The problem addressed in this study was the lack of critical thinking (CT) and clinical judgment (CJ) skills of senior level associate degree nursing students entering nursing orientation programs. The purpose of this randomized Solomon four-group pretest-posttest comparative study was to compare CJ and CT of senior level ADN students entering these programs, which used either simulation-based or lecture-based learning methods. The four groups included experimental condition 1 (simulation), control condition 1 (pretest and posttest), experimental condition 2 (lecture), and control condition 2 (posttest only). The 98 participants graduated in May 2023, lived, or worked in the 26 counties of the Texas Panhandle and were enrolled in RNSG 2231/2262. The National Council State Boards of Nursing Clinical Judgment Model Tanner's, Benner's, and Kolb's learning theories were the theoretical frameworks for this research project. A one-way analysis of variance test was used to compute the results of the pretest and posttest means for comparison. The results showed experimental condition 1 had the highest posttest means (M = 77.3, SD = 17.04) and control condition 2 with the lowest posttest means (M = 13.64, SD = 12.74). The results of the study show high-fidelity simulation had a significant impact on the critical thinking and clinical judgment skills of the research participants. Implications included improved training during orientation decreases medical errors, improving patient safety outcomes. Future research recommendations included expanding the research population and using a general concept (analysis of labs) universal to nursing, as hemodynamic monitoring is specific to intensive care units. [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.]