The purpose of this study was to examine the effect of a renal nursing professional practice model (PPM) on nurses'perceptions of empowerment, characteristics of practice environments and the impact on nursing care outcomes in a university-based teaching hospital in Canada. Quantitative and qualitative methodologies were used. This paper will focus on the qualitative results. Content analysis was the data analysis method used. The following themes emerged: 1) Attunement, familiarity/knowing the patient, going the distance, 2) Patient outcomes, consistency and continuity of care, autonomy/taking the initiative, 3) Nurse rewards: satisfaction and accountability, empowerment/input, and 4) Facilitating systems: communication, support and assignment. The quantitative results had a significant (p = .005) improvement post-PPM implementation in the nursing foundations for quality of care subscale of the Practice Environment Scale of the Nursing Work Index (NWI-PES) and organizational relationships (p =.016) measured by the Conditions of Work Effectiveness II (CWEQ-II) questionnaires. This study provides evidence for PPMs and primary nursing as effective frameworks to positively impact nursing and patient outcomes in a hemodialysis unit.