Background: The effects of stress on nursing students' health and learning is important to educators. The purpose of this review was to critically integrate the literature related to the stress that nursing students experience regarding high-fidelity simulation (HFS). Method: Literature from multiple search engines and databases was systematically searched. Keywords and Boolean combinations included nursing students, simulation, stress, anxiety, and self-efficacy. Qualitative or quantitative studies published in English between 2010 and 2015 and studies including the effects of simulation on nursing student anxiety and stress were included. Seventeen studies were chosen. Results: Overall, students reported either moderate or high stress associated with simulation, but they rated the HFS experience as a valuable learning tool. Conclusion: This review demonstrated student acceptance of simulation as a learning strategy. However, more high-quality studies are needed to investigate techniques that can be implemented to decrease the negative effects of simulation stress on nursing students.