The use of simulation as a teaching modality has been rooted in the military, aviation, space, and engineering for centuries (Bradley, 2006). Clinical simulation allows for training of healthcare providers that might be too costly, risky, or hazardous in the clinical setting (Bradley, 2006). A variety of simulation modalities are used including virtual learning, task trainers, mannequins, and standardized patients (SPs). External demands for improved accountability of clinical performance is requiring nursing educators to reevaluate methods of teaching and how we measure nursing competence (Nehring & Lashley, 2010). Standardized patients have been used in medical school curricula to teach and evaluate clinical competence of medical students for decades (Boulet, 2008). Even though SP programs are used and well-researched in medical schools, the majority of nursing schools have adopted high-fidelity mannequin simulation programs (Sanford, 2010). Standardized patients contribute to increased realism by exposing students to a "real" patient with opportunities to practice compassionate and empathetic communication skills and receive feedback on how to fine-tune their bedside manner. The capacity to provide compassionate care is the heart and soul of nursing practice as identified by American Association of Colleges of Nursing and the National League of Nursing (Rhodes, Morris, & Lazenby, 2011). SP reliability and validity are well established within medical education, reporting 88-92% agreement on checklists between SPs and faculty. Competency checklists in pre- licensure registered nursing curricula have not been accompanied with equally rigorous psychometric evaluation thus it is unclear whether SP utility in nursing is equivalent to medical education. This study examines the inter-rater reliability and percent agreement of standardized patients and faculty checklist scores when evaluating pre-licensure nursing students. Data analysis of SP and faculty scores found significant agreement (94%-98%) as seen in medical education decades ago. Low internal consistency measures and moderate kappa scores suggest additional research is needed working with multi-site, large sample sizes using the same methodology, cases, and checklists. Nursing programs primarily using mannequins have not been able to realize the potential of using SPs, not only in the evaluation of competence, but also in laying the foundation of practicing and reflecting on humanistic care.