The aims of this study were to explore the effects of simulation-based learning (SBL) on nursing student competences and performance in the clinical setting. A comparison group design was used with data obtained from self-administered questionnaires at the onset and end of the semester. Students\' practicum grades were also collected to examine their clinical performance. Four simulated scenarios were added to the course and a Chinese version of the Simulation-Based Learning Evaluation Scale (SBLES) was distributed to the participants. The student practicum evaluation form was used to collect the participants\' practicum grades. Data analyses included descriptive statistics, paired t-test, and analysis of covariance (ANCOVA). Positive, significant differences were found in five competences in the test group. In the comparison group, results in the professional knowledge and nursing process subscale showed significant differences, and no significant difference was found in the patient safety, communication, and attitude of reflection subscales. The students in the test group perceived greater competences than those in the comparison group. Finally, no significant findings were found in clinical performance between two groups. The findings showed that SBL is seen as an attractive teaching strategy for students\' learning as part of their curriculum and that the effects of SBL on clinical practice need further examination.