This study applied Transmodal Analysis (TMA), a newly developed quantitative ethnographic approach, to examine whether and how virtual patient simulations can aid in educating undergraduate nursing students with competencies that exemplify practice-ready nurses. Across three scenarios (mental health, gerontology, community health), similar patterns of engagement were observed for both students as they completed learning activities such as collecting patient data and establishing a caring relationship. These activities—guided by the instructional design of DCE—indicated how students practiced recognizing and analyzing cues, subjective assessment, diagnosing and prioritizing hypotheses, generating solutions, evaluating outcomes, therapeutic communication, and care coordination and management in relation to each patient’s needs and conditions. A statistical difference was observed between competencies practiced while completing focused exam (mental health, gerontology) and contact tracing (community health) assignments. This study provides evidence for using simulations to facilitate competency-based education in nursing. Additionally, it provides motivation for using Transmodal Analysis combined with Ordered Network Analysis (T/ONA) to advance quantitative ethnography research in health care and health professions education.