Introduction: Empathy is an essential trait for nursing. Empathy as a construct consists of a cognitive and affective domain. The construct is associated with decreased clinician burnout, reduced stress, and improved patient-centered care. Nursing education has recognized the clinical benefits of empathy and has implemented various educational interventions to foster empathy in students. Although there is evidence that nursing students' empathy can be improved through training, little research has been completed to identify if students' baseline empathy level affects their benefit from training. There have also been few studies that attempt to discover what domain of empathy is developed from participation in educational interventions. This study aimed to understand how nursing students' baseline empathy level affected their experience with a simulation, how students expressed their empathic responses after participating in a simulation experience, and whether there was a relationship between empathy level and empathic experience. Methods: A mixed-methods study consisted of 82 undergraduate nursing students who participated in a simulation from the patient's viewpoint. The Jefferson Scale of Empathy-Health Professions Student (JSE-HPS) captured empathy quantitative data one week before and immediately following the simulation. A hierarchical cluster analysis (HCA) was performed on the pretest JSE-HPS data to identify baseline empathy levels. Qualitative data were gathered using open self-debriefing questions. A two-way ANOVA was performed between the empathy level and the change in the JSE-HPS score. A chi-squared test for independence assessed for associations between qualitative themes and level of empathy determined. Results: The HCA revealed two clusters representing a high empathy group (n=47) and a low empathy group (n=35). The low empathy group had significantly higher empathy (p < 0.001), while there was no change (p=0.149) in the high empathy group following the training. Qualitative analysis revealed four themes: appreciating the patient's perspective, self-other awareness, personal distress, and empathic concern. The chi-square revealed no relationship (p=0.193) between empathy level and their empathic response. Conclusion: Students identified as having low empathy at baseline significantly benefited from empathy training, while high empathy students did not have a change. Students demonstrated cognitive and affective empathetic responses to the simulation regardless of baseline level. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]