Objective To explore the effect of project-based learning on the training of sharp injury prevention skills in the pre-job training for nursing interns and its impact on the incidence of sharp injuries during internship. Methods Two classes (class A and B), majoring in nursing at Medical College of Nanchang Institute of Technology in March 2023 were selected as the research subjects by convenience sampling method. Coin flipping method was used to designate class A as the routine group and class B as the intervention group. The routine group received routine pre-job training which mainly focused on retrospective intensive training on nursing operation skills. On this basis, the intervention group integrated project-based learning as compensation education on sharp injury prevention skills. Kirkpatrick’s four level training evaluation model was adopted to comprehensively evaluate the educational effectiveness at the four progressive levels of "reaction, learning, behavior, and outcome" at corresponding stages. Results 56 nursing interns were included in the class A routine group and class B intervention group, respectively. The course evaluation score (128.67±4.39 vs 117.28±6.55), needlestick protection knowledge cognition score (109.11±4.38 vs 96.44±6.72), safe injection behavior score (38.45±4.91 vs 32.30±5.62), occupational identity score (58.02±8.55 vs 51.77±15.86), and job competency score (82.59±13.35 vs 75.61±15.09) of nursing interns in the intervention group were all higher than those in the routine group, differences were all statistically significant (all P<0.05). The incidence of sharp injuries (19.64% vs 57.14%) and the average frequency of occu-rrence (1.45 vs 2.13) in nursing interns in the intervention group were both lower than those in the control group. The case intervention rate (87.50% vs 45.59%) and case reporting rate (93.75% vs 32.35%) after sharp injury were both higher than those in the routine group, and the differences were both statistically significant (both P<0.05). Conclusion Introducing project-based learning in pre-job training for nursing interns can effectively improve their mastery of protection skills, reduce the incidence of sharp injuries during internships, and have important practical value in cultivating their occupational protection abilities.