Nurses require ongoing opportunities to expand knowledge and skills; this expansion of knowledge and skills is one aspect of continued competence. One method that may be used to maintain and refine knowledge and skills is participation in continuing education activities. However, there has been little inquiry into creative strategies used in conjunction with continuing education activities for practicing nurses in the clinical arena. One such method is simulation--it represents an approach to learning that allows participants to integrate theory and practice and experience complex problems without jeopardizing patient safety. Experiences related to high-risk patients cannot be created on demand and the prevalence of these experiences is unpredictable. Thus, it is important to find the most effective way to assist practicing nurses to maintain and enhance knowledge and skills for high-risk populations such as those found in the neonatal intensive care unit (NICU). A quasi-experimental, pre-test, post-test mixed design with a control group of 48 NICU nurses was utilized to examine the effects of high-fidelity simulation on the knowledge acquisition, satisfaction, and self-confidence of practicing neonatal intensive care nurses. This program was centered on six critical components of neonatal care: Sugar and Safe Care, Temperature, Airway, Blood Pressure, Lab, and Emotional Support (S.T.A.B.L.E.). All participants completed the S.T.A.B.L.E. program, which made up the instructional content and a pre-test. Post-test occurred four weeks after the course and included completion of the NLN Student Satisfaction and Self-Confidence in Learning scale to measure attitudes on self-confidence and satisfaction. Results from post-testing revealed that the mean post-test score for participants who completed the simulation exercise was higher (3.71%) than for participants who did not. Analysis indicated that the difference in mean change scores from pre- to post-test for the two groups was not statistically significant (1.71, p = 0.489). Results also revealed that participants with less experience had greater gains in mean post-test scores (11.40) than participants with three years of more experience (9.58). In addition, results indicated that nurses were satisfied with and confident in learning from the simulation activity. Additional analyses revealed that nursing experience and previous experience with high-fidelity simulation did not have a statistically significant effect on self-confidence in and satisfaction with learning of practicing NICU nurses. Participants were given the opportunity to share their thoughts and experiences from the course and how it was utilized in their practice. Data revealed that of the 48 study participants, over 90% made changes in bedside nursing care as a result of the material learned in the S.T.A.B.L.E. program. Overall, participants enjoyed the simulation and reported it clarified current knowledge, reinforced learning, and fostered teamwork. [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.]