Nurses’ occupational autonomy is attacked as a consequence of new public sector management attempts to gain control of nurses’ (as well as other health professionals) labour process. Shifts in organisation and management of healthcare are indicated in new language. Keywords associated with these shifts are cost-effectiveness (value-for-money service and cost-cutting), control mitigation (risk management using actuarial technologies) and safety (protecting patients from harm). Health services management has enthusiastically embraced discourses of Total Quality Management that emphasize the needs of consumers rather than providers and create a level of normative control within an organisation. This paper explores some of the competing ways professional responsibility is constructed in contemporary nursing and argues how different and often contradictory discourses and ideologies inform the varying positions in which nurses find themselves located. We analyse how nurses face new dilemmas and new modes of reasoning and acting as professionally responsible. Special attention is given to the two dominant and interrelated themes. First, discourses of quality and risk assessment and management. Second, discourses surrounding clinical research in nursing, and the dominance of particular forms of evidence-based practice. Case-studies in Australian and Norwegian health service settings of nurses in practice highlight how nurses negotiate decision-making and responsibility.