The healthcare sector is a significant contributor to climate change, responsible for nearly 5% of global greenhouse gas emissions. Climate change poses severe global health risks, intensifying extreme weather events, exacerbating health inequities, and straining already burdened healthcare systems. In Australia, healthcare emissions are disproportionately high, constituting 7% of national totals, driven largely by systemic inefficiencies and resource-intensive practices. As the largest profession in healthcare, nurses and midwives are well-positioned to advance environmentally sustainable (ES) practices. However, their contributions are often hindered by systemic challenges. This study explores the barriers and facilitators to environmentally sustainable practices among Australian nurses and midwives, offering actionable insights to bridge the gap between policy and practice. Using qualitative descriptive methodology, semi-structured interviews were conducted with 11 nurses and midwives actively engaged in implementing ES practices within Australian clinical settings. Reflexive thematic analysis identified seven key themes: four barriers – organisational inertia, resource constraints, communication gaps, and reliance on single-use materials – and three facilitators – grassroots advocacy, institutional support and collaborative networks. Barriers include bureaucratic inefficiencies, fragmented strategies, and inadequate ES training, which disempowered staff and limited progress. Facilitators highlighted the critical role of engaged leadership, formal ES roles, and collaborative efforts in fostering a culture of sustainability. Participants emphasised the transformative potential of embedding ES goals into organisational frameworks and integrating sustainability education into clinical practice. This research underscores the urgency of addressing the identified systemic challenges through cohesive policies, resource allocation, and leadership development. By fostering supportive frameworks and leveraging the advocacy and expertise of nurses and midwives, healthcare organisations can catalyse meaningful sustainability progress. Uniquely, this study explores Australian nurses’ and midwives’ perspectives, contributing novel insights to the global discourse on sustainable healthcare. These findings offer practical strategies to empower nurses and midwives as agents of change towards environmentally sustainable healthcare.