The safety and quality issues identified in the United States healthcare system have resulted in a call to transform healthcare education, preparing graduates to work in teams and within systems that promote patient safety. Responding from funding by the Robert Wood Johnson Foundation, a National Nursing Advisory Board and the American Association of Colleges of Nurses created six Quality and Safety Education for Nurses (QSEN) competencies for nursing: patient-centered care, teamwork and collaboration, evidence based practice, safety, quality improvement, and informatics. These competencies provided a systematic pedagogical structure for course redesign and content to prepare nurses to value quality and safety in caring for patients. The course redesign incorporated a wide variety of active learning modalities, simulation being an ideal education technique to implement QSEN because of the multiple levels of knowledge, skills, and attitudes that can be practiced and evaluated in each competency.