AIM AND OBJECTIVE: To evaluate the impact of a structured learning programme as a component of the clinical practicum in final year bachelor of nursing course on the student's report of their anxiety and self-efficacy pre-post programme participation. BACKGROUND: Student anxiety and low levels of self-efficacy are known to affect the quality of clinical learning. A three-day structured learning programme at the commencement of an acute care clinical placement was designed to reduce student anxiety and enhance self-efficacy. DESIGN: A pre-post test design. METHOD: OUTCOME MEASURES: The hospital anxiety and depression scale (The HAD) and the general self-efficacy scale (GSES-12) were administered prior to the commencement of the structured learning programme (time one) and at the end of the programme (time two). RESULTS: One hundred and twenty final year students undertaking an acute care clinical placement participated in the programme in three cohorts and completed the questionnaires at time one and 118 at time two. FINDINGS: Students levels of anxiety >8 with The HAD pre-post programme 53 vs. 30% (p < 0·001). Levels of self-efficacy <40 with the GSES-12 pre-post programme were 7 vs. 4% (p < 0·001). CONCLUSIONS: Participation in the structured learning programme resulted in a statistically significant reduction in student anxiety and increase in self-efficacy across the three cohort groups. This effect can be achieved with the development of a relatively low cost/low technology structured learning programme that is part of an acute care clinical placement. RELEVANCE TO CLINICAL PRACTICE: Nurse educators should not assume that students are less anxious about their acute care clinical placements as the semester proceeds. There is a typical correlation between increased anxiety and decreased self-efficacy which is likely to impact on student learning in the clinical setting. Significant results can be achieved with a relatively low cost and a low technology enabling intervention.