The aim of this systematic review was to investigate the relationship between self-efficacy and skill performance in undergraduate student nurses. Across higher education, self-efficacy is an important predictor of student success in skill-based learning. Nursing students are required to demonstrate skills prior to caring for hospitalized patients. Understanding the relationship between self-efficacy and nursing student skill performance may support patient safety. Following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a systematic search was conducted of four databases: CINAHL, Medline, Psychinfo, and Web of Science. Quantitative, peer-reviewed studies published in English were included with no limitation on year. Hands-on skill performance had to be performed in laboratory or simulation settings and evaluated by an expert. Identified studies were assessed for methodological rigor using Joanna Briggs Institute's Critical Appraisal Tools. A total of 2,450 items were identified by database search and screened, resulting in 20 eligible studies. Most of the studies included novice first- or second-year students. Self-efficacy was operationalized as either a general or skill-specific measure, while the type of skill and associated instrumentation varied widely. Sixteen (80%) of the included study reports showed weak to no correlation between self-efficacy and skill performance. The remaining 4 reports noted a moderate-to-strong relationship. Our findings conflict with existing research in other higher education disciplines where self-efficacy is a significant predictor of performance success. Explanations for this contradiction likely center around how self-efficacy was operationalized and rigor of the included studies. Larger studies controlling for confounding variables are needed to understand this relationship with a goal of developing more consistent approaches to teaching and learning skills within prelicensure curriculums.