Purpose <p>This study aimed to investigate the impact of the work environment, emotional intelligence, and empathy fatigue on nurse presenteeism and to examine the mediating roles of emotional intelligence and empathy fatigue.</p> Methods <p>This study employed a cross-sectional research design and conducted a questionnaire survey from April to July 2024 among 1,375 nurses (aged 18–24, 25–34, 35–44, and ≥ 45&#xa0;years) from six tertiary hospitals in Henan Province. The questionnaire included demographic characteristics, the Nursing Practice Environment Scale, the Emotional Intelligence Scale, the Empathy Fatigue Scale, and the Stanford Presenteeism Scale. Statistical analyses were conducted using SPSS 27.0 and AMOS 26.0. A structural equation model was constructed, and the Bootstrap method was employed to assess the mediating effects.</p> Results <p>The average presenteeism score among nurses was 19.49 ± 5.910. A partial mediation effect exists among the four variables: work environment, emotional intelligence, empathy fatigue, and nurse presenteeism. Specifically, the nursing work environment not only directly negatively influences nurse presenteeism but also indirectly affects it through the mediating roles of emotional intelligence and empathy fatigue. Furthermore, emotional intelligence and empathy fatigue serve as a chain mediator between the work environment and nurse presenteeism.</p> Conclusion <p>The results indicate that the nursing work environment not only directly affects nurse presenteeism but also indirectly influences their presenteeism through emotional intelligence and empathy fatigue. These findings provide theoretical support and guidance for reducing nurse presenteeism rates, emphasizing the importance of optimizing the nursing work environment, enhancing emotional intelligence, and alleviating empathy fatigue in nursing practice.</p>