Background <p>Evidence-based nursing (EBN) plays a vital role in enhancing care quality and improving patient outcomes. However, in traditional Chinese medicine (TCM) hospitals, nurses often demonstrate suboptimal levels of EBN competence due to limitations in educational models, resource allocation, and clinical environments. Despite the growing emphasis on evidence-based practice, there is a lack of large-scale, systematic investigations into the EBN competence of nurses in TCM settings and the factors that influence it. This gap hinders the development of effective training and management strategies tailored to the unique characteristics of TCM nursing.</p> Objective <p>This study aimed to assess the current status of the EBN competence among nurses in TCM hospitals in Hunan Province, China, and to identify key factors that influence its development.</p> Design <p>A cross-sectional survey study.</p> Methods <p>From July to August 2025, a total of 460 nurses were recruited from TCM hospitals in Hunan Province using convenience sampling. Data were collected using a demographic questionnaire, the EBN Competence Scale, and the Evidence-Informed Decision-Making (EIDM) Competence Measure. Univariate analysis, Spearman correlation analysis, and multiple linear regression were performed to identify significant influencing factors of the EBN competence.</p> Results <p>The mean score for the EBN competence was 57.50(39.00,69.00), while the mean score for the EIDM competence was 100.00(80.25,123.00). Multiple regression analysis revealed that educational background (β = 0.119, <i>P</i> = 0.002), average monthly income (β=–0.090, <i>P</i> = 0.008), work department (Emergency Department or ICU) (β=–0.080, <i>P</i> = 0.036), and the EIDM competence (β = 0.692, <i>P</i> &lt; 0.001) were significant predictors of the EBN competence.</p> Conclusion <p>Nurses in TCM hospitals demonstrated a moderate level of the EBN competence. To enhance evidence-based practice in this context, healthcare administrators should implement stratified training programs, improve workplace conditions, and establish incentive systems. Particular attention should be given to strengthening the EIDM competence, as it plays a critical role in supporting the development and application of the EBN competence and in advancing overall nursing quality.</p> What is already known? <p>Evidence-based nursing enhances nursing quality and improves patient outcomes. Nurses’ EBN competence is influenced by their education, training opportunities, and organizational support.</p> What this paper adds? <p>Perform a quantitative evaluation of the EBN competencies among nurses working in TCM hospitals. The EIDM competence was identified as the strongest predictor of EBN competence, highlighting the need for targeted decision-making training in this setting.</p> Clinical trial number <p>Not applicable.</p>