This quantitative study compared changes in level of confidence resulting from participation in simulation or traditional instructional methods for BSN (Bachelor of Science in Nursing) to DNP (Doctor of Nursing Practice) students in a nurse practitioner course when they entered the clinical practicum. Simulation has been used in many disciplines over the last century, but has only been used in the last decade in nursing mostly at the undergraduate level. The majority of the current research is at the undergraduate level and has demonstrated positive added value. Because of these results, there has been increased funding in simulation for labs, equipment, and staff. Sample is volunteers from 3 groups of mental health, acute and primary adult nurse practitioner classes at a private BSN-DNP program on the West Coast. The students are in the 3rd year of a three year program. Faculty was blinded to the identity of students who participated in the study. Repeated measurements using two valid and reliable instruments were obtained by online survey at three different points. Two instruments were used to measure confidence. They are The General Self Efficacy Scale (GSE) which is valid and reliable with a Cronbach's alpha ranged from 0.76 to 0.90, (with most of them in the high 80's). Numerous correlation studies demonstrate criterion validity and are summarized online (GSE Online) and The Self-Confidence Learning Survey reliability (0.87 Cronbach's alpha) developed in 2005 by Jeffries's team for the National League of Nursing. Data analysis was performed with SPSS 23 using Wilcoxon Signed Ranks Test. This study adds to the limited understanding of the pedagogy of simulation at the graduate level in nursing education.