To investigate the perceived self-efficacy, structural empowerment and power of middle nurse managers before the implementation of a major reform of public hospitals in Cyprus. Nurse managers' self-efficacy is important as it makes a difference in nurses' motivation and the way they feel, think and behave. Empowerment promotes workers' engagement at work, leading to positive performance outcomes. This is a descriptive correlational study with a sample of 175 nurse managers. It was conducted during March-April 2019. The results showed that nurse managers perceived relatively high scores of self-efficacy, moderate levels of empowerment and moderate levels of both formal and informal power. Access to resources has been recorded as low. Statistically significant correlations have been found between self-efficacy, age and work experience. Nurse managers with a bachelor's degree had a higher informal power than those with a master's degree. The present study provides recommendations for maintaining and enhancing the self-efficacy, empowerment and power of nurse managers in the evolving conditions of health care reforms. Nurse managers need to improve their access to empowerment structures and be involved in policy decision-making, future planning, organisation and control, aiming for the improvement of services and care that they provide.