Background <p>Radiation safety competence is essential for nursing professionals to ensure safe practices in radiology settings. However, nursing academic programs often fail to adequately address this critical area, leaving notable deficiencies in knowledge and preparedness that can hinder the implementation of radiation safety measures. This study aimed to assess radiation safety competence among final-year nursing students at Jazan University, Saudi Arabia, and to examine associated attitudes and perceived preparation for radiology-related practice.</p> Methods <p>A cross-sectional study was carried out involving final-year nursing students in Saudi Arabia. Data were gathered through a structured survey designed to evaluate radiation safety competencies, attitudes, and perceptions regarding the adequacy of academic preparation and readiness for work in radiology departments after graduation. The data were analyzed using descriptive and inferential statistical methods.</p> Results <p>The study included 258 nursing students, the majority of whom were female (68.60%). Among the participants, 40.70% considered their academic preparation for radiology to be adequate, and only 20.93% felt prepared for work in radiology post-graduation. The overall competence level was moderate, with a mean score of 3.35 ± 1.03, and attitudes toward radiation safety were generally positive, averaging 3.88 ± 1.16. Students who perceived their academic preparation as sufficient or reported feeling ready for radiology work achieved significantly higher competence scores (<i>p</i> = 0.032 and <i>p</i> = 0.026, respectively) compared to those who felt unprepared or uncertain. The lowest rated items were observed in foundational knowledge areas, including understanding ionizing radiation types and sources and explaining the health risks associated with ionizing radiation (37.21%). Attitude toward radiation safety emerged as the most influential predictor of the perceived competence (<i>p</i> &lt; 0.001).</p> Conclusions <p>Final-year nursing students rated their radiation safety competence as moderate, with positive attitudes being strongly associated with higher self-perceived competence. Nursing curricula should incorporate a dedicated radiation safety module with supervised clinical orientation in imaging areas, simulation-based training, and competence-based assessment to strengthen foundational knowledge and readiness for radiology-related practice.</p>