Nursing Research and Practice engage professionals in deliberate practice of skills and has the ability to improve performance in professionals that require deliberate, goal-oriented, and structured practice [14]. 3. Materials and Methods The speciﬁc aim of this study was to examine the relationship between student learning and use of virtual simulated clinical experiences. A repeated-measure design was used to evaluate the eﬀectiveness of virtual simulation on improving student’s performance over a series of two virtual simulation scenarios. This study was conducted over one academic semester with a convenience sample of senior nursing students at one mid- western, university-based School of Nursing. The students were traditional undergraduate students taking Leadership and Management. Student demographic information was not collected; however, the majority of students were young, post high school students completing their ﬁrst degree. At total of 61 students participated in this study. They received education in the traditional manner (i.e., lecture and seminar discussion) in addition to the two virtual simulations. Institutional Review Board review was obtained, and the study was considered exempt. 3.1. Instruments. Student (avatar) performance in vir- tual scenarios was measured using 8 of the 10 items from the Emergency Medicine Crisis Resource Management (EMCRM) tool, developed by Youngblood et al. [14]. This tool was developed to evaluate participant’s crisis manage- ment skills in a virtual emergency department. The EMCRM assesses subject’s team leadership skills, including utilization of information and resources and overall ability to com- municate and facilitate task completion. Initial reliability testing of the tool was supported with a Cronbach’s alpha of 0.96 [14]. The tool was reduced by two items (those items did not apply to the virtual simulations designed for this study) to measure nurse’s performance in a crisis situa- tion in an acute care unit setting. The remaining categories included leadership, communication, delegation, attention, information utilization, resource utilization, early call for help, and professional behavior. The deﬁnition of these categories was adjusted to account for nursing student expectations of behavior. Cronbach’s alpha on the revised EMCRM was 0.9 as measured during this study. Student satisfaction was measured through a satisfaction questionnaire developed for the initial beta testing of the SL environment [16]. The six-question survey measured stu- dent’s perceptions on a 5-point Likert scale (strongly disagree to strongly agree). Questions included SL experiences helped prepare me for clinical, SL experiences resembled a realistic clinical environment, SL experiences reinforced the course objectives, SL experiences were an eﬀective learning experi- ence, SL experiences improved my decision making skills, and overall the SL experiences were a positive experience. Four open-ended questions were also asked: what I like most about the experience in SL, what I liked least about the experience in SL, and how do you rate this experience in 3 Figure 1: Second life nursing station. Figure 2: Second life patient care room. comparison with other simulations (i.e., SimMan) and sug- gestions for improvement. 3.2. Intervention. The intervention consisted of two virtual scenarios that the students participated in at two diﬀerent times during one academic semester. Prior to creating the simulations, a hospital unit was developed on the university owned space in SL, which was subsequently used as a training environment for the virtual simulation scenarios [16]. The virtual unit consists of eight acute care beds with mannequins (patients), a nursing conference room, a nursing station, and a variety of medical equipment staged throughout the unit to enhance realism of the unit (Figures 1 and 2). The unit was constructed for minimal cost as the University already owned the space and had developed the building used. The costs included buying items for the unit (e.g., hospital beds, desks, equipment, etc.) and some developer time to put up walls and create or modify objects used on the inside of the building. The total project cost was under $3000. The University provided in-house experts to the project team to support the training and development of the facilitators using SL for this project. Two scenarios were developed by two content and simu- lation experts. Objectives for the scenarios were developed in alignment with the Quality and Safety Education for Nurses (QSEN) recommendations (Cronenwett et al. [17]) and The Baccalaureate Essentials for Practice [18], in addition to speciﬁc course and overall nursing program objectives. Speciﬁcally, objectives were focused on QSEN’s teamwork, collaboration and patient safety objectives and the Essentials IV and VIII focusing on interprofessional communication and professionalism. As described in Table 1, Scenario 1 involved a safety issue and a medication adverse event, and Scenario 2 involved a diﬃcult interprofessional communication situation. Each