Objective To explore the sense of coherence in female empty nest elderly and its influence on health self-management skill. Methods There were 124 female empty nest elderly collected from 2 communities in Beilun and Jiangbei District by convenience sampling between April and October 2017. The basic data questionnaire, Sense of Coherence-13 and Health Self-management Skill Scale for Adults were used to collect data. Results The score of sense of coherence was 57.64 ± 11.35, which was in the low level. The score of health self-management skill was 125.64±20.22, with the highest score in self-management cognition, lowest score in self-management behavior. The sense of coherence and comorbidity can influence the self-management behavior. The educational level, comorbidity and religion can influence the self-management cognition. The sense of coherence and live alone or not can influence the self-management environment. Conclusions Community workers should pay attention to the management of female empty nest elderly, expand their social contact, encourage and guide them to use all kinds of social resources to face the difficulties, improve the data for the elderly living alone, establish periodic condolences and follow-up system, and improve the health self-management skills.