Nursing profession accrediting agencies and associations, including the National League for Nursing, the American Association of Colleges of Nursing, the National Council of State Boards of Nursing, and the Institute of Medicine, have called for the implementation and evaluation of educational innovations. Many nursing schools have attempted to be innovative with their curricula by employing High-Fidelity Simulation (HFS), which allows nursing students to practice and improve their skills on life-like mannequins without harming any real patients (Jeffries, 2006; Jeffries, 2007; Medley & Home, 2005). Qualitative research exists that detail some of the advantages and disadvantages of HFS, but objective quantitative measures of its effect on students' learning outcomes has been lacking. The purpose of this study was to evaluate the effect of HFS on nursing students' learning outcomes as measured by their HESI© scores and course grades. HESIC examination scores and course grades in Foundations, Pediatrics, Obstetrics, and Medical Surgical I and II for 376 students who experienced traditional instruction were compared to those scores for 352 students who experienced HFS in their nursing courses at a private university in Pennsylvania that changed its curriculum in 2010. HESI© examination scores increased in all courses after the introduction of HFS with an effect size ranging from a small effect of 0.31 in Medical Surgical II to a large effect of 0.81 in Foundations. Course grades, which were based in part on HESI© examination scores, similarly increased statistically in all courses but with smaller effect sizes. The correlation between HESI© examination scores and course grades did not change but remained large after the introduction of HFS ( r = 0.69, 0.70), an expected finding as the HESI© examination is a part of the course grade calculation. This study provides evidence that HFS can be an effective innovation for nursing schools and shows an increase in HESI© examinations scores which, in previous studies, have been shown to correlate with a first time pass rate for the National Council Licensure Examination for Registered Nurses (NCLEX-RN®). [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]