Clinical judgment is defined as an interpretation and reaching a conclusion about a patient’s situation and the decision by the nurse to intervene. Improving students’ decision making and judgment skills becomes an essential part of nursing education. The simulations speak to what they thought was important for students to experience in preparation for their professional practice. Clinical judgment is a very essential skill in caring for patients, but nurse educators may struggle with how to present it to students and assess it. This paper describes the design of the Objective Structured Clinical Examination (OSCE) in high-fidelity simulations for assessing nursing students’ clinical judgment. Based on Tanner’s clinical judgment model, the OSCE incorporates the stations of noticing, interpreting, responding and reflection. The noticing refers to assessing patient conditions, recognizing the abnormal signs and verbalizing the causes for abnormal signs. The interpreting  involves prioritizing data and making sense of data. Responding is assessed by monitoring the patient conditions, dealing with the changes and conducting patient education. The reflection is evaluated by knowledge application, communication and group cooperation. It is the observational measurement with three levels (0 Not achieved, 1 Partly Achieved, 2 Achieved) and is used to evaluate students’ clinical judgment in high-fidelity simulations by two raters. The higher score indicated the better actions in clinical judgment. The inter-rater reliability should be established for minimizing the possibility that the scores would vary from rater to rater.