Aims and objectives: To assess changes in perceptions of confidence and preparedness for practice of preregistration nursing students before and after the introduction of a capstone subject, and factors associated with perceptions of preparedness. Background: Preregistration nursing student 'readiness' or 'preparedness' for practice has been highlighted in the literature in recent years, along with employer concerns that university graduate nurses are not work ready. Few studies have examined Australian preregistration nursing students' perceptions of preparedness for clinical practice following their final clinical placement or assessed whether preregistration student nurses' perceptions of preparedness change as the result of undertaking a capstone subject. Design: A capstone subject was introduced at a regional northern Australian university in 2013. Perceptions of preparedness were assessed in two different cohorts of final year nursing students; one of which undertook a capstone subject. Methods: Two separate cohorts of third year nursing students were surveyed regarding their perceptions of preparedness for practice at the conclusion of their final 240 hour clinical placement. The 2012 cohort did not experience a capstone subject, whereas the 2013 cohort were the first nursing students to experience the new capstone subject. Results: Both cohorts were uncomfortable performing invasive procedures and reported low levels of confidence in the area of professional identity. An overall trend of decreasing confidence as patient assignment size increased was observed for both cohorts, and higher confidence was associated with previous health care experience. Perceptions of preparedness for practice did not increase significantly following the introduction of a capstone subject. Conclusions: Although Australian undergraduate nursing student report feeling prepared for practice there are areas of knowledge, skills and patient care in which confidence is low. The results of this study highlight the importance of experience in building confidence and competence. Relevance to clinical practice: This study highlights that while final year nursing students report feeling prepared for practice there are areas where additional support can be provided. It is recommended that nurse educators and health care facilities tailor their programs to provide support focused on the areas highlighted by this study.