This paper sets out to examine health promotion practice in hospital settings from a sociological viewpoint. It starts by tracing the development of health promotion among hospital and community nurses. The influences that professional and institutional structures and agendas have in health promotion are explored and a model of operation is proposed. The main emphasis is that health promotion is not an activity relying solely on skills acquisition by the nurse, but one that requires recognition of where power and control are located. A model of working is proposed which takes account of the institutional and professional agendas and the need to balance these with the needs and rights of the patient.