Introduction: High-quality care renders patients to be fully informed and involved in the decision-making process. A literature review also reveals that the involvement of patients in healthcare has been associated with improved clinical outcomes. However, it rarely happens as several studies demonstrated that patient involvement in decision-making is lacking worldwide. Hence, health professionals, especially nurses, play an important role in patient involvement in decision-making as they are mostly engaged with patients during the care plan. This study aimed to assess the nurses’ perceptions and their role on patient involvement in nursing care decision-making. Method: A cross-sectional descriptive study was conducted at one of the university hospitals in Malaysia. About 105 nurses from 3 major departments (internal medicine, general surgery, and orthopaedic) were involved in this study. The data were analysed using IBM SPSS Statistics version 25. Results: The result showed that most of the nurses agree their patient involvement in decision-making relates to their encouragement to participate as well as having opportunity and enough information to participate. However, many of the nurses believe that they have to decide for their patients. Besides, a significant association between nurses’ years of service and their perception of patient’s involvement in decision-making (p = 0.01) was noted. Similarly, there is a significant association between the nurses’ department and their preferred role with p-value of 0.001 (p < 0.05). Conclusion: This study indicates the need to further improve nurses’ awareness of the importance and benefits of patient involvement in decisions related to their nursing care.