The impulse for patient and public involvement (PPI) in health services reflects wider societal and policy concerns with citizenship and democratic participation. A consumerist turn in health policy has opened the door to advances in involvement initiatives, with nurses often playing a lead role. These involvement practices have developed in the interlinked areas of nursing practice, research, and education. Effective involvement is predicated upon emancipatory values and, as such, involvement practices are concerned with prevailing power relations. The actual form that involvement takes can be thorough, systematic, and empowering or partial, tokenistic, and subsumed under oppressive governance systems. Ultimately, involvement poses key questions for professional nursing identity, allowing for a re-imagining of professionalism that is essentially democratized and cooperative.