Nurses working on medical-surgical units are often responders to situations of acute patient deterioration and must be ready to act and implement life-saving interventions (Buckley & Gordon, 2011). Training programs that incorporate high-fidelity simulation (HFS) provide an effective and safe environment for nurses to learn and practice clinical skills required during emergency situations (Cant & Cooper, 2009; Huseman, 2012; Sullivan et al., 2015). The purpose of this pilot study was to evaluate the impact of a HFS training intervention on medical-surgical nurses’ self-confidence and mock code blue performance. A one-group, pre- and post-test, quasi-experimental pilot study was conducted with 37 medical-surgical nurses at the project facility. A HFS training intervention was implemented and changes in self-confidence and mock code blue performance were evaluated. Overall response improved, but changes were not statistically significant (t = 1.1754, p = .140); however, time to defibrillation significantly improved (t = 7.025, p = .001). In addition, changes in participant satisfaction (t = 6.556, p = .001) and self-confidence (t = 6.220, p = .002) were statistically significant. HFS training can be used to improve medical-surgical nurses’ self-confidence and performance for responding to in-hospital cardiac arrest (IHCA), and provides a safe environment for clinical staff to practice and refine skills necessary to improve outcomes of patients experiencing these events.