High-fidelity patient simulation is becoming an essential component of prelicensure nursing education. A survey was mailed to the boards of nursing in all states, the District of Columbia, and Puerto Rico to ascertain the use of high-fidelity patient simulators for clinical time in current regulations. Participants were asked if high-fidelity patient simulation could be substituted for clinical time in the regulations and, if so, for what percentage. If not, they were asked whether they gave approval to nursing programs to substitute clinical time with high-fidelity patient simulators and, if so, for what percentage. Finally, the participants were asked whether they felt that the regulations would be changed in the future to allow the use of high-fidelity patient simulators to substitute for clinical time. Five states and Puerto Rico have made regulation changes to allow for such substitution, but only Florida has indicated a percentage of time. Sixteen states currently give approval for simulation substitution, and 17 states may consider regulation changes concerning high-fidelity patient simulation in the future. Such findings have implications for alterations in the prelicensure nursing curriculum that could examine patient safety and quality concerns addressed by the public and leading health and nursing organizations.