Self-Leadership Based on Caring Among Primary Nurses: A Qualitative Study in Hospital Settings

Healthcare organisations increasingly require nurses to enact leadership within everyday clinical practice to sustain care quality in complex and resource-constrained environments. This study aimed to explore how self-leadership grounded in caring is enacted by primary nurses and to examine organisational and relational factors shaping this process. A qualitative descriptive design was employed, involving semistructured interviews with ten primary nurses working across inpatient wards, intensive care units and emergency departments. Data were analysed using thematic analysis. Six interrelated themes were identified: self-regulation as the foundation of self-leadership, caring practices as a relational framework for care delivery, professional identity and clinical autonomy, systemic and interpersonal barriers, organisational support as an enabling condition and perceived impacts on care quality. The findings indicate that leadership enacted at the point of care operates through self-regulation and caring-oriented interactions, supporting professional accountability and autonomous decision-making, while being shaped by organisational conditions and systemic constraints. Participants perceived that integrating leadership with caring may enhance care quality, strengthen nurse-patient relationships and support professional satisfaction. This study contributes to nursing management scholarship by providing empirical insight into leadership as a relational and contextually situated process in everyday care rather than solely an individual competency, suggesting the relevance of organisational strategies that support nurses' leadership and caring practices.