Background: Nursing cultural competency is sine qua non for the provision of equitable, respectful, and quality care, especially in rural and culturally diverse places like Osmanabad, Maharashtra. In such health care settings, nurses are frequently coming into contact with patients from diverse linguistic, religious, and traditional health backgrounds, and culturally appropriate care is a vital element of the patient-centred care approach. Objectives: The purpose of this study was to develop and evaluate the level of cultural competence (CC) among nurses in Osmanabad, barriers to inclusive care, and nurse-led interventions to provide culturally congruent care. It also aimed to provide practical recommendations for policy and educational reform in rural health systems. Methods: A descriptive cross-sectional mixed methods design was used. Sixty registered nurses from six PHCs and two CHCs were recruited using purposive sampling. Data were collected through a structured questionnaire based on Campinha-Bacote’s model, and qualitative information was also collected from 15 participants. SPSS for descriptive statistics and thematic analysis for qualitative narratives was used for data analysis. Results: Nurses had higher levels of cultural awareness (mean score: 4.1/5), yet cultural encounters and skills mean scores were lower. The main obstacles were a lack of formal training (78.3%), language difficulties (66.7%), and time pressure. Qualitative themes included emotional labour, adaptive communication, and the role of institutions in supporting participants. The nurse-led methods, multilingual teaching, visual tools, and community involvement were found to be valuable for equal care. Conclusion: The study highlights that cultural competence is not a discretionary skill but is integral to ethical nursing in rural India. Enhancing training, institutionalizing cultural frameworks into policy, and empowering nurses as cultural intermediaries can greatly improve health equity