Background: Job burnout is linked to various negative physical and mental effects. In nursing, burnout can result in depression due to the stressful nature of the profession. Aim: This research aimed to examine job burnout and depression among nurses during the COVID-19 pandemic. Methods: This cross-sectional study utilized a census method to assess 155 nurses working at the Imam Khomeini Hospital during the COVID-19 pandemic in 2021. Data were collected face-to-face using a three-part questionnaire, which included demographic information, the Beck Depression Inventory (BDI-13), and the Maslach Burnout Inventory. The analysis of the data was performed using Kolmogorov-Smirnov statistical tests, t-tests, and analysis of variance in SPSS-22 statistical software, with a significance level set at less than 0.05. Results and Discussion: The frequency of individuals exhibiting moderate and severe depression symptoms was reported as 20.6% and 4.6%, respectively. Among hospital nurses, 23.2% experienced emotional exhaustion burnout, 7.4% faced depersonalization, and 57.5% reported feelings of ineffectiveness. Young and single individuals with long working hours were found to be more vulnerable to burnout compared to their colleagues, and a significant relationship was found between depression and job burnout. Conclusion: The prevalence of both depression and job burnout among nurses was notably high, with a significant relationship observed between these two variables. The findings highlight an urgent need for proactive measures to tackle the mental health challenges faced by nurses. By implementing targeted interventions, establishing support systems, and fostering a culture of well-being, the nursing profession can thrive, ensuring optimal care delivery and enhancing the overall wellbeing of healthcare professionals.

Factors influencing clinical decision-making skills among nurses in Malaysia: A three-level general linear mixed-effects analysis.

Linking talent management practices to autonomous work motivation and proactive customer service behavior: Insights from hospital nurses of Bangladesh

Opioids are the cornerstone of severe pain management but they have a strong potential for abuse. To mitigate this risk, hospitals are required to track and account for these controlled substances (CS). Despite widespread adoption of electronic medication administration records (eMAR), nurses also performed paper-based registrations for CS. We hypothesised that a validated dashboard combining dispensing and eMAR data could be implemented for CS accountability. This study describes trends in accountability of dispenses through administrations before, during and after implementation of the dashboard that replaced the paper-based process. Furthermore, we describe its application in analysing signalled discrepancies. This implementation study was performed in a university hospital. The dashboard was developed by a multidisciplinary team consisting of hospital pharmacists, pharmacy technicians, nurses and data analysts. Data from 2018 to 2024 were compared in three periods: prior implementation (2018-2019), during implementation (2020-2022) and after implementation (2023-2024) of the dashboard. Monitored CS medications were limited to oral solids. The data for dispenses and administrations were validated against the electronic health record (EHR) and electronic delta calculations were manually recalculated. The dashboard was piloted on a single ward by shadow running the dashboard for 6 months. Processes were optimised before hospital-wide implementation. The dispense and administration data in the dashboard accurately reflected the registrations in the EHR and all predefined validation criteria were met. Subsequently, the paper process for accounting for CS was successfully digitised, allowing nurses to discontinue the double registration workflow. The CS accountability showed a slight upward trend from 88% prior to implementation to 91% after implementation. Furthermore, use of the dashboard resulted in a more efficient workflow and facilitated evaluation between the pharmacy and the wards, contributing to optimisation of prescribing, administration and the logistical processes. The dashboard provided an accurate and reliable reflection of CS-related dispenses and administrations documented in the EHR, supporting its hospital-wide implementation for CS monitoring. The CS accountability dashboard reduced the administrative workload for nurses and the pharmacy and improved traceability.

Nurses manage nursing care within an organization work environment, which influences professional practice, quality of care, and staffing. A supportive environment and empowerment contribute to clinical leadership skills, enhanced performance, and patient engagement, which facilitate organizational objectives. The aim of the study is to assess Jordanian nurses perceptions of the work environment, their psychological and structural empowerment, the relationship between the work environment and empowerment, and whether socio-demographic variables can predict empowerment. A descriptive cross-sectional correlational research design. A power analysis was conducted using G*Power software. A medium effect size (Cohen d = 0.5), an alpha level of 0.05, and a desired power of 0.80, for a 2-tailed independent samples t test. A study surveyed 405 nurses from 32 Jordanian governmental hospitals across 3 regions, achieving a response rate of 47% (405 out of 930). an online self-reported questionnaire was utilized in the data collection procedure, which the questionnaire encompassed 2 major instruments, the psychological empowerment scale and the work environment scale. The participants had a mean age of 34 years (±5.13), with females comprising the majority. Overall, nurses work environment and psychological empowerment scores were at a moderate level. Significant differences were observed between the mean scores of the main variables and the established cutoff points (P < .001). A weak positive correlation was identified between work environment and psychological empowerment among registered nurses in hospitals (r = 0.128; P ≤ .05). Additionally, female nurses exhibited lower psychological empowerment scores compared to male nurses, with a mean difference of β = −0.492 (P = .007). The findings highlight the critical role of fostering positive and supportive work environments to enhance nurses psychological empowerment. Such empowerment contributes to improved performance, higher quality patient care, and the achievement of organizational objectives. Moreover, a healthy work environment can reduce staff turnover, increase job satisfaction, and sustain the delivery of high-quality care.

ABSTRACTBackgroundThe recent global outbreaks of Mpox, an emerging zoonotic viral disease, highlight sustained transmission in Africa and spread across Europe, challenging public health preparedness among frontline healthcare workers (HCWs). This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding Mpox among hospital nurses and HCWs in Bangladesh and to identify sociodemographic factors influencing KAP outcomes.MethodologyA cross‐sectional survey was conducted from October 1, 2024 to November 15, 2024 in eight hospitals in Dhaka district. Hospitals were selected via convenience sampling based on referral status and patient load, and participants were randomly chosen from active healthcare staff across categories. Data were collected using a pretested questionnaire, following a pilot study among 30 nurses and HCWs. Responses were recorded through KoboToolbox, and statistical analyses were performed using univariate and multivariate logistic regression.ResultsOut of the 200 HCWs approached, 110 provided complete and valid responses and were included in the final analysis. Among those who had heard (60.9%) about Mpox, 47.3% demonstrated good knowledge, 86.4% showed positive attitudes, and 82.7% reported correct preventive practices. Only 60.9% of participants reported having heard about Mpox. Among these, Facebook (29.9%) was the most commonly reported source of Mpox‐related information. Knowledge gaps were evident regarding zoonotic transmission, preventive guidelines, and the protective role of smallpox vaccination. Education level was significantly associated with knowledge (adjusted odds ratio [AOR] = 4.45; 95% confidence interval [CI]: 1.83–11.7; p = 0.002). Settlement type was significantly associated with practices, with urban HCWs more likely to report correct preventive measures (AOR = 4.13; 95% CI: 1.10–19.0; p = 0.047). Correlation analysis revealed significant positive associations among KAP (p < 0.001).ConclusionTargeted training and awareness programs are vital to improve preparedness and infection control among hospital nurses, strengthening the national response to Mpox outbreaks in Bangladesh.

Neonatal resuscitation is critical for survival, yet data on NICU nurses' competency in Palestine are lacking. To assess knowledge and self-reported practice of neonatal resuscitation among NICU nurses in West Bank hospitals and identify associated factors. A cross-sectional study was conducted across 10 West Bank hospitals. Using proportional convenience sampling, 200 NICU nurses completed a validated questionnaire assessing knowledge (16 items) and self-reported practice (12 items) based on AHA/NRP guidelines. This study is reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Among 182 respondents (91% response rate), mean knowledge was 69.8%; 40.7% demonstrated high knowledge (⩾80%). Critical gaps included ventilation indicators (36.8%), compression-to-ventilation ratio (48.4%) and epinephrine dosing (47.8%). Self-reported practice was high (mean = 91.4%), with 90.7% reporting 'good' practice. Knowledge correlated moderately with practice (r = 0.429, p = 0.001). Female gender predicted higher knowledge (β = 0.187, p = 0.021); prior training paradoxically predicted lower knowledge (β = -0.241, p = 0.003). Educational level and experience predicted better practice. A significant disconnect exists between self-reported practice and verified knowledge. Findings underscore the inadequacy of one-time interventions. Simulation-based training and regular competency assessment are urgently needed.

Delirium-care barriers among intensive care nurses based on the Capability, Opportunity, Motivation-Behaviour (COM-B) model: A cross-sectional study.

Background: Peripheral intravenous catheters (PIVCs) is widely considered the most common invasive procedure in hospitals, and it is estimated that these devices are used annually up to two billion times worldwide. The main complication of this procedure is the appearance of phlebitis, which can cause pain, edema, tenderness, erythema, or the development of a palpable cord around the cannulated vein. Premature failure of PIVCs increases the cost of health care. Objective: To describe interventions carried out by nursing professionals aimed at increasing the lifespan of PIVCs. Methods: A systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) was carried out. A bibliographic keyword search was performed on search engines between December 2021 and January 2022. Articles were selected independently by two of the authors. The protocol for this systematic review was properly recorded. Inclusion and exclusion criteria were defined (see "Methods" section). The PEDro scale was used to ensure the quality of the selected studies. Results: Fifty-two articles were screened, with 14 articles ultimately selected. The outcomes were prioritized by the number of articles that mentioned them, divided into primary and secondary outcomes. We found the following as primary outcomes: phlebitis occurrence, PIVC location, occlusion occurrence, PIVC dwell time, bloodstream infection, and infiltration rate. Secondary outcomes were dislodgement occurrence, presence of pain, local venous infection, PIVC colonization, number of PIVCs per patient, and accidental removal. Conclusions: PIVC material or the use of heparin can prevent phlebitis or the occurrence of occlusion. Ultra-long PIVCs show improvements in dwell time. Routine PIVC replacement has fallen into disuse. Implications for Nursing: Knowledge of the different PIVC materials and their lifespan is an area of nursing competence. Some methods increase PIVCs' dwell time. The use of heparin solutions or Vialon catheters may prevent phlebitis occurrence. The use of Vialon catheters or achieving better fixation by adding cyanoacrylate drops under the dressings could reduce occlusion occurrence. Hospital nurses are the main parties responsible for the management of peripheral venous catheters, and their interventions should be aimed at increasing the catheters' dwell time and reducing complications.

Background and Purpose: The Revised Professional Practice Environment (RPPE) scale is widely used to assess organizational attributes that support nursing practice. A Filipino adaptation is needed for use in the Philippines. This study evaluated the translated version's parallel forms reliability and initial convergent validity with the original English instrument. Methods: A psychometric evaluation design was implemented with 200 hospital nurses who completed both language versions of the RPPE. Pearson correlation coefficients between corresponding subscales were calculated to assess score consistency across forms and convergence with the English version. Results: All RPPE subscales showed high Filipino-English correlations (r = .779-.940), indicating strong alignment in how constructs were measured across languages. Conclusions: The Filipino RPPE shows strong parallel forms reliability and initial convergent validity. Further research should assess structural properties, invariance, and external validity.

Rheumatology and immunology nursing involves complex, long-term patient care. However, the effectiveness of current training in supporting early-career nurses remains unclear. Therefore, this study aimed to explore stakeholders' perspectives on training experiences and perceived learning needs, and to identify key implications for competency-based continuing professional development, with a focus on enhancing sustained patient safety. This descriptive qualitative study employed semistructured interviews with 26 participants (15 trainees and 11 trainers) from six county-level hospitals in Ningxia, China. Data were analyzed using Braun and Clarke's reflexive thematic analysis, and reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Three main themes emerged: (1) Trainees reported misalignment between training content and daily clinical demands, insufficient support for safe routine practice, and limited opportunities for supervised skill development; (2) Trainers highlighted gaps in preparation and educational resources, resulting in primarily didactic approaches and variable training quality, which may hinder the development of patient safety-related competencies; (3) Trainers emphasized the need for a structured, progressive training framework integrated with clinical practice. Shared priorities included clearly defined competency progression, contextually relevant content, experiential learning strategies such as case discussions and supervised practice, and the integration of psychological support, humanistic care, and lifelong learning awareness and methods. Faculty development and standardized teaching materials were considered essential to ensure consistent and safe practice standards. Strengthening specialist nursing capacity in resource-limited county hospitals requires not only structured, practice-integrated training curricula but also sustainable continuing professional development pathways that support progressive competency development. Embedding competency-based learning within routine clinical practice, alongside investment in trainer capability and standardized educational resources, may help reinforce patient safety competencies and promote sustained professional growth across the early stages of nursing careers.

With the population of older adults growing, nurses are increasingly likely to care for older patients. Ageist attitudes and behaviors in nurses may affect care quality, patient health, and care willingness. Ageism, referring to prejudice, stereotyping, or discrimination against individuals or groups based on their age, has been widely studied in the literature, primarily in non-East Asian countries, and few studies have been designed to investigate ageism and ageist behaviors among hospital nurses in Taiwan. This study was designed to investigate ageism and ageist behaviors among hospital nurses and identify the factors associated with ageist behaviors. A cross-sectional approach was used, and 359 nurses in Taiwan were enrolled as participants. Data were collected using a structured questionnaire comprising sociodemographic characteristics, the Fraboni Scale of Ageism (FSA), and Relating to Older People Evaluation (ROPE). The mean FSA scale score was 68.77 ± 8.83 and the mean proportion of ROPE was 0.39 ± 0.13, with 0.51 ± 0.16 for positive ageist behaviors and 0.34 ± 0.15 for negative ageist behaviors. Age, working unit, having taken age-related courses at school, and aging anxiety were all shown to relate significantly to ageist behaviors. In addition, a significant association was found between ageism and ageist behaviors. Predictors of ageist behaviors include age, working unit, having taken age-related courses at school, and ageism. The findings of this study indicate discriminatory attitudes and behaviors toward older adults exist among hospital nurses and that nurses who are older, work in operating rooms or critical care units, have not taken age-related courses in school, or have higher levels of ageism are at higher relative risk of exhibiting ageist behaviors. The findings of this study may be used to guide nursing managers in developing tailored interventions for nurses across different age groups and work units to effectively prevent or mitigate ageist behaviors. Furthermore, nursing educators may use this information to design age-related courses to enhance student awareness of ageist behaviors.

Compassion fatigue is an occupational hazard among nurses that arises from prolonged exposure to patient suffering and to work-related stress. In resource-limited healthcare settings, such as public district hospitals in Bangladesh, high patient loads, staffing shortages, and limited organizational support may increase nurses' vulnerability to CF. However, evidence from district-level hospitals in low- and middle-income countries is limited. A cross-sectional study was conducted between January and June 2025 among nurses working at a 250-bedded district hospital in Bangladesh. Using stratified random sampling, 380 nurses from the medicine, surgery, pediatrics, and intensive care/emergency units were recruited. Compassion fatigue was assessed using the Professional Quality of Life Scale (ProQOL-5). Descriptive statistics were used to estimate the prevalence. Chi-square tests and multivariate logistic regression were performed to identify the demographic and occupational predictors of high compassion fatigue. Overall, 44.2% of nurses reported high compassion fatigue, and 37.6% reported moderate levels. The highest prevalence was observed among nurses working in intensive care/emergency units (52%). Multivariate analysis identified lack of organizational support (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.6-4.1), more than 10 years of service (OR 2.3, 95% CI 1.4-3.8), and intensive care/emergency assignment (OR 1.9, 95% CI 1.2-2.9) as significant predictors of high compassion fatigue scores. Subscale analyses indicated higher burnout and secondary traumatic stress among nurses working in high-acuity departments. Compassion fatigue is highly prevalent among nurses in a resource-limited district hospital in Bangladesh, particularly among those working in high-acuity settings and those reporting insufficient organizational support. These findings highlight the need for targeted organizational strategies, including improved support systems, workload management, and mental health interventions, to promote nurses' well-being and sustain quality patient care in similar healthcare contexts.

Vicarious trauma is prevalent among nurses in paediatric intensive care units (PICUs), which induces adverse physiological, psychological and cognitive alterations. These alterations not only impair nurses' well-being but also compromise patient safety, necessitating more research in this understudied area. To explore the cognitive and emotional experience of vicarious trauma undergone by PICU nurses. This study employed a qualitative descriptive design. The research team conducted semi-structured individual interviews among 12 critical care nurses in a tertiary children's hospital. Participants were recruited by means of purposive sampling in October 2025. Data were analysed following a thematic analysis method in ATLAS.ti version 25. The experience of vicarious trauma among PICU nurses was summarized into four major themes and 11 sub-themes. The major themes included traumatic scenario, double-edged sword effects, coping strategies and multi-level support needs. The experience of vicarious trauma among PICU nurses involved various triggers and led to negative holistic impacts. In response, the nurses predominantly adopted emotion-focused coping strategies, highlighting a need for enhanced support structures to promote post-traumatic growth. The findings lay a foundation for targeted interventions aimed at mitigating vicarious trauma among PICU nurses, ultimately improving nurses' well-being and patient safety. Following the EQUATOR guidelines, reporting was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). No patient or public contribution. PICU nurses should pay attention to vicarious trauma and actively adopt corresponding strategies to mitigate its negative impacts, thereby facilitating its transition toward posttraumatic growth. Clinical administrators should establish comprehensive, multi-level support systems to assist nurses in managing vicarious trauma and to promote their overall psychological well-being and occupational health.

The voices of implementers are crucial in enhancing policy implementation. In the North West Province of South Africa, there have been no studies on the implementation of national guidelines for patient safety incident reporting since its introduction. Hence, this study explored the implementation of the national guidelines for patient safety incident reporting in selected public hospitals in the Dr Kenneth Kaunda district from the implementers' perspectives. This study employed a qualitative exploratory design with purposive sampling of hospital leaders, nurses, doctors, physiotherapists, occupational therapists, and pharmacists, leading to a total of 23 focus group discussions, spread across three participating hospitals, with four to seven participants in each focus group. The policy triangle framework of context, content, actors, and process guided the development of the focus group discussion guide and informed a deductive thematic analysis. Seven themes emerged, including contextual issues leading to implementing guidelines, common incidents & contributing factors, clarity of policy content, actors' knowledge, role clarity, motivation, and implementation process. The context of implementing guidelines was a need to standardise reporting practices, improve record-keeping, and mitigate potential litigation risks. Key contributing factors to patient safety incidents were inadequate security response, staff shortages, and resource constraints. The content of standard operating procedures was clear, yet lengthy. Discrepancies between the reporting tool and standard operating procedures complicated the reporting process. The actors' knowledge gaps hindered accurate reporting. Managers lacked effective strategies for motivating their reporting staff, further impeding the system's efficacy. While intrinsic motivation, grounded in professional accountability, drove some reporting, fears of consequences were present. The process of reporting was considered burdensome, and insufficient feedback mechanisms left staff uncertain about the value of their contributions. To improve implementation of the patient safety incident reporting, a system-wide approach is necessary; healthcare providers and leaders' knowledge must be improved, strategies to motivate reporting must be explored, leaders must create environments conducive for reporting, including protection of the reporters, and improvements after every reported system-level weakness are mandatory in order to encourage reporting. If reporting is for learning, anonymous reporting should be emphasised. Reporting processes must be made easy and consider available technology.

BackgroundNurses are vital in addressing global healthcare workforce shortages. The shortage of nurses and high turnover rates are concerned with the quality of care. To further explore the mechanisms underlying nurse turnover, this study focuses on the mediating role of work engagement, examining the relationship between hospital safety climate, work engagement, and turnover intention.MethodsThis was a cross-sectional research design of nurses in hospitals in Guangdong Province using a convenience sampling method. General information survey, hospital safety climate scale, work engagement scale, and turnover intention scale were adopted. The obtained data were analyzed through descriptive statistics, Pearson's correlation coefficient, and the mediating effect of work engagement was tested through the PROCESS macro mediation model in SPSS.ResultsThe hospital safety climate was positively correlated with work engagement (r = 0.549, P < 0.01), and negatively correlated with turnover intention (r = −0.324, P < 0.01). Work engagement was negatively correlated with turnover intention (r = −0.400, P < 0.01). The mediating effect of work engagement on the relationship between hospital safety climate and turnover intention has been demonstrated. The mediating effect is significant, with a value of−0.175, representing 53.77% of the total effect.ConclusionsThe turnover intention of nurses in Guangdong Province is high. Work engagement plays a partial mediating role between hospital safety climate and turnover intention among nurses. This study further enriches JD-R theory and new ideas for nurse managers to take measures to stabilize the nursing workforce and reduce turnover.

BackgroundThe ongoing genocide (as declared on September 16, 2025 by the UN Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel) and militarized siege in Gaza has led to the systematic collapse of the health system, with hospitals overwhelmed by targeted bombings, mass casualties, infrastructural annihilation, and profound psychological suffering. Nurses have been subjected not only to extreme occupational stress but to deliberate conditions of deprivation and moral violation.Research aimTo explore the lived experiences of nurses in Gaza's hospitals, documenting compassion fatigue, burnout, and moral injury within a genocidal context of healthcare destruction.Research designA qualitative design was employed using thematic analysis of in-depth testimonies.Participants and Research ContextTestimonies were collected from nurses working in Gaza's remaining hospitals between late 2023 and mid2025. Participants served as frontline caregivers while enduring forced displacement, starvation, and personal bereavement.Ethical considerationsEthical approval was obtained from local review boards. Informed consent, confidentiality, and emotional safety were ensured under exceptionally high-risk conditions.FindingsSix themes were identified: (1) collapse of hospital care; (2) nurses' bodies and minds under siege; (3) maternal starvation and neonatal death; (4) burden of infection and decay; (5) solitary mourning and improvised funerary practices; and (6) the struggle to endure and find meaning. Nurses reported compassion fatigue, moral injury, somaticexhaustion, and cognitive impairment, all intensified by the genocide's material and emotional toll.DiscussionCaregiving persisted despite repeated targeting of medical personnel and infrastructure. Findings extend conventional models ofburnout and secondary trauma by situating experiences within the concept of 'medicide,' defined as the systematic destruction of health systems.ConclusionsThis study provides an empirically grounded account of nursing labor under conditions described by international bodies as genocidal. Insights have urgent implications for nursing ethics, international humanitarian law, and interventions to support health workers in colonized and militarized settings.

Toward an AI-integrated nursing curriculum: A Kano model analysis of generative AI competency needs.

Explore the perspectives of Clinical Academic Nurses and stakeholders on strategies for positioning Clinical Academic Nurses in Dutch hospitals. A descriptive qualitative study. Semi-structured interviews and focus groups were conducted with Clinical Academic Nurses and stakeholders from five hospitals involved in the positioning of Clinical Academic Nurses. Data was analysed using thematic analysis to identify strategies for positioning these nurses. Four themes emerged: (1) 'Supportive vision and culture' is crucial for a shared vision and enables a culture for consistent support in the positioning, (2) A clear defined and strategic 'Position of Clinical Academic Nurses' is needed for uniform positioning, (3) 'Research infrastructure' describes the important supportive elements, and (4) 'Leadership' describes Clinical Academic Nurses' pioneering role in aligning research with organisational goals which strengthens their position. Positioning Clinical Academic Nurses in hospitals requires a vision, well-defined positions, a research infrastructure, and leadership support. Long-term strategic investments are needed to integrate research into clinical nursing practice and recognise Clinical Academic Nurses as strategic assets. Positioning Clinical Academic Nurses requires visionary leadership, institutional commitment and investment in research infrastructure. The Nurse Advisory Board should support this by aligning positioning, support and evaluation with strategic policies. Strategic hospital-academic partnerships foster research, education, mentorship and grant support. Clinical Academic Nurses should set measurable goals, proactively align research with clinical priorities and increase visibility to advance nursing practice. This study identifies empirically grounded insights into strategies to position Clinical Academic Nurses and offers actionable insights for management, policymakers and Clinical Academic Nurses to strengthen knowledge infrastructure and improve patient care. COREQ. Limited patient and public involvement, focusing on feedback on preliminary results.

Nursing work in several Western countries has been affected by evolving discourses of managerialism and professionalism. Interdisciplinary working has given nurses more prominence in high-level teams and created hybrid management roles that have affected understandings of professionalism. Such changes generally followed broader new public management (NPM) reforms that shifted power from senior doctors to executive managers. Yet, although there is an extensive literature on the global spread of NPM reforms, less is known about the influence of associated discourses concerning nurse management and professionalism. This paper addresses that gap by presenting qualitative data on the evolving situation of hospital nursing in Türkiye, a country that implemented NPM-type reforms in the early 2000s. Based on 40 in-depth interviews completed in 2021/22, it describes the uneven impact of these reforms on medicine and nursing, the continuing reality of medical dominance and the development of a professionalising project among Turkish hospital nurses that avoids directly challenging medical power. This emphasises continuing professional education, practice guideline development and a curtailed form of teamwork away from doctors. Nurses exercised greatest autonomy in specialised wards, intensive care units and emergency departments, where a stable staff group could operate at a distance from oversight by senior doctors.