The research question of this study was: to what degree do nursing students perceive using the High Fidelity Simulation (HFS) learning environment to be helpful in their ability to achieve clinical competency. The research sub-questions (7) explored the students' demographics as an influence on rating of reality and helpfulness and the correlation between the students' rating of reality in their HFS learning experience and their rating of helpfulness of achieving clinical competencies and their ability to learn. The purpose of this study was to explore and describe the phenomena of student perceptions of learning in the simulation environment and the role of the level of reality. The significance of the study is the lived experience of the nursing student in the High Fidelity Simulation learning environment is better understood. The detailing of relationships between the study variables and the strength of those relationships may provide guidance for educators to direct their efforts more effectively in teaching and learning. This study used the research approach of a sequential mixed methods descriptive study: survey research and focus groups. The data analysis reveals that for eight of the eleven items in Section II of the survey, which covered Role Expectations and Clinical Competencies, the students rated the simulation learning environment in the Helpful range, least Helpful; "Evidenced Based Practice", most helpful; "Teamwork and Collaboration". A second statistically significant correlation revealed the more real the student perceived the simulation environment they also rated more highly the helpfulness of the environment in achieving clinical competencies. The positive correlation suggests that the more real the student perceives the simulation learning environment to be, the more helpful they will find the environment in achieving clinical competencies. Another statistically significant finding: the more real the student perceived the simulation environment to be they also reported more strongly that the level of reality had an impact on their ability to learn. A clearer understanding of why some competencies were more challenging and others less so was achieved. Also, recommendations by the students on how those identified as challenging could be improved were documented for use by simulation learning facilitators. [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.]