Despite decades of acknowledgement among nursing academics and organizations, end-of-life (EOL) nursing education is significantly lacking. Insufficient EOL care education leaves nursing students feeling ill-prepared to adequately care for clients and their loved ones at EOL. Though the literature reveals a recent increase in didactic and simulation-related EOL education sporadically being integrated into nursing curricula, minimal research addresses important topics of pediatric EOL care and provision of therapeutic communication, considered critical to EOL care. End-of-life clinical experiences, particularly in pediatrics, are limited for pre-licensure nursing students. Though effective, simulations can be costly and timely to execute, are restricted by limited availability of space, and require facilitators who are adequately trained in provision of EOL care. Such barriers prompt the question as to whether there is a more cost and time-effective alternative to active simulation, by which students can gain improved self-efficacy in provision of therapeutic communication during pediatric EOL situations. The literature has shown vicarious learning to provide students with opportunities to gain experience and knowledge through observation of their peers in simulated settings. This study specifically evaluated the effectiveness of vicarious versus active learning on pre-licensure nursing students’ perceived self-efficacy in providing therapeutic communication during pediatric EOL situations. Data collected over time with baseline Self-Efficacy in Communication During Difficult Situations Scale scores (SECS1), post-EOL simulation self-efficacy scale scores (SECS2), and post-simulation debriefing self-efficacy scale scores (SECS3) revealed no statistically significant differences in perceived self-efficacy within or between the vicarious and active learner groups. Therefore, vicarious learning seems to be a viable pedagogical approach for providing pre-licensure nursing students important learning opportunities related to pediatric EOL care, as well as improved self-efficacy in providing therapeutic communication during difficult situations.