The study purpose was to evaluate the effectiveness of a structured education curriculum with simulation training in educating undergraduate Baccalaureate of Science in Nursing (BSN) students to recognize and respond to patients experiencing acute deterioration as first responders. Researchers have demonstrated a lack of adequate clinical reasoning skills in new graduate nurses is a factor in critical patient incidents. A mixed methods design using a quasi-experimental, repeated measures and a descriptive, qualitative approach was used. A convenience sample of 48 BSN students was recruited. Statistically significant increases were shown in knowledge, self-confidence, and perceptions of teamwork. Six categories emerged from the qualitative data analysis: sources of knowledge, knowledge as a person, knowledge as a group, reasoning under pressure, feelings, real person versus simulation, and values. Nursing educators need to use innovative teaching strategies to ameliorate or even eliminate the theory–practice gap in nursing.