Background The time before surgery is a traumatic period for patients. Despite this fact, no research has been conducted on nurses’ preoperative patient education in Ethiopia. This study aimed to assess preoperative patient education practices and associated factors among nurses working in East Amhara comprehensive specialized hospitals, Ethiopia, 2022. Methods A hospital-based cross-sectional study was conducted with 416 nurses. Pretested, structured questionnaires were used to collect the data. Bivariable analysis was performed for each independent variable with a P-value < 0.25 on the data imported to multivariate logistic regression analysis. AOR with a 95% CI and a P-value < 0.05 at a 5% level of significance were considered. Results Only 38.5% of nurses were found to have good practices for preoperative patient education, with a response rate of 98%. Nurses with 6 years of work experience (AOR = 3.15, 95% CI: 1.692–5.874), adequate time (AOR = 2.33, 95% CI: 1.119–4.889), training (AOR = 4.27, 95% CI: 1.548–11.796), age 25–29 (AOR = 0.15, 95% CI: 0.070–0.331), age 30–34 (AOR = 0.25, 95% CI: 0.137–0.479), and knowledge (AOR = 3.73, 95% CI: 2.222–6.273) were significantly associated. Conclusion Preoperative patient education practices among nurses were poor. Work experience, knowledge, training, and adequate time were found to be significant. Organize preoperative patient education programs for nurses that share experiences and provide ongoing training.