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Preparing nursing students for transition to practice is challenging in light of the increasing complexity of today's health care environment. A clinical simulation was developed to engage senior-level bachelor of science in nursing students in the management of a critically ill patient whose deterioration warranted timely transfer to an intensive care unit. In this fast-paced, highly charged simulation, students were challenged to implement priority setting, delegation, communication methods, and teamwork. This article examines the gaps in students' understanding of complex patient situations and points to the need for simulations that bridge the gap between education and practice.