High fidelity simulation is known to improve problem solving and critical thinking skills as well as professional role acquisitions in nursing students. This descriptive study examined the perceptions of 186 culturally diverse baccalaureate nursing students enrolled in fundamentals of nursing and senior preceptorship courses about their experience in high fidelity simulation activities. Perceptions were examined in relation to the acquisition factors of nursing skills using the Simulation Evaluation Questionnaire and open-ended questions in two simulation labs at the end of each simulation session during academic years 2008-2011. The results indicated that the majority of students agreed or strongly agreed that the simulation experiences helped them prepare for clinical practice. Ninety five percent of the students reported that they were able to reflect on their own simulation experience; and 82% agreed or strongly agreed that they were able to problem solve and critically think while they participated in simulation activities. With the clearly defined scenario objectives, there were better ratings of problem solving and critical thinking of students during the simulation activity (r = 0.61, p < 0.002). Those who had the chance to problem solve and critically think were able to communicate more openly about simulation experiences during debriefing (r = 0.704, p = 000). The most important nursing techniques that they learned from simulation experiences included skills on how to assess patients’ baseline data,communicate with patients/families using interpersonal communications, mediate a person’s frustration efficiently while sticking to the goals, and deal with social aspects of care. Students reported that they least liked about simulations as they felt they were pressed and put on the spot and having to act in front of the class. Suggestions included sufficient scenario activity time and hands-on experiences for the future. Findings suggest that the students valued the high fidelity simulation as an effective medium for improving their clinical skill acquisitions.