For decades, simulation has been quietly positioned on the periphery of nursing education, most often viewed as a useful tool for bridging gaps in clinical placement hours. But this framing limits its potential. What if we stopped treating simulation as a clinical substitute and started seeing it for what it truly is: a transformative, evidence-based instructional approach that can enhance learning far earlier, and far more broadly, than its current use suggests?

As a nurse educator and simulation specialist, I’ve seen the endless benefits that simulation can offer nursing students. From critical thinking and prioritization, to teamwork and time management, simulation has the power to grow students’ skills exponentially—before they ever see a real patient! With a little dedication and creativity, I believe simulated scenarios can be applied to every course within the nursing school curriculum, providing students with immersive experiences that mimic the real-life situations they will encounter as professional nurses.

Simulation is not a backup plan. It is not the “next best thing” when clinical sites are scarce. It is an intentional, dynamic learning environment with unique strengths. By repositioning simulation as a core learning strategy from the very start of nursing education, we can shift its impact from a clinical replacement to a foundational builder of confidence, critical thinking, and professionalism.

Why Simulation Is More Than a Clinical Substitute

Many nursing programs have embraced simulation to meet clinical hour requirements and regulatory expectations. While valuable, this perspective is also limiting. When simulation is viewed only as a substitute, its implementation tends to mirror clinical experiences rather than maximize its unique pedagogical strengths. The focus becomes replication rather than innovation.

Simulation offers something traditional clinical settings cannot: structured, safe, and repeatable learning opportunities. In real-world clinical environments, student learning often depends on whatever patient situations arise on a given day or the willingness of nursing staff to include students in their tasks. In contrast, simulation allows faculty to design experiences that align precisely with learning outcomes, ensuring that every student encounters critical concepts and scenarios.

Moreover, simulation can be paused, replayed, and debriefed in ways that clinical settings can’t. This creates space for deliberate practice, reflective discussion, and targeted feedback—key elements for developing both competence and confidence. When we recognize simulation as pedagogy, not just a workaround, we free ourselves to leverage these strengths more fully and creatively.

How Early Simulation Reduces Student Anxiety and Stigma

Most nursing programs introduce high-fidelity simulation after students have already entered clinical rotations. By that point, many learners have internalized an unspoken hierarchy: “real clinicals” are the gold standard, and simulation is a second-best approximation. This can create a stigma around simulation that undermines its educational value. At the same time, early clinical encounters often provoke intense anxiety for students who feel unprepared to translate theoretical knowledge into patient care.

In a recent UbiSim/Healthy Simulation webinar, Dr. Sheri Howard, PhD, RN, CHSE, discusses how fear of the unknown deeply contributes to student anxiety.

“A lot of it is fear of the unknown because they have no idea what to expect. We’re all scared of things that we’ve never done. We’re all scared of things that we don’t know about. And most of the time, the only way to overcome that fear is to do it.”

Introducing simulation early in the curriculum—before the first clinical placement—can help gradually ease these feelings of fear and unease.

“Sometimes people will say, ‘You need to stay in your lane. Simulation is for clinical, simulation is for practicum. It doesn’t belong in the classroom.’ But why not?” Dr. Howard asks.

Early exposure allows students to:

• Build psychological safety before they ever enter a clinical setting. Practicing assessment, communication, and procedural skills in a simulated environment lets students confront uncertainty and error without fear of harming a real patient.
• Normalize simulation as part of professional learning, not just as a remedial or alternative activity.
• Experience the full learning arc of preparation, action, reflection early on, so they can approach their first clinical experiences with greater confidence and a growth mindset.

Dr. Howard also discusses her recent research: “Using Virtual Reality in Mental Health Nursing to Improve Behavioral Health Equity,” which showed VR simulation before clinical exposure reduced student stigma toward mental health patients by 32%, proving that timing and context matter in simulation-based learning.

In many ways, simulation is the ideal bridge between theory and practice. When students rehearse clinical reasoning and patient interaction in a low-stakes environment, their first encounters with real patients become opportunities for refinement, not baptism by fire.

Integrating Simulation into Classroom Teaching

One of the most underutilized aspects of simulation is its potential to transform classroom learning. Too often, we silo simulation in the lab, reserving it for hands-on skills training or end-of-course check-offs. But what if simulation lived alongside lectures, discussions, and case studies?

Imagine:

• Interactive classroom scenarios where students engage with a simulated patient via virtual reality or standardized patient while applying theoretical concepts from pharmacology, pathophysiology, or leadership courses.
• In-situ simulations embedded within non-clinical courses to bring abstract concepts to life and foster critical thinking.
• Progressive, integrated simulation threads that build complexity over time, linking classroom concepts to practical decision-making and professional behaviors.

These approaches can help students connect the dots between what they learn in theory and how they act in practice. When simulation is woven into the fabric of the curriculum, not just clustered around clinical preparation, it reinforces learning through active engagement and experiential problem-solving.

5 Key Benefits of Simulation-Based Nursing Education

Repositioning simulation as pedagogy rather than clinical substitution also aligns with modern learning science. Simulation uniquely supports:

1. Experiential learning: Students learn through doing, reflecting, and applying knowledge in context.
2. Deliberate practice: Learners can repeat skills, receive feedback, and refine performance in ways that clinical environments rarely allow.
3. Metacognition: Structured debriefing helps students identify knowledge gaps and build critical thinking skills.
4. Psychological safety: Simulation can be designed to foster safe risk-taking, mistake-making, and resilience-building.
5. Equity in learning: Every student encounters the same scenario, ensuring consistent exposure to key concepts and competencies.

These advantages make simulation a powerful equalizer ensuring that all students, regardless of clinical placement variability, receive intentional, high-quality learning experiences.

What Faculty Need to Know: Shifting from Supervisor to Learning Designer

To fully unlock simulation’s pedagogical potential, nursing faculty must also rethink their own roles. In traditional clinical settings, faculty often act as supervisors or evaluators, reacting to unpredictable patient encounters. In simulation, faculty are designers of learning—architects who craft purposeful scenarios, facilitate reflection, and guide meaning-making.

This shift requires intentional faculty development. Educators must be comfortable not only operating simulation technology but also leveraging instructional design principles and evidence-based debriefing strategies. They must also challenge their own assumptions about what “counts” as real learning. Simulation isn’t “less than” clinical—it’s different, and in many ways, more controlled, equitable, and educationally robust.

The Future of Nursing Education: Simulation as Core Strategy

Nursing education is facing mounting challenges: clinical site shortages, faculty workload, regulatory pressures, and the need to prepare graduates for increasingly complex healthcare environments. Simulation alone won’t solve these problems—but when embraced as a core instructional strategy, it can help us educate more confident, competent, and resilient nurses.

As a nurse educator, I have come to see simulation not as a supplement, but as an irreplaceable tool in preparing our students for the realities of clinical practice. I have witnessed student abilities flourish the more they are exposed to simulated scenarios. Those moments solidified for me that simulation builds a kind of muscle memory—not just in skills, but in confidence, critical thinking, and teamwork—that textbooks and clinical rotations alone can't always deliver.

I've seen firsthand how simulation creates a safe environment where students can make mistakes, reflect, and grow—something our real-world settings often can't accommodate due to patient safety concerns. When students engage in debriefings after simulation, their ability to self-assess and integrate feedback deepens in ways I rarely see elsewhere. It’s not just about the clinical content; it’s about cultivating professional confidence. 

We need to advocate for simulation not as a luxury or a “nice-to-have,” but as a core pillar of nursing education. It’s not replacing bedside clinical rotations, it’s preparing students to arrive there ready and competent.

How to Integrate Simulation Throughout Your Nursing Curriculum

Reframing simulation as a cornerstone of nursing education requires more than a mindset shift—it calls for intentional, concrete action. Faculty are uniquely positioned to lead this transformation by embedding simulation throughout the curriculum, shaping how future nurses experience and value this powerful learning modality.

To integrate simulation more intrinsically:

1. Map your curriculum to identify where simulation can enhance, not just replace, learning.
2. Introduce simulation in the first semester, even if at a low fidelity, to normalize it as part of the learning journey.
3. Use simulation to teach concepts in classroom courses, not just skills in labs.
4. Invest in faculty development around scenario design, debriefing, and learner engagement.
5. Gather and share data to demonstrate simulation’s impact on learning outcomes, confidence, and clinical readiness.

Final Thoughts

Simulation is so much more than a backup plan. It is a powerful, flexible, evidence-based educational tool that belongs at the heart of nursing education—early, often, and everywhere learning happens.

By rethinking the role of simulation, we can move from reactive substitution to proactive transformation, ensuring our students don’t just survive their first clinical experiences, but thrive as emerging professionals from day one.