Background: Continuous and accelerated developments in medical technology, austerity measures in healthcare reforms, global nurse shortages and the emergence of diseases such as COVID19 have resulted in work practice changes within the medical field. These challenging conditions require nurses to continually adjust themselves to their work environment to provide quality care. The aim of this study was to assess occupational adjustment and its relation with innovative work behavior among nurses at specialized hospitals. Research design: A descriptive correlational design was utilized in the current research. Setting: The study was conducted in four specialized hospitals at Mallawi City, Minia governorate, Egypt. Sample: Convenience sample (No. =268) of nurses. Tools: Two tools namely, The Occupational Adjustment scale, and Innovative Work Behavior scale. Results: Show that (75.7 %) of the studied nurses have moderate level of total occupational adjustment, and (65.7%) of the studied nurses perspectives refer to high level of total innovative work behavior. While, (57.8%) of the head nurses perspectives to their staff' total innovative work behavior refer to moderate level. Conclusion: There was positive association between occupational adjustment and innovative work behavior among the studied nurses at the four Hospitals. Recommendations: Providing a positive organizational environment which strengthens employees' willingness to work hard, innovate and enable them to cope with challenges.