Abdulrhman Khaled Al Abdulqader, Sayed Ibrahim Ali, Fatmah Ahmed Alamoudi, Mostafa Shaban
AIM: To explore how nurses in interprofessional hospital teams experience and negotiate professional autonomy within hierarchical decision-making environments. BACKGROUND: Nurse autonomy is essential for safe, patient-centred care, yet it is often constrained by institutional protocols, electronic order-entry systems, and interprofessional hierarchies. While international literature highlights systemic barriers, little is known about the subtle strategies nurses use to reclaim influence within team-based hospital contexts, particularly in Middle Eastern healthcare settings. DESIGN: A qualitative hermeneutic phenomenological design was employed, following COREQ guidelines. METHODS: Seventeen registered nurses working in polyclinics affiliated with King Faisal University, Al-Ahsa, Saudi Arabia, participated in semi-structured interviews conducted. Data were analysed using reflexive thematic analysis, supported by NVivo 14. Ethical approval was obtained from the King Faisal University Institutional Review Board. RESULTS: Four interrelated themes emerged: (1) The invisible architecture of (de)autonomy, (2) Teamroom hierarchies and the choreography of voice, (3) Quiet resistance and boundary work, and (4) Conditions that enable nurse autonomy. Nurses described struggling with structural and cultural barriers but also revealed micro-autonomies, alliances, and advocacy practices that protected both patient safety and professional identity. CONCLUSIONS: Autonomy is not merely an individual trait but an organisational property shaped by policies, governance, and team dynamics. Leadership strategies that embed nurses' voices into decision-making structures are critical for improving patient outcomes and professional well-being. TRIAL REGISTRATION: Not applicable (qualitative study).