It is estimated that over 30,000 applicants to registered nursing (RN) programs are turned away each year following a rigorous selection process for the limited available program admissions. An alarming number of those students who are accepted and enter upper division programs and depart prior to completion do so because of increased stress and anxiety experienced during clinical activities. Attrition occurs when students repeatedly experience levels of stress and anxiety and feel they have reached a breaking point. Self-efficacy impacts the amount of stress and anxiety an individual can tolerate before encountering negative outcome expectations. The theoretical framework for this study was underpinned by Bandura's (1995) theory of self-efficacy. A multi-case study approach and cross-case analysis was utilized to identify if a link existed between simulation and self-efficacy. Beginning nursing students engaged in a simulated clinical experience prior to the initial acute care clinical experience. Nursing students discoursed about physical and sociostructual influences on agency and environment related to self-efficacy and negative affective behaviors. Based upon students' discourse, this study supports a link does exist between simulation and self-efficacy for beginning nursing students.