Purpose This study was conducted to investigate the affect that metacognitive awareness in nursing students has on self-confidence and anxiety with respect to clinical decision-making. Design and methods The sample for this descriptive, correlational, and cross-sectional study consisted of 186 nursing students who voluntarily participated. Data were collected using the Metacognitive Awareness Inventory and Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale. Correlation and regression analyses were then performed on the data. Findings Nursing students' metacognitive awareness level explained the three subdimensions of self-confidence in clinical decision-making by 26.7% (r(2) = 0.267,p < 0.01), 24.6% (r(2) = 0.246, p < 0.01), and 26.8% (r(2) = 0.268, p < 0.01), respectively. Nursing students' metacognitive awareness level explained the three subdimensions of anxiety in clinical decision-making by 3.7% (r(2) = 0.037, p < 0.01), 3.2% (r(2) = 0.03,p < 0.05), and 2.4% (r(2) = 0.024, p < 0.05), respectively. Implications for nursing practice Clinical decision-making skills can be supported by increasing students' metacognitive awareness.