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PurposeDrawing on signaling theory and the "signal transmission–interpretation–feedback" framework, this study explores the effects of perceived distributive justice and respect from managers on nurses' work meaningfulness and work effort in public hospitals in China and examines the moderating role of work self-efficacy.Design/methodology/approachWe collected 341 paired questionnaires for nurses and managers from four public hospitals in China. The data were analyzed by structural equation modeling and hierarchical regression analysis.FindingsDistributive justice and managers' respect for employees are positively related to work meaningfulness. Additionally, work self-efficacy negatively moderates this relationship. Work meaningfulness is positively related to work effort and fully mediates the relationships between perceived distributive justice and respect from the manager and work effort.Practical implicationsThis study provides useful insights for healthcare organizations to improve nurses' work meaningfulness from the perspectives of their material and emotional needs, according to their work self-efficacy characteristics, thus promoting their work effort. The findings offer important guidance for improving the effectiveness of grass-roots human resources to cope with unpredictable situations such as the COVID-19 pandemic.Originality/valueThis study focuses on the organization's environmental factors that affect the primary staff's work meaningfulness. Further, it analyzes the differences in signal interpretation among nurses with different work self-efficacy characteristics, thus providing new insights into work meaningfulness. Through manager–nurse pairing data, it reveals the important role of work meaningfulness in motivating work effort.