In this repeated-measures observational study, eleven acute care and critical care registered nurse participants were evaluated at four different time points to measure the effect of an education program on observed performance of crisis resource management (CRM) skills. Performance was measured using the Ottawa Global Rating Scale and a checklist developed for this study. One-on-one semi-structured interviews also assessed nurses’ perceptions of the learning that occurred in the education program. Results were mixed with statistically significant changes in mean scores occurring between time one and time two and non-statistically significant improvement in mean scores overall. Interview results indicated nurses perceived a high degree of learning through passive observer roles as well as active responder roles. This study adds to the body of evidence on the effectiveness of high-fidelity simulation education programs and highlights the need for further research in multiple areas.