AimThis study aimed to examine if a cooperative intervention improved outcomes for a simulation-based paediatric nursing course. BackgroundFostering cooperative learning can enhance student engagement and improve learning. Simulation-based courses provide nursing students an opportunity to practice and hone nursing skills when hands-on experiences are limited. Providing instruction in cooperative learning could improve course outcomes. DesignA quasi-experimental study with pre-test/post-test assessments. MethodsThird-year nursing students enrolled in an 18-week paediatric simulation-based nursing course were purposively recruited (N = 110). One class (n = 55) received a researcher-developed cooperative learning program, which encouraged student support during class activities and simulations. The second class (control) received usual class instruction and simulations. The efficacy of the intervention was assessed by comparing mean scores at class enrolment (pre-test) and completion (post-test) for self-perceived problem-solving attitude, cooperative learning experience and knowledge of paediatric nursing. Paired t-tests compared pre-test with post-test scores for the two groups. ANCOVA examined differences in mean scores between groups. Correlations between differences in mean pre-test and post-test subscale scores for problem-solving attitude and cooperative learning experience were also examined. ResultsThere was no significant difference in age or gender between groups. Mean post-test scores on the final exam were significantly higher for students who received the intervention (85.26, 95 % CI 84.19, 86.33) compared with controls (83.61, 95 % CI 82.52, 84.69; F = 4.63, p = 0.034). There were no significant differences in total scores for problem-solving attitude or cooperative learning experience or between groups. For the intervention group, two problem solving subscales were correlated with two cooperative learning subscales: problem solving confidence with learning motivation, respectively (r = 0.302, p = 0.025) and personal control with classroom learning, respectively (r = 0.389, p = 0.003). For the control group, approach-avoidance problem solving was negatively correlated with cooperative learning efficacy (r = −0.343, p = 0.01). ConclusionsCompared with the control group, nursing students who received the cooperative learning intervention had higher scores for knowledge of paediatric nursing, as well as learning motivation and attitude and problem-solving confidence, suggesting that the researcher-designed intervention facilitated simulation-based learning as well as confidence in problem-solving. Nurse educators could easily integrate the intervention into simulation-based paediatric nursing courses to enhance students' problem-solving abilities.