Several patient safety organizations have acknowledged that interruptions may be a contributing factor in medical error. Studies examining individual cognitive reactions to interruptions are lacking, which hinders the development of effective interventions to reduce interruptions. A mixed-methods study was conducted including observations (n = 15), participation in high-fidelity simulations (n = 30), and debriefing interviews with participants after completion of the simulation exercise. Experienced nurses more frequently violated policy in terms of allowing interrupting events to continue during time-out procedures (p < .003). Results from debriefing interviews indicated that participants used two cognitive strategies to manage distractions and interruptions. This study showed that there were frequent distractions and interruptions during critical tasks in the operating room. It also supports the use of high-fidelity simulation as a tool to examine circulating nurses' decision-making in management of distractions. •We found a high frequency of distractions/interruptions during the induction period.•Simulation scenario can be used as a tool to explore cognitive process.•The majority of participants were prioritizing and were concerned about patient safety.