With the rapid development of science and technology, the application of artificial intelligence in the field of healthcare is becoming increasingly widespread. As the executors and responsible persons of nursing work, nurses' understanding and attitude toward AI technology determine whether AI can be deeply integrated and successfully applied in the field of nursing. To investigate nurses' negative and positive attitudes toward the use of artificial intelligence and influencing factors, explore the mediating effect of artificial intelligence literacy and anxiety between hospital hierarchy differences and negative and positive attitudes toward the use of artificial intelligence, and provide basis for improving nurses' attitudes toward the use of artificial intelligence. In November 2025, the convenience sample of 436 nurses from different hospitals in Shandong Province was surveyed. Data were collected using the general information questionnaire, the attitude scale toward the use of artificial intelligence technologies in nursing, the artificial intelligence anxiety scale, and the artificial intelligence literacy scale. Multiple linear regression analyzed the influencing factors of nurses' negative and positive attitudes toward the use of artificial intelligence. Mediation analyses explored the mediating effect of artificial intelligence literacy and anxiety between the hospital hierarchy differences of nurses and their negative and positive attitudes toward the use of artificial intelligence. The score of negative attitude was 14.55 ± 6.63, and the score of positive attitude was 38.21 ± 3.87. Artificial intelligence literacy and anxiety partially mediated the relationship between hospital hierarchy differences and the negative and positive attitudes toward the use of artificial intelligence, with the total mediating effects being 3.067 and -1.011, respectively. Hospital hierarchy differences could directly positively predict the negative and positive attitudes toward the use of artificial intelligence and could also indirectly positively predict the negative attitude toward the use of artificial intelligence through mediation by artificial intelligence literacy and anxiety and negatively predict the positive attitude toward the use of artificial intelligence. Providing personalized artificial intelligence training based on the needs of hospitals could improve nurses' attitudes toward the use of artificial intelligence, increase their artificial intelligence literacy, and reduce their anxiety.