This study compared the academic performance of nursing students under annual and semester examination systems using a descriptive comparative design. Data was collected from a selected nursing college in Bangalore through structured questionnaires administered to teachers and also from students’ academic records. The study focused on learning outcomes, adaptability, and examination-related stress. Results indicated that students in the semester system scored on average 5% higher than those in the annual system, demonstrated better retention, and adapted more effectively to continuous assessments. In contrast, students in the annual system reported greater preparation flexibility but experienced higher exam-related stress and fewer opportunities for ongoing evaluation. Furthermore, 60% of teachers agreed that the semester system enhanced assessment and feedback practices. The findings highlight that while the semester system fosters consistent learning and skill development, the annual system provides broader preparation time. The study concludes that integrating the strengths of both systems through a blended evaluation approach may optimize nursing education and improve academic performance among students.