Abstract: Background　Hip fragility fractures are associated with a high incidence of subsequent fractures, leading to poor patient outcomes and increased medical and family costs. Currently, the uptake of evidence-based preventive measures in nursing practice is inconsistent, and considerable variations exist among nurses' clinical practices. Objective　To explore the causes of heterogeneity in nursing practice for secondary hip fracture prevention and to identify improvement needs and strategies based on the COM‑B theoretical model, so as to provide entry points for developing standardized, homogeneous nursing practice protocols. Methods　Purposive sampling was adopted in this study, with information saturation serving as the guiding principle for sample size determination. Semi-structured interviews were conducted with 15 nursing staff recruited from medical institutions in various regions across the country, as well as with 6 experts affiliated with the Orthopaedic Nursing Committee of the Chinese Nursing Association. Data extraction was facilitated using NVivo 15.0, and the analysis was primarily conducted through directed content analysis underpinned by the COM-B theoretical framework, while also incorporating analytic procedures from Colaizzi's phenomenological approach. Results　Three main themes-opportunity, ability, and motivation-and 11 sub-themes were extracted. Opportunity-related factors included skills training, time availability, resources, standardized guidance, managerial support, supervisory evaluation, and value-based incentives. Ability-related factors comprised clinical competence and self-directed learning. Motivation-related factors involved self-awareness and learning initiative. Conclusion　Future efforts should focus on creating opportunities through the provision of accessible hip fracture care protocols, enhancing nurses' secondary fracture prevention practice capabilities via stratified training, and strengthening motivation for secondary fracture prevention by refining incentive mechanisms. These three dimensions should be addressed synergistically through the development of tailored interventions, with the ultimate goal of narrowing the gap in nursing practice and improving patient outcomes.