Objective To identify the preferences and heterogeneity in preferences for prescribing authority among specialty nurses in tertiary hospitals, and to provide a reference for developing practical protocols and management policies for nurse prescribing. Methods A convenience sample of 650 specialty nurses from 11 tertiary hospitals in Hubei Province were surveyed from August to September 2025 with a self-designed questionnaire on preferences for prescribing authority.A mixed logit model was used to analyze prescribing authority preferences, and a latent class logit model was employed to explore population heterogeneity. Results Specialty nurses′ preferences for prescribing authority were affected by all six attributes:entry qualifications for nurse prescribing, duration of training, certifying institution, primary supervisory measures, scope of prescribing, and form of prescribing (all P＜0.05).Entry qualifications showed the highest relative importance, while the form of prescribing had the lowest.Heterogeneity analysis identified two distinct preference groups:the "Independent-Technical" type and the "Medication-Protocol" type.Nurses′ general data were not associated with their preference group membership. Conclusion All six included attributes significantly inf-luence the preferences of specialty nurses in tertiary hospitals regarding prescribing authority.It is recommended that provincial-level institutions conduct the training and certification of nurse prescribing, utilizing clinical decision support systems for supervision.A hierarchical authorization model that is tailored to local resources and population characteristics, differentiating by "content and form," can be implemented for prescribing practice.