Assessment and evaluation of competency for advanced practice registered nurses (APRNs) is a challenge facing educators, regulators, and consumers of health care. The purpose of this study was to determine the effectiveness of using simulation to assess and evaluate APRN student competence in managing complex cases. Students were videotaped in the simulation laboratory at four separate intervals; two independent reviewers used the APRN Competency Evaluation Tool to review the simulation. Results showed statistically significant improvement in all categories of evaluation following increased exposure to simulation of complex cases. Student competence increased for managing complex patients, use of evidence-based guidelines, patient safety, leadership, prioritization, delegation, collaboration, communication, and professionalism.