“…Positive student learning outcomes associated with simulation include enhanced knowledge acquisition, critical thinking, psychomotor skills, and confidence, which translate into higher quality health care and greater patient safety (Kameg, Howard, Clochesy, Mitchell, & Suresky, 2010;Ortega, Gonzalez, De Tantillo, & Gattamorta, 2018). Given these benefits and the comparative effectiveness of simulation relative to clinical experience, the United States National Guidelines for Pre-Licensure Nursing Programs allow for the substitution of ''high-quality simulation'' for up to half of traditional clinical hours (Beddingfield, Davis, Gilmore, & Jenkins, 2011;Gore, Leighton, Sanderson, & Wang, 2014; (Hayden et al, 2014b); Hayden, Smiley, & Gross, 2014). However, it is important to note that this clinical replacement recommendation is only valid when ''high-quality simulations'' are administered.…”