The nursing professionalization is still a work in progress, especially because forms of medical dominance and conflicts with other health professions often undermine its professional autonomy. This article contributes to the understanding of the relationship between professionalization and autonomy building in the health professions by presenting the case of Italian nursing, where medical dominance, supported by the legal system, is the main factor preventing nursing from achieving professional autonomy. The work aims particularly to understand how professionalization and professional autonomy can follow two parallel and sometimes opposite paths toward building the nursing profession, and the role of academic knowledge and specialized roles to legitimize and strengthen professional autonomy. The analysis draws on the literature addressing professionalization, professional autonomy, and medical dominance, as well as various sources on Italian nursing. They include national legislation, research literature, and national sociological surveys on Italian nurses.