This meta-analysis was designed to systematically determine the effect of high-fidelity simulation teaching on nursing students' knowledge level, professional skill level and clinical ability. High-fidelity simulation is an increasingly popular pedagogical approach in nursing education. It provides students with opportunity to practice in a variety of simulations before entering clinical practice through a variety of real-life situational experiences and many institutions and educators have embraced this method for enhancing access to clinical skills. However, evidence for the effectiveness of the method in nursing teaching remains scarce. A meta-analysis and systematic review. The following Chinese and English databases were searched for relevant articles: PubMed, Embase, Cochrane library, Web of Science, CNKI (China National Knowledge Infrastructure) and Wangfang. The search encompassed the establishment of these databases up until November 2021. Two reviewers separately entered the data into Review Manager Software 5.3. A total of 15 studies were included in this study. High-fidelity simulation significantly increased nursing students' knowledge acquisition (SMD = 1. 37, 94％CI:0. 73–2. 00， P ＜0. 0001), enhanced nursing students'professional skills (SMD = 0. 90, 95％CI:0. 36–1. 44， P = 0. 0001). In terms of clinical practice ability outcomes, high-fidelity simulation significantly improved the levels of critical thinking ability (SMD = 0. 58, 95％CI:0. 09–1. 07， P ＜0. 00001), Clinical judgement ability (SMD = 1. 34, 95％CI:0. 38–2. 31， P ＝0. 006) and communication skills (SMD = 2. 62, 95％CI:1. 84–3. 40， P ＜0. 001) of nursing students. We found that high-fidelity simulation have strong educational effects in nursing education, helping nursing students to increase knowledge acquisition, enhance professional skills and cultivate their clinical practice ability (critical thinking ability, communication skills and clinical judgement ability). These findings can provide guidance for nursing educators, indicating that the use of High-fidelity simulation teaching represents an effective solution for transitioning students from the learning environment to clinical practice. [ABSTRACT FROM AUTHOR]