© 2020 International Federation of Gynecology and ObstetricsObjective: To investigate the impact of high-fidelity simulation on nursing students’ knowledge, critical thinking, and clinical decision-making in the management of pre-eclampsia, and to explore the students’ views and learning experiences. Methods: A mixed-methods design study was conducted on 107 third-year nursing students. The students were randomly assigned to the control group (n=54) or the experimental group (n=53). The students in the experimental group attended the simulation training using a high-fidelity simulator, while the students in the control group attended only the classical training on “the management of pre-eclampsia.”. Results: Knowledge (P<0.001), critical thinking (P<0.05), and clinical decision-making (P<0.05) scores of students in the experimental group increased after the simulation. In the focus group interviews, five themes were identified: learning development; closing the gap between theory and practice; confident decision-making and self-confidence; professional preparation; and recommendations. Conclusion: High-fidelity simulation is efficacious for improving the management of pre-eclampsia among nursing students.