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The perceptions of staff nurses on factors affecting patient care quality and safety have received little attention in the literature. Narrative analysis of comments provided by 106 staff nurses working in a medical-surgical setting revealed that nurses experienced contradictions and unmet expectations related to their professional role. The consequence was feelings of powerlessness, isolation, and low self-esteem, which affected nurses' perceived ability to provide quality patient care and ensure patient safety. This perceived inability to act in a professionally autonomous manner on behalf of patients, in turn, influenced nurses' professional self-concept. Recommendations are offered to enhance nurses' professional self-concept through staff development and policy changes.