Background <p>Amid the rapid expansion of digital nursing education, digital health literacy is considered key to enhancing students’ engagement in online learning. However, the underlying mechanism of this relationship remains unclear. This study examines the relationship between digital health literacy and online learning engagement, while also examining the roles of academic self-efficacy and future work self-salience in this process.</p> Methods <p>A cross-sectional study was conducted between February and March 2024, involving 518 undergraduate nursing students from two medical universities in Anhui Province, China. Data were collected using the Digital Health Literacy Scale, the Academic Self-Efficacy Scale, the Future Work Self-Salience Scale, and the Online Learning Engagement Scale.</p> Results <p>The mean score for online learning engagement among undergraduate nursing students was 53.83 (8.16). Digital health literacy exerted a significant total effect on online learning engagement (β = 0.781). This total effect comprised both a direct effect (β = 0.400) and a significant total indirect effect (β = 0.381) mediated by academic self-efficacy and future work self-salience. Notably, academic self-efficacy and future work self-salience played an important chain-mediating role in this relationship (β = 0.065), accounting for 8.32% of the total effect.</p> Conclusions <p>Digital health literacy is a significant positive predictor of online learning engagement. It enhances students’ academic self-efficacy, which in turn clarifies their future work self-salience, ultimately promoting higher online learning engagement. Therefore, nursing educators should not only strengthen students’ digital health literacy but also foster their academic confidence and career foresight. Such strategies are crucial for improving the quality of digital nursing education and student learning outcomes.</p> Clinical trail number <p>Not applicable.</p>