1. A study explored using the virtual world Second Life to deliver nursing simulation education to 350 students. 2. Students participated in a virtual clinical simulation, making decisions as nurses caring for 6 virtual patients over 1 hour. Their communications and decisions were analyzed. 3. Results found that students were more reactive than proactive in their decision making, delegated tasks frequently, and did not use assessment tools. The simulation helped students realize they were engaging in clinical decision making.