Objective To investigate the current implementation status of syndrome differentiation and care in department of Traditional Chinese Medicine of 61 tertiary general hospitals in Shandong Province. Methods A total of 121 nurses recruited by cluster sampling from 61 tertiary general hospitals of Shandong Province were investigated by self-designed questionnaire method from Feb to Apr 2021. Results TCM nurses were evaluated as low for syndrome differentiation and medium for nursing care. Factors affecting the syndrome differentiation and care included being unclear syndrome differentiation，inability to fully grasp all the contents of care based on syndrome differentiation，being obscure and difficult to remember nursing contents，lacking of daily assessment requirements in functional departments，and insufficient nurse manpower. Conclusion In 61 general hospitals in Shandong Province，the nurses in the departments of Traditional Chinese Medicine are in poor condition of syndrome differentiation，and care needs to be strengthened. On-the-job training should be strengthened in nurses and a perfect guarantee system should be built up to promote the implementation of syndrome differentiation and care in traditional Chinese medical in general hospitals in depth.