Leading Preventive Care: Confidence, Collaboration, and Systemic Challenges Among Primary Health Care Nurses

General Practice Nurses (GPNs) collaborate with General Practitioners (GPs) to provide preventive care through comprehensive health assessments, risk appraisal, lifestyle counselling, and delivery of continuous patient-centred care. This research explored how GPNs identify, negotiate, and sustain preventive care within a complex multilayered health system. Informed by the Socioecological Model, a qualitative descriptive design employed semi-structured interviews with 33 GPNs across diverse practice locations. Data underwent reflexive thematic analysis through iterative familiarisation, inductive coding, and theme development. Five interconnected themes captured nurses' multilevel preventive care practice. The first theme was Adaptive Leadership of Prevention at the individual level, where nurses tailored interventions to patient readiness, coordinated general practitioner-nurse-patient monitoring, and set focused goals despite resistance from patients and busy lifestyles. The second theme was Brokering Interprofessional Collaboration at the interprofessional level, securing practitioner endorsement and linking fragmented care teams for universal referrals. The third theme was Championing Prevention Amid Organisational Constraints at the organisational level, where nurses managed time pressures, staff turnover, delegation, and local knowledge. The fourth theme was Community Connectivity and Extended Reach at the community level, which included word-of-mouth recommendations, interpreters, external support services, targeted programs for marginalised communities, low-socioeconomic status, and migrant populations. The fifth theme was Local Adaptation within Policy Constraints at the policy level, where prevention is embedded within Australia's Medicare Benefits Schedule care plans despite inadequate nurse funding. These findings position GPNs as boundary-spanning professionals who translate nationally framed prevention priorities into locally responsive care consistent with prevention strategies. Sustainable, equitable outcomes for patients demand aligned funding, team-based policy recognition, practice infrastructure investment, clearly defined roles, ongoing professional development, and policy reform.