High fidelity simulation is a well documented adjunctive teaching method in medical and nurse practitioner programs, but few studies of effectiveness on this technology on the development of competency have emphasized pre-licensure associate degree level programs. This study explored student competency in the application of the nursing process using the Advanced Technology comprehensive predictor examination for nursing students in the last semester of an associate degree nursing program who had participated in traditional clinical experiences and traditional clinical with the addition of a high fidelity simulation experience. This study used a retrospective causal comparative design. ANCOVA test was used for data analysis to compare differences in examination scores for overall nursing process, as well as the subcategory scores of assessment, planning, intervention and evaluation between the treatment and comparison group. The results of this study indicate a statistically significant difference between scores for overall application of the nursing process between groups. No statistical difference was found for the subcategories of the nursing process. Generalizing the findings is limited due to the retrospective design which prevented randomization of participants into the two groups. No inference of causation can be inferred due to the causal comparative methodology. [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.bibliotheek.ehb.be/en-US/products/dissertations/individuals.shtml.]