Abstract
BACKGROUND: The global shortage of nursing staff and the increasing demand for medical services have made enhancing nurse job performance a critical focus in health human resource management. Improving nurse performance is essential for enhancing hospital service quality, ensuring patient safety, and supporting the sustainable development of hospitals. This study examined nurses in tertiary public hospitals in China to explore the impact of the nurse-patient relationship on job performance and its underlying mechanisms. The aim was to identify effective strategies to enhance nurse performance and improve medical service quality. METHODS: A cross-sectional survey was conducted among 321 nurses working in four public tertiary hospitals in Sichuan, Zhejiang, and Fujian Provinces, China, from August to October 2022. Participants were selected using a convenience sampling method and surveyed using the General Information Questionnaire, Perceived Doctor-Patient Relationship Scale, General Self-Efficacy Scale, and Job Performance Scale. RESULTS: The nurse-patient relationship negatively correlated with self-efficacy (r = -0.361, P < 0.01) and job performance (r = -0.301, P < 0.01), while self-efficacy positively correlated with job performance (r = 0.549, P < 0.01). Mediation analysis revealed that self-efficacy partially mediated the relationship between the nurse-patient relationship and job performance, with a mediation effect of -0.182, accounting for 60.47% of the total effect. CONCLUSION: The nurse-patient relationship directly and indirectly affects nurse job performance in public tertiary hospitals, with self-efficacy playing a mediating role. Policy, hospital, and societal interventions should focus on alleviating nurse -patient conflicts to reduce their negative impact on nurse performance. Such measures can ultimately enhance the overall quality of medical services. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-025-12850-2.