Objective To explore the application effect of case-based learning based on the 4F dynamic guided reflection method in the teaching of fundamental nursing in an on-site nursing education program. Methods The baccalaureate nursing students enrolled in 2023 were selected and randomized into a control group of 26 students studying in school, and an intervention group of 28 students in an on-site nursing education program. In the teaching of fundamental nursing, the control group adopted the traditional teaching mode, while the intervention group applied case-based learning based on the 4 F dynamic guided reflection method. After the teaching, the teaching satisfaction, theoretical knowledge and operational skills levels, and core ability of the two groups were compared. Results After teaching, the teaching satisfaction, theoretical knowledge scores, operational skills test scores, and core ability scores of the intervention group were significantly higher than those of the control group (all P<0.05). Conclusion Application of case-based learning based on the 4F dynamic guided reflection method is beneficial to improving students′ teaching satisfaction, enhancing their theoretical knowledge and operational skills levels, and cultivating their core abilities, which will promote their job adaptability and competence.