Background: To improve the quality of nursing services at the Hospital, it is necessary to have a learning process (education and training) using clinical skills facilities. This provides an ideal place for the development of a nurse's learning and confidence before entering the real world of work. Problem Based Learning Approach that is able to use simulation learning methods or Practice Based Simulation can increase the confidence and clinical skills of new nurses. Research purposes. This aims to analyze the effect of practice based simulation on clinical skills and Self confidence in new nurses at Rumah Sakit Umum Islam Harapan Anda Kota Tegal. Methods: Using Quasy - Experiment method with pretest - posttest approach and control group design. Sampling selected by simple random sampling technique with 40 respondents both intervention group and control group. Data analysis was using Paired T-Test and Independent Samples T-Test. Result: The results was the difference in improvement of clinical skills ECG installation in the intervention group were 9.65 points and in the control group 6.90 points, and for clinical skills the infusion pairs in the intervention group were 10.30 points and the control group was 7.20 points, while the difference in the increase in self confidence in the intervention group was 34.90 points and the control group was 23.35 points. Statistical tests using Independent Samples T-Test for clinical skills found that P = 0.00 <0.05 while for confidence P = 0.00 <0.05 Conclusion: practice based simulation was affected to clinical skills and self confidence in new nurses at the Harapan Anda Islamic General Hospital in Tegal