Empathetic communication enhances the nurse-patient relationship and improves patient outcomes and needs to be taught and evaluated during simulated clinical experiences. Experience in healthcare education has shown students' empathy levels decrease over time. The purpose of this quasi-experimental pretest posttest, study was to compare nursing students' empathy levels, self-confidence, and satisfaction with simulation between the use of the high-fidelity manikin simulator (HFMS) and a standardized patient (SP) used during their simulated clinical experience. Kolb's experiential learning theory was used to guide the study through the four phases specific to simulation and learning. Convenience sampling was used to recruit 135 nursing students in the pre-simulation survey; 123 participants completed the post-simulation survey with 64 in the control group (HFMS) and 59 in the experimental group (SP). Data were analyzed using an independent t-test to determine if there were any mean differences between the HFMS and SP groups in terms of empathy, satisfaction, and self-confidence. Empathy was measured using the Jefferson Scale of Empathy-Health Professions Student and the NLN's Satisfaction and Self-Confidence Scales. Results revealed there were no significant difference in students' empathy levels, self-confidence, and satisfaction. Positive social change through prioritizing nursing students' empathetic communication in patient care may be enhanced in the simulated clinical environment with various approaches. Recommendations for future research are to determine what interventions best develop nursing students' empathy, satisfaction, and self-confidence in patient care .