Objective This study aims to explore the impact of patient gratitude on nurse creativity and examine the me-diating role of job satisfaction and the moderating role of safety climate.Methods In May 2023,a questionnaire survey was con-ducted among all nurses in two county-level public hospitals in Yangquan City,using the Patient Gratitude Scale,Creativity Scale,Job Satisfaction Scale,and Safety Climate Scale.A total of 448 valid questionnaires were collected.Mediation and moder-ation effects were tested using SPSS 20.0 and Model 4 and Model 7 in the Process v3.0 plugin.Results Patient gratitude showed a significant positive correlation with job satisfaction and creativity(r=0.558,0.591,P<0.01),and job satisfaction showed a significant positive correlation with creativity(r=0.581,P<0.01).Job satisfaction partially mediated the relationship between patient gratitude and creativity(mediation effect value=0.1850,95%confidence interval[0.1190:0.2484]),ac-counting for 34.76%of the total effect.Safety climate moderated the relationship between patient gratitude and job satisfaction(β=-0.048,P<0.05).Conclusion Patient gratitude has a positive impact on nurse creativity through job satisfaction.Ad-ditionally,safety climate moderates the relationship between patient gratitude and job satisfaction.