Introduction: Communication and critical thinking are essential practice competencies for every registered nurse. However, newly licensed registered nurses (NLRN) often lack these skills on entry into practice contributing to low levels of clinical confidence. Aims: The purpose of this Quality Improvement (QI) project was to implement and evaluate the effectiveness of simulation on clinical confidence among NLRNs. Methods: This QI project was guided by the MAP-IT model and involves NLRNs in a Pediatric Intensive Care Unit within an urban academic teaching hospital. NLRNs participated in three clinical simulations reflecting common PICU clinical practice, utilizing the Simulation Module for Assessment of Resident’s Targeted Event Responses (SMARTER) and the Behavior Assessment Tool (BAT). NLRN confidence data were collected immediately pre-simulation and post-simulation, as well as one-month post-simulation using the self-report C-Scale Instrument of Clinical Confidence. Qualitative data was collected via observation by the NLRN preceptor using the C-Scale Instrument of Clinical Confidence. Paired sample t-tests were used to determine a significant change in confidence, and content analysis was performed by two evaluators on the qualitative data derived from the C-Scale observations to identify confidence themes and patterns. Results: Paired sample t-tests revealed a significant increase in clinical confidence between baseline and sustained one-month post simulation. Qualitative data collection of preceptor observations revealed improved clinical confidence and communication abilities. Conclusions and Implications: Data indicates that simulation is an effective strategy to increase clinical confidence as perceived by the NLRNs. Incorporation of simulation into transition-to-practice programs such as Nurse Residency or facility orientation is an evidence-based recommendation to improve development of clinical confidence and communication abilities in this population.