Abstract: Background　With the continuous advancement of refined hospital management and performance reform, traditional evaluation models focusing solely on nursing quality or workload are no longer sufficient to comprehensively reflect the overall level of nursing services. A comprehensive evaluation of nursing performance that integrates quality, efficiency, and effectiveness is of great significance for improving the scientific management of nursing. Objective　To evaluate the current status of nursing performance in general hospitals and analyze differences across hospitals of different levels, thereby providing evidence for nursing performance management. Methods　A convenience sampling method was used to select secondary and tertiary general hospitals from eastern, central, and western regions of China. Data for relevant indicators in 2025 were collected using the Nursing Quality and Performance Evaluation Indicator Data Collection Form. The Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was applied to evaluate and rank hospital nursing quality and performance. The robustness of the evaluation results was assessed using 5% two-sided Winsorization. Results　A total of 30 general hospitals were included in this study, comprising 19 tertiary hospitals and 11 secondary hospitals. In the nursing quality dimension, there were no statistically significant differences between tertiary and secondary hospitals in the incidence of nursing adverse events and inpatient nursing service satisfaction (P＞0.05). The incidence of nursing adverse events remained at a low level in both groups, with 0.02‰ (0, 0.16‰) in tertiary hospitals and 0 (0, 0.10‰) in secondary hospitals, respectively. For outpatient and emergency nursing service satisfaction, tertiary hospitals were significantly higher than secondary hospitals (P=0.006), with values of 99.36% (98.65%, 99.81%) and 99.43% (98.56%, 99.66%), respectively. In the nursing efficiency dimension, tertiary hospitals were significantly higher than secondary hospitals (P＜0.001). The nursing workload ratio for outpatient and emergency care was 343 253.85% (165 350%, 798 470.83%) in tertiary hospitals, higher than 135 789.23% (97 023.33%, 170 071.67%) in secondary hospitals. The inpatient nursing workload ratio was 295.42% (198.35%, 375.81%) in tertiary hospitals, compared with 128.20% (48.09%, 159.66%) in secondary hospitals. In the nursing effectiveness dimension, tertiary hospitals showed significantly higher values than secondary hospitals (P＜ 0.05) in the proportion of critical patients, workload of nursing assistance and capacity-building, community-level nursing service workload, and nursing education and training workload. Specifically, the proportion of critically ill patients was 1.30% (0.20%, 3.19%) in tertiary hospitals versus 0.01% (0, 0.28%) in secondary hospitals. The workload of nursing assistance and capacitybuilding was 0.98% (0.15%, 2.85%) vs 0 (0, 0.09%), respectively. The community-level nursing service workload was 2.23% (0.18%, 3.92%) vs 0.66% (0.03%, 1.00%), and the nursing education and training workload was 0.03% (0, 1.27%) vs 0.01% (0, 0.27%). The TOPSIS evaluation results indicated heterogeneity in nursing service quality and efficiency between tertiary and secondary hospitals. The C-values of tertiary hospitals ranged from 0.41 to 0.63, with a coefficient of variation of 12.3%, indicating moderate overall variation. In contrast, secondary hospitals ranged from 0.31 to 0.66, with a coefficient of variation of 21.7%, indicating greater internal dispersion. After 5% two-sided Winsorization, the TOPSIS ranking results remained unchanged, suggesting that the evaluation outcomes are stable and robust. Conclusion　Differences in nursing performance exist across hospital levels. Tertiary hospitals demonstrate advantages in patient load and critical care nursing but need to further strengthen resource outreach and mentoring support. Secondary hospitals play an important role in basic nursing services but still have shortcomings in capacity building and primary-level support. Guided by the hierarchical diagnosis and treatment system, it is necessary to enhance the leading role of tertiary hospitals and promote the downward flow of nursing resources, while strengthening the primary-level support capacity of secondary hospitals, in order to improve the overall quality and performance of nursing services.