Background : There has been little use of simulation to investigate speaking-up behaviors in response to routine clinical errors. We designed a simulation-based intervention to study the communication skills of nursing students. Methods : The content of debriefings was coded to identify the barriers, enablers, and strategies used to voice concerns in 17 groups. Questionnaires assessed students’ attitudes before and after the simulation (N = 98). Results : The most commonly perceived barriers were the students’ status, the presence of the patient, and fear of consequences. Openness of the supervisor, risk assessment, and team familiarity were the most frequently mentioned enablers. The main strategy was asking naïve questions. Teamwork climate was rated lower after the simulation training. Conclusion : Nursing students tend to remain silent or to use inefficient strategies in response to violations of standard precautions. The simulation session had an impact on nursing students’ attitudes.