Background <p>Self-medication and medicine distribution within families are prevalent among nurses due to easy access to medications in clinical wards. This study examines the prevalence, patterns, and awareness gaps of self-medication and medicine distribution in nurse-led families among nurses from public and private secondary-level hospitals in Jashore district, Bangladesh.</p> Methods <p>A cross-sectional study was conducted across Jashore 250-Bedded General Hospital and three private hospitals, involving 320 nurses from various departments. Data were collected using the Self-Medication Practice Questionnaire (SMPQ) and Medicine Distribution and Awareness Scale (MDAS). Descriptive statistics, chi-square tests, and logistic regression analyzed prevalence and predictors.</p> Results <p>Self-medication prevalence was 80.6% (95% CI: 76.1–84.5), with 65.3% distributing medications to family members. Analgesics (67.8%) and antibiotics (31.2%) were commonly used. Easy ward access was a significant predictor (OR = 2.32, <i>p</i> &lt; 0.001). Awareness gaps were noted in 38.4% of nurses. Private hospital nurses showed higher self-medication rates (OR = 1.45, <i>p</i> = 0.04).</p> Conclusion <p>High self-medication and medicine distribution, driven by easy drug access, necessitate stricter controls and educational interventions across public and private hospitals to promote safe practices.</p>