Background: Minimal evidence compares nursing student outcomes when replacing clinical hours with manikin-based highfidelity patient simulation (HFPS) or virtual simulation. Purpose: The study aims were to compare differences in outcomes: (1) between 2 intervention groups (HFPS or virtual simulation) when replacing 25% of pediatric/obstetrics clinical hours and (2) pass/fail for clinical practice between the intervention groups and a face-to-face clinical group (control). Methods: A quasi-experimental study was conducted to determine differences in knowledge between intervention groups participating in 6 pediatric/obstetrics simulation scenarios. Results: No differences in composite knowledge were found between simulation groups (P = .319). There also was no difference in clinical practice pass/fail among the groups. Conclusions: HFPS and virtual simulation were equally effective in achieving learning goals.