Aim <p>To explore how nurses in interprofessional hospital teams experience and negotiate professional autonomy within hierarchical decision-making environments.</p> Background <p>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.</p> Design <p>A qualitative hermeneutic phenomenological design was employed, following COREQ guidelines.</p> Methods <p>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.</p> Results <p>Four interrelated themes emerged: <i>(1) The invisible architecture of (de)autonomy</i>,<i> (2) Teamroom hierarchies and the choreography of voice</i>,<i> (3) Quiet resistance and boundary work</i>, and <i>(4) Conditions that enable nurse autonomy.</i> 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.</p> Conclusions <p>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.</p> Trial registration <p>Not applicable (qualitative study).</p>