Objective: This study aims to the effect of role-play-based gamification on the analysis of symptoms in Internal Medicine Nursing, decision making, administration of appropriate nursing care, and the communication skills of nursing students. Methods: The study was designed in participatory action research as a qualitative design. In the action research, gamification elements were constructed on a role-play performance of the students in Nursing Department at a private university in Ankara-Türkiye. A gamification based on systems role play was performed for students taking the internal medicine nursing course (n=10). Checklists for each system regarding the selection and use of equipment appropriate for nursing interventions have been added to the games. At the end of the semester they were asked to evaluate this intervention via qualitative interview. In the in-depth interviews, data were collected by asking the students 9 unstructured open-ended questions prepared by the researchers. Data analysis was carried out by hand coding by the researchers. Codes were created from the research objectives based on Werbach's D6 Model for gamification design. Results: The qualitative analysis revealed six major themes (i) Defining Business Goals (ii) Delineating Target Behaviors (iii) Describing Players (iv) Devising Activity Loops (v) Deploying Tools (vi) Not forgetting the fun. In these themes, students stated that by using game elements in lessons, it became easier to remember and apply theoretical knowledge about internal medicine nursing, improved their practical skills, time management skills and critical decision-making abilities, and that they better understood the importance of effective communication within the team. Additionally, students stated that the experience of learning the basic aspects of internal diseases, which are difficult to learn in theory, became fun with the gamification technique. Conclusion: The use of gamification, students learned nursing care and communication skills related to Internal Medicine Nursing education in a motivated and more permanent manner.