Simulation, as a widely applied approach in nursing education, offers a safe environment for practicing clinical skills before entering real hospital settings. The aim of this narrative review was to examine advancements in improving nursing students’ clinical skills through simulation-based learning. This review was conducted via a systematic search of PubMed, Scopus, Web of Science, ERIC, MagIran, IranDoc, and SID databases from 2010 to 2025. Keywords used included “simulation-based learning,” “nursing education,” and “clinical skills.” Screening, data extraction, and content analysis were performed independently by two researchers according to inclusion criteria. Out of 1,234 retrieved articles, 45 studies (20 RCTs, 10 meta-analyses, 15 qualitative/mixed-methods studies) were included. Simulation with high-fidelity models and standardized patients revealed significant improvement in clinical skills such as respiratory assessment, cardiopulmonary resuscitation, and effective patient communication. Additionally, increased self-confidence, reduced anxiety, and enhanced critical thinking were reported among nursing students. Meta-analyses indicated effect sizes ranging from moderate to large (Cohen’s d = 0.5–0.8). The findings suggest that simulation-based learning is an effective tool for strengthening clinical skills, reducing anxiety, and improving self-efficacy among nursing students. Expanding its use requires standardized protocols, quality assurance in simulation design, and longitudinal studies to assess long-term impacts.

Keywords: Simulation based learning; Nursing education; Clinical skills