The high fidelity simulation (HFS) has been used in nursing education to promote nursing students’ essential skills before handling with real patients. However, it is little know what an effective design of HFS looks like. This article therefore first aims to review existing four frameworks for designing the HFS in nursing education. Then it attempts to synthesize these frameworks into one. The synthesized framework points out three main important roles in the effective HFS design: instructor roles, student roles and technical support. The instructors are to set clear objectives of the simulation, provide a realistic and problem-specific context and give student support. The roles of nursing students include debriefing through individual and group reflections after experiencing with the simulation, practicing the role of observer, as well as taking a role play to make the scenario more realistic and to understand different roles more deeply. Finally, technical support like setting up computer and preparing medical materials is crucial to make the HFS effective.