The use of simulation in nursing education has grown because of the need for dynamic, flexible, critically thinking nurses and the difficulty in securing clinical placements. As simulation has become part of nursing curricula, questions concerning instructional design have grown as well. Cognitive load theory (CLT) has been used by researchers to conceptualize instructional design for complex learning situations such as simulation. The purpose of this integrative review was to examine CLT in relation to simulation design and implementation. A theoretical overview is provided with specific applications that add to nursing simulation design and future research as well as implementations related to CLT.