Objective To investigate and analyze cognitive similarities and differences of nurses factors that lead to the tense nurse-patient relationship from both attitudes of nurses and patients. Methods By using the method of questionnaire, 284 nurses and 305 patients were investigated respectively in a top'three hospital of a city. Results There was a significant difference in cognitive scores of nurses factors that lead to the tense nurse- patient relationship (P < 0.01), patients' scores were (3.90±0.47) points which were higher than (3.52±0.35) points of the nurses′. In dimensions of prioritization, both nurses and patients believed that technical ability, professional knowledge and service attitude were the main factors leading to the tense relationship between nurses and patients. While nurses held that communication ability was more important, patients held that the nurse′s own personality was more important. Conclusions There are similarities and differences of attitudes to nurs's factors between nurses and patients regarding tension in nurse- patient relationship. The tense relationship between nurses and patients is affected to a great extent by nurses' professional knowledge, technical ability and service attitude. Managers should objectively evaluate and fully pay attention to cognitive similarities and differences of both sides, strengthen nurses′theoretical knowledge and clinical skills training, improve service attitude, and develop good character,in order to provide high quality nursing service for patients.