This descriptive study explored the use of simulation as a means to increase cognitive and reflective practice as well as determining if simulation can alter perceptions and attitudes related to the lesbian, gay, bisexual and transgender (LGBT) community. This manuscript describes how student nurses perceive their role when providing care to and, more specifically, the care of transgender patients. The research question asks: How does a transgender simulation impact the attitudes and beliefs of nursing students related to the LGBT community? One-hundred and fifty-nine students, with a subset of 120 students attending a school in central Florida and 50 students attending a Connecticut programme, participated in the completion of the instruments. The Gender Affirmative Practice (GAP) scale was used to evaluate their attitudes and practice concerning LGBT issues. Findings suggest that the majority of the students rarely or never discuss pertinent sexual orientation issues. Students are not comfortable creating a climate that allows for self-identification by gay/ lesbians, despite admitting to being open and accepting the LGBT community with their faculty. Limitations were based on multisite location and the use of the GAP. It is important for nursing students, and healthcare providers, to acknowledge and recognise the unique vulnerabilities of transgender persons who are seeking healthcare. The exposure to transgender individuals in a clinical setting may be limited; therefore, the use of simulation will offer the opportunity to examine their beliefs and reflect on their attitudes towards this population. Simulation incorporating mental health issues is a newer training technique in which psychosocial aspects of healthcare are addressed.