Psychomotor nursing skills are a fundamental part of curricula for all schools of nursing no matter the degree level of the program. Demands placed on schools to produce a generalist nurse with the ability to safely practice in the clinical setting is high. There is no standard method of teaching or evaluation regarding psychomotor nursing skills, and there is much room for studies to demonstrate best practice. On top of the already mentioned high demands placed on schools of nursing are the demands of content-saturated nursing curricula on the students. Nursing students are placed under stress-producing situations that create high levels of anxiety. Schools expect students to perform at very high levels and to demonstrate competency of skills learned in a practicum setting. There is a need for best practice in teaching and evaluating psychomotor nursing skills. There is also a need for experienced faculty to teach the skills. The purpose of this exploratory study was to evaluate student levels of self-efficacy in the performance of psychomotor nursing skills after implementation of the learning strategy self-directed simulation. Self-directed simulation is a strategy created by the researcher in response to students' level of anxiety and uses theoretical knowledge of ways to decrease student anxiety and increase learning and retention. Self-efficacy was measured in 94 students from a Midwestern school of nursing who were enrolled in a fundamentals of nursing course. Additionally, the researcher conducted 14 qualitative interviews to further investigate the self-directed simulation strategy, self-efficacy, and learning.