Purpose: This study is to assess the level of student perceptions, academic achievement, satisfaction, and their relationships in a medical-surgical nursing course using team-based learning (TBL). Method: Four-hour TBL sessions were given in a structured three-phase sequence in a cohort of 261 second year nursing students. Results: Mean perceptions of TBL was 6.64±5.11, and 8.30±4.11 for perceptions of teamwork. On a 7-point scale, the mean satisfaction score was 4.85±1.41, and 64.0% of nursing students were satisfied with TBL compared to lecture. Group readiness assurance test score was significantly higher than individual readiness assurance test score (t=-16.76, p<.001). Perceptions of TBL (F=1.40, p=.245), perceptions of team work (F=1.55, p=.202) and satisfaction (F=0.81, p=.489) was not different by the level of students’ academic achievement on items related TBL. Conclusion: Results indicates that TBL was an effective instructional strategy including favorable perceptions and satisfaction for nursing students. TBL could be an adjunct educational strategy for undergraduate nursing education.