Research demonstrates the prevalence of moral distress in licensed nurses often begins during undergraduate training. While the concept of moral distress is evolving, this study used a conceptual definition of moral distress defined as negative self-directed emotions in acknowledgement of involvement in morally difficult situations. The purpose of this study is to determine whether integrating an ethical simulation-based education (SBE) module into fourth semester undergraduate nursing students’ curriculum would affect moral distress levels as measured by a validated Moral Distress Scale for Nursing Students. Using a longitudinal embedded mixed methods design in a required final-semester undergraduate nursing leadership course, students participated in an ethical SBE module with debriefing and completed the It-ESMEE as a pretest. During weeks two and three of the semester participants completed the SBE module using role play to practice speaking up with integrity. The closing of the module included a recorded debriefing to collect qualitative data related to the module and feelings of moral distress and the It-ESMEE for a second time. The final It-ESMEE was completed 13 weeks after the SBE module the final week of the semester. The recorded debriefings were transcribed and thematically analyzed. A repeated measures analysis of variance tested the within-subject differences of mean total It-ESMEE moral distress scores across all time points. A total of 48 students were included in the study. There was no statistically significant difference among mean moral distress scores, (F (2, 94) = 1.369, p = .259). Analysis of recorded debriefings revealed four primary themes: 1) powerlessness as a student, 2) students have a basic moral understanding, 3) there is discomfort in speaking up with integrity, and 4) students understand the importance of emotional intelligence. In conclusion, the measurement of overall moral distress levels over three time points did not show a statistically significant difference. However, the mean 13-week post-intervention survey score (M = 173.85) was the lowest of all three perceived moral distress scores. Though not statistically significant, this data in conjunction with the results of the thematic analysis could indicate that integrating meaningful simulation-based ethical training throughout undergraduate nursing curriculum may affect perceived moral distress levels. Future studies should address integration of ethical SBE throughout curricula.