Background <p>Internationally, interest in the expanding role of registered nurse–led consultations in primary care is increasing. This role requires effective communication to support triage and clinical decision-making. While physician‒patient communication has been extensively studied, research on registered nurse‒patient communication remains limited, particularly in primary care. Therefore, the aim of this scoping review was to map and describe how registered nurse–patient communication and decision-making in primary care consultations are characterised in the existing literature, based on observations of clinical practice.</p> Methods <p>This scoping review included a systematic literature search conducted in March 2025 in the PubMed, CINAHL, Web of Science and Scopus databases. A total of 12,066 records were identified and screened. The review followed the methodological framework of Arksey and O’Malley and adhered to the PRISMA-ScR reporting guidelines.</p> Results <p>A total of 16 studies were included. Registered nurse‒patient communication was observed using audio- and video-recorded observations and participant observations during telephone consultations (<i>n</i> = 5), chronic disease management consultations (<i>n</i> = 3), mental health consultations (<i>n</i> = 1) and walk-in clinic consultations (<i>n</i> = 7). Findings on communication and decision-making were organised into four themes related to the key characteristics of exploring patients’ concerns, observing and assessing patients’ health status, tailoring communication, and facilitating decision-making with patients.</p> Conclusion <p>The findings indicate that registered nurses use various communication skills during different phases of consultations. However, comprehensive studies on registered nurse–patient communication and decision-making in primary care are lacking. This highlights the need for future in-depth and comprehensive studies on registered nurse–patient communication in primary care to inform both clinical practices and nursing education.</p> Trial and protocol registration <p>Prospero registration: PROSPERO 06 June 2023 CRD42023425582. Available from:<a href="https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023425582">https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023425582</a>.</p>