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BACKGROUND: Healthcare systems are adapting to environmental challenges and digital transformations. Practical nurses' perceptions and engagement are key to advancing sustainability in everyday care in a digital setting. Hence, it is essential to explore whether practical nurses within telehomecare settings are prepared for the adoption of sustainable practices and the implications of their perceptions of sustainability within nursing practice for nursing leadership.

AIM: To explore how practical nurses perceive and engage with sustainability within telehomecare.

DESIGN: This study had a qualitative exploratory design.

METHODS: Ten practical nurses working in telehomecare were interviewed between February and April 2024 in Finland. The interviews were individual and semistructured. Data were analyzed through reflexive thematic analysis.

RESULTS: The main themes identified in this study, Emerging Eco-Consciousness in Telehomecare and Constrained Eco-Engagement in Telehomecare, encapsulate the tension between emerging environmental awareness and the limitations of telehomecare settings. The participants demonstrated limited awareness of and engagement with sustainability in their professional roles. Moreover, they regarded the concept of sustainability as ambiguous and had a fragmented understanding of what it entails in the context of healthcare. Their capacity to actively engage in sustainable practices was shaped by challenges related to assuming responsibility, the need to balance professional values with the potential negative outcomes of sustainable digital practices, and limited opportunities for involvement in key organizational decision-making processes.

CONCLUSION: This study highlights a need to cultivate greater consciousness among healthcare professionals and leaders of the critical role of sustainability in healthcare delivery. The results highlight the importance of integrating targeted education and training on environmental issues and sustainable practices to foster climate-health literacy and deepen engagement and of equipping leaders to champion green transitions. Enhancing knowledge and competence in sustainability can, in combination with an ethical, green, transformational leadership style, support organizational shifts toward more environmentally sustainable healthcare systems.