Background <p>There have been changes in nurse-patient trust in China during the COVID-19 pandemic. However, it remains unclear how nurse-patient trust changed during the pandemic compared to the pre-pandemic period, or what factors potentially influenced these changes.</p> Objective <p>This study aimed to explore the changes in nurse-patient trust in China due to the COVID-19 pandemic, as well as the moderating roles of medical expectations and communication skills during this period.</p> Design <p>Using convenience sampling, surveys were conducted among nurses and patients aged 18 and above with Chinese - language proficiency in 38 cities across 11 provinces from November 18 to December 8, 2019 (before the pandemic) and from February 1 to April 8, 2020 (during the pandemic).</p> Participants <p>Data were obtained from a survey of 1883 nurses and 1850 patients in China.Chinese nurses and patients over 18 years old who could read Chinese, and the principle was that they would participate voluntarily and obtain oral consent.</p> Methods <p>From 18 November 2019 to 8 December 2019, and from 1 February 2020 to on April 8 2020,participants of 38 cities in China on medical expectations, nurses’ communication skills and nurse-patient trust by Chinese Nurse Trust Scale, Chinese version of the Wake Forest Trust Scale, self-designed medical expectations scale and the Chinese version of the SEGUE Frame-work Communication Scale.</p> Results <p>During the COVID-19 pandemic, nurses’ trust in patients significantly increased (t = -20.69, <i>p</i> &lt; .001), while patients’ trust in nurses decreased significantly (<i>t</i> = 12.64, <i>p</i> &lt; .001) compared to the pre-pandemic period.In addition to the influence of patients’ expectations on the nurse-patient trust, nurses’ expectations and communication skills and patients toward nurses had a significant impact on the change of the nurse patient trust.Before the pandemic, patients’ expectations were positively correlated with nurse - patient trust (β = 0.18, 95% CI [0.13, 0.24], <i>p</i> &lt; .001), and nurses’ communication skills had a significant impact on patients’ trust (β = 0.41, 95% CI [0.36, 0.47], <i>p</i> &lt; .001). During the pandemic, nurses’ expectations were negatively correlated with nurse-patient trust (β = -0.10, 95% CI [-0.19, -0.02], <i>p</i> = .02), while for patients, it was positively correlated (β = 0.16, 95% CI [0.11, 0.21], <i>p</i> &lt; .001). Nurses’ communication skills still played an important mediating role in patients’ trust, but the mediating role in nurses’ own trust changed from non-significant to significantly negative (indirect effect = -0.08, SE = 0.03, 95% CI [-0.13, -0.02]).</p> Conclusions <p>COVID-19 appears to have contributed to a ‘Divergent Dynamics’ in nurse-patient trust (defined as nurses and patients experiencing opposing trends in their perception of trust changes).This phenomenon seems to have influenced established patterns in the nurse-patient trust relationship, while also affecting the roles of medical expectations and communication skills. Expectations and communication skills may have a moderating effect on nurse-patient trust. This underscores the context-dependent necessity for emergency communication adaptations, providing psychological support for medical staff, and implementing targeted interventions during major public health events.</p> Clinical trial number <p>Not applicable.</p>