Aims and objectives To understand the factors that influence nurses empathy towards patients and to explore its influence on effort–reward imbalance involving empathy. Background Empathy is highly valued in nurse–patient relationships. However, currently, little evidence currently exists on the impact of work‐related stress measured by effort–reward imbalance and empathy. Design An anonymous, cross‐sectional online survey using a sample of convenient was conducted. Methods Convenient online sampling was conducted with select nurses from seven cities in Shandong province, China. The nurses worked in clinical settings in 10 different hospitals. Two questionnaires, for example the Effort‐Reward Imbalance Questionnaire and the Jefferson Scale of Physician Empathy, were used. Medians, percentages, related analysis and regression analysis were used to measure the relationship between Effort‐Reward Imbalance and empathy levels among nurses in China. In addition, this study adhered to the EQUATOR checklist, STROBE (see Supplementary file 1). Results Among 1,077 participants, 26.5% stated experiencing an Effort‐Reward Imbalance, with a mean empathy score among Chinese nurses, was 109.78 ± 13.98. Multiple regression analysis revealed that females and head nurses had higher levels of empathy, and that those who had no experience learning about empathy‐related courses and an Effort‐Reward Imbalance ratio were negatively associated with empathy. Conclusions Gender, department, position, experience learning about empathy‐related courses and Effort‐Reward Imbalance ratio were significant elements related to nurses’ empathy levels. Relevance to clinical practice As we all know, empathy can affect the relationship between nurse and patient. If nurses are in an Effort‐Reward Imbalance, they may have less empathy. It is advised to improve the reward level of nurses, so that the level of empathy towards patients is enhanced.

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