It is not sufficient to just make changes in a nursing curriculum without a plan to evaluate the impact on program outcomes. This study sought to determine the outcomes of teaching the nursing process to Foundation of Nursing students in an Associate Degree Nursing program using a factorial design study. Four groups of students were taught the nursing process as follows: case study and concept mapping; case study, concept mapping with a pocket reference; case study, two hours HFHS, concept mapping with a pocket reference, or four hours of HFHS, concept mapping with a pocket reference. The Simulation Design Scale (SDS) measured the perceptions of the simulation groups for design elements. The four hour group mean was significantly lower on both the importance of the objectives and information and importance of fidelity design elements (p < 0.05). This suggests that as time in a simulation increases more attention to these elements is required. There was not a significant difference between the four study groups on the Nursing Process or the Assessment Technology Institute (ATI) RN Fundamentals 2010 Assessment Form B examinations individual scores. Two sub-categories on the ATI were significant. Planning was significantly higher for fall 2012 cohort (p = 0.024) and analysis/diagnosis was almost significant for fall 2011 cohort (p = 0.054). The results for Factorial Groups was not significant. The National League for Nursing (NLN) PAX-RN entrance examination had a significant correlation with students passing onto the second semester in a nursing program (p < 0.001). The ATI results of students were the same without regard to the Factorial Group assigned in relation to instructor employment status of full time versus part time. [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.]