. Bala-Kerr et al. (2023) reported simulation aids first responder nurses in developing essential skills such as teamwork, leadership, and delegation, which are crucial for managing high-pressure scenarios. Jeong and Lee (2023) highlight the importance of leadership, communication, and experience in enhancing triage skills through practice, underscoring the role of simulation in achieving triage competency. Al-Yatim et al. (2023) advocate for integrating nursing leadership skills into educational curricula to enhance workplace readiness.

Nursing students are often eager to assist in crises, yet they may lack sufficient training or psychological support to manage the emotional toll of such roles (ANA, 2017; Prashar et al., 2023). Ahmed et al. (2023) found a higher level of trust in leaders enhances the effectiveness of leadership in reducing burnout. Cobianchi et al. (2021) discussed challenges posed by extreme stress and time constraints in disasters, which can cause limited patient awareness. Therefore, emergency response training is vital to increase the capacity of nurses to respond to disasters. Ensuring trainings adhere to the standards established by the International Nursing Association for Clinical Simulation and Learning (INACSL) and the American Association of Colleges of Nursing (AACN) can ensure appropriate and rigorous training occurs. The authors argued for educational initiatives to enhance teamwork and non-technical skills to improve interdisciplinary relations. Research has supported integrating leadership opportunities into simulation-based training (Ahmed et al., 2023; Cobianchi et al., 2021; International Council of Nurses [ICN], 2019; Prashar et al., 2023). A literature gap was identified in research on interdisciplinary training and collaboration between nursing students and EMTs during MCIS. There is also a scarcity of qualitative research exploring participants' personal and shared experiences.