Background: Nursing students need to be socialized in caring behaviors as evidenced by patient care that is attentive, competent, responsible, and responsive to the care received by the patient. The effect of clinical simulation as pedagogical praxis for defining and promoting caring behaviors at one of three different time points in a first semester medical surgical course: either at the beginning, middle, or end of an eight-week medical-surgical clinical rotation, remains a relatively unexplored subject. Methods: This study utilized pre-collected data, cleansed of all identifiers, from a parent project with first semester Associate Degree Nursing (ADN) students. A comparative and descriptive research design with qualitative thematic analysis was conducted to compare student self-ratings of caring behaviors before and after participating in a structured clinical simulation at one of three different time points: either at the beginning, middle, or end of an eight-week medical-surgical clinical rotation. The study was conducted in a simulation laboratory at a two-year ADN program at a community college in Southern California. Criteria for inclusion of subjects included matriculation at the community college with registration and attendance in all first semester nursing courses. Inferential and descriptive statistics were conducted using IBM SPSS version 22. Results: Findings from the quantitative and qualitative data supported placing simulation at the beginning of a medical-surgical course in promoting clinical confidence and professional caring behaviors in students. Students' self-rated caring behaviors related to Tronto's (1998) operational definitions of responsibility, competence, and responsiveness to the care received by the patient, demonstrated statistical significance (p